Bulimia nervosa is a serious eating disorder marked by a destructive pattern of binge-eating and recurrent inappropriate compensatory behaviors to control one's weight. It can occur together with other psychiatric disorders such as depression, obsessive-compulsive disorder, substance dependence, or self-injurious behavior. Bulimia nervosa is an invisible eating disorder, because patients are of normal weight or overweight. Binge eating is the rapid consumption of an unusually large amount of food in a short period of time. Unlike simple overeating, the hallmark feature of a binge is feeling out of control. This means that one cannot stop the urge to binge once it has begun or that one has difficulty ending the eating episode even when far past being full. "Inappropriate compensatory behavior" to control one's weight may include purging behaviors (such as self-induced vomiting, abuse of laxatives, diuretics, or enemas) or non-purging behaviors (such as fasting or excessive exercise). Some people who have placed strict restrictions on what and when it is OK to eat might feel like they have binged after only a small amount of food (like a cookie). Since this is not an objectively large amount of food by social comparison, it is called a subjective binge.
There are two types of bulimia nervosa. In the purging type, the person regularly engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas. In the nonpurging type, the individual uses fasting or excessive exercise to control weight, but does not regularly purge.
People with bulimia nervosa often feel a lack of control during their eating binges. Food is often eaten secretly and rapidly. A binge is usually ended by abdominal discomfort, social interruption, or running out of food. When the binge is over, the person with bulimia often feels guilty and purges to rid his or her body of the excess calories. To be diagnosed with bulimia nervosa, a person must have had, on average, a minimum of two binge-eating episodes a week for at least three months. However any amount of binge eating and purging is unhealthy and is worthy of an evaluation.
Common Signs of Bulimia Nervosa
Constant concern about food and weight is a primary sign of bulimia. Common indicators of self-induced vomiting are the erosion of dental enamel (due to the acid in the vomit) and scarring on the backs of the hands (due to repeatedly pushing fingers down the throat to induce vomiting).
A small percentage of people with bulimia show swelling of the glands near the cheeks called parotid glands. People with bulimia may also experience irregular menstrual periods and a decrease in sexual interest. A depressed mood is also commonly observed as are frequent complaints of sore throats and abdominal pain. Despite these telltale signs, bulimia nervosa is difficult to catch early. Binge eating and purging are often done in secret and can be easily concealed by a normal-weight person who is ashamed of his or her behavior. Characteristically, these individuals have many rules about food -- e.g. good foods, bad foods -- and can be entrenched in these rules and particular thinking patterns. This preoccupation and these behaviors allow the person to shift their focus from painful feelings and reduce tension and anxiety perpetuating the need for these behaviors.