Abnormal Psychology

442 CHAPTER 10

Bulimia Nervosa

Marya Hornbacher describes her descent into bulimia nervosa:

I woke up one morning with a body that seemed to fi ll the room. Long since having

decided I was fat, it was a complete crisis when my body, like all girls’ bodies, acquired

a signifi cantly greater number of actual fat cells than it had ever possessed. At puberty,

what had been a nagging, underlying discomfort with my body became a full-blown,

constant obsession.... When I returned [from the bathroom after throwing up], ev-

erything was different. Everything was calm, and I felt very clean. Everything was in

order. Everything was as it should be....

I remember devouring piece after piece [of a loaf of bread, toasted with butter],

my raging, insatiable hunger, the absolute absence of fullness. I remember cheerfully

heading off for my bath. Night, I said. Locking the bathroom door, turning the water on,

leaning over the toilet, throwing up in a heave of delight.... But the delight did not

last long. The daily bingeing was making me heavier.... Though the purging was ini-

tially rare—maybe once or twice a week—it was right about this time that I began to

get in trouble at school. With frequency. I got into fi ghts. My grades fl uctuated, notes

were sent home about my disruptive behavior.

(1998, pp. 40–44).

For Hornbacher, as for many people with bulimia, the maladaptive eating

behaviors started off as an attempt to cope with negative feelings about weight,

appearance, or eating “too much.” As in her case, such behaviors can become en-

trenched and lead to additional negative feelings; the maladaptive eating behaviors

and ensuing feelings can create their own problems. In this section we examine the

criteria for bulimia nervosa, and the medical effects of the disorder; we then discuss

criticisms of the diagnostic criteria and consider the disproportionately high preva-

lence of the related disorder, eating disorder not otherwise specifi ed.

What Is Bulimia Nervosa?

A key feature of bulimia nervosa (often simply referred to as bulimia) is repeated

episodes of binge eating followed by inappropriate efforts to prevent weight gain.

Such inappropriate efforts to prevent weight gain are categorized by DSM-IV-TR as

either purging or nonpurging:

Key Concepts and Facts About Anorexia Nervosa

• The hallmark of anorexia nervosa is a refusal to maintain a
  healthy weight; DSM-IV-TR defines the weight cutoff as less
  than 85% of expected body weight. Other criteria include an
  intense fear of becoming fat or gaining weight, distortions in
  body image, and amenorrhea. DSM-IV-TR includes two types of
  anorexia: restricting and binge-eating/purging.


• Anorexia can lead to signifi cant medical problems, most impor-
  tantly muscle wasting (particularly of heart muscle), as well as low
  heart rate, low blood pressure, loss of bone density, and decreased
  metabolism. Other symptoms include irritability, headaches, fa-
  tigue, and restlessness. All methods of purging—vomiting, diuret-
  ics, laxatives, and enemas—can cause dehydration because they
  primarily eliminate water, not calories, from the body.


• Starvation also leads to various psychological and social problems,
  including a heightened sensitivity to light, cold, and noise, poor
  sleep and mood, irritability, anxiety, and preoccupation with food.
  
  
  • Critics of the DSM-IV-TR diagnostic criteria for anorexia point
    out that the criteria of low weight and amenorrhea aren’t highly
    associated with general medical status, prognosis, or outcome.
    Also, the two types of anorexia—restricting and binge-eating/
    purging—may better represent stages of the disorder rather
    than distinct paths it can take.
  
  
  
  

Making a Diagnosis

• Reread Case 10.1 about Caroline Knapp, and determine whether
  or not her eating-related symptoms meet all of the criteria for
  anorexia nervosa. Specifi cally, list which criteria apply and which
  do not. If you would like more information to determine her
  diagnosis, what information—specifi cally—would you want, and
  in what ways would the information infl uence your decision? If
  you decide that her symptoms do meet the criteria, which DSM-
  IV-TR type of anorexia is the most appropriate and why?