and Statistical Manual for Mental Disorders Fourth
Edition-Text Revision (DSM-IV-TR)published by
the American Psychiatric Association.
Bulimia nervosa is diagnosed when most of the
following conditions are present:
Repeated episodes of binge eating followed by
behavior to compensate for the binge (i.e. purging,
fasting, over-exercising). Binge eating is defined as
eating a significantly larger amount of food in a
limited time than most people typically would eat.
Binge/purge episodes occur at least twice a week for a
period of three or more months.
The individual feels unable to control or stop an
eating binge once it starts and will continue to eat
even if uncomfortably full.
The individual is overly concerned about body
weight and shape and puts unreasonable emphasis
on physical appearance when evaluating his or her
self-worth.
Bingebingeinging and purging does not occur exclu-
sively during periods of anorexia nervosa.
Many people with bulimia will consume 3,000–
10,000 calories in an hour. For example, they will start
out intending to eat one slice of cake and end up eating
the entire cake. One distinguishing aspect of bulimia is
how out of control people with bulimia feel when they
are eating. They will eat and eat, continuing even when
they feel full and become uncomfortable.
Most people with bulimia recognize that their
behavior is not normal; they simply cannot control
it. They usually feel ashamed and guilty over their
binge/purge habits. As a result, they frequently
become secretive about their eating and purging.
They may, for example, eat at night after the family
has gone to bed or buy food at the grocery store and
eat it in the car before going home. Many bulimics
choose high-fat, high-sugar foods that are easy to eat
and easy to regurgitate. They become adept at induc-
ing vomiting, usually by sticking a finger down their
throat and triggering the gag reflex. After a while, they
can vomit at will. Repeated purging has serious phys-
ical and emotional consequences.
Many individuals with bulimia are of normal
weigh, and a fair number of men who become bulimic
were overweight as children. This makes it difficult for
family and friends to recognize that someone suffering
from this disorder. People with bulimia often lie about
induced vomiting and laxative abuse, although they
may complain of symptoms related to their binge/
purge cycles and seek medical help for those problems.
People with bulimia tend to be more impulsive than
people with othereating disorders. Lack of impulse
control often leads to risky sexual behavior, anger
management problems, and alcohol and drug abuse.
A subset of people with bulimia also haveano-
rexia nervosa. Anorexia nervosa is an eating disorder
that involves self-imposed starvation. These people
often purge after eating only a small or a normal-
sized portion of food. Some studies have shown that
up to 60% of people with bulimia have a history of
anorexia nervosa.
Dieting is usually the trigger that starts a person
down the road to bulimia. The future bulimic is very
concerned about weight gain and appearance, and
may constantly be on a diet. She (most people with
bulimia are female) may begin by going on a rigorous
low-calorie diet. Unable to stick with the diet, she thenEffects of bulimia on the bodyBlood Anemia
Body fluids Dehydration
Low potassium, magnesium, and
sodium
Brain Anxiety
Depression
Dizziness
Fear of gaining weight
Low self-esteem
Shame
Cheeks Soreness
Swelling
Heart Heart failure
Heart muscle weakened
Irregular heart beat
Low pulse and blood pressure
Intestines Abdominal cramping
Bloating
Constipation
Diarrhea
Irregular bowel movements
Hormones Irregular or absent period
Mouth Cavities
Gum disease
Teeth sensitive to hot and cold food
Tooth enamel erosion
Muscles Fatigue
Skin Abrasion of knuckles
Dry skin
Stomach Delayed emptying
Pain
Rupture
Ulcers
Throat and esophagus Blood in vomit
Soreness and irritation
Tears and ruptures
SOURCE: National Women’s Health Information Center, Office on
Women’s Health, U.S. Department of Health and Human Services(Illustration by GGS Information Services/Thomson Gale.)
Bulimia nervosa