BULIMIA NERVOSA

Bulimia Nervosa

BULIMIA NERVOSA

Introduction

Bulimia nervosa is a complex eating disorder characterized by episodes of eating large quantities of food (bingeing) and then engaging in purging or other methods to compensate for the binge eating. The term bulimia is derived from Greek to mean “ox hunger,” thus giving a concise description of one of the disor-der's key clinical features: excessive food consumption. Methods of purging typically include self-induced vomiting and abusing laxatives and/or diuretics. Fasting or excessive exercise are “nonpurging,” but they are, nonetheless, compensatory behaviors. Another significant feature of bulimia nervosa is a strong dissatisfaction with the individual's body weight and shape. Eating disorders such as bulimia nervosa and anorexia nervosa primarily affect women; an estimated 1 to 2 million women are afflicted with this disorder in the United States alone. If undiagnosed, bulimia nervosa can lead to serious medical consequences. Eating disorders are a spectrum of illnesses that have serious psychological and medical consequences, both in the short and long term. In the case of bulimia nervosa, the general trend is to binge, or eat profound quantities of food, and then use compensatory measures to remove calories and prevent weight gain. To understand bulimia, a number of topics must be explored, including the clinical definition, epidemiology, the signs and symptoms, treatment, and consequences.

Definition

The Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) defines bulimia nervosa with the following four criteria. There are episodes of binge eating with a sense of loss of control. The binge eating is followed by compensatory purging behavior, such as self-induced vomiting, laxative, or diuretic abuse. The binges and compensatory behavior must occur a minimum of two times per week for at least three months. The individual must also have dissatisfaction with his or her body shape and weight (Stice and Shaw, 2002).

Bingeing is described as eating, in a defined and self-limited amount of time, an amount of food that is larger than most people would eat during a similar time period and under similar circumstances. During this time, the person feels out of control with his or her eating, as though he or she cannot stop. Purging can take many forms and is an attempt to compensate for the extreme food intake during a binge. Purging can be achieved by self-induced vomiting, using laxatives, diuretics, or with excessive exercise. Bulimia is frequently divided into two subtypes: purging and nonpurging. Purging involves those who induce vomiting, or use laxatives, diuretics or enemas to remove calories, whereas those who use excessive exercise or periods of fasting to compensate for calorie intake fall into the nonpurging type. Nonpurging is rarer and accounts for only 6 to 8 percent of bulimic patients (Polivy and Herman, 2002).

EPIDEMIOLOGY

There is great difficulty in accurately evaluating the epidemiology of eating disorders due to changes in diagnostic criteria over time, the reliance on self-reporting, and the tendency for those affected to deny the disorder. Bulimia nervosa was first described in 1977, at the Royal Free Hospital in London and was recognized as ...