Many of us have at some point experienced the need to comfort ourselves with that one – or two – piece of scrumptious chocolate cake. But for some people, normal eating can spiral out of control where they end up “bingeing” i.e. consuming a large quantity of food in a relatively short period of time.

Bulimia nervosa is a type of eating disorder where the sufferer is trapped in an endless cycle of bingeing and undoing the “damage”. Right after gorging on food, the person seeks extreme ways to redeem the extra calories, propelled by intense guilt and anxiety.

Just like anorexia nervosa, bulimia nervosa is commonly associated with females, particularly teenage girls.

Criteria for diagnosing bulimia

Doctors diagnose bulimia based on five main criteria defined in the Diagnostic and Statistical Manual of Disorders (DSM-IV) published by the American Psychiatric Association. These include:

  1. Recurrent episodes of eating abnormally large amounts of food in a short time frame (i.e., two-hour period), with a sense of lack of control over that behaviour.
  2. Recurrent compensatory measures to prevent weight gain, such as self-induced vomiting, misuse of medications, fasting or excessive exercise.
  3. Such excessive behaviours take place, on average, at least twice a week for three months.
  4. Body shape and weight have a disproportionate influence on self-image.
  5. If the bingeing and purging happen during an episode of anorexia nervosa, a diagnosis of anorexia nervosa should be considered instead.​

Two types of bulimia - purging and non-purging​

“There are two types of bulimia, purging and non-purging. In the purging subtype, the patient forces himself/herself to vomit or uses emetics, laxatives, diuretics or enemas to get rid of the excessive food, making frequent and secretive trips to the bathroom after meals. In the non-purging subtype, the patient fasts or exercises intensely,”​ explains Dr Lee Huei Yen, Senior Consultant and Director of the LIFE ​Centre's Eating Disorders Programme​ at Singapore General Hospital (SGH), a member of the SingHealth​ group.

According to Dr Lee, “the difference between bulimia and ​binge ​​​​eating disorder is the compensatory behaviour. Binge eaters consume large quantities of food and feel guilt and self-loathing afterwards, but they do not resort to self-i​nduced vomiting, strenuous exercise, fasting or other measures to compensate.”

Prevalence of eating disorders in Singapore

In Singapore, like anorexia nervosa, binge eating an​d bulimia are on the rise. SGH gets three new cases of bulimia every month, with 10 per cent being girls aged under 15 years, reveals Dr Lee.

Bulimics are likely to have relationship issues which could be the trigger for the disorder, as well as a family history of obesity and substance abuse, says Dr Lee.

They may have personality traits such as perfectionism and low self-esteem, with a disproportionate dependence on others for validation of their self-image. Bulimia usually follows unsuccessful attempts at dieting. “Females who severely restrict their diets are at risk of developing bulimia. But while anorexics are thin or underweight, bulimics are usually of normal weight,” points out Dr Lee.

Treatment involves cognitive behavioural therapy and other forms of psychological counselling, as well as anti-depressants in some cases. Patients with associated conditions such as depression or anxiety, must be treated for these along with the management of bulimia. Bulimic patients may also require treatment for swollen throat glands, tooth decay and gum disease caused by frequent vomiting.

To stop the binge-purge cycle, it is important to seek professional help early, follow through the treatment process and resolve any underlying psychological issues.

Ref: T12​