Bulimia comes from the Greek bulimia and literally means ox hunger. The Bulimia nervosa is characterized by recurrent episodes of binge . An episode is called a ” binge ” if it has the following characteristics:
- eating more food in a given period of time (for example two hours) than most people eat in the same time
- feeling of losing control during these episodes: not being able to stop eating or controlling what or how much you are eating.
Bulimia Nervosa can be characterized by emotional dysregulation and poor impulse control. Dialectical Behavior Therapy (DBT) is now recognized as the gold standard psychological treatment for these symptoms. Are you interested in joining one of our DBT groups? Click here: DBT Groups in Rome or DBT Groups in Caserta.
A single binge episode does not necessarily have to occur in a single context: a person, for example, may start binging in a restaurant and continue on returning home; while it is not to be considered a binge to constantly eat small quantities of food during the day. The food ingested in binges varies from person to person; what seems, therefore, to unite the binges is the quantity of food ingested rather than the irrepressible desire for a certain food. However, we tend to eat foods that would otherwise have been avoided.
Those who suffer from Bulimia Nervosa , following the binge , usually implement compensatory measures to prevent weight gain such as:
- self-induced vomiting;
- use of laxatives, diuretics, or other medications;
- fasting;
- excessive physical activity.
In order to make a diagnosis it is necessary that the binges are present at least once a week for at least 3 months. There are two types of bulimia nervosa:
PARTIAL REMISSION : Following diagnosis, not all criteria were met for a consistent period of time.
FULL REMISSION : Following diagnosis, none of the criteria were met for a substantial period of time.
Also, according to the DSM-5, bulimia nervosa travels along a severity continuum that is based on the frequency of inappropriate compensatory behaviors per week:
- Mild: 1-3 episodes per week;
- Moderate: 4-7 episodes per week;
- Severe: 8-13 episodes per week;
- Extreme: 14 or more episodes per week.
There are three fundamental characteristics of this disorder:
- recurring binges;
- recurrent and inappropriate compensatory behaviors to prevent weight gain following binge eating. Among these the most common is self-induced vomiting and, in some cases, vomiting becomes a goal in itself: the person will binge in order to vomit or will vomit even after having ingested small amounts of food. Less common is the use of laxatives, diuretics or enemas (enemas). A particular case are those subjects with Bulimia Nervosa in comorbidity with insulin-dependent diabetes mellitus who may not take or reduce insulin to decrease the metabolism of the food ingested during binges . Finally, behaviors characterized by fasting or excessive physical activity have also been described;
- self-esteem significantly influenced by shape and body weight.
Another distinctive feature of those with Bulimia Nervosa is the sense of shame they feel about their eating problems that leads them to hide their symptoms. The binges therefore occur in solitude, as secretly as possible and end when the person feels full.
The most common triggers are:
- experiencing a negative emotion;
- stressful interpersonal conditions;
- dietary restriction;
- negative feelings about your weight and fitness;
The binge eating can in the short term to minimize the factors that triggered the incident, but in the long run it will have negative consequences as feelings of worthlessness and mood disforico.La Bulimia Nervosa also distorts other areas of a person’s life: because of feelings of shame that they try, these people often give up social situations in which one is at the table with others, or they become anxious and irritable, thus making relationships with others very difficult.
DSM-5 reports a prevalence of the disorder among young adults as it peaks in late adolescence and early adulthood. Especially women with a 10: 1 ratio are affected. In Italy, published studies reveal a prevalence of 1-5% for Bulimia Nervosa , in line with data provided by other countries. A research conducted on a sample of 770 people with an average age of 25 found a percentage of 70.3% affected by Bulimia Nervosa . In the sample analyzed, the date of onset of the disorder is on average between 15 and 18 years, with two peaks (15 and 18 years), ages representing two significant developmental periods (data extrapolated from the site of the National Center for Epidemiology, Surveillance and Promotion of Health www.epicentro.iss.it)
Onset, course and remission
As mentioned above, Bulimia Nervosa disorder rarely occurs in the prepubertal age or after age 40. The binges usually begin after a period of restrictive diets or following stressful events. The altered eating behavior persists for several years and the course can be chronic or intermittent, or with phases of remission alternating with phases of reappearance of binges . Remission periods longer than one year appear to be those associated with a better long-term outcome. The literature reports a significantly high mortality rate (rough mortality rate of about 2% per decade) due to medical or suicide complications. The diagnostic cross-over towards Anorexia Nervosait is around 10-15% but subjects generally return to Bulimia Nervosa . Then there is a subgroup of subjects who continue to binge but no longer implement compensatory behaviors and, in so doing, meet the criteria for binge eating disorder (period of at least 3 months). However, more than five years after the onset of the disease, 50% of patients no longer have symptoms of the disorder, 20% tend to become chronic and 30% have experienced one or more relapses.
