Article written by Dr. Sherry Boles

What is Bulimia Nervosa?

Bulimia Nervosa is a mental health eating disorder characterized by recurrent episodes of binge eating and purging. Meaning a person diagnosed with Bulimia Nervosa eats significantly larger amounts of food than most individuals would consume during the same period of time. Furthermore, people with Bulimia Nervosa lack a sense of control during these episodes of binge eating. They then practice compensatory behaviors such as self-induced vomiting, misuse of laxatives, diuretics or other medications, fasting, or excessive exercise in an effort to avoid weight gain.

A person struggling with Bulimia Nervosa, like the person struggling with Anorexia Nervosa, judge themselves harshly when it comes to body image, shape and size. Although a person’s goal with Bulimia Nervosa is to prevent weight gain these people may or may not experience the intense fear of weight gain or getting fat, as those people with Anorexia Nervosa experience.

Is there a difference between Bulimia and Bulimia Nervosa?

Bulimia and Bulimia Nervosa are terms used interchangeably. Bulimia Nervosa is the appropriate term used when diagnosing the eating disorder, Bulimia Nervosa. However, often in casual conversation the term Bulimia is used to refer to the eating disorder, Bulimia Nervosa in laymen’s terms.

What qualifies as Bulimia Nervosa?

Bulimia Nervosa like many of the eating disorders, including Anorexia Nervosa and Avoidant Restrictive Food Intake Disorder (ARFID) are similar because of their behaviors associated with food. For example persons with Anorexia Nervosa and ARFID restrict their caloric intake and are often very particular about what foods they will eat however, the “why” behind this behavior is completely different. The person with Anorexia Nervosa restricts food intake with the goal of being thin and fear of getting fat while the person with ARFID restricts food has no such goal or fear but rather has an apparent lack of interest in food and avoids food based on the sensory characteristics of food, such as taste, texture or smell.

Although some people with Anorexia Nervosa may eventually succumb to purging behaviors such as vomiting, the person with Bulimia Nervosa the act of purging is inherent with the disorder. Just as starvation threatens the life of the person struggling with Anorexia Nervosa for the person struggling with Bulimia Nervosa, life is equally threatened by the danger associated with self-induced vomiting which can result in electrolyte imbalance and death from cardiac arrest.

The “why” behind the behaviors of a person with Bulimia Nervosa are also equally important to understand. Losing weight is also the goal of the person with Bulimia Nervosa however, their perceived lack of control around food is the differentiating factor. While the person with Anorexia Nervosa diligently works to control the food they consume the person with Bulimia Nervosa feels absolutely out of control to the point they believe they cannot stop eating and then must purge.

Who is most affected by bulimia?

The DSM 5 states that Bulimia Nervosa is far less common in males than in females. With the prevalence of Bulimia Nervosa being approximately 10:1 female to male ratio. That being said it is important to note that eating disorders, including Bulimia Nervosa are equally distributed across socioeconomic lines, meaning that all cultures, all walks of society are impacted by these eating disorders.

Bulimia Nervosa treatment

DSM 5 Diagnostic Criteria for Bulimia Nervosa includes:

Eating, in a discrete period of time, an amount of food larger than what most individuals would eat in a similar time period.
A sense of lack of control over eating during the episode; feeling that one cannot stop eating, or control what or how much one is eating.
Recurrent compensatory behaviors in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics or other medications, fasting, or excessive exercise.
The binge eating and inappropriate compensatory behaviors both occur on average, at least once a week for 3 months.
Self-evaluation is unduly influenced by body shape and weight
The disturbance does not occur exclusively during episodes of anorexia nervosa.

Bulimia Nervosa requires treatment and there are several levels of care that someone with Bulimia Nervosa should access and the sooner the better. These levels of care include:

Inpatient Hospitalization – This level of care includes 24/7 care and is reserved for those people with BulimiaNervosa who are medically unstable, may be severely underweight and may have other medical challenges as well. It is important to note that people with Bulimia Nervosa who are actively purging by inducing vomiting can easily cause an imbalance of electrolytes which can result in cardiac arrest.

Residential Care – This level of care includes 24/7 care and is for people with Bulimia Nervosa who are medically stable but need more support than they can obtain while living at home while working toward recovery. Residential care facilities specialize in the treatment of eating disorders such as Bulimia Nervosa and a person can be admitted and remain in care from several weeks to several months in duration.

Partial Hospitalization Program (PHP) – This level of care is considered a step-down in care from Inpatient care where the person with Bulimia Nervosa has achieved medical stability but still requires care seven days a week but can safely be home at night.

Intensive Outpatient Programs (IOP) – This level of care is also considered a step-down in care either from Inpatient, Residential or PHP for the person with Bulimia Nervosa who needs continued structured care. These programs require usually 2-3 days or 1-5 days of program participation but the person can safely be home the remainder of the time.

Outpatient Treatment – This is the lowest and least intrusive level of care. For the person with Bulimia Nervosa can be successful working toward recovery at this level of care however, a multi-disciplinary team is the standard of care. Meaning that the outpatient psychotherapist works with and coordinates care with the family, a nutritionist, primary care physician and psychiatrist, if applicable. If it becomes apparent that the person with Bulimia Nervosa is unable to make progress at this level of care that person should be referred to a higher level of care.

If you or someone you know has Bulimia Nervosa please get help immediately. The sooner you get into the treatment the shorter the journey to recovery. If you can’t find the help you need please access my resource guide at my Website, www.drsherryboles.com. Please don’t give up hope, people with Bulimia Nervosa find recovery every day and you can too!