Bulimia Nervosa
Bulimia nervosa (BN) is a condition characterized by a cycle of binging and purging. The size of the binge isn’t as important as the feelings that accompany it. Sometimes a binge might be 200 calories and sometimes it could be several thousand. What matters most is the feeling that they have lost control during the eating episode. Purging is a way to “undue” or make up for the binge and relieve anxiety over having consumed so much food. Methods of purging include self-induced vomiting, laxatives, diuretics, syrup of ipecac and over-exercising.
In the beginning...
BN usually begins with some kind of caloric restriction, such as dieting or starvation associated with anorexia nervosa (AN). In response to this hunger, the person ends up losing control and binging. Binges can also be induced by stress, anxiety or other strong emotional states. The first purging episode is usually a response to this binge.
Why keep purging?
Although self-induced vomiting is extremely unpleasant, the body releases endorphins in response to it, which make the person feel better. Purging then becomes a means for her to make herself feel better. So, while the purging was first done in response to binging, it changes so that the binging facilitates purging.
The binge-purge cycle
After purging, she is left feeling ashamed about her behavior and lack of control. Because of the lack of nutrients and fluids in her body following vomiting and the effects of insulin, she is also hungry. She is upset with herself for having binged and purged and tries harder to restrict calories, which sets her up for another binge. This cycle traps the person into bulimia and makes it extremely difficult to break free.
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Diagnostic Criteria (according to the DSM-5):
- Recurrent episodes of binge eating. An episode of binge eating is characterised 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 under 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).
- Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
- The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for three months.
- Self-evaluation is unduly influenced by body shape and weight.
- The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
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