As opposed to Anorexia nervosa, Bulimia nervosa is a relatively new eating disorder in diagnostic history. In 1979, British psychiatrist Dr. Gerald Russell found several of his patients to be suffering from a different type of eating disorder than the typical version of Anorexia. He thought it was a “chronic phase of anorexia nervosa” (Castillo and Weiselberg, 2017, p. 85), as the patients experienced insatiable waves of overeating followed by compensatory methods, such as self-induced vomiting. While the patients had intense fears of becoming fat, they were victims to irresistible urges to overeat. The fear of fatness these women experienced has grown throughout the 20th and 21st century, as the trend of thinness has gained more recognition.
Introduced to the DSM-III in 1980, Bulimia translates to “ravenous hunger” or “ox-hunger” in Greek. This term was originally defined as the presence of binge eating behaviors (Castillo and Weiselberg, 2017, p. 86), but by 1987 was adapted to further the definition. The updated version also added the term “nervosa” to keep in line with the psychiatric nature of the disorder, much like Anorexia nervosa. After Bulimia was introduced to the DSM-III, the number of cases in the United States rose to about 40 in every 100,000 people (Russell, 1997). I believe there is something to be said about the symptom pool of Bulimia and the increase in incidences. While the aspiration of thinness began to reach its peak in the 1980s and Bulimia could have been a symptom of that, I think it is interesting to note that cases of this disorder rose at the same time that the disorder was introduced into the literature.
In 1994, the DSM-IV was published and changed the definition of this disorder even more, stating that Bulimia consisted of binge eating episodes with compensatory behaviors that occurred, on average, at least twice per week for at least 3 months (American Psychiatric Association, 1994). Building off of this definition, the DSM-V changed the frequency of the binge episodes and compensatory mechanisms from twice per week for at least 3 months to once per week for 3 months and defined the cases as mild: one to three episodes per week; moderate: four to seven; severe: eight to thirteen; and, extreme: fourteen or more per week (American Psychiatric Association, 2013). All of this being said, Bulimia nervosa can loosely be defined as episodes of binge eating followed by compensatory behavior, most commonly vomiting or “purging.”
The lifetime prevalence of Bulimia nervosa in the United States is between 0.9% and 3% with a female-to- male ratio of 3:1 and the average age of onset at 16-17 years (Castillo and Weiselberg, 2017, p. 87). Most interestingly, the rates are highest among the Hispanic/Latino population, second highest among African-Americans and lowest in non-Latino whites at 0.51% (Castillo and Weiselberg, 2017, p. 87). I say this is interesting as this prevalence is much different from Anorexia nervosa, where non-Lation whites have the highest rates. The etiology of Bulimia nervosa is multifactorial, as genetic predisposition, environmental influences, and psychological traits all play a role. Studies have found that eating disorders are inheritable, in addition to several other parental factors that can influence the susceptibility of developing an eating disorder, like parental mental illness or parents with negative views of weight (Castillo and Weiselberg, 2017).
Treating Bulimia nervosa can be difficult, as it is often hard to diagnose. As people suffering from Bulimia are likely to hide their symptoms and physical signs are usually absent, diagnosis often comes from people around the patient noticing a change in behavior. Treatment usually consists of cognitive behavioral treatment (CBT), in either in- or -out patient depending on how severe the case may be. If the disorder is extremely severe, treatment hospitalization may be required. The most important thing to take note of is that recovery from Bulimia is not a one size fits all approach and requires careful planning of the physical, psychological, and social needs to create the best possible chance for recovery (Castillo and Weiselberg, 2017, p. 91).
While it is a relatively new eating disorder in the extensive history of mental illness, Bulimia nervosa is a serious disorder that can afflict anyone. Although eating disorders are regarded as mostly female, our next post will address how Bulimia affects all genders and the social stigma that comes with it.
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders. (4th ed.) Washington, DC: APA Press.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th ed.) Washington, DC: APA Press.
Castillo, M., & Weiselberg, E. (2017). Bulimia Nervosa/Purging Disorder. Current Problems in Pediatric and Adolescent Health Care, 47(4), 85–94.
Russell, G. (1997). The history of bulimia nervosa. D. Garner & P. Garfinkel (Eds.), Handbook of Treatment for Eating Disorders (2nd ed., pp. 11–24). New York, NY: The Guilford Press.