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DSM criteria for bulimia

The DSM-IV-TR criteria for bulimia nervosa are:

recurrent episodes of binge eating recurrent inappropriate compensatory behaviour, such as vomiting after eating, in order to prevent weight gain compensatory behaviours occur, on average, at least twice a week for three months undue influence of weight or shape on self-evaluation.

Many people with bulimia feel unattractive, have a fear of becoming fat, and consider themselves to be heavier than they actually are. Their attempts to avoid being overweight are more chaotic than in anorexia, and periods of controlled eating are frequently interrupted by repeated, relatively short episodes of uncontrollable eating. These are followed by behaviours designed to counteract the consequences of bingeing. The amount of food consumed in binges can be vast: up to and beyond 5000 calories at any one time. Food is not eaten for pleasure; indeed, it is usually eaten secretly, rapidly and barely tasted. Episodes are usually preceded by periods of considerable physical and psychological tension, and eating serves to reduce this tension. While bingeing, the individual may feel out of control, and episodes are typically followed by feelings of guilt, self-blame and depression. The weight of people with bulimia usually remains within the normal range, although it may fluctuate considerably over time. Between 80 and 90 per cent of people with bulimia vomit after eating in an attempt to control their weight, one-third abuse laxatives, while others may exercise excessively. Compensatory behaviours reduce discomfort and feelings of anxiety, self-disgust or lack of control associated with bingeing. Ironically, however, they frequently fail to prevent the calorifi c intake from much of the ingested food. Bulimia involves some risk to health. Repeated vomiting and laxative abuse can lead to problems including abdominal pain, digestive problems, dehydration, damage to the stomach lining and to the back of the teeth, where regurgitated acid can do permanent damage to the tooth enamel. The most serious outcome can be an electrolyte imbalance leading to renal damage and potentially fatal cardiac arrhythmias. Between 1 and 3 per cent of women will develop bulimia in their lifetime, and although the majority will no longer be bulimic five years after diagnosis, nearly a half will revert back to bulimic behaviours at some point. Among young women, rates are particularly high. Up to 50 per cent of female students surveyed by Schwitzer et al. reported periodic binges; 6 per cent had tried vomiting; and 8 per cent had used laxatives on at least one occasion. Few, however, engaged in these behaviours suffi ciently frequently for them to be considered a disorder.

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