By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
When eating and avoiding weight gain collide.
Bulimia Nervosa, Bulimia for short, is one of the feeding and eating disorders and is diagnosed about 4 times more often than Anorexia Nervosa according to the DSM-5. For the full description consult the DSM-5, what follows is my simple language version of this disorder and my experiences in seeing clients with these issues.
Women are ten times as likely to receive this diagnosis as men. Bulimia has three defining characteristics, “pigging out” and extreme measures to make up for that episode of excessive calorie intake as well as self-esteem or self-worth that is excessively based on weight and body type. These three characteristics make Bulimia sort of like Anorexia Nervosa on the one hand and Binge Eating Disorder on the other.
Pigging out is more than just liking to eat.
What makes the pigging-out or “binge eating” different in this disorder is the feeling of loss of control. In Bulimia, the client will eat far more than would be normal and do this in a relatively short time. The official definition sets this time limit more or less at 2 hours.
So binge eating is not snacking all day or having a big appetite. It is a loss of control over how much they eat and once they start the eating run it goes on until something interrupts the binge. Some have described these loss-of-control episodes as “spacing out” or dissociating. What they binge on can be very individual and can vary from episode to episode.
This loss of control is very similar to what we see in Substance Use Disorders. Turns out that about 30 % of those with Bulimia also develop a substance use disorder. Mostly this will be alcohol which is readily and legally available and can temporarily dissolve the guilt that comes from overeating. The other common drug of choice among many people with Bulimia is a stimulant use disorder. Start off on the “Jenny-Crank” diet to lose weight and you too may develop a Stimulant Use Disorder.
Once the guilt sets in you try to undo the binge.
Characteristic of Bulimia is the use of unhealthy ways of offsetting the excess calories consumed on the binge. Those with Bulimia may force themselves to vomit to get rid of the over-full feeling and to lose weight. They also can try laxatives, water pills (diuretics) and extreme episodes of fasting. Those fasts by the way often end with another binge.
In Bulimia, self-worth is based on weight.
All this pigging-out style overeating and then trying to make up by extreme measures is hard on the self-esteem and self-confidence. Those with Bulimia base their self-esteem and self-worth on their weight and or body. So when they put on weight, they feel bad about themselves.
Bulimia is not something that just happens during Thanksgiving week.
To be defined as Bulimia we expect this person’s dance with overeating to go on for say three months or more and they will probably be binging at least once per week. In Bulimia the revolving pattern is binge, feel bad about yourself, and then do the extreme measures to keep the weight off. The recurring story the person with Bulimia tells themselves is that if they were just thinner they would feel better about themselves and others would like them more. Unfortunately, the only way to discharge the anxiety around food is with another binge and purge.
Which eating disorder is which?
Bulimia is separated from Anorexia mostly by the person’s body weight. In Anorexia they weigh significantly less than they should and are trying to stay that way or lose even more. In Bulimia, the person weighs about normal or even a little beyond but they are defiantly not obese. In Bulimia, the main difference is that they binge and then feel they have to do extreme measures to compensate. In Binge Eating Disorder there is still the binging and the feeling bad but no compensating behaviors.
For more on this and related topics see – Feeding and Eating Disorders.
FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5, some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.
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