What Is Bulimia Nervosa?

About halfway into 2020, medical professionals realized that the COVID-19 pandemic was uniquely affecting people with eating disorders. As a result of changes such as sheltering in place or feeling isolated from family, friends, and outside activities, many people were struggling with disordered eating. A July 2020 study published in the International Journal of Eating Disorders found that people with bulimia and binge eating disorder were reporting increases in their binge eating episodes and urges to binge. Some felt the need to stockpile food due to potential shortages in the food supply. Many were anxious about not being able to exercise.

An eating disorder is marked by an unhealthy relationship with food. This might mean that a person diets or exercises excessively, as someone with the eating disorder anorexia nervosa might do. It may mean patterns of extreme eating (also called bingeing) followed by compensating for overeating such as purging, as some people who have bulimia nervosa may do. It may simply be periods of overeating, which plagues people who have binge eating disorder.

Eating disorders are more than just problems with food. Having negative feelings about food can seriously affect not only how you eat but also how you interact with your friends, family, and everyone else around you. Your unhealthy relationship with food can harm both your body and your emotions.

The word “bulimia” comes from the Greek words buos (“ox”) and limos (“hunger”), which together mean “hunger of an ox.” People who have bulimia eat a lot of food at once (called bingeing) and then try to get rid of that food (called purging) so that they don’t gain weight.

Eating disorders are more common than you might think. According to the National Eating Disorders Association (NEDA), about 20 million women and 10 million men in America will have an eating disorder at some point in their lives. Canada’s National Initiative for Eating Disorders (NIED) estimates that about 1 million Canadians have a diagnosis of an eating disorder such as anorexia or bulimia. Although eating disorders are far more likely to affect young girls and women, NEDA estimates that, at any given point in time, 1.0 percent of young women and 0.1 percent of young men will meet diagnostic criteria for bulimia nervosa.

The reasons why a person develops an eating disorder are complex. They involve eating habits, attitudes about weight and food, attitudes about body shape, and psychological factors, especially the need for control.

The Definition of Bulimia

Doctors and psychiatrists rely on the Diagnostic and Statistical Manual of Mental Disorders (frequently known as the DSM) for the definitions they use in diagnosing conditions. According to the fifth edition of the DSM, the official diagnostic criteria for bulimia nervosa include:

  • Repeated episodes of binge eating. (An episode of binge eating is characterized by eating, within a period of time, an amount of food that is definitely larger than most people would eat during a similar period of time, and feeling like you can’t stop eating or control how much you’re eating.)

  • Repeated inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting; misusing laxatives, diuretics, or other medications; fasting; or excessive exercise. (Compensatory behaviors are things that are meant to “un-do” eating and consuming calories.)

  • The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.

  • The patient’s self-esteem is too closely tied to his or her body shape or weight.

About Bulimia Nervosa

Springfield High School: David F., Brianna L., Khaysi S.
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Let’s make a change. Let’s stick together. Let’s end this. Before it ends us. Don’t let them suffer. Let’s make a promise. I promise. I promise. I promise.
Although it was first diagnosed in the 1950s, and was probably around even before then, bulimia nervosa wasn’t really understood until the 1980s. Since then, we have learned of famous people who suffered from it, including Demi Lovato, Lady Gaga, and Kesha. Researchers also found that substance abuse problems often go hand in hand with eating disorders.

Today, bulimia is a major social concern. It can have devastating effects on the mind and body. Many eating disorder experts believe that images in the media put a lot of pressure on young men and women to reach an “ideal” body shape—one that is impossible for most people to achieve.

Now parents, doctors, and school counselors are learning about the early warning signs of bulimia and other eating disorders in young people. Researchers are working to help people recover, but they also understand that more needs to be done to help prevent these harmful disorders in the first place.

Two Types of Bulimia

Bulimia nervosa is a type of eating disorder in which a person binges and purges. Bingeing means eating a large amount of food in a short period of time. Purging means getting rid of all the food by self-induced vomiting; abuse of laxatives, diet pills, and/or diuretics; excessive exercise; or fasting.

Bingeing can mean eating a lot of calories—as many as 5,000 or more at a time. People with bulimia can binge once in a while, or twenty times each day or more. Then they will purge to rid their bodies of the extra calories. They may purge even after eating small amounts of food.

There are two types of bulimia: purging and non-purging. People with the purging type get rid of food in different ways. Some people purge by self-inducing vomiting. Others use drugs, such as diuretics (pills that increase urination), diet pills, laxatives (usually mild drugs that induce bowel movements), or enemas (liquids injected into the anus for cleansing the bowels) to clear the digestive tract. Both bingeing and purging can be experienced as intense, overwhelming urges that become uncontrollable. People with the non-purging type of bulimia exercise compulsively to get rid of the extra food they’ve eaten or rely on fasting.

Who Suffers from Bulimia?

