What is Bulimia Nervosa? - Definition, Symptoms, Treatment and Prognosis

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  • 0:05 Definitions
  • 3:18 Subtypes & Symptoms
  • 5:55 Causes & Treatment
  • 8:24 Lesson Summary
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Lesson Transcript
Instructor: Devin Kowalczyk

Devin has taught psychology and has a master's degree in clinical forensic psychology. He is working on his PhD.

This lesson explores bulimia as well as challenges many common misconceptions of bulimia. Specifically, this lesson describes the diagnostic requirements, the subtypes, and the treatments known to help with bulimia.

Definitions

There are a lot of misconceptions that come with eating disorders. These misconceptions come from over-generalizations made by lay people as well as the biggest propagator of lies: television. People with eating disorders are commonly mis-portrayed, or the actual facts are glossed over.

One eating disorder that is particularly misunderstood is bulimia, or bulimia nervosa. Many people make broad assumptions when it comes to eating disorders and simplify them down to one basic idea. With bulimia, it has been reduced down to 'someone who throws up after they eat.' There is also the simplification that it only affects women or that models have it. Let's examine actual psychology so that you can keep people from continuing these lies.

Bulimia nervosa is an eating disorder found in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. People suffering from this disorder do not need to be extremely thin. Many, in fact, are normal weight or overweight. This disorder is not defined by weight but as an eating disorder where a person displays the following symptoms:

  • Recurrent binge eating, defined as eating a definitively larger amount of food than most people during a discrete period of time and a sensation of no control over eating
  • Recurrent compensatory behavior to prevent weight gain, which we will explore in the subtypes below
  • Binge eating and compensatory behavior occur an average of once a week for three months
  • The individual's self-esteem is disproportionately influenced by body shape and weight
  • Is not better explained by anorexia nervosa

As you can see by this list, it is not as simple as someone who eats and throws up. Even the simple classification of it as an eating disorder is not really sufficient. 'Eating disorder' only means that a person eats too much or too little of something. I mean, I eat a lot of candy and drink a lot of soda, which could be defined as an eating disorder. Bulimia nervosa goes beyond just eating and is actually rooted in a psychological issue.

It is estimated that 1.1% to 4.2% of women suffer from bulimia during their lifetimes, and many more will have disordered eating, or pathological and unhealthy patterns to eating that don't meet the criteria for an eating disorder. An example is excessive or unhealthy dieting. Percentages of women who have aspects of bulimia are covered up by the acceptable term 'dieting' or 'watching my figure.' Exact figures are not available for men, but there has been a recent upswing in diagnosis and awareness as society has placed more emphasis on fit men. There may also be less willingness on doctors' parts to diagnose males with this disorder as well as a strong support in the literature that this is a female problem.

Bulimia nervosa has two main subtypes, which we will get into. They each have their own specific symptoms to diagnose them. After we look at the subtypes, we will take a brief look at the causes of bulimia as well as what one might do to treat it.

Subtypes & Symptoms

We briefly discussed binge eating, and I gave you a rough outline of it, but there is some subtlety to it that needs to be covered. Binge eating has to do with how much the person with bulimia eats in addition to how much other people eat. If I said someone ate 2,000 calories in less than 2 hours, would this be binge eating? That's a lot more calories than anybody else would eat, unless it's Thanksgiving, in which case it's very normal. So binge eating has some components that make it a little more complicated, such as how much other people are eating.

Binge eating is a common characteristic of bulimia, so we have to look at different characteristics to differentiate the subtypes. The easiest way is by how the person with bulimia controls their caloric intake. While many are normal weight or overweight, consistently binge eating would cause a person to become overweight. Calories are controlled by the compensatory behavior, which allows us to differentiate.

Purging bulimia is characterized by the removal of the food through laxatives, water pills, or vomiting. This type of bulimia is the one where the individual is trying to get the food out as quickly as possible so they don't retain any of the calories. The repeated use of these methods can cause severe damage to the body. All three of these methods can lead to malnourishment. Laxatives can cause the bowel to become unresponsive and can disrupt the normal manner of the colon. Water pills can cause kidney damage, and vomiting can erode teeth, damage the muscles in the gut and diaphragm, and even cause eye problems.

Non-purging bulimia is characterized by either restricting further intake of calories or by excessive exercise. Non-purging really has two components. The first is restricting, which is either complete fasting with no food intake or a strict diet in which only certain foods are consumed in a highly controlled manner. It could be thought of as a swinging between extremes, with binge eating and binge starving. The other type is excessive exercise, where the person with bulimia tries to burn off the calories so they don't put on any weight. And we aren't talking about going to the gym every day; we're talking going to the gym twice a day for two hours of intensive cardio. These methods are just as destructive to the body but in a more holistic way. Calories are the fuel that runs the body, and if they are all burnt up exercising or are restricted, then the body can't run like it should.

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