It’s eating disorder awareness week so over the next few days, we’re going to go through the symptoms of some eating problems, starting with Bulimia Nervosa.
Below, I’ll take you through the DSM-5-TR criteria for Bulimia Nervosa providing insight into the symptomology we look for as psychologists. This criteria is used to identify and formulate a clinical diagnosis which then informs our treatment approaches. If you notice these symptoms in your own experiences, please speak with your doctor to discuss options for support.
The diagnostic criteria:
A. Recurrent episodes of binge eating. An episode of binge eating is characterised by both of the following:
Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Text Revision (DSM-5-TR), American Psychiatric Association, 2022
1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B. Recurrent inappropriate compensatory behaviours 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 behaviours 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.
A DSM-5-TR diagnosis can involve specifiers such as “In full remission” or “In partial remission” and generally also specifies regarding severity. Severity as per the DSM processes is determined based on the number of symptoms present or in the case of Bulimia Nervosa, the frequency of compensatory behaviours. Let’s look at this in a bit more detail.
What is a binge?
There are two types of binges, subjective and objective binges. Most people have only ever heard of objective binges but it is helpful to have an understanding of both.
A subjective binge, is an episode of eating where the individual perceives their eating to be in excess, regardless of the meal quantity (e.g., someone who has a food rule that says no chocolate, may perceive eating one or two squares of chocolate to be a binge as it breaks this rule).
In contrast, and objective binge is an episode of eating that most people would identify as excessive / beyond typical expectations.
Binges within Bulimia Nervosa typically fall into the objective category though individuals may also experience subjective binges.
What is compensatory behaviour?
Compensatory behaviours occur in response to binges and generally include attempts to “undo” the impact of eating. This may include:
If you suspect you may have an eating problem, consider talking to your GP. Eating disorders pose significant risks to physical and mental health and may result in death if left untreated.
