Bulimia Nervosa is a disorder in which eating binges are followed by self-induced vomiting or ‘purging.’ The DSM-IV-TR criteria are mostly about observable behaviours, but there is also a crucial psychological element, i.e. that the eating disordered individual determines self-esteem in relation to body weight. “People with bulimia are ashamed of both the problem itself and their lack of control” (Barlow, 2005).
Characteristics of Bulimia
The defining features of the bulimic are:
- Recurrent episodes of binge eating.
- A sense of lack of control over eating during the episode
- Self-evaluation is unduly influenced by body shape and weight
- Recurrent inappropriate compensatory behaviour in order to prevent weight gain
The DSM-IV-TR (2000) considers there to be two types of bulimic:
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.
Non-Purging Type: During the current episode of bulimia nervosa, the person has used other inappropriate compensatory behaviours, such as fasting or exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
Medical Consequences of Bulimia
Bulimia nervosa, with its pattern of repeated purging, has a number of consequences:
- Salivary gland enlargement (caused by repeated vomiting) which gives the face a chubby appearance
- Erosion of dental enamel
- Electrolyte imbalance: repeated vomiting causes chemical imbalance, especially to sodium and potassium levels. The resulting electrolyte imbalance can cause cardiac arrhythmia, seizures, and renal failure
- Intestinal problems from laxative abuse; i.e. severe constipation or colon damage
- Calluses on hands and fingers from repeated contact with teeth and throat when inducing vomiting
Models of Treatment for Bulimia
Antidepressant medications, i.e. triyclic antidepressants and fluoxetine, are considered effective for the treatment of bulimia, measured in terms of reduction in frequency of bingeing (Walsh, 1991; Walsh et al., 1991). However, there is evidence that anti-depressants do not hold substantial long-term gains with bulimia nervosa (Walsh, 1995; Wilson and Fairburn, 2002).
2. Cognitive-Behaviour Therapy
Short term cognitive-behavioural therapy aimed at problem eating behaviour, and accompanying attitudes/thoughts about the importance of body shape and weight, is now the treatment of choice for bulimia (Fairburn, 1985; Wilson et al., 2002).
This treatment has two stages:
Stage 1: Teach the patient the physical consequences of bingeing and purging. Educate as to the ineffectiveness (in terms of calorie control) of vomiting and laxative use for controlling weight. Patients are put on an eating plan, which will constitute five or six small, manageable, meals per day. There should never be more than a three-hour interval between snacks or meals. This serves to eliminate alternating periods of dietary restriction and overeating.
Stage 2: Cognitive Therapy that focuses on altering dysfunctional thoughts and attitudes about body weight, shape, and purging
3. Interpersonal Psychotherapy (IPT)
With IPT, the focus is on improving interpersonal functioning. IPT does not concentrate on disordered eating patterns or dysfunctional attitudes about eating, but views these as a product of poor interpersonal functioning, and the existence of interpersonal conflict. Studies (Fairburn, 1995) indicate that IPT is as efficacious in the treatment of bulimia as CBT.