Bulimia nervosa (or psychogenic) is characterised by repeated episodes of hyperphagia (overeating-binge eating), which are combined with vomiting, or laxative abuse, or other methods of avoiding weight gain.
During the bulimia attack, the amount of food consumed is clearly much higher than the expected normal quantity. For example, an entire cake, or a whole tray of food or sweets is consumed within a short time. The person literally loses control and continues to eat, despite the discomfort caused by the quantity of food.
As in anorexia, in bulimia nervosa, body weight plays an important role in the individual’s self-esteem and sense of self-worth. For this reason, the affected person resorts to so-called "compensatory behaviours" to avoid weight gain from ingesting large quantities of food. In the context of compensatory behaviours, they induce vomiting, or use laxatives or suppositories to bring on multiple bowel movements and lose weight. They may also follow a strict diet, or a programme of intense physical activity, which is something also observed in anorexia nervosa.
The diagnosis is based on the above characteristics. Early diagnosis correlates with clearly better rates of treatment success.
Therefore, if bulimia nervosa is suspected based on clinical characteristics, assistance from a specialist experienced in the management of nutritional disorders should be sought. In recent years cognitive behavioural therapy has been shown to generate very good results, especially if implemented in time.
Unlike anorexia, body weight is usually kept normal. In addition, bulimic episodes take place in an "appropriate" space at an appropriate time so that friends or family don’t notice them occurring. Parents often see indirect evidence of purging behaviour. For example, they may notice vomit stains, frequent bathroom visits after meals, or empty food cupboards. Relatively normal body weight in combination with the concealment of bulimic episodes, which are carried out "privately", make it difficult for the people around the affected individual to become aware of this severe eating disorder.
Bulimia nervosa is accompanied by many severe acute and chronic medical complications and requires concurrent monitoring by a specialist who works with the psychologist and psychiatrist. During bulimic episodes and induced vomiting, acute complications of the gastrointestinal system may occur, such as bleeding, while self-inducing vomiting causes damage to the oesophagus, such as oesophagitis, or complications to the lungs due to aspiration. Also, common problems are damage to the teeth due to exposure to acidic gastric fluids, which is exacerbated by the erroneous practice of brushing the teeth immediately after vomiting. It is clear that in order to address the problems associated with bulimia nervosa, as with anorexia, a partnership between experts in different areas of specialisation is vital.