Bulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating accompanied by inappropriate compensatory strategies that are used to prevent weight gain. These inappropriate compensatory strategies include self-induced vomiting, fasting, excessive exercise, and the misuse of laxatives, diuretics, enemas, or other medications. Self-induced vomiting is the method used most frequently by individuals seeking treatment for bulimia nervosa. However, it is not unusual for individuals with bulimia nervosa to use multiple strategies to compensate for binge eating. To receive a diagnosis of bulimia nervosa, the binge eating and inappropriate compensatory weight control strategies must occur frequently, averaging at least twice a week for the previous 3 months. There are two subtypes of bulimia nervosa: the purging type, characterized by the regular use of self-induced vomiting or regular misuse of laxatives, diuretics, or enemas to prevent weight gain; and the nonpurging type, characterized by the regular use of fasting or excessive exercise, but not purging.
In bulimia nervosa, binge eating and the use of inappropriate compensatory behaviors are accompanied by an additional symptom: an overemphasis on weight and shape in one’s self-evaluation. The body dissatisfaction experienced by individuals with bulimia nervosa often leads to chronic restriction in the amounts and types of food consumed. When food intake is severely restricted, binge eating is more likely to occur.
Following the binge, an individual with bulimia nervosa may purge to relieve the physical discomfort associated with the binge and reduce the fear of weight gain. Between binge-purge episodes, individuals with bulimia nervosa typically restrict their caloric consumption, limiting their food choices to low-calorie, “diet” foods and avoiding foods perceived as “fattening.”
According to the current Diagnostic and Statistical Manual of Mental Disorders, bulimia nervosa is fairly prevalent, affecting between 1% and 3% of women. Men are much less likely to develop bulimia nervosa, comprising only 5% to 10% of all cases. Bulimia nervosa typically begins in adolescence or early adulthood. During adolescence, girls experience significant changes in their body shape and weight. Young women’s internalization of the extremely thin contemporary beauty ideal promoted in Western society is one factor that may contribute to the much higher prevalence of bulimia nervosa among women.
Bulimia nervosa is associated with depressive symptoms and mood disorders. However, it is not clear whether the depressive symptoms precede or follow the development of bulimia nervosa. There also are medical complications associated with various forms of purging. Self-induced vomiting and laxative or diuretic abuse may be associated with hypokalemia, a serious electrolyte disturbance. Self-induced vomiting also may be associated with swelling of the parotid glands, esophageal problems, and erosion of dental enamel, while laxative abuse may result in the loss of normal peristaltic function.
There are several different treatments for bulimia nervosa. The most widely investigated form of psychotherapy for bulimia nervosa is cognitive behavior therapy. This treatment focuses on educating individuals about the disorder, normalizing their eating patterns, addressing dieting and the overemphasis on weight and shape in self-evaluation, and preventing relapse. Research has found that cognitive behavior therapy for bulimia nervosa produces substantial reductions in binging and purging, gains that are usually maintained over follow-up periods of 6 to 12 months. Many regard cognitive-behavioral therapy as the treatment of choice. Although less widely investigated, interpersonal psychotherapy, a short-term psychological treatment that focuses on identifying and resolving interpersonal problems, also has been used in the treatment of bulimia nervosa. The rationale for this treatment is that interpersonal stressors may precipitate binge episodes. Finally, since bulimia nervosa frequently is associated with depression, antidepressant medications may be used with therapy in the treatment of this disorder.
References:
- American Psychiatric (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
- Fairburn, C. G., & Brownell, K. D. (2002). Eating disorders and obesity: A comprehensive handbook (2nd ). New York: Guilford.
- National Eating Disorders Association, http://www.nationaleating.org