Bulimia is an obsession with food and weight characterized by repeated overeating binges followed by compensatory behavior, such as forced vomiting or excessive exercise. For an epidemic number of women and men, bulimia is a secret addiction that dominates their thoughts, undercuts their self-esteem, and threatens their lives. The symptoms are described by the Egyptians and in the Hebrew Talmud; and bulimia (Greek for “oxhunger”) was widely practiced during Greek and Roman times. In the later half of the twentieth century, though, eating disorders, and particularly bulimia, have been identified as widespread cultural phenomena. Bulimia is also termed bulimia nervosa and bulimarexia.

In 1980, the American Psychiatric Association formally recognized bulimia. In its fourth edition, the Diagnostic and Statistical Manual of Mental Disorders (APA, 1994) lists the following criteria that an individual must meet to be diagnosed:

A. Recurrent episodes of binge eating, with an episode characterized by (1) eating in a discrete period of time, usually less than two hours, an amount of food that is significantly larger than most people would eat during a similar period of time and under similar circumstances; and, (2) a sense of lack of control over eating during the episode, such as a feeling that one cannot stop eating

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or enemas (purging type); or, through fasting or excessive exercise (nonpurging type).

C. These behaviors occur at least twice a week for at least three months.

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

E. The behavior does not only occur during episodes of anorexia nervosa.

The above list was created to help clinicians diagnose and treat this complex disorder. However, many individuals, termed “subclinical,” fulfill only some of the criteria. These cases are also life-damaging and need to be taken seriously.

Although the overt symptoms of bulimia revolve around food behaviors and a fear of gaining weight, bulimia is actually a way to cope with personal distress and emotional pain. Eating binges take time and focus away from more disturbing issues, and purges are an effective way to regain the control and feelings of safety lost during the binge. Also, while bulimic behavior may have started as a seemingly-innocent way to lose weight, the cycle of bingeing and purging usually becomes an addictive escape from all kinds of other problems.

Most individuals with bulimia are extremely secretive about their behavior, sometimes going to great lengths to maintain the appearance of normal eating around other people. They are ashamed of their behavior and what it has done to their lives. Many describe feeling like two people—one who wants to give it up and be healthy, and another who constantly sabotages. Lying and sneaking are common traits. Many people describe stealing food that they know belongs to other people or digging through the trash during particularly desperate episodes.

Although a typical binge represents a large quantity of food, usually between 1500 and 3000 calories and primarily high carbohydrates, a binge is uniquely defined by the person doing it. Even a “normal” meal might feel like “too much” to someone who is terrified of getting fat.

Binges can be triggered in a number of ways: by higher numbers on a scale, eating something that is normally forbidden or taking one bite more than allowed, difficult feelings, a traumatic event, or something as innocuous as thinking about food. Many people describe their feelings during binges as completely out of control, driven by a desperate desire to feel even a little bit better. While they might feel ugly, unworthy, hopeless, and helpless before and during a binge/purge episode, after, they might feel a mix of control, shame, relief, disgust, dizziness, exhaustion, and resolution. Part of the cycle often includes the promise that each time will be the last.

It is difficult to say how many people have bulimia. Statistics may not truly reflect the total numbers because, as we said, bulimics generally hide their behavior. In fact, one study showed that college students answered questionnaires more truthfully when told to put a dab of their saliva on the survey paper, because they believed it could be chemically analyzed to determine if they were bulimic!

Of the research done on the prevalence of eating disorders, the most reliable statistics indicate that about 5% of college-aged women meet the strict clinical criteria for bulimia. However, some studies offer much higher numbers. A recent one of female high school and college students reported that 15% met the criteria for bulimia (Cavanaugh, 1999), and some experts suggest that as many as one of every three women have engaged in some bulimic behavior. Men account for at least 10% of cases, although, this number has seemed to increase in recent years. There is also evidence that—unlike anorexia nervosa, which has remained fairly constant in the past few decades—the incidence of bulimia rose significantly in the early 1980’s (Russell, 1997). Whatever the actual figures, a significant number of both women and men are engaging in this self-destructive behavior.

Reprinted from Bulimia: A Guide to Recovery
By Lindsey Hall and Leigh Cohn
To find out more about this helpful book click here.

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