About Bulimia
What is an 'eating disorder'?
An eating disorder is a disturbance that an individual has in their attitude, their selection, and their appetite regulation toward food. It includes changes in their image of their body, changes in mood, anxiety, and it has negative consequences ultimately for their nutrition and their state of health. What really characterizes an eating disorder is that it's persistent day after day, month after month, and we have to make a difference between the eating disorder and minor and temporary changes in eating that occur because of anxiety or because of arguments or because of minor hunger strikes, because the teenager is angry at a parent. Eating disorders come day after day, preoccupy the mind of an individual and distort and alter their attitude toward food.
What is 'bulimia'?
During a bulimic episode, large amounts of food is eaten rather rapidly, continuously, for instance, seven bagels, large amounts of fluids, a pint of ice cream, seven tacos and things like this. It's usually eaten within an hour or two with feelings of being out of control following a period of bingeing. A binge period like that is when an individual feels guilty, they feel stuffed and full. Very often, they seek out some way of compensating for what they do. They will either go to sleep and not eat the next day, or they will regurgitate right after binging or they will take large amounts of laxatives. Other kinds of compensation consist of excessive exercise the very next day after a binge.
What is 'purging'?
Purging can be self-induced, for instance, self-induced vomiting. Sometimes vomiting can occur after one does it for months at a time and after meals, it can occur spontaneously right after a meal. And then sometimes, rumination occurs, where, because of vomiting and excessive purging over time, that food comes up by itself. One cannot even keep the food down. Other forms of purging, in the mind of an individual, would be to use laxatives so that they feel that they're getting the food out of them, and also to use water pills or so-called diuretics. So essentially, purging is both a mental and physical compensatory mechanism in getting intake out of you.
What is 'non-purging' bulimia?
With bulimia we actually consider three behaviors or three mechanisms as being non-purging. One is the use of medication, for instance stimulants over the counter, diet pills. The other is fasting, gross fasting, for instance not eating the whole day after a binge. And then finally, exercise, if you want to use the word, exercise, purging, just the idea of blowing off calories, the mental idea that occurs in the mind of the individual that by exercising they are essentially blowing off calories and undoing the damage that they did from the binge the other day. But technically exercise, the use of drugs to inhibit appetite and gross fasting are really non-purging when compared to vomiting, laxatives and diuretics.
What is required for a diagnosis of bulimia?
The term we use is bulimia nervosa. Alright so, for a formal diagnosis, there are several components. The bulimia component is the eating component and we also refer to that as binge eating. These have to occur with a frequency of several times a week; usually two to three times a week over several months. So that is one criteria. Then the nervosa criteria (we use the word bulimia), the nervosa criteria consists of mental attitudes and compensating behaviors. The mental attitudes are usually related to a fear of being fat or body image distortions. And then the compensating mechanisms are purging and non-purging. So, the total picture -- on the front end, the intake (that is the abnormal eating) and then the compensatory mechanism, that total picture is what we diagnose as bulimia nervosa.
What is the difference between anorexics, bulimics and binge eaters?
In anorexia nervosa, the primary behavior is restriction of food intake and restriction of food selection, so the cuisine of the anorexic patient is markedly reduced from their food selections previously. They have body image distortion, fear of being fat, dissatisfaction with their appearance and they may have both mood and anxiety disturbances. Bulimia nervosa, usually these individuals are of, rather than being of low weight, as we see in anorexia, where the weight loss is fifteen to twenty-five percent, patients with bulimia nervosa usually are within five or ten percent of their normal weight. They have the bulimic symptoms, that is the food on the mind, binge eating and so on occurring day after day, week after week, and then they have compensatory mechanisms, including regurgitation that we mentioned. Binge eating disorder is a form of disturbance in which there's that normal intake, that is there's bulimic behavior, with no regurging, that is no vomiting, no laxatives and so on. Therefore, patients with binge eating disorder are more likely to become obese.
