Bulimia nervosa is when a person eats large quantities of food (binges) and rids of the food and calories by compensatory behaviors such as severe restricting, purging through vomiting, exercise, laxatives or using diuretics. Someone with bulimia nervosa also has excessive concern about their body and weight, oftentimes accompanied by depression. The behaviors are a way to reduce the anxiety and stress through the binging and purging. Some people with bulimia describe feeling empty. The food is a way in which they can fill up the emptiness, while the purging is a feeling of relief or a stress reduction.
Bulimia nervosa can be thought of as a “silent” disorder because there is so much shame associated with it. When someone has anorexia nervosa, it is very visible by the size of the body, but someone with bulimia will be of a normal body weight. The person will engage in behaviors behind closed doors so that others are not aware of what they are doing. Often loved ones have no idea that their child, sister or friend has an eating disorder.
Bulimia nervosa also has many medical complications and can result in death. Someone with bulimia nervosa will have mineral loss through the purging which will cause the electrolytes in the body to be off and can result in a heart attack or heart failure. The acid from the vomit can cause damage to the lining of the esophagus, causing tears or ruptures. The salivary glands become swollen and there can be tooth decay from the stomach acid in vomit. A female with bulimia nervosa may have irregular menstrual cycles. If there is laxative abuse, there can be irregular bowel movements and constipation.
The DSM V states the following as criteria for bulimia nervosa:
• Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
• Eating in a discrete period of time an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
• A sense of lack of control over eating during the episode (i.e., a feeling that one cannot stop eating or control what or how much one is eating).
• Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting or excessive exercise.
• The binge eating and inappropriate compensatory behaviors both occur, on average, at least once per week for 3 months.
• Self-evaluation is unduly influenced by body shape and weight.
• The disturbance does not occur exclusively during episodes of anorexia nervosa.