It is difficult to say exactly how many people suffer from bulimia because doctors are not required to report it to health agencies. In addition, many who suffer from bulimia do not seek help. According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), eating disorders affect at least 9 percent of the population worldwide. ANAD also found that 47 percent of girls in fifth to twelfth grade want to lose weight because of the pictures they see in magazines, 42 percent of first- to third-grade girls report wanting to be thinner, and 81 percent of 10 year olds fear becoming fat. Boys who are involved in activities that have them gain and lose weight quickly, such as wrestling and gymnastics, are most at risk. While most people who suffer from bulimia are in their late teens and early twenties, the disorder is affecting people at younger ages than ever before. Therapists are also seeing an increase in the numbers of middle-aged women who suffer from bulimia.

Symptoms of Bulimia

It can be difficult to tell if a person has an eating disorder. Bulimia is especially tough to diagnose because the problem is often hidden.

Many people struggle with their relationship to food. We are taught from an early age to feel anxious and guilty around food, worry about our weight, and fear fat. People who are in the early stages of bulimia (or another eating disorder) may be overly concerned with their weight, but that isn't out of the ordinary in our culture.

People with bulimia are also not always really skinny, as you might think they would be. They can be of normal weight, or even overweight.

Warning Signs

Even though people with bulimia may not look different from anyone else, there are warning signs of the condition. A person with the disorder may use extreme methods to lose weight, and they may act different from how they used to act. It's important to recognize these warning signs so that you can help yourself or help someone else who is struggling with bulimia. An eating disorder left untreated can be life threatening.

People with bulimia may do one or more of these things:

  • Believe that they would be happier and more successful if they were thinner

  • Have severe mood swings

  • Overeat in response to stress or other uncomfortable feelings

  • Alternate between strict dieting and overeating

  • Go to the bathroom a lot to throw up after eating

  • Exercise all the time

  • Buy or steal large amounts of food

  • Buy certain products, such as laxatives or syrup of ipecac (used to induce vomiting)

  • Have cuts or marks on their knuckles and fingertips from using their fingers to induce vomiting

  • Show other types of impulsive behavior, such as abusing drugs, going on shopping sprees, and/or shoplifting.

How Is Bulimia Different from Anorexia and Orthorexia?

Although they are different disorders, anorexia and bulimia share many of the same symptoms. This is the reason why “nervosa” is part of both terms. In fact, about 50 percent of people who have bulimia had anorexia first. In both cases, the person is preoccupied with dieting, food, weight, and body size. Another eating disorder in which sufferers share these preoccupations is orthorexia nervosa. According to the National Eating Disorders Association, people who suffer from orthorexia nervosa develop an unhealthy obsession with healthy eating to the point that it becomes detrimental.

But there are also a few differences. People with anorexia refuse to eat. They also deny to themselves and to others that there is a problem. People with bulimia usually eat, but then purge. They are aware that there is a problem, even though they may try to keep it a secret from others.

People with anorexia may be very thin, but they do not need to be emaciated or underweight to be struggling. Those with bulimia are usually of average weight, though they may weigh 10 or 15 pounds (4.5 or 6.8 kg) above or below the average.

Emotions and Bulimia

When people purge, they are not just getting rid of food. They are also trying to get rid of unwanted feelings like anxiety, anger, guilt, panic, and stress. And it doesn’t take very long for the bingeing and purging habit to become an addictive pattern.

Although scientists are still researching this idea, some believe purging may affect chemicals in the brain, causing a person to feel satisfied after an episode. Comedian Russell Brand mentioned that he felt “euphoric” after purging. A person with bulimia repeats the cycle to feel the same rush after purging. They believe that purging is the only way to get those feelings again.

Bulimia turns the act of eating into a self-destructive behavior. Eating stops being a pleasurable experience. Food is instead used to deal with uncomfortable feelings like fear, anger, and guilt. People with bulimia are unable to stop the secret cycle of bingeing and purging because they rely upon this ritual to handle their feelings. Soon it has taken over their lives.

No matter how thin they are, people with bulimia always fear that they will get fat. They feel that being thin means being happy.

People with bulimia are unable to deal with uncomfortable feelings. They see their bodies as being much larger than they really are. As a result, they refuse to eat in a healthy way and use dangerous methods to lose weight.

Who Is at Risk?

While the majority of bulimia sufferers are women between the ages of twelve and twenty-five, usually from upper middle-class families, this is an eating disorder that can affect anyone. Western society puts a lot of pressure on young people to look thin because of the media stereotypes of beauty. Both men and women of any age and every economic group can be affected by these images and, coupled with other factors, can develop an eating disorder like bulimia. Popularity, wealth, race, or IQ have no bearing on who may develop an eating disorder. The main factor is how people feel about themselves and what they look like. Remember that people who suffer with bulimia may appear to have an average weight or may even be overweight. Unlike anorexia, where the person can become extremely thin, people suffering from bulimia can easily hide among a crowd. People who have drug or alcohol problems may be at higher risk than others, as well as people who connect weight with performance, such as dancers or athletes. Because many people think of this as a “female problem,” some young men may be too embarrassed to tell anyone about it and get the help they need. However, more and more men of all ages are being affected by this disorder.