Bulimia Nervosa, Binge Eating and Purging

Bulimia and anorexia are probably the most commonly known eating disorders thanks to the media, movies, and other pop culture – but how much do you actually understand about them?

In the interest of keeping people informed, I want to explore a bit more about Bulimia in this article, looking at what it is, how it differs from other eating disorders, and how it can be managed or treated.

The word bulimia is short for Bulimia Nervosa (BN) which is the name given to a form of disordered eating that involves episodes of binge eating, accompanied by behaviours to manage weight gain¹.

These weight management strategies can take many forms include purging or vomiting, dietary control such as fasting, misuse of laxatives or medications, or excessive exercise.

It is the combination of both binge eating and weight control behaviours that distinguishes BN from other eating disorders such as anorexia, which is predominantly about weight management strategies in the absence of binge eating.

Let’s look at what we mean by binge eating and weight control behaviours.

What is Binge Eating?

Binge eating is characterised by:

• Eating an excessive amount of food in a period of time¹.
  • Excessive amount being determined by comparison to the amount that most individuals would consume in that period of time.
  • Doesn’t have to be confined to one situation, the episode may start at a party or dinner, but continue when you get home.
• Feeling like you can’t control it.
  • Feeling like you can’t stop eating, can’t control how much you’re eating, or what you’re eating.

Compensatory Weight Management Strategies

Compensatory weight management strategies may include:

• Behaviours that the individual engages in following a binge:
  • Eg vomiting, misuse of laxatives or medications, fasting or calorie restriction, or excessive exercise.
  • Vomiting is the most common, along with other purging behaviours such as the use of laxatives or diuretics.
• Many individuals will use multiple weight management behaviours.
• They often serve two purposes:
  • Relief from physical discomfort caused by the binge eating; and
  • Relief from fear of gaining weight, or feelings of guilt associated with the binge.

One of the challenges of bulimia is that, unlike other eating disorders, it doesn’t always result in a significant weight change.

Anorexia, for example, can involve similar behaviours such as bingeing and purging, or other weight management strategies, but is associated with significant weight loss and fear of gaining weight even when the individual is significantly below what would be an expected or “normal” weight. The obvious weight change and continued obsession with their weight even though they are very skinny is easier for people to identify as unhealthy.

On the other hand, binge eating disorder, where an individual engages in recurring episodes of binge eating without the compensatory weight management behaviour, will typically result in weight gain over time that is also noticeable to those around them.

However, an individual with bulimia is engaging in both bingeing and compensatory weight management and may not experience any significant weight change that would be noticeable by others. Furthermore, the individual may be able to keep both binge eating and purging behaviours secret from friends and family. Because of this, it can be important for people to know the risk factors associated with Bulimia.

Risk Factors

The risk factors associated with bulimia can typically be categorised into three interacting categories: biological, psychological, and social/environmental.

Biological/Genetic:

• Yes there is a biological or genetic component to bulimia^2,3, meaning:
  • People with family history of bulimia are at higher risk of also developing bulimia, even if they are adopted.
  • There isn’t a single gene that is a “bulimia gene”, rather scientists believe that a number of interacting genes that can be passed down may contribute to the development of bulimia.
• No it doesn’t mean that if you have bulimia you are stuck with it or can’t get rid of it.
• It does mean that some people are more susceptible/predisposed to bulimia and may be more likely to experience eating disorders when confronted with a range of other risk factors.
• Women are more likely to experience bulimia than men, however, this shouldn’t stop men from reaching out if they feel they are struggling with an eating disorder¹.
• Childhood obesity and going through puberty early may also increase the risk of developing bulimia¹.
• Age: An individual will typically develop bulimia as an adolescent or young adult, with onset in people over 40 or before puberty being less common¹.

Psychological:

• A number of negative beliefs about the self may contribute to the development and maintenance of bulimia¹.
  • Eg low self-esteem, persistent weight concerns.
• Experiencing multiple stressful events¹.
• People experiencing symptoms of depression and anxiety may be more susceptible to developing bulimia¹.
• Negative and unhelpful thought patterns such as focusing attention on negative comments or taking comments the wrong way.

Social/Environmental:

• Childhood abuse and trauma are both associated with increased risk of developing bulimia^1,4.
• Internalisation of unrealistic beliefs about culturally desirable weight and image¹.
  • Eg internalising the unrealistic portrayal of both males and females in the media.
• Family and social group behaviour⁴.
  • Eg a child that sees a parent binge eating when they’re upset, will likely mirror that behaviour and adopt binge eating as a coping strategy.

Treatment for Bulimia Nervosa, Binge Eating and Purging

Cognitive behavioural therapy (CBT) is recognised as being the most effective treatment for bulimia^4,5. CBT interventions often involve targeting distorted thinking, self-monitoring of behaviours, exposure and body image therapy, and relapse prevention.

In cases where the individual’s negative relationship with food stems from negative relationships with those in their life, interpersonal therapy is also a good option because it will look more specifically at how to improve those relationships⁴.

Pharmacotherapy (medication) may also be beneficial in managing symptoms in the short term and if it is decided that this is an appropriate course of action, a psychologist can work with your doctor to identify a plan that balances medication and therapy to provide a long term solution.

Author: Nikki Crossman, B Psych Science (Hons).

Nikki Crossman is a Master of Psychology (sport and exercise) candidate at the University of Queensland, passionate about the benefits of sport and exercise for mental health. She takes a holistic approach to wellbeing that recognises the strong connection between our body and our mind, and draws on evidence-based therapies such as CBT and Interpersonal therapy.

To make an appointment try Online Booking. Alternatively, you can call M1 Psychology Brisbane on (07) 3067 9129

References:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
2. Mazzeo, S. E., & Bulik, C. M. (2009). Environmental and genetic risk factors for eating disorders: what the clinician needs to know. Child and Adolescent Psychiatric Clinics, 18(1), 67-82.
3. Baker, J. H., Maes, H. H., Lissner, L., Aggen, S. H., Lichtenstein, P., & Kendler, K. S. (2009). Genetic risk factors for disordered eating in adolescent males and females. Journal of Abnormal Psychology, 118(3), 576-586. doi:10.1037/a0016314
4. Bernacchi, D. L. (2017). Bulimia nervosa: A comprehensive analysis of treatment, policy, and social work ethics. Social work, 62(2), 174-180.
5. Linardon, J., Wade, T. D., de la Piedad Garcia, X., & Brennan, L. (2017). The efficacy of cognitive-behavioral therapy for eating disorders: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 85(11), 1080-1094. http://dx.doi.org.ezproxy.library.uq.edu.au/10.1037/ccp0000245