Bulimia Nervosa DSM-5 307.51 (F50.2)

Bulimia Nervosa DSM-5 307.51 (F50.2)

Bulimia nervosa

Bulimia nervosa is a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th ed.) diagnosis assigned to individuals who recurrently overeat and use inappropriate measures to prevent weight gain afterwards, such as purging, fasting or exercising excessively.

Introduction

A mental health condition and eating disorder, bulimia nervosa - also known as simply bulimia - is characterized by eating a lot of food and then taking inappropriate steps to prevent weight gain, such as vomiting or misusing laxatives. Bulimia sufferers feel that they are not in control of how much food they consume during an episode of binge eating and subsequent purging, which usually occurs at least once a week (American Psychiatric Association 2013).

Affecting more women than men - around 1.5 per cent of women across America suffer from bulimia at some point in their lifetimes (Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. 2007) - the condition is most prevalent among young adults, rarely occurring before puberty or after the age of 40. Usually beginning in adolescence or young adulthood, the symptoms of binge eating and bulimia may present during or after a period of dieting or a stressful life event.

Bulimia may have a range of consequences across different areas of a sufferer’s wellbeing, negatively impacting on their social life and increasing the risk of damage to the teeth and other medical complications. With the right treatment, however, bulimia can be overcome.

Symptoms

People suffering from bulimia may be a normal weight but see themselves as being too heavy. As a result, they may seek to lose weight. Bulimics will often display the following symptoms:

  • Overeating and experiencing a loss of control or inability to stop eating
  • Being extremely concerned with weight and body shape
  • Obsessively or compulsively exercising
  • Vomiting after eating to rid the body of food
  • Misusing laxatives or diuretics
  • Fasting for periods of time

 

(Mental Health America 2018)

Bulimics may overeat several times a day over months, often in secret. Sufferers often feel ashamed or disgusted after a binge and subsequently purge the food from their bodies, which can bring about a feeling of relief.

Other signs that a person is suffering from bulimia nervosa include exercising to the extreme, buying large amounts of food that vanish quickly and visiting the bathroom straight after eating on a regular basis (US National Library of Medicine 2018).

Diagnostic criteria for bulimia nervosa

Bulimia nervosa is diagnosed when a number of criteria are met, namely that the sufferer shows the following behaviors and characteristics:

  • Engages in binge eating on a recurrent basis via episodes characterized by eating more food in one sitting than most other people would. The sufferer also experiences a lack of control over how much food they eat, or feels unable to stop eating.
  • Recurrently takes inappropriate steps to prevent weight gain, such as by vomiting, fasting, excessively exercising or misusing laxatives and/or diuretics.
  • Experiences episodes of binge eating and compensatory purging behaviors at least once a week for three months or more.
  • Preoccupied with body shape and weight in self evaluation.

For bulimia to be diagnosed, health professionals also need to ensure that the disturbance experienced by the sufferer does not occur exclusively during episodes of anorexia nervosa, that is - that the disorder can be identified as separate.

Bulimia nervosa has several levels of severity, usually specified during diagnosis. Between one and three episodes per week is classed as mild bulimia; four to seven weekly episodes is moderate. Severe bulimia is specified if the sufferer records between eight and 13 episodes each week and 14 or more episodes over a seven-day period constitutes extreme bulimia (American Psychiatric Association 2013).

There is no set test for diagnosing bulimia but physical and dental examinations may be carried out, which can reveal signs indicating that a person is bulimic.

Cavities, gum infections and enamel erosion may be present as a result of exposure to the acid in vomit. Signs to note in a physical exam include a dry mouth, broken blood vessels in the eyes, cuts or calluses around the finger joints from forced vomiting. Bulimics may also have puffy cheeks, rashes, pimples and signs of dehydration (US National Library of Medicine 2018).

Causes of bulimia nervosa

There is no known single cause of bulimia; a variety of factors are believed to play a role in the onset of the condition, including familial, societal, psychological and genetic influences. Bulimia nervosa is usually the result of a combination of these factors but may also be triggered by stressful life events (US National Library of Medicine 2018).

A number of connections have been made with the onset of bulimia and childhood sexual or physical abuse, low self-esteem, dieting, involvement in athletics or employment in occupations where weight is a key focus (Rushing, J.M. B.S., Jones, L.E. M.S., and Carney, C. P. M.D., M.Sc. 2003).

People who display depressive symptoms, suffer from social anxiety or who internalize thinness as the ideal body shape are also thought to be at greater risk of developing bulimia (American Psychiatric Association 2013).

Comorbidity

Bulimia nervosa is usually comorbid with at least one other psychological disorder, commonly major depressive disorder or anxiety (Rushing, J.M. B.S., Jones, L.E. M.S., and Carney, C. P. M.D., M.Sc. (2013)). Some bulimics may suffer from multiple mental conditions along with the eating disorder.

