Types of Bulimia: Causes, Symptoms, and Treatment
Bulimia is an eating behavior disorder in which a person, after binge eating, often engages in purging behaviors to get rid of calories. Let’s see what are the various types, causes, and symptoms of Bulimia.
Bulimia is a mental disorder classified within eating disorders. We will be able to differentiate different types of this pathology according to the mode of compensatory behavior, the weight of the subject, or the degree of remission or severity.
The typical criteria for bulimia that must be met to make the diagnosis are the presence of recurrent binge eating, the performance of compensatory behaviors, the fulfillment of criteria at least once a week for three months, and a self-assessment or self-assessment that is highly influenced by weight and body image.
Likewise, a characteristic pattern of the presence of the pathology is observed, frequently linked to repetition in the form of a loop. A binge-eating phase is performed, followed by a compensatory behavior phase and finally a vigilance phase and increased restriction.
The different types, as we have pointed out, are distinguished according to whether or not purging behavior is observed, whether the individual is overweight or obese or has a variable weight, whether symptoms are still shown or whether they are more or less severe depending on the number of compensatory behaviors per week. In this article, we will talk about bulimia, what this pathology consists of and what types of it exist.
What is Bulimia?
Bulimia is an eating behavior disorder, affecting not only physical health but also mental health. The latest version of the Diagnostic Manual of the American Psychiatric Association (DSM 5) classifies it as an independent disorder, requiring that 5 criteria be met.
Criterion A requires recurrent (repeated) episodes of binge eating, understood as the behavior of eating a large amount of food in a short period, less than that used by the majority of the subject, and a feeling of loss of control before eating behavior.
Criterion B must also be shown in the performance of inappropriate compensatory behaviors, to counteract binge eating and prevent weight gain. The behaviors used can range from the consumption of laxatives or diuretics to the provocation of vomiting. This combination of binge eating and compensatory behavior should be observed at least once a week for three months.
Likewise, self-assessment and self-assessment are highly influenced by physical appearance and body condition. Finally, it is necessary to make a differential diagnosis with anorexia, where a low weight will be observed.
Phases of Bulimia (Eating Disorder)
Now that we know the necessary criteria that must be met to make a diagnosis of bulimia, it will be easier for us to understand the phases that bulimia goes through and the loop in which subjects with this pathology enter. It is possible to divide the behavior of bulimia into three phases, we must contemplate these as a circle or loop.
As we have mentioned, one of the essential criteria is the appearance of recurrent binge eating. In these episodes, the subject eats a large amount of food in a very short time. He loses control and eats the forbidden foods, which he avoids when he is on surveillance. The type of food can be of all kinds and in any condition, even without cooking. Thus, impulsive behavior is observed.
- Compensatory Behavior
Another criterion that this disorder presents is the performance of compensatory behaviors, which try to counteract the binge and reduce the discomfort caused by having eaten so much. Thus, behaviors such as taking medications (such as those prescribed for hypothyroidism) or laxatives, inducing vomiting, or exercising excessively will be carried out.
- Surveillance Phase
In this phase, the discomfort of having carried out the binge-eating behavior continues, so the subject sets a very strict exercise and eating plan, this restriction added to the continuous ruminative, repetitive thoughts about his lack of control over eating increases the risk of increasing your state of anxiety and stress, thus making it more likely that you will binge again.
How is bulimia classified?
Although the basic characteristics are the same and the aforementioned criteria of binge eating plus purging behavior must be met, we can differentiate between different types of bulimia depending on the compensatory behavior, whether it is related to the presence of obesity or not, the time of remission or severity of symptoms.
6 Types of Bulimia (Eating Disorder)
- Purging Bulimia
As the name indicates, this type of bulimia is characterized by the presence of a purging behavior as a compensatory behavior and to reverse the binge carried out .
In the same way, that the binge is not planned and responds more to impulsive behavior, in the case of purging behavior the same thing happens, the subject does it without thinking, without taking into account the negative consequences that it entails.
Purging behaviors are harmful to health and even more so if they are carried out repeatedly. These behaviors can range from causing vomiting, which if they occur continuously can damage the digestive tract due to the rise in gastric acids, to the use of laxatives, diuretics, or enemas.
The taking of drugs to treat hypothyroidism, that is, the consumption of thyroid hormone without a medical prescription or the abandonment of insulin by individuals with type I diabetes who need its administration has also been observed.
In the end, these behaviors affect the correct nutrition of the subject and the proper functioning of the body, not allowing the necessary nutrients to be absorbed. Purging-type bulimia is associated with greater severity of body distortion, a more intense desire to stay or become thin, and greