San Jose Counseling and Psychotherapy
Bulimia nervosa is the most common eating disorder seen in therapy. It is characterized by a repeated pattern of compulsive and emotional eating large quantities in a relatively short period.
The food is typically high-calorie food and the period of eating is followed by either induced vomiting or other compensating behaviors. Some bulimics use laxatives, drugs that cause vomiting, diuretics, extreme exercise, and fasting in an attempt to purge.
Bulimia nervosa can be hard to detect in eating disorder therapy due to the fact that people with bulimia typically have an average or slightly above average weight. Additionally, some people develop disordered eating behaviors without meeting the full diagnostic criteria for bulimia nervosa.
Diagnostic Criteria for Bulimia Nervosa
The diagnostic criteria utilized the DSM-5 for bulimia nervosa includes repetitive episodes of binge eating (a discrete episode of overeating during which the individual feels out of control of consumption) compensated for by excessive or inappropriate measures taken to avoid gaining weight DSM-5.
The diagnosis of bulimia nervosa is made only when the behavior is not a symptom of anorexia nervosa and when the behavior reflects an overemphasis on appearance or physical mass. Bulimia nervosa has two distinct sub-types which are:
- Purging, which is accomplished by vomiting, laxatives, diuretics, or enemas.
- Non-purging behavior includes excessive activity after bingeing by exercising or food restriction.
- They account for around 7 percent of bulimics. Bulimcs who purges sometimes exercise and fast as a secondary measure of weight control.
Bulimia Nervosa Research and The Brain
Research using fMRI (functional magnetic resonance imaging) has shown that women with eating disorders have differential neural activation to viewing food images. Studies have found that anorectics and bulimics have a significantly different cognitive response to food images than those without the disorders.
Additionally, women with bulimia nervosa have increased activation in reward and somatosensory regions of the brain, which could impinge on cognitive control over food consumption and binge eating.
In research, patients with bulimia nervosa have reported an excessive urge to eat, coinciding with a sense of lack of control over their eating. This is in contrast to anorexia nervosa where sufferers report an ability to suppress the urge to eat. Bulimics tend to have deficient self-regulatory control, which has been found at the neural level by reduced prefrontal and increased mesolimbic responses.
Bulimia Nervosa and Eating Disorder Treatment
For the bulimic, fasting is part of a vicious cycle that is divided into three stages: 1) bingeing, 2) compensation, and 3) dietary restriction, usually in the form of fasting. After gorging on high-calorie foods, the bulimic is driven to compensate for over-eating. This compensation stage is what separates the two sub-types of bulimia.
When the bulimic fasts, it may not be for any specific amount of time, but the fast always has an anorexic quality to it in that the goal is to control weight. This may be why so many anorectics are or were previously bulimic.
Research has indicated that bulimics tend to have specific fasting patterns. For example, bulimics will tend to not eat for the rest of the day after a binge and fasting for more than 24 hours is uncommon. After the fast is over, bingeing begins again, and the cycle repeats itself.