Bulimia Nervosa

Bulimia, the ingestion and subsequent purging of copious amounts of food, has been part of human society, sporadically, since the Roman orgies. In the 1960’ it re-emerged as a dissolution of primary anorexia. When an anorexic patient could no longer sustain her rigid self-denial, she gave in to her desire to eat but then vomited to maintain her low body weight. By 1980, bulimia had appeared singularly with enough frequency to warrant a separate classification in DSM-III. Now bulimia is estimated to affect 4 to 10% of adolescent and college-aged women with some estimates rising as high as 19 to 20%. It is also on the rise in men. However, it is a disease based in feelings of shame, insecurity and inadequately, so the best estimates probably fall short of the true magnitude of the problem. Sub clinical bulimia is much more prevalent. Binge eating was reported by 65 to 69% of female undergraduates in surveys, but is estimates to affect up to 80% of collegiate women.

Bulimia nervosa is defined by five characteristics, all of which must be present for the diagnosis. If only the bingeing behavior is present, in the absence of purging, the provisional diagnosis of binge-eating disorder may be given. The validity of this classification as a completely separate entity is still under investigation and hotly debated.

Diagnostic Criteria for Bulimia Nervosa

1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of following:

· Eating, in a discrete period of tike (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)

2. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.

3. The binge eating and inappropriate compensatory behaviors both occur, on average at least twice a week for 3 months.

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

5. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Specify type:

Purging type: during the current episode of bulimia nervosa, the person has regularly engaged in self induces vomiting or the misuse of laxatives, diuretics or enemas.

Nonpurging type: during the current episode of bulimia nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting of the misuse of laxatives, diuretics, or enemas.

Source:

Debra A. Krummel, Penny M. Kris-Etherton. Nutrition in Women's Health. Aspen Publishers, 1996.