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.
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.