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Bulimia: Diagnostic Criteria and Treatment

Bulimia is one of the most common psychological disorders affecting young females. The primary characteristic of the condition is the consumption of large amounts of food, usually junk food rather than healthy fruit and vegetables. Just as important as the amount of food eaten, is the experience of being out of control, i.e. the person cannot control the binging incident at the time. In addition, there is an attempt to compensate for the bingeing behavior in the form of purging, where the food consumed is expelled by a variety of means.

The DSM-IV outlines the following criteria for the diagnosis of bulimia nervosa:

  1. Recurring episodes of binge eating in which the following occurs:

    a) Consuming an amount of food in a particular block of time (say two hours) which considerably exceeds that which most people would eat in an equivalent timeframe.

    b) During the binging episode, there is a sense of lack of control over the eating process. The person cannot control how much they eat or willingly stop eating under the episode is completed.
  2. The use of behaviors to counteract the effects of the binge eating. For example, the use of laxatives to flush out the system, the inducement of vomiting to immediately remove the food from the stomach, the use of fasting to control food intake, and excessive exercise to remove any weight gained from the bingeing behavior.
  3. The binge eating and behaviors aimed to counteract the binge eating (i.e. vomiting, purging, laxative use, diuretic use to remove excess water, and excess exercising) occur at least twice a week over a period of three months.
  4. The person is obsessed by bodily appearance and shape.

Sufferers of bulimia also commonly suffer from associated anxiety disorders. Over 75% of bulimics experience other anxiety-related problems such as social phobia and generalized anxiety disorder. Mood disorders, especially depression, are also commonly present in suffers of bulimia, although the depression experienced may be secondary to the bulimia. Substance abuse is also prevalent among bulimics.

Several causes have been suggested as to the origins of this disorder, in particular, the effect of the media on the self-esteem of young women in regard to their body shape. Other factors include poor interpersonal relationships, particularly among family members, a stressful event in the life of the adolescent, and a desire by the adolescent to be “perfect”.

Traditional treatment for bulimia includes both physical and emotional aspects and involves psychiatrists, psychologists, dieticians, and social workers. Hospitalization may be required to monitor electrolyte imbalances and monitor heart and kidney problems.

In recent years, a more holistic approach to eating disorders has been introduced by practitioners such as Peggy Claude-Pierre who have instigated treatment that attempts to resolve the underlying belief systems that cause the problem to develop in the first place. Rather than utilizing the often dehumanizing environment of hospital wards, these alternate recovery methods involve providing unconditional love and support to sufferers. This enables the bulimic to begin to love themselves, often for the first time in their lives, and by doing so, to cease the self-harming behaviors they inflict upon themselves.

It is imperative for family and friends of the bulimic sufferer to understand the condition fully, to realize that this is a legitimate medical disorder shared by tens of thousands of other young women and that they require unconditional patience and love to help them overcome this crippling and painful condition.

Statements such as “Why don’t you just eat like everyone else? or “Just pull yourself together” are both devastating to the sufferer and a display of profound ignorance on behalf of the speaker. Although bulimics modify their eating patterns in an attempt to stay in control they are, in fact, profoundly out of control. Understanding and compassion are the twin roots to unraveling the mystery surrounding bulimia and instigating recovery for any bulimia sufferer.


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