Curriculum · Mental Health / Psychiatry
Bulimia nervosa
What it is
Bulimia nervosa rests on two things that recur together: episodes of binge eating, and inappropriate compensatory behaviors done in order to prevent weight gain. A binge is eating, in a discrete period of time such as any 2-hour period, an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances, together with a sense of lack of control over eating during the episode. The compensatory behaviors include self-induced vomiting, misuse of laxatives, diuretics or other medications, fasting, and excessive exercise. Emotional distress accompanies the binge eating.
How it presents
Bulimic patients often have a normal body weight, in contrast to patients with anorexia nervosa, so weight does not make the diagnosis, and they conceal their behaviors from family and friends. Self-evaluation is unduly influenced by body shape and weight. The behaviors are purging, fasting, misuse of diuretics or laxatives, and intense exercise after eating. The weight is not always normal either. A woman with long-standing concerns about her eating habits, a body mass index of 34 and a history of hypertension and type 2 diabetes, who typically skips breakfast and lunch then eats a very large dinner with snacks in the evening, feels that she cannot stop herself from eating, is unhappy with her weight and frequently vomits or exercises intensively, is still the bulimia nervosa picture.