People with bulimia nervosa consume large amounts of food and then rid their bodies of the excess calories by vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively. Some use a combination of all these forms of purging. Because many individuals with bulimia “binge and purge” in secret and maintain normal or above normal body weight, they can often successfully hide their problem from others for years.
Family, friends, and physicians may have difficulty detecting bulimia in someone they know. Many individuals with the disorder remain at normal body weight or above because of their frequent binges and purges, which can range from once or twice a week to several times a day. Dieting heavily between episodes of binging and purging is also common. Eventually, half of those with anorexia will develop bulimia.
As with anorexia, bulimia typically begins during adolescence. The condition occurs most often in women but is also found in men. Many individuals with bulimia, ashamed of their strange habits, do not seek help until they reach their thirties or forties. By this time, their eating behavior is deeply ingrained and more difficult to change.
Specific Symptoms of Bulimia
This disorder is characterized by recurrent episodes of binge eating, occurring at least twice a month for a minimum of 3 months, which consists of:
- Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
- A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
Additionally, the criteria for Bulimia Nervosa requires recurrent, inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise. A person’s self-image is usually directly correlated with their weight, with a great deal of attention focused on how their body looks.
This disorder can only be diagnosed if it is not better accounted for by anorexia nervosa.
The level of severity of a bulimia diagnosis is based on the frequency of inappropriate compensatory behaviors (see below). The level of severity may be increased to reflect other symptoms and the degree of disability caused to the person.
- Mild: An average of 1–3 episodes of inappropriate compensatory behaviors per week.
- Moderate: An average of 4–7 episodes of inappropriate compensatory behaviors per week.
- Severe: An average of 8–13 episodes of inappropriate compensatory behaviors per week.
- Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors per week.
Body Mass Calculator:
Body Mass Index or BMI is a tool for indicating weight status in adults. It is a measure of a person’s weight in relation to their height. Individuals with bulimia nervosa typically are within the normal weight or overweight range (body mass index [BMI] ≥ 18.5 and < 30 in adults).
Formerly, in the fourth diagnostic manual (DSM-IV), there were two types of bulimia nervosa:
- Purging Type: The person regularly engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
- Non-purging Type: The person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
Now, according to 2013 DSM-5, these specifiers no longer exist (remain listed here for historical/informational purposes only). The deletion of the purging/non-purging specifier types was made with the rationale that compensatory behaviors may change from purging (e.g., using laxatives) to non-purging forms (e.g., extreme dieting) within the same individual over the course of the disorder.
This entry has been adapted for DSM-5; diagnostic code 307.51.
Psych Central. (2014). Bulimia (Bulimia Nervosa) Symptoms. Psych Central. Retrieved on December 18, 2014, from http://psychcentral.com/disorders/bulimia-bulimia-nervosa-symptoms/
Symptom criteria summarized from:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Washington, DC: American Psychiatric Association.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.
Last reviewed: By John M. Grohol, Psy.D. on 22 Jun 2014
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