1. Bulimia Nervosa
SOWK-230
Sydney Gaver

2. Diagnostic Criteria DSM-5
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following
Eating, in a discrete period of time, an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
A sense of lack of control over eating during the episode.
B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight
E. The disturbance does not occur exclusively during episodes of anorexia nervosa.

3. What Does That Mean? Bulimia is characterized by:
a cycle of binge eating & compensatory behaviors such as self- induced vomiting in an attempt to undo the effects of binge eating (bingeing and purging).

4. Symptoms of Bulimia
Frequent episodes of consuming large amounts of food followed by behaviors to prevent weight gain such as self-induced vomiting, laxative abuse, and excessive exercise.
Feeling out of control during binge-eating episodes.
Extreme concern with body weight and shape.
Most people with bulimia are a normal body weight according to the Body Mass Index (BMI).

5. Warning Signs of Bulimia What to Look For
Going to the bathroom after meals
Excessive exercise regimen; obsession with “burning off” calories
Discoloration/staining of teeth (from self-induced vomiting)
Withdrawal from friends and usual activities
Continued exercise despite injury
Calluses on hands and knuckles from self-induced vomiting

6. Health Consequences
Electrolyte imbalances as the result of dehydration
Can lead to irregular heartbeat, heart failure, or death
Gastric rupture (stomach bursting) during binge-eating episodes
Inflammation or rupture of the esophagus from self- induced vomiting
Tooth decay and staining
Irregular bowel movements as a result of laxative abuse

7. Why Do People Develop Eating Disorders?
National Eating Disorder Association, 2014

8. Contributing Factors Psychological Biological Low self-esteem
Feelings of lack of control in their life
Depression, anxiety, anger or loneliness
Eating disorders run in families
Chemicals in the brain that control hunger, appetite, and digestion are unbalanced
Genetics account for 59-83% of the liability for bulimia

9. Factors Continued… Interpersonal Social
Troubled personal relationships
Difficulty expressing emotions
History of being teased based on weight
History of abuse
Drive for thinness and body dissatisfaction
Culture values people based on physical appearance and not traits

10. Co-occurring Disorders
50% of people with eating disorders abuse either drugs or alcohol
Depression and anxiety disorders frequently comorbid with eating disorders
Elevated risk for Obsessive Compulsive Disorder (OCD)
Self-harm
PTSD from prior abuse

11. How to Help
National Eating Disorder Association, 2014

12. Eating Disorder Treatment
Residential Treatment
Patient is medically stable
Patient is psychiatrically unstable
Inpatient Treatment
Patient is medically unstable
Partial Hospitalization
Patient is medically stable but needs daily assessment
Patient is psychiatrically stable but unable to function in normal situations
Intensive Outpatient/Outpatient
Patient is psychiatrically stable enough to function in normal situations

13. Resources National Eating Disorder Assocation (NEDA)
NEDA Helpline
Academy for Eating Disorders
Proud 2 B Me
Project HEAL