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Bulimia Nervosa

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Its normal to binge...isn't it...?

A binge is eating a large amount of food in short period of time.  The amount of food consumed depends on the person.  A binge can range from a cookie to 10,000 calories.  Binges can occur outside of bulimia.  Anorexics binge as well.  A purge is any method of ridding the body of food consumed.  Purging does not always have to occur after a binge and it can also occur outside of bulimia.  An anorexic can purge without having binged at all.  This explains why there is so much overlap between anorexia and bulimia.  It is often said that out of all the people with anorexia, 50 percent of them will develop bulimia.

Signs and Symptoms

  • Impulsive personalities
  • Likely to engage in risky behavior (ie. drug or alcohol use)
  • Diminished interest in sex
  • Visible binging and/or purging
  • Heavy dieting between binges and purges is common (these periods may include many symptoms of anorexia-see anorexia page for complete list)
    • Fasting
    • Enemas
    • Misuse of laxatives or diuretics
    • Compulsive overexercise
  • Frequent trips to the bathroom immediately following meals (sometimes accompanied with water running in the bathroom for a long period of time to hide the sound of vomiting)
  • Vague or secretive eating patterns (including stashing or hiding food)
  • Self-defeating statements after food consumption
  • Gums become infected and teeth wear down
  • Sores can be found on the first knuckle of the forefinger or middle finger (This is from forcing the fingers down the throat to induce vomiting.-This is a very tell-tale sign since one has to purge frequently in order to develop sores or scabs.)

Affects

  • Vital minerals are lost during purging
  • Purging can also cause the heart to fail
  • Acid that comes up during self-induced vomiting, wears out the outer tooth layer.
  • Scars or scabs can also be found on the knuckle of the first two fingers of a hand.  This is from forcing the finger(s) down the throat to induce vomiting.  It is actually the teeth scraping against the knuckle that causes this.
  • The esophagus will become extremely inflamed
  • Blood may begin to come out with the vomit
  • The glands near the cheeks will become swollen
  • Menstraul cycles become irregular
  • Interest in sex will diminish
  • Although rare, during binge eating it is possible for the stomach to actually rupture.

 

Diagnosis

In order to be diagnosed with bulimia nervosa the following must be present:
  1. Episodes of binging and purging during which the individual senses a lack of control of eating.
  2. Inappropriate behavior designed to prevent weight-gain recurring between binges and purges.
  3. These behaviors must occur at least twice a week for at least three months.
  4. Body shape and body weight have a large effect on self-evaluation.
  5. These behaviors must occur when there are no anorexic attitudes or behaviors present.

This is according to the Diagnostic and Statistical Manual Fourth Edition, 1994

 

Note:

There is no definite line between anorexia nervosa and bulimia nervosa.  50% of people with anorexia nervosa develop bulimia nervosa.  Many of the signs, symptoms, and effects are very similar.  It is also very clear that the criteria for diagnosing bulimia nervosa is a very fine line.  It is very possible to have bulimia nervosa and not meet the clinical definition.  If you have any signs, symptoms or effects it may be a good idea to seek help.  However, when you seek help, keep in mind that many M.D.'s do not recognize eating disorders.  There are eating disorder specialists that you can contact.  See the treatment page for more information.