Bulimia Diagnosis - OmniMedicalSearch.com

Conditions & Diseases: Eating & Weight Disorders

Bulimia Nervosa

Bulimia Nervosa Overview and Diagnosis

Bulimia nervosa was initially diagnosed around 1950s but most of the mental heath professionals at that time were not aware of the disorder. The condition was initially described by a British professor name Gerald Russell who worked with patients suffering from what is known today as bulimia. The condition started to be better understood in the 1980s when the American Psychiatric Association recognized bulimia as a psychiatric condition. In time, bulimia became a "major social concern" due to its devastating effects on the mind and body. (6)

Bulimia nervosa is listed by Diagnostic and Statistical Manual of Mental Disorders as an eating disorder together with anorexia nervosa. According to DSM - IV, there are six diagnostic criteria that define bulimia nervosa.

The first criterion for bulimia nervosa is the presence of recurrent episodes of binge eating. A binge eating episode is define as "eating in a discrete period of time (usually less than 2 hours) an amount of food that is definitely larger than most individuals would eat under similar circumstances."(4) Characteristic for a binge eating episode is the abnormal amount of food consumed rather than the person's craving for a certain nutrient such as carbohydrates. The amount of food eaten during a binge episode is significantly distinct from a common understanding of an over-eating episode, and although the type of food consumed can vary greatly, it typically includes high amounts of sweets and high-calorie food such as a bucket of ice cream, several cakes and chocolate bars, a packet of biscuits and on top of that a significant amount of left-over food from previous meals. "Continual snacking on small amounts of food throughout the day would not be considered a binge."(4) Usually the binge eating is kept secret because the person is ashamed of their habits and try to conceal the symptoms, and may or may not be planned in advanced. A binge eating episode is characterized (but not always) by rapid consumption of high amounts of food until the person feels uncomfortably and even painfully full. The triggers of a binge eating episode include dysphoric mood states (sadness, anxiety, irritability, and restlessness), interpersonal stressors, intense hunger following dietary restrain, uncomfortable/upsetting feelings related to body weight/shape, and food. Although the binge eating can "transiently reduce the dysphoria", the episode is usually followed by disparaging self-criticism and depressed mood. (4)

A second criterion is a sense of lack of control over the eating behavior during binge eating episodes. An individual suffering from bulimia feels that they cannot stop or control what and how much they eat. This feeling is perceived as being more intense early in the course of the disorder when the individual is in "frenzied state while binge eating." (4) After the condition persisted for some time, the individual describes their binge eating episodes as no longer being accompanied by an acute feeling of losing control rather "behavioral indicators of impaired control, such as difficulty resisting binge eating or difficulty stopping a binge once it has begun." (4) However, the control impairment is not absolute. The person may continue the binge eating when the phone rings but will stop if a person unexpectedly enters the room.

The third criterion is "recurrent use of inappropriate compensatory behaviors to prevent weight gain." (4) Some of the most common compensatory methods used by individuals with bulimia are:

self-induced vomiting (method used by 80 to 90 percent of the bulimia patients),
misuse of laxatives, diuretics, enemas or other medications,
strict dieting, fasting,
vigorous or excessive exercising (that significantly interferes with important activities or that are performed at inappropriate times or in inappropriate settings, or despite injuries or other medical conditions).

Bulimia patients that engage in purging behaviors choose to vomit mostly to gain relief from the physical discomfort of eating enormous amount of food and to reduce the fear of gaining weight. However, in some cases purging becomes a goal in itself and the person will binge in order to vomit or will vomit after eating small amounts of food. In order to induce vomiting a bulimia patient might uses their fingers or instruments to stimulate the gag reflex or rarely consuming ipecac syrup, and eventually they will be able to vomit at will. In rare cases, patients with bulimia nervosa take thyroid hormones to avoid gaining weight.

The fourth criterion is an "excessive emphasis on body shape and weight" which disproportionately influences the person's self-evaluation and self-esteem. Individuals suffering from bulimia nervosa are preoccupied with losing and not gaining weight and are unsatisfied with their physical appearance.

According to the presence or absence of purging methods used in order to compensate episodes of binge eating, there are two forms of bulimia nervosa: the purging type (the person affected by this form engaged in self-induced vomiting or misuse of laxatives, diuretics, or enema) and the nonpurging type (the person affected by this form engages in alternative compensatory behaviors such as aggressive fasting or excessive exercising).

Although it is hard to identify those suffering from such disorder, bulimia nervosa is a common illness that affects both genders. More than 8 million people in the United States suffer from bulimia with more than 90 percent of this number being women. It is estimated that 3 percent of all women will be affected by the disorder at some point in their life. Approximately 6 percent of teenager girls and 5 percent of college age female are believed to be affected by the condition. (5) Based on the gender differences, according to the American Psychiatric Association more women suffer from bulimia nervosa than men. Recent studies reveal that 1 in 400 men between 13 and 30 suffer from an eating disorder. The ration between gender is not clearly established yet. Some sources claim that the women vs men ration for bulimia is 10: 1, while some studies claim that this ratio is actually lower 4:1. Men are less likely to report suffering from a "woman's disease". Recent studies suggest that the disorder is becoming more common among the male population "particularly for men between the ages of twenty-one and twenty-four who are involved in sports and activities that connect weight with performance." (6)

The onset of the disorder can occur in late adolescence or early adult life. The disease' course can be chronic or intermittent "with periods of remission alternating with recurrence of binge eating." (4)

Article by Alina Morrow
MS Psychology
Medical Writer
OmniMedicalSearch.com