Thursday, May 25, 2006

Did You Know?

When I’ve lectured about eating disorders in the past, one item that tends to surprise people has to do with bulimia. Now, because of our growing fascination with pop psychology, as well as the media’s love for stars who suffer, most people are vaguely familiar with this disorder. In sum, bulimia translates to binge and purge.

But, the sticking point here has to do with the word, “purge.” The most commonly mentioned methods of purging, or compensating for bingeing, include vomiting and laxative use. However, other compensatory mechanisms included as part of the diagnostic criteria are: use of diuretics/enemas, food restriction, and excessive exercise (for full criteria for bulimia, see below).

That is, even if you’re bingeing without vomiting or using laxative/diuretics or overexercising, you might still meet criteria for bulimia, as long as your binges are followed by periods of fasting/food restriction. This is, “I ate so much—I’m not going to eat again until tomorrow” gone bad.

With a diagnosis not as cut and dry as previously thought (now claims of, “I’m not bulimic—I don’t throw-up” warrant a second look), I wonder how many more people fit the bill. And, in my argument that eating problems exist along a continuum, the possibility of a non-purging bulimia adds yet another shade of grey.

(from the DSM-IV TR, the diagnostic manual of mental disorders, published by the American Psychiatric Association)

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by
both of the following:
1. eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
2. a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Specify type:
Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.


Joyce said...

I don't know whether to cry, or shout, or pray aloud, but I"M SO GLAD I FOUND YOUR SITE!! I "recovered" from bulimia 13 years ago, but am constantly propelled into searching for more truth, more clarity in the regard of body image and western culture. I dream of running seminars, or writing helpful tidbits, but often feel "too small" or "too big" to be much use in that regard. This in turn drives me further to seeking truth and resolution to the beliefs that we have attached to our body shapes and sizes. I will instantly add you to my "favorites".
thank you
(and when I saw Geneen Roth on your sidebar, I nearly stopped breathing. She saved my life.)

drstaceyny said...

Thanks, Joyce! And, to all my commenters--when I embark on my fabulous book tour, I'll have so many wonderful people to meet! : )

Joyce said...

Again- YIKES! I used to fantacize about going to a Geneen Roth seminar, but then I got better, and had kids, and got busy, etc. You are the first person I know who a)knows of Geneen and b) who is going to her seminar! I can't wait to hear about it!

Haley-O said...

Then it could be said that "every woman has bulimia"! --Most women I know do this kind of thing....I.e., most of them say stuff like, "I had that piece of chocolate--I'll be 'good' tomorrow." And, they feel guilty, etc..

I struggled with all those types of bulimia (except laxatives--never did that) for years and years. I have a child now, and refuse to go there now. It's so important to be healthy for your child (if not for yourself!), and to set a good example!

Anonymous said...

I don't really want to write a comment, I would prefer to send this as an email. I just wanted to tell you a little bit about my story. I read a book when I was about 9, the same age when I started to think I was too fat and went on a diet. I was always under weight. The book was about a girl in her early teens that developped anorexia. The authors point was to teach girls like me how dangerous it was. I read the book at least 6 times in my adolescence. Each time I would remind myself that I was too fat and I should diet, but not to the point of going to the hospital. I still worry about being fat, but rarely do anything stupid. I threw up once when I was 17 and stopped eating meals (I just snacked) for about 36 hours in the winter. I learned my lesson as it rendered me incapable of actual thought. I just wanted to let you know that sometimes well intentionned books can go the other way, depending on how the reader interprets them.

Anonymous said...

Eating and food is not the problem...(as Oprah often says)it's a cover-up for much deeper issues...that the person can't face, perhaps isn't mature enough or strong enough yet to tackle yet...Even talking about food this much is it any wonder men run the world..they're more interested in challenge and accomplishment than superficiality...spend your time having fun or learning something...not being a food junkie obsessive. Yipes..