Symptoms Used as Criteria for Diagnosis of Bulimia Nervosa
- Recurrent episodes of binge eating, defined as:
- Eating an amount of food that is clearly larger than what most persons would eat in the same situation with the same amount of time, AND/OR
- A sense that one cannot stop eating or control content or quantity of food intake
- Behavior to compensate for binges; e.g., vomiting, abuse of laxatives or diuretics, fasting, excessive exercise
- Binges and compensation both occur at least twice a week for 3 months (average)
- Self-evaluation is influenced disproportionately by body composition/shape
Some persons have a number of the above symptoms, but in less severe forms—for example, a person may binge and compensate less than twice a week. Individuals in these situations may meet the criteria for eating disorder not otherwise specified.
- Purging Type: Compensatory behaviors include vomiting or the abuse of laxatives, diuretics, or enemas.
- Non-purging Type: Compensatory behaviors are generally carried out without purging; e.g., the individual compensates exclusively via exercise or fasting.
While it is a misconception that every person who struggles with bulimia nervosa engages in some form of purging, it is true that some form of compensation for binge eating must be present. The least recognized of these forms of compensation is fasting. In this case, the disorder can look like anorexia nervosa for a time (note that anorexia nervosa may include binge eating as well). The key difference is that the person with bulimia will not insist on being underweight.
The Dangers of Stereotypes
The fine distinctions between some types of bulimia nervosa and anorexia nervosa serve as reminders that diagnoses are generally methods of classification. While each person and each eating disorder are unique, they do share common elements. Most importantly, diagnoses can become grounds for stereotypes, even among those with eating disorders (for example, a young woman with anorexia may view another woman's diagnosis of bulimia as a sign of weakness and treat her accordingly). The most important thing to remember is that the symptoms of eating disorders indicate significant problems that require treatment.
Back to the Major Features of Bulimia Nervosa
Source:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, D.C.: American Psychiatric Association; 1994.
