Bulimia Nervosa

Bulimia Nervosa, also known simply as bulimia, is an eating disorder characterized by recurrent episodes of binge eating (bingeing) as well as a compensatory behavior intended to prevent excessive weight gain. According to the National Institutes of Mental Health (NIMH), 0.6% of the U.S. population will be affected by Bulimia during their lifetime.

Bulimia Nervosa affects more females than males, with a prevalence of 0.5% in women and only 0.1% in men.

DSM Criteria for Bulimia Nervosa

According to the current edition of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), Bulimia Nervosa exists when bingeing and compensation behaviors occur on average 2 times weekly or more for a period of at least 3 months, when the behaviors are not exclusively those of Anorexia Nervosa, and when self-evaluation is unduly influenced by body shape or weight. As in Anorexia Nervosa, those with Bulimia Nervosa are often very concerned about gaining weight and body image and also intensely fear getting fat. However, unlike those with Anorexia Nervosa who typically present with low body weights, those with Bulimia Nervosa may present with a normal body weight, or even as slightly overweight.

In bulimia, as in Binge Eating Disorder (BED), bingeing is defined as the consumption of more food than most other people would eat in a similar circumstance over a discrete period of time accompanied by a sense of lack of control over the food consumption. However, unlike those with BED, people with bulimia may engage in a variety of either purging or non-purging behaviors such as vomiting, using laxatives, using diuretics, using enemas, fasting, or exercising excessively in an attempt to compensate for binges. Binges in bulimia can occur frequently and as often as many times a week to many times a day.

Bulimia Nervosa Purging Health Complications

The purging associated with bulimia may cause a variety of health complications including metabolic and electrolyte disturbances, acid reflux, erosion of tooth enamel, weakening of bones, and other health problems. If electrolytes become extremely imbalanced, a patient may experience heart palpitations or even arrhythmias. In such cases, urgent medical treatment may be necessary.

Bulimic bingeing and purging cycles are often conducted in secret because of the shame and disgust associated with the process. Lifetime treatment for bulimia is estimated to be less than 45% according to the NIMH. Although the disorder is considered to be a chronic condition, complete recovery is possible, through according to a report in Science, relapse rates hover around 30%.

Image: detail from the mural ‘Anorexia Y Tabaquismo’ by Jorge Figueroa Acosta

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