Most people suffering from bulimia and anxiety or depression experience symptoms of the psychological condition prior to onset of the eating disorder but in some cases, the reverse is true.

Substance abuse is also commonly comorbid with bulimia. Figures suggest that up to 70 per cent of bulimics abuse substances, including tobacco, alcohol and medications like stimulants or diet pills. Almost a third of bulimics are affected by alcoholism, according to statistics, often alongside major depressive disorder and posttraumatic stress disorder (Jona M. Rushing, B.S., Laura E. Jones, M.S., and Caroline P. Carney, M.D., M.Sc. 2013).

Living with bulimia nervosa

Eating disorders are psychiatric conditions that impact both body and mind. In terms of physical health, people with bulimia nervosa or other eating disorders may suffer from bloating and stomach pain, nausea, vomiting and blood sugar imbalances. Constipation, intestinal obstruction and infections are also possible complications.

Someone with an eating disorder may also find that their hormones are affected; women may stop menstruating and fertility can be affected. A reduction in levels of the sex hormone may result in bone loss and related conditions like osteoporosis. Thyroid hormones may also decline, negatively affecting metabolism (NEDA 2018).

Bulimia may also affect a person’s day-to-day life, especially in the social arena, as sufferers may avoid social activities involving food. Bulimics may become depressed, moody and irritable, experiencing feelings of guilt and disgust following the binge-purge cycle (Jarvis, S. MBE, 2017). Suicide risk is also heightened (American Psychiatric Association 2013).

Although bulimia nervosa is usually a long-term condition, it is possible to recover fully with the right treatment.

Treatment for bulimia nervosa

There is no set ‘cure’ for bulimia nervosa - treatment usually takes the form of therapy and may also include medication, nutritional counseling and both medical and psychiatric monitoring.

When treating bulimia, symptoms must be addressed, along with any contributing factors where possible. A number of health professionals may be involved in the treatment strategy, including a counselor or psychologist, psychiatrist and dietician (Mental Health America 2018).

The type of therapies recommended are decided on a case-by-case basis and may include:

Cognitive behavioral therapy - Focusing on changing distorted attitudes or beliefs

Acceptance and commitment therapy - Detaching from emotion and focusing on identifying and taking action on values instead

Dialectical behavior therapy - Focusing on developing the skills to change behavior

Family-based treatment - Involving family members in helping the sufferer restore their weight

Psychodynamic psychotherapy - Identifying the root cause or motives behind the eating disorder

(NEDA 2018)

In some cases, medication may also be used to treat psychological conditions coexisting with or contributing to the bulimia, like depression, anxiety or social phobia. Commonly, SSRIs such as fluoxetine, venlafaxine and duloxetine may be prescribed.

Tricyclic antidepressants like imipramine and amitriptyline may also be used to reduce the binging and purging cycle. Patients who cannot tolerate or do not respond to other medications may be given antiepileptic drug topiramate (Dryden-Edwards, R. MD. 2018).

Bulimia nervosa may affect sufferers over the long term and individuals may still experience symptoms of the eating disorder even with treatment. Early intervention and treatment is advised for the best chance at overcoming the disorder.

Many bulimics are able to recover from the condition. Statistics are promising - approximately 50 per cent of bulimia sufferers are free from all symptoms five years after treatment (Rushing, J.M. B.S., Jones, L.E. M.S., and Carney, C. P. M.D., M.Sc. 2003).

 


Dr. Kevin Fleming obtained his PhD from Notre Dame and is the Founder of Grey Matters International (www.greymattersintl.com) a neuroscience-based behavior change consulting firm.

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007) The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry 61(3), 348–358.

Mental Health America (2018) Eating Disorders http://www.mentalhealthamerica.net/conditions/eating-disorders Date Accessed: 22/03/2018.

US National Library of Medicine (2018) Bulimia https://medlineplus.gov/ency/article/000341.htm Date Accessed: 22/03/2018

Rushing, J.M. B.S., Jones, L.E. M.S., and Carney, C. P. M.D., M.Sc. (2003) Bulimia Nervosa: A Primary Care Review Prim Care Companion J Clin Psychiatry 2003; 5(5): 217–224. Viewed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC419300/ Date Accessed: 22/03/2018.

National Eating Disorders Association (NEDA) (2018) Health Consequences https://www.nationaleatingdisorders.org/health-consequences Date Accessed: 22/03/2018.

Jarvis, S. MBE. (2017) Bulimia Nervosa https://patient.info/health/eating-disorders/bulimia-nervosa#nav-3 Date Accessed: 22/03/2018.

Dryden-Edwards, R. MD. (2018) Bulimia Nervosa https://www.medicinenet.com/bulimia_nervosa/article.htm#what_is_the_prognosis_for_bulimia Date Accessed: 22/02/2018.

 


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