Characteristics Of Bulimia Nervosa

Bridget Engel, Psy.D., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D. Feb 2, 2007

The literal translation of bulimia means “hunger like an ox”. The diagnostic criteria for bulimia in the DSM are: 1) recurrent episodes of binge eating with a sense of lack of control occurring at least twice per week for at least three months, 2) recurrent, inappropriate compensatory behavior, such as vomiting, in order to prevent weight gain 3) and self-evaluation that is unduly influenced by body shape and weight.

Symptoms/Criteria

As outlined in the DSM, binge eating is one of the primary symptoms of Bulimia Nervosa. A binge involves eating, in a short period of time, an amount of food that is larger than most individuals would eat under similar circumstances. The food consumed during binges varies, but typically includes sweet, high-calorie foods. Binging is often characterized by rapid consumption until the individual is uncomfortably or even painfully full.

Binge episodes are often surrounded by painful emotions. Preceding a binging incident, bulimic individuals often describe depressed moods, stress, or intense hunger following dietary restraint. They try to stay in control and talk themselves into believing that they should not binge, developing increasing levels of anxiety. During the binge, there is typically a sense of lack of control and an increase in self-criticism, as well as justification for the behavior. After the binge, many individuals experience shame, guilt and regret.

Individuals with bulimia fear weight gain and typically believe they have to undo or compensate for the binge episode, so they purge what they consumed by inducing vomiting. Ironically, bingers do not recognize that most of the calories consumed during a binge remain in the body and are not reduced by purging. However, the immediate effects of vomiting include relief from physical discomfort as well as fear reduction related to gaining weight. Other purging behaviors include the misuse of laxatives and diuretics (medications that cause you to urinate), as well as excessive exercising. Individuals with bulimia may also fast and skip meals frequently in order to lose weight. When they do eat meals, they may drink large amounts of fluids, take very small portions, cut food into tiny pieces, or chew their food excessively.

Bulimic individuals believe they need to keep their embarrassing behaviors hidden from their friends and family. These individuals may avoid eating meals with others, or make frequent trips to the bathroom during or after meals. They may have a heightened desire for privacy in the bathroom or run water to conceal the sound of vomiting. Bulimic individuals may also go for unexpected walks or drives at night after meals or go to the kitchen after every one else is in bed. It is not uncommon for these individuals to chew mints or gum to conceal the smell of vomit on their breath, and they might also wear baggy clothing to conceal the size of their body.

Health Problems

The medical complications related to bulimia are very serious. Many of the physical side effects are the result of chronic vomiting. Frequent vomiting causes infected and swollen salivary glands, stomach ulcers, reflux disease, broken blood vessels, and sore cheeks. Bulimics can experience lung aspiration (inhaling foreign matter, typically vomit, into the lungs), which causes damage to lung tissue, pneumonia, shock, and/or respiratory disease. Tearing or rupturing of the esophagus and stomach can also occur due to the pressure of binge eating and vomiting, causing serious, life-threatening medical problems. Also, a metabolic imbalance called alkalosis (an imbalance of pH levels in the blood and body fluids), causes symptoms ranging from slowed breathing to coma. Furthermore, gum disease, tooth enamel erosion and sensitivity to hot and cold can result. Many individuals with bulimia have skin abrasions on their knuckles from inducing vomiting.

The use of laxatives and diuretics has long-term and serious side effects. Constipation, dehydration, diarrhea, bloating, abdominal cramping, hemorrhoids, and irregular bowel movements are not uncommon. Some of these symptoms may take a long time to alleviate once treatment begins.

Insufficient vitamins and minerals in the diet and severe weight loss cause abnormalities in electrolyte levels. As mentioned in the section on anorexia, electrolytes are electrically charged chemicals in your blood and cells that help to keep your heart and body functioning properly. Imbalances in electrolytes can cause fatigue, overall weakness, confusion, decreased concentration, and even seizures. Electrolyte problems and hormone imbalances can also lead to insomnia (impaired sleep). Hypokalemia is a deficiency in potassium that causes diminished reflexes, fatigue and cardiac abnormalities.

Heart problems are the leading cause of death among bulimic patients. Many individuals with bulimia experience dizziness, irregular blood pressure, and abnormal heart beat.