Is It The Same As Anorexia Nervosa?
For many years bulimia was considered to be one type of anorexic behavior. Certainly, in both cases, the relationship with food is a symptom of other serious problems and many other similarities do exist. By recognizing bulimia as a separate disorder in 1980, however, the American Psychiatric Association identified a much larger group than those who could be clinically classified as strictly anorexic.
The fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (APA, 1994) lists four criteria that an individual must meet in order to be diagnosed as anorexic, generalized as follows:
A. The individual maintains a body weight that is about 15% below normal for age, height, and body type.
B. The individual has an intense fear of gaining weight or becoming fat, even though they are underweight. Paradoxically, losing weight can make this fear of gaining even worse.
C. The individual has a distorted body image. Some may feel fat all over, others recognize that they are generally thin but see specific body parts (particularly the stomach and thighs) as being too fat. Their self-worth is based on their body size and shape.
They deny that their low body weight is serious cause for concern.
D. In women, there is an absence of at least three consecutive menstrual cycles. A woman also meets this criteria if her period occurs only while she is taking a hormone pill (including, but not limited to, oral contraceptives).
The DSM-IV also differentiates between two specific types of anorexia nervosa. “Restricting Type” denotes individuals who lose weight primarily by reducing their overall food intake through dieting, fasting and/or exercising excessively. “Binge-Eating/Purging Type” describes those who regularly binge (consume large amounts of food in short periods of time), and purge through self-induced vomiting, excessive exercise, fasting, the abuse of diuretics, laxatives, and enemas, or any combination of these measures (Hall and Ostroff, 1998).
Although some anorexics also purge after eating, anorexia nervosa is generally characterized by self-starvation. In general, anorexics reject food, have lower body weight, often begin younger, and are socially and sexually less mature. In contrast, the majority of bulimics’ weight appears closer to normal, most began purging in their late teens or early twenties (many anorexics turn to bulimia), and are more socially outgoing. Also, as noted, the DSM-IV criteria includes amenorrhea, which is generally rare amongst bulimics, who nevertheless, frequently report irregular menses.
Hospitalization is often necessary for anorexics, who have a higher fatality rate: 5-20% of anorexics die from complications related to the disease (Zerbe, 1995). There is no definitive data for bulimia fatality statistics, but the clinical impression is that they are low, and not as high as for anorexia nervosa.
There are, as mentioned above, similarities in the issues underlying anorexia nervosa and bulimia. Individuals with the disorders share an overconcern with the size of their bodies and what they have or have not eaten. They are focused on an inner empty place, which can be viewed in physical, emotional, social or spiritual terms. Both use the control of food to handle intense feelings of different kinds, such as depression, anger, rejection, loneliness, selfishness, fear of independence or dependence, and love. Each also uses food to avoid situations where there is a potential for conflict, disapproval, or failure. Ultimately, both use food to express something that they feel is unacceptable or they are unable to express directly.
However, while a binge and purge can give a bulimic the courage to face the world, not-eating is empowering to an anorexic. Although some anorexics engage in purges if they eat more than they consider safe, not-eating remains their primary tool for self-preservation. Recovery for these individuals is less a matter of avoiding a binge than it is eating enough to be healthy. But the bottom line for both remains to be able and willing to care for themselves with appropriate amounts of food (not starving or stuffing) in a healthy, self-nurturing way.￼
Reprinted with permission from Bulimia: A Guide to Recovery
By Lindsey Hall and Leigh Cohn
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