Bulimia nervosa may begin in childhood, adolescence or adulthood. Eating disorders can involve a variety of symptoms and do not necessarily have to “fit” into the diagnostic definition to deserve help. Please keep this in mind as I explain an overview of the eating disorder diagnosis, bulimia nervosa.
The DSM-5 diagnostic criteria for bulimia nervosa:
Recurrent episodes of binge eating
“binge eating” is characterized by eating in about a 2 hour period what is considered an larger amount that what most people would consume in a similar period of time and under similar circumstances.* AND a sense of lack of control during this episode (feeling as if one cannot stop or control their eating).
Recurrent inappropriate compensatory behaviors to avoid or prevent weight gain (i.e. self-induced vomiting, misuse of laxatives, diuretics, other medications fasting or excessive exercise)
Both the above binge eating and inappropriate compensatory behaviors occur on average, at least once a week for 3 months.
Self-evaluation is unduly influenced by body shape or weight.
The disturbance does not occur exclusively during episodes of anorexia nervosa.
(Ratings of severity range mild, moderate, severe, extreme)
*The words “binge eating” are often confused with what is actually called a perceived or subjective binge. This may be a feeling of fullness that is considered uncomfortable, eating more than was planned or eating after a long period of restriction and then perceiving the quantity consumed as “too much”. Whereas the definition of “binge eating” listed above is less subjective.
Binges can occur from undereating. When a person does not eat enough, this can lead to an intense hunger that contributes to a binge, then purge, then restriction again to “make up for” the binge, but this leaves the person under eating again, and this becomes a cycle. When working with a dietitian, the goals of treatment often include eating smaller amounts of food more frequently to stop this cycle from continuing. (Side note: This may be scary, difficult, hard for people working through eating disorder treatment which is totally normal. When working with a dietitian, there is not a “one size fits all approach” and goals of treatment change to reflect individuality.)
Emotions can play a role in this cycle and calm environments for eating are encouraged. Activities after meals are promoted to help clients find something engaging to do rather than at risk for a purge to occur (Setnick, 2013). Therapy sessions with a licensed counselor or psychologist are important in combination with nutrition therapy.
Goals of Treatment
The goals of bulimia nervosa treatment include:
· Reducing and eliminating binge eating and forms of purging whenever possible
· Treating physical complications that may occur
· Supporting the client in motivation to change and participation in treatment, provide nutrition education and eating pattern support
· Help clients assess and change thoughts, attitudes, motives, conflicts and feelings related to the eating disorder that appear dysfunctional
· Treating associated psychiatric conditions
· Enlist family support and counseling when appropriate, and prevent relapse
(Yager et al., 2010)
Seeking out help from a registered dietitian that understands and specializes in eating disorders is a great first step to recovering from bulimia nervosa. Registered dietitians with this specialty understand the complexities of eating disorders and can work with you to keep you safe and make an individualized treatment plan with you that helps you on the path to recovery. Recovery looks different person to person and we honor and respect that. Eating disorder recovery is also not a straight road, it may be bumpy with detours and pit stops along the way. But that is why recovery is viewed as a process.
Please ask for help if you are struggling with bulimia nervosa or any other form of an eating disorder or disordered eating pattern. The hardest part is reaching out. We are here for you when you are ready!
Setnick, J. (2013). The eating disorders clinical pocket guide. 2nd Ed. Snack Time Press.
Yager, J. et al. 2010. Practice guideline for the treatment of patients with eating disorders. 3rd ed. American Psychiatric Association. https://www.researchgate.net/publication/285994599_Practice_guideline_for_the_treatment_of_patients_with_eating_disorders_third_edition#read