Bulimia nervosa is characterized by recurring periods of binge eating, during which large amounts of food are consumed in a short period of time — sometimes as many as 20,000 calories during the course of a single binge. The bulimic is aware that his or her eating is out of control. He or she is fearful of not being able to stop eating, and is afraid of being “fat.” The bulimic usually feels depressed and guilty after a binge. Frequently, the binges are followed by purging, through self-induced vomiting, abuse of laxatives and/or diuretics, or periods of fasting. The bulimic’s weight is usually in a normal or somewhat above normal range; it may fluctuate more than 10 pounds due to alternating binges and fasts.
Source: ANAD (National Association of Anorexia and Associated Disorders) www.anad.org
DSM-V Technical Criteria for Bulimia Nervosa
1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and similar circumstances
- 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)
2. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas or other medications; fasting; or excessive exercise.
3. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
4. Self-evaluation is unduly influenced by body shape and weight.
5. The disturbance does not occur exclusively during episodes of anorexia nervosa.
Source: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, American Psychiatric Association
The former edition of the DSM distinguished between “Purging Type” bulimia (regularly engaging in self-induced vomiting or the misuse of laxatives, diuretics or enemas) and “Non-purging Type” (use of other inappropriate compensatory behaviors, such as fasting or excessive exercise).
Signs and Symptoms
Physical symptoms of bulimia include bloating, dental problems (such as discoloration and enamel erosion), cuts and calluses across the top of finger joints (from self-induced vomiting), swelling around the salivary glands area, and noticeable weight fluctuations. Chronic binge and purge cycles of bulimia can lead to dangerous electrolyte and chemical imbalances that can damage organs and lead to cardiac arrest.
Evidence of binge eating includes disappearance of large amounts of food in a short period and the presence of a lot of empty containers and wrappers. Evidence of purging behaviors includes frequent bathroom trips after meals, smell and signs of vomiting, and packages or wrappers of diuretics or laxatives.
For a detailed list of signs, symptoms and health consequences of bulimia nervosa, visit nationaleatingdisorders.org
Perhaps you or someone you care about are struggling, yet the symptoms don’t exactly match the DSM-V criteria above. That doesn’t mean that you don’t have an eating disorder and/or serious issue. Here are some examples:
Bulimia Nervosa (of low frequency and/or limited duration)
This diagnosis falls under the DSM-V OSFED category (Other Specified Feeding or Eating Disorder). All of the criteria for Bulimia Nervosa are met, except that the binge eating and inappropriate compensatory behaviors occur, on average, less than once a week and/or for less than 3 months.
Also under OSFED, Purging Disorder is characterized by recurrent purging behavior to influence weight or shape (e.g. self-induced vomiting, misuse of laxatives, diuretics, or other medications) in the absence of binge eating.
Although not recognized in the DSM-V, diabulimia is a form of disordered eating in which people with Type 1 diabetes withhold insulin in order to lose weight. This is a dangerous practice with short-term risks and long term consequences, including potential kidney disease and blindness. For more details, visit nationaleatingdisorders.org
What Do I Do Now?
As with anorexia, there are many health problems caused by bulimia, including tearing of the esophagus, electrolyte imbalance, severe tooth decay, eye blood vessel hemorrhages, kidney damage, liver damage and a weakened immune system. And this does not take into account the psychological problems caused by bulimia (or any type of disordered eating) including loss of confidence, loss of self-esteem, depression, guilt and shame.
Unlike the slow, silent process of anorexia, bulimia is a violent cycle – the “high” one experiences during bingeing, followed by the “low” of fear, followed by a “rush” of purging, followed by more guilt, shame and fear. The important thing is to start breaking the cycle. For help in doing that, we highly recommend you talk with someone who is experienced in working with eating disorders.
- Search for videos and other resources on bulimia by typing it in the search box on the site.
- Read our article, “Finding Treatment,” to get ideas about who to talk to.
- Visit www.nationaleatingdisorders.org, or www.aacc.net to search for a counselor, therapist or treatment center in your area.
- If you are seeking Christ-centered treatment, search our Treatment Finder.
- Seek community and support.
- Consider taking one of our Lasting Freedom self-study courses (not a replacement for one-on-one care with a professional).
- Visit your primary care physician or ob/gyn and tell them exactly how you’re eating/exercising/dieting.
- If you are under eighteen, tell your parents or an adult you can trust about your fears of weight gain and/or obsession with thinness.
- Read Overcoming Binge Eating by Christopher Fairburn for keys to overcoming the urge to binge and purge.
Even though it may seem impossible to break the cycle you’re trapped in, please know that others have done it successfully, and you can too. It will take hard work, determination, and faith, but you can do it. And the benefits of being free will exceed even the highest “high” you may have felt before.
You may also feel that your struggle has separated you from God’s love. This is not true. Here is one of our favorite verses to inspire you in your journey toward freedom:
“Let us then with confidence draw near to the throne of grace, that we may receive mercy and find grace to help in time of need.” Heb. 4:16 (ESV)