The Psychology of Eating: From Healthy to Disordered Behavior

(nextflipdebug5) #1
Eating Disorders 225

Bulimia Nervosa


The term bulimia nervosawas first used by Russell in 1979 to describe a
variant of anorexia nervosa in 30 of his patients. He suggested that bulimia
nervosa consisted of three factors: a powerful and intractable urge to eat
resulting in episodes of overeating, avoidance of the fattening effects of food
by inducing vomiting or abusing purgatives or both, and a morbid fear of
becoming fat. Descriptions of bulimia nervosa focus on self-control, but
in contrast to anorexia nervosa the absence of this control is emphasized.
For example, Cooper and Taylor (1988) stated that “episodes of excessive
uncontrolled eating are a central feature” of bulimia, Cooper and Fairburn
(1986) described bulimia as resulting from “a profound and distressing loss
of control over eating,” and “irresistible cravings for food” were central to
the diagnostic criteria set by Russell (1979). Binge eating was similarly defined
by Fairburn (1984) as “episodes of eating which are experienced as exces-
sive and beyond the subject’s control” (p. 235). DSM-IV’s (1994) most recent
description of bulimia nervosa characterizes it by the following:



  • Recurrent episodes of binge eating. An episode of binge eating is
    characterized by both 1) eating in a discrete period of time (e.g., in any
    2-hour period) an amount of food that is definitely larger than most
    people would eat in a similar period of time (taking into account time
    since last meal and social context in which eating occurred), and 2) a
    sense of lack of control over eating during the episodes (e.g., a feeling
    that one can’t stop eating or control what or how much one is eating).

  • Recurrent use of inappropriate compensatory behavior to avoid weight
    gain, e.g., self-induced vomiting.

  • A minimum average of two episodes of binge eating and two inappro-
    priate compensatory behaviors a week for at least three months.

  • Self-evaluation unduly influenced by body shape and weight.

  • The disturbance not occurring exclusively during episodes of anorexia
    nervosa.


DSM-IV recommends that bulimia nervosa be divided into two types:
the purging type, to describe those who binge and purge using vomiting
and/or laxatives, and the nonpurging type, to describe those who binge
only. This latter type of patients mostly uses excessive exercise or dieting
as a means to compensate for food intake.

Free download pdf