Bulimia is an eating disorder whose main feature
is eating an unreasonably large amount of food in a
short time, then following this binge by purging the
body of calories. Purging is most often done by selfinduced
vomiting, but it can also be done by laxative,
enema, or diuretic abuse. Alternately, some people
with bulimia do not purge but use extreme exercising
and post-binge fasting to burn calories. This can lead
to serious injury. Nonpurging bulimia is sometimes
called exercise bulimia.
Bulimia nervosa is officially
recognized as a psychiatric disorder in the Diagnostic and Statistical Manual for Mental Disorders Fourth
Edition-Text Revision (DSM-IV-TR) published by
the American Psychiatric Association.
Bulimia nervosa is diagnosed when most of the
following conditions are present:
-Repeated episodes of binge eating followed by
behavior to compensate for the binge (i.e. purging,
fasting, over-exercising). Binge eating is defined as
eating a significantly larger amount of food in a
limited time than most people typically would eat.
-Binge/purge episodes occur at least twice a week for a
period of three or more months.
-The individual feels unable to control or stop an
eating binge once it starts and will continue to eat
even if uncomfortably full.
-The individual is overly concerned about body
weight and shape and puts unreasonable emphasis
on physical appearance when evaluating his or her
self-worth.
-Bingebingeinging and purging does not occur exclusively
during periods of anorexia nervosa.
Many people with bulimia will consume 3,000–
10,000 calories in an hour. For example, they will start
out intending to eat one slice of cake and end up eating
the entire cake. One distinguishing aspect of bulimia is
how out of control people with bulimia feel when they
are eating. They will eat and eat, continuing even when
they feel full and become uncomfortable.
Most people with bulimia recognize that their
behavior is not normal; they simply cannot control
it. They usually feel ashamed and guilty over their
binge/purge habits. As a result, they frequently
become secretive about their eating and purging.
They may, for example, eat at night after the family
has gone to bed or buy food at the grocery store and
eat it in the car before going home. Many bulimics
choose high-fat, high-sugar foods that are easy to eat
and easy to regurgitate. They become adept at inducing
vomiting, usually by sticking a finger down their
throat and triggering the gag reflex. After a while, they
can vomit at will. Repeated purging has serious physical
and emotional consequences.
Many individuals with bulimia are of normal
weigh, and a fair number of men who become bulimic
were overweight as children. This makes it difficult for
family and friends to recognize that someone suffering
from this disorder. People with bulimia often lie about
induced vomiting and laxative abuse, although they
may complain of symptoms related to their binge/
purge cycles and seek medical help for those problems.
People with bulimia tend to be more impulsive than
people with other eating disorders. Lack of impulse
control often leads to risky sexual behavior, anger
management problems, and alcohol and drug abuse.
A subset of people with bulimia also have anorexia
nervosa. Anorexia nervosa is an eating disorder
that involves self-imposed starvation. These people
often purge after eating only a small or a normalsized
portion of food. Some studies have shown that
up to 60% of people with bulimia have a history of
anorexia nervosa.
Dieting is usually the trigger that starts a person
down the road to bulimia. The future bulimic is very
concerned about weight gain and appearance, and
may constantly be on a diet. She (most people with eats voraciously far more than she needs to satisfy her
hunger, feels guilty about eating, and then exercise or
purges to get rid of the unwanted calories. At first this
may happen only occasionally, but gradually these
sessions of bingeing and purging become routine and
start to intrude on the person’s friendships, daily activities,
and health. Eventually these practices have serious
physical and emotional consequences that need to
be addressed by healthcare professionals.
bulimia are female) may begin by going on a rigorous
low-calorie diet. Unable to stick with the diet, she then
