Bulimia (cont.)
How is bulimia diagnosed?
As with anorexia, denial and secrecy complicate the
diagnosis of bulimia. The individual usually does not come to the attention of the practitioner until an
associated medical condition or serious psychological problem manifests itself.
Truthful disclosure of behaviors is critical for an accurate diagnosis. The
actual criteria for bulimia nervosa are found in the American Psychiatric Association's Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). There are five basic criteria in the diagnosis of bulimia:
- Recurrent episodes of binge eating. This is
characterized by eating within a two-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.
- A sense of lack of control over the eating during the
episode, or a feeling that one cannot stop eating.
- In addition to the binge eating, there is an
inappropriate compensatory behavior in order to prevent weight gain. These
behaviors can include self-induced vomiting, misuse of laxatives, diuretics,
enemas or other medications, fasting, or excessive exercise.
- Both the binge eating and the compensatory behaviors
must occur at least two times per week for three months and must not occur
exclusively during episodes of anorexia.
- Finally, there is dissatisfaction with body shape and/or weight.
The DSM-IV also identifies two subtypes of bulimia nervosa. The purging type regularly engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas. The nonpurging type engages in other inappropriate compensatory behaviors, such as fasting or excessive exercise, rather than purging methods.
What are signs that may suggest a person has bulimia?
It is not always possible to tell whether a person has bulimia. Those affected may be overweight, underweight, or of normal body weight. However, some warning signs may be present, although these do not confirm the diagnosis of bulimia:
- going to the bathroom after every meal (to induce vomiting)
- compulsive or excessive exercising
- physical signs arising from excessive vomiting such as swollen cheeks or jaws, broken blood vessels in the eyes, or teeth that appear clear due to damage to tooth enamel
- excessive preoccupation with body image or weight
Next: What medical complications and long-term effects can bulimia have? »
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