Eating Disorder – Bulimia nervosa – Disorders & Treatments
Many bulimics also have anxiety or mood disorders. One study found anxiety in 75% of bulimic patients. Prominent mood disorders include depression and substance abuse. Recent research suggests that depression is caused by the eating disorder. Bulimics are also more likely to attempt suicide and engage in impulsive behaviors.
Bulimic females typically have a less favorable opinion of themselves than control groups. They are more pessimistic, more ambivalent towards others, strive for less recognition in areas that are socially significant or require leadership. However, they also express a need to solicit sympathy, affection, and emotional support. Bulimics are usually raised in dysfunctional families. Many also display alexithymia, the inability to consciously experience and express emotions.
The main criteria differences involve weight: an anorexic must have a body mass index of less than 17.5. Typically an anorexic is defined by the refusal to maintain a normal weight by self-starvation. Another criterion which must usually be met is amenorrhea, the loss of a female’s menstrual cycle not caused by the normal cessation of menstruation during menopause for a period of three months. Generally the anorexic does not engage in regular binging and purging sessions. If binging and purging occurs but rarely, and the patient also fails to maintain a minimum weight, they are classified as a purging anorexic, due to the underweight criterion being met and cessation of menstruation.
Characteristically, bulimics feel more shame and out of control with their behaviors, as the anorexic meticulously controls their intake, a symptom that calms their anxiety around food as s/he feels s/he has control of it, naïve to the notion that it, in fact, controls him/her. For this reason, the bulimic is more likely to admit to having a problem, as they do not feel they are in control of their behavior. The anorexic is more likely to believe they are in control of their eating and much less likely to admit that a problem exists.
Anorexics and bulimics have an overpowering sense of self determined by their body and their perceptions of it. They trace all their achievements and successes to it, and so are often depressed as they feel they are consistently failing to achieve the perfect body. Bulimics feel that they are a failure because s/he cannot achieve a low weight, and this outlook infiltrates into all aspects of their lives. Anorexics cannot see that they are underweight and constantly work towards a goal that they cannot meet. They too allow this failure to define their self worth. As both the anorexic and bulimic never feel satisfaction in the more important part of their lives, depression often accompanies these disorders.
Treatment is most effective early in the development of the disorder, but since bulemia is often easy to hide, diagnosis and treatment often come when the disorder has already become a static part of the patient’s life. Historically, bulimics were often hospitalized to end the pattern and then released as soon as the symptoms had been relieved. But this is now infrequently used, as this only addresses the surface of the problem, and soon after discharge the symptoms often reappeared as severe, if not worse.