Bulimia Nervosa – Binge-Eating

If Anorexia Nervosa is primarily characterized by food avoidance, the last two feeding and eating disorders I’ll discuss are defined by episodes of binge eating. I’m referring to Bulimia Nervosa and Binge-Eating Disorder.

Intuitively, a binge can be described as eating a lot of food in a relatively short period. Clinically, "eating a lot" means consuming a significantly larger amount of food than what would typically be eaten in a similar situation. "Short period" is defined as less than two hours. Additionally, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), binge eating is characterized by a sense of loss of control—the inability to stop eating once started.

According to the DSM-5, Bulimia Nervosa is characterized by:

1. Episodes of binge eating.
2. Compensatory behaviors to prevent weight gain.
3. Binge episodes and compensatory behaviors occur at least once per week for three months.
4. Self-esteem is excessively tied to body shape and weight. This alteration in self-perception does not occur exclusively during episodes of Anorexia Nervosa.

Typical compensatory behaviors include: self-induced vomiting (rarely through the use of emetics like ipecac syrup), laxative use, enemas.

Binge episodes are often followed by shame. While binge eating temporarily alleviates emotional discomfort, it eventually leads to dysphoria (intense emotional distress). As a result, bulimic episodes are typically conducted in secret.

Although individuals with Bulimia Nervosa often maintain a normal weight, the disorder can have severe physical consequences, including: chemical imbalances in the body, loss of dental enamel. In severe cases: Pharyngeal tears and cardiac myopathies caused by repeated vomiting.

In Binge-Eating Disorder, binge episodes are not only marked by loss of control but also by a pattern of uncontrolled eating. Similar to bulimia, binge eating is intended to reduce psychological pain, but it ultimately results in intense feelings of self-devaluation. Binge-Eating Disorder can occur in individuals who are: of normal weight, overweight, obese.

DSM-5 Criteria for Binge-Eating Disorder

1. Episodes of binge eating.
2. Binge episodes are associated with at least three of the following:
   • Eating rapidly.
   • Eating until feeling uncomfortably full.
   • Eating even when not physically hungry.
   • Eating alone due to embarrassment.
   • Experiencing feelings of disgust, depression, or guilt after the episode.
3. Binge episodes cause significant distress.
4. Episodes occur at least once per week for three months.
5. Binge episodes are not followed by compensatory behaviors (as in bulimia) and do not occur exclusively during episodes of Anorexia or Bulimia Nervosa.

Sources

• American Psychiatric Association (2013) - Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
• Bernhill, J. W. (2014) - DSM-5 Clinical Cases.

I also recommend watching this video.

If you’d like me to describe another topic in psychology in my own words, feel free to ask in the comments!