Recurrent episodes of binge eating.

A. An episode of binge eating is characterized by both of the following:

1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Both Anorexia and Bulimia

Eating disorders are very complex emotional issues. Though they may seem to be nothing but a dangerously obsessive dietary concern on the surface, for most men and women suffering with an eating disorder there are deeper emotional conflicts to be resolved.

Causes of Bulimia Nervosa

Bulimia is more than just a problem with food. A binge can be set off by dieting or stress. Painful emotions, like anger or sadness, also can bring on binging. Purging is how people with bulimia try to gain control and to ease stress and anxiety. There is no single known cause of bulimia. But these factors might play a role:

• Culture. Women in the U.S. are under constant pressure to be very thin. This "ideal" is not realistic for most women. But seeing images of flawless, thin females everywhere can make it hard for women to feel good about their bodies. More and more, men are also feeling pressure to have a perfect body.
• Families. It is likely that bulimia runs in families. Many people with bulimia have sisters or mothers with bulimia. Parents who think looks are important, diet themselves, or judge their children's bodies are more likely to have a child with bulimia.
• Life changes or stressful events. Traumatic events like rape can lead to bulimia. So can stressful events like being teased about body size.
• Psychology. Having low self-esteem is common in people with bulimia. People with bulimia have higher rates of depression. They may have problems expressing anger and feelings. They might be moody or feel like they can't control impulsive behaviors.
• Biology. Genes, hormones, and chemicals in the brain may be factors in getting bulimia.

For comprehensive information on bulimia and other eating disorders, visit the HealthyPlace.com Eating Disorders Community.

Source: American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Association.

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