What is Bulimia Nervosa?

Repeated episodes of binge eating followed by behaviours to prevent weight gain, such as self-induced vomiting, excessive exercise, or the use of laxatives or diuretics is what identifies bulimia nervosa. People with bulimia often have a distorted body image seeing themselves larger than they actually are and place a strong emphasis on their weight and shape as well as feeling a lack of control over their eating habits. It’s a serious mental health condition that can have severe physical and emotional consequences so treatment at the earliest possible opportunity gives the best chance for a fast and sustained recovery.

Everybody overindulges from time to time and that’s not to be confused with binge eating.  During a binge eating episode with bulimia, people don’t feel in control of how much or how quickly they’re eating and it might often include foods they tend to avoid. It can feel mindless or even dissociative and is often very distressing.

Bulimia nervosa can have several consequences on both physical and emotional health. Some of the physical consequences include dental problems caused by frequent vomiting, digestive problems such as acid reflux and constipation, hormonal and electrolyte imbalances and dehydration and malnutrition.  Bulimia can be extremely distressing and can cause feelings of shame, guilt, low self-esteem, depression, anxiety and hopelessness.

Diagnosis

Typically, diagnosis of bulimia nervosa will be done with a qualified healthcare professional, such as a psychiatrist, psychologist, or a specialised eating disorder practitioner. The evaluation may involve a thorough assessment of medical history, physical examination, psychological evaluation, and discussion of eating behaviours and thoughts related to food and body image. The healthcare provider will use specific criteria outlined for bulimia nervosa in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which are:

• Recurrent episodes of binge eating. An episode of binge eating is characterised by both of the following:

    • Eating in a discrete period of time (e.g. within a two hour period), an amount of food that is definitely larger than what most people would eat during a similar period of time and under similar circumstances.
    • Lack of control overeating during the episode (e.g. a feeling that you can’t stop eating, or control what or how much you’re eating).

  • Recurrent inappropriate compensatory behaviour 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 behaviours both occur, on average, at least once a week for three months.

  • Self-evaluation is unduly influenced by body shape and weight.

  • Binging or purging doesn’t occur exclusively during episodes of behaviour that would be common in those with anorexia nervosa.

Treatment

Treatment for bulimia usually involves a multidisciplinary approach including nutritional and psychological interventions.  The goals of treatment are to eliminate the purging behaviour, implementing a healthy and structured eating plan addressing any nutritional deficiencies while addressing unhealthy thoughts and behaviours related to food and body image.   In some cases, medication such as antidepressants may be prescribed to help manage co-occurring mental health conditions like depression or anxiety.

Even if all the DSM-5 criteria for bulimia aren’t met, a serious eating disorder can still be present. 

 

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