Bulimia Nervosa (which etymologically means “ox hunger”) is characterized by the presence of bulimic crises (or “binges”) followed by compensatory behaviors to try to avoid weight gain. Bulimic crises are episodes in which a person ingests large quantities of food, often without tasting it, literally losing control over his eating behavior. A bulimic crisis generally lasts for a limited time, but some people who suffer from this disorder can have many within the same day. Usually foods are ingested that the person does not habitually indulge in with a preference for sweets and high-calorie or high-fat foods. Some people may lose control over their diet so much that they eat spoiled, raw,
The onset of bulimia nervosa usually occurs following a low-calorie diet or rapid weight loss (which can also be an episode of anorexia nervosa ) sometimes associated with stressful events or a real emotional trauma. If at the beginning the bulimic crisis may be occasional or occasional, over time it can become a compulsion that is difficult to escape.
In people who suffer from bulimia nervosa, attention and dissatisfaction with one’s body and physical appearance can take on excessive and absolute importance. Self-esteem is strongly linked to the body and any physical modification can be experienced as a frustration and a loss of control over one’s body.
The emotional consequences of a bulimic crisis can be different; in some cases people report experiencing temporary relief and a sense of pleasure. Studies show an effect of bulimic crises in the regulation of negative emotional states, which would partly explain the ‘addiction’ to food in those suffering from this disorder. As in most eating disorders in which bingeing occurs, usually these “positive” effects are soon replaced by a deep anxiety about the possibility of gaining weight and because one has not been able to control oneself. Compensation methods, especially vomiting, can give the temporary feeling of relieving anxiety, but then a sense of emptiness may appear that can trigger a new binge. Vomiting, in particular, it also has a ‘physiological’ role in the risk of having further bulimic crises: the increase in insulin and the hypoglycemia that follows vomiting episodes can in fact cause an increase in hunger and trigger a new bulimic crisis. Furthermore, according to some studies, repeated vomiting would cause a decrease in the basal metabolism.
An almost always present feeling is that of shame and guilt. And this is why the disease is often hidden from family and friends for as long as possible and in many cases the request for help is made after a long time after the disorder has begun.
Bulimia nervosa disrupts not only eating behaviors, but also other important areas of a person’s life. It can happen that you give up social situations that involve being at the table with others, or you become anxious and irritable.
Bulimia nervosa is often associated with other mental disorders such as depression, substance abuse, anxiety disorders (especially social phobia, obsessive compulsive disorder, panic disorder) and personality disorders. Self-aggressive behavior such as suicide attempts or self-harm is not uncommon.
The main psychological characteristics associated with bulimia nervosa are:
▪ Perfectionism
▪ All or nothing thinking
▪ Low self-esteem
▪ Impulsiveness
Perfectionism
A common feature of patients with bulimia nervosa (as well as anorexia nervosa) is perfectionism which often expresses itself in imposing very high levels of expectation both in daily life and in eating goals. Anything that deviates from absolute success is considered a failure and can weaken a level of self-esteem that is in most cases already very low and vulnerable.
The “all or nothing”
thinking This type of thinking, also called dichotomous thinking, is expressed with the tendency to see things in black or white, to divide them into good or bad. Food will then be good or dangerous, one day will be either totally positive or catastrophic. Often the bulimic crisis is triggered by the all or nothing thought as the person, convinced that he has now broken the strict diet after eating even small amounts of food, guided by the thought “so much by now I have ruined everything” continue in the binge.
Low self-esteem
A very low self- esteem is one of the fundamental aspects for the understanding of eating disorders; in the case of bulimia bulimic crises often aggravate this aspect of personality as having a binge represents a loss of control over the diet and depression, disappointment and anguish can result. The fact of not being able to maintain a rigid eating pattern and indeed of having upset it with bulimic crises makes bulimic patients feel unworthy, guilty and worthless.
Impulsivity
In some cases, bulimic patients may show considerable difficulty in controlling and managing impulses that can manifest themselves with behaviors such as making small cuts or burns on the skin, adopting promiscuous sexual behavior, using alcohol or drugs, putting in dangerous situations.
Diagnostic criteria of bulimia nervosa according to the DSM-5
- Recurrent bulimic crises. A bulimic crisis is characterized by both of the following:
- Eating significantly more food over a defined period of time (e.g. a 2-hour period) than most people would eat at the same time and under similar circumstances
- Feeling of losing control during the episode (e.g. feeling of not being able to stop eating or not being in control of what or how much you are eating)
- Recurrent and inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting, abuse of laxatives, diuretics or other drugs, fasting or excessive exercise
- Binge eating and inappropriate compensatory behaviors both occur on average at least once a week for 3 months
- Self-esteem levels are inappropriately affected by body shape and weight
- The disorder does not occur exclusively during episodes of anorexia nervosa
Specify the current severity level :
The minimum level of severity is based on the frequency of inappropriate compensatory behaviors (see below). The level of severity can be increased by taking into account other symptoms and the degree of functional disability
- Mild: An average of 1-3 episodes of inappropriate compensatory behaviors per week
- Moderate: An average of 4-7 episodes of inappropriate compensatory behavior per week
- Severe: An average of 8-13 episodes of inappropriate compensatory behaviors per week
- Extreme: An average of 14 or more episodes of inappropriate compensatory behavior per week
