Bulimia Nervosa: Causes, Diagnosis, and Treatment
This paper examines bulimia nervosa as a disorder of abnormal psychology, beginning with the DSM-IV diagnostic criteria that define binge eating, compensatory behaviors, and the purging versus nonpurging subtypes. It distinguishes bulimia from anorexia nervosa and binge eating disorder, reviews prevalence estimates among college-aged women, and explores cultural and personal causes. The paper further outlines the serious physical consequences of the disorder — including tooth decay, electrolyte imbalances, and cardiac risk — and surveys treatment approaches, including SSRI pharmacotherapy and Cognitive Behavioral Therapy.
- Introduction: Bulimia as underdiagnosed, stigmatized, hard to treat
- DSM-IV Diagnostic Criteria: Formal DSM-IV criteria and subtypes defined
- Distinguishing Bulimia from Related Disorders: Differences from anorexia and binge eating disorder
- Prevalence and Causes: Prevalence estimates and cultural versus personal causes
- Health Consequences and Treatment: Physical risks and CBT and SSRI treatment options
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What makes this paper effective
- Grounds the discussion in authoritative diagnostic criteria by quoting the DSM-IV directly, giving the paper a strong clinical foundation.
- Clearly distinguishes bulimia nervosa from related disorders (anorexia nervosa, binge eating disorder), demonstrating nuanced understanding of the diagnostic landscape.
- Balances biological, psychological, and cultural explanations for the disorder before pivoting logically to treatment approaches.
Key academic technique demonstrated
The paper effectively uses definitional scaffolding: it establishes the formal clinical definition of bulimia before layering in epidemiological data, causal theories, and treatment options. This approach ensures readers share a common reference point before encountering more complex or contested claims, a strategy common in abnormal psychology writing.
Structure breakdown
The paper opens by framing bulimia as under-understood despite its cultural visibility, then moves through formal diagnostic criteria, differential diagnosis, prevalence statistics and cultural causes, physical health consequences, and finally treatment modalities. The conclusion integrates pharmacological and psychotherapeutic approaches, giving the paper a logical clinical arc from definition to intervention.
Introduction
One of the most widely publicized yet little understood disorders in abnormal psychology is bulimia nervosa. Although jokes about bulimia — particularly regarding slender young models and actresses — are common, the causes and methods of treatment of the disease remain elusive. Sufferers of eating disorders are also notoriously unreliable in terms of reporting their behaviors accurately to therapists, and may only enter treatment under pressure from friends and family. Unlike many people suffering from other mental illnesses, they may feel ambivalent about abandoning their behaviors. These factors make effectively diagnosing and treating bulimia especially difficult.
DSM-IV Diagnostic Criteria
According to the DSM-IV, the diagnostic criteria for 307.51 Bulimia Nervosa are as follows:
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 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; and 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).
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. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for three months. Self-evaluation is unduly influenced by body shape and weight.
The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
The DSM-IV further specifies two subtypes:
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. ("Bulimia Nervosa," DSM-IV, 2000)
Distinguishing Bulimia from Related Disorders
The distinctions regarding Bulimia Nervosa subtypes are meant to differentiate it from a diagnosis of Anorexia Nervosa, an eating disorder characterized by self-starvation. A purging anorexic may engage in inappropriate compensatory behaviors, but there is no minimum frequency requirement as there is for bulimia nervosa — to be diagnosed with bulimia, the person must engage in purging or inappropriate compensatory behavior at least twice a week for three months. Anorexics also refuse to maintain a normal body weight, defined in the DSM-IV as falling below 85% of normal body weight. Bulimics, by contrast, can be underweight, overweight, or of normal weight. Bulimia is also distinguished from binge eating disorder, in which individuals binge but do not engage in compensatory behavior afterward.
Prevalence and Causes
The number of people suffering from bulimia is difficult to determine precisely. "Research suggests that about four percent (4%), or four out of one hundred, college-aged women have bulimia. About 50% of people who have been anorexic develop bulimia or bulimic patterns" ("Statistics: How many people have eating disorders?" ANRED, 2007). Other estimates place the figure around 3% (Rowan, 2006).
The causes of Bulimia Nervosa are even more difficult to pinpoint. Some therapists believe that "the pressure to be thin and resulting abnormal eating patterns that are regarded as normal are probably partly to blame." Individuals in appearance-conscious professions or weight-conscious sports such as wrestling, gymnastics, and running have a higher incidence of bulimia (Rowan, 2006). Additionally, Western countries have higher rates of eating disorders than non-Western countries, and exposure to Western media correlates with a higher incidence of eating disorders in non-Western countries ("Statistics: How many people have eating disorders?" ANRED, 2007).
Works Cited
"Anorexia Nervosa." Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. American Psychiatric Association, 2000. Accessed 7 May 2007.
"Bulimia Nervosa." Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. American Psychiatric Association, 2000. Accessed 7 May 2007.
"Eating Disorders." [Course] PowerPoint Lecture. [University] Psychology Homepage. Accessed 7 May 2007. http://homepage.psy.utexas.edu/HomePage/Class/Psy394Q/Behavior%20Therapy%20Class/Eating%20Disorders.ppt
Rowan, Peter. "Introducing Bulimia Nervosa." The Priory. 2006. Accessed 7 May 2007. http://www.psychiatrist4u.co.uk/htm/bulimi.htm
"Statistics: How many people have eating disorders?" ANRED: Anorexia Nervosa and Related Eating Disorders, Inc. 2005. Updated 6 February 2007. Accessed 7 May 2007. http://www.anred.com/stats.html
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