Bulimia Nervosa

A bulimic person binges then throws up in order to feel in control. Their self-evaluation is unduly influenced by how much they eat and their body weight.

Thus, Bulimia Nervosa involves recurrent episodes of binge eating. An episode of binge eating is characterized by consuming a large amount of food in a fixed period (e.g., within any two-hour period) and by a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

This binge is then followed by recurrent inappropriate compensatory behaviour to prevent weight gain – purging. Methods such as self-induced vomiting; misuse of laxatives, diuretics or other medications; fasting, or excessive exercise are used.

The binge eating and inappropriate compensatory behaviours both occur, on average, at least twice a week for at least three months. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Types of Bulimia

There are two types of Bulimia:

1.       Purging Type - involves regular self-induced vomiting or the misuse of laxatives, diuretics, or enemas; and

2.       Nonpurging Type – involves use of other inappropriate compensatory behaviours, such as fasting or excessive exercise, but no regular self-induced vomiting or the misuse of laxatives, or other weight-loss pills (e.g. diuretics, or enemas).

Signs and Symptoms

Physical

Behavioural

People suffering from Bulimia have particular eating habits.

People suffering from the disorder do not want others to find out about their eating habits, and thus are secretive about their behaviour. They binge in private, therefore tend to eat at night when everyone is asleep, or go on unexpected walks or drives. Disappearance of large amounts of food, or numerous empty wrappers/containers in the garbage are also signs of binging.

The purging behaviour is also kept secret. Bulimics thus exhibit excessive desire for privacy in the bathroom. In order to cover up the noise of throwing-up they open the tap for the sound of water running water. The smell of vomit is concealed by using air-freshener, perfume and chewing gum.

They avoid eating with others or take very small portions when eating with others and often skip meals.

Bulimics tend to consume a lot of water or diet soda (to make vomiting easier), to cut food into very small bites and chew excessively. They may also have unpredictable and sudden dietary likes and dislikes.  One may even notice them separate different types of food on the plate or make strange pairings of foods.

Excessive exercise and using laxatives is also common as a way of purging.

Psychological and Emotional

Severe self-criticism and self-deprecating thought following eating are common symptoms of Bulimia. Bulimics fear that they would not be able to stop eating voluntarily. They may also have mood swings or are unable to consciously experience and express emotion.

Social

People with Bulimia usually have a need for approval from others and they seek sympathy, affection and emotional support. They avoid restaurants, planned meals or social events.

Although there may be overlapping signs and symptoms in people suffering from Anorexia Nervosa and Bulimia Nervosa there are also distinct features. Bulimics do not feel they are in control of their behaviour and therefore are more likely to admit to having a problem. They tend to feel they are a failure because they cannot achieve a low weight, and this outlook infiltrates into all aspects of their lives. On the other hand, Anorexics believe they are in control of their eating and thus are much less likely to admit that a problem exists. They cannot see that they are underweight and constantly work towards a goal that they cannot meet.