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Bulimia Nervosa

What constitutes "bulimia nervosa?"

Those suffering from bulimia nervosa alternately binge and purge, usually by vomiting, though other means of compensating for calories consumed include exercising excessively or using laxatives, enemas, or diuretics. After a binge - which involves losing control and eating more food than deemed acceptable-a bulimic feels disgusted and ashamed. The binge is usually triggered by a build-up of tension, often accompanied by negative emotions. The binge releases the tension and provides an escape from painful emotions. However, the binge itself results in shame, guilt, and self-blame, as well as fear of gaining weight, which usually leads to renewed attempts to restrict eating. Hunger and deprivation from restricting, plus other stresses that occur, cause another cycle of tension build-up, leading to yet another binge. The purge that follows each binge relieves the anxiety that the overindulgence will lead to weight gain. As in all eating disorders, a central feature of bulimia is a poor body image-significant dissatisfaction with the body's shape or weight.

Bulimics, who are usually within the normal weight range, place excessive emphasis on body shape and weight, which almost exclusively define their self-worth. They frequently compare themselves to others and to internally held, frequently perfectionistic standards. Often falling short in their estimation, bulimics experience self-doubt, low self-esteem, shame, and a variety of painful feelings. Bulimia affects an estimated 1 to 3% of adolescents and young adult females, although increasingly males are becoming bulimic.

How is bulimia nervosa treated?

Those suffering from bulimia nervosa often binge in order to stop feeling overwhelmed and to alter an unpleasant mood. Purging is an attempt to undo the damage of excess calories. The binge/purge behavior becomes the glue that holds together day-to-day survival. At the same time, the fear of gaining weight causes them to engage in dieting and other restrictive eating. Certain foods are declared forbidden and rules are set up to regulate eating. Internally bulimics are very self-critical, often holding themselves to high standards of performance for everything. Soon they begin to feel deprived, tense, and overwhelmed, which sets the stage for the next binge/purge episode. Treatment focuses on normalizing eating and "legalizing" formerly forbidden foods. In addition, the inner war between they critical self and the rebel eater must be resolved. The bottom line in the treatment of bulimia is to identify and change fundamental belief systems and address the core pain that the bulimia serves to assuage, as well as to improve interpersonal functioning and emotional coping.

Dr. Joyce Nash, PhD    (650) 329-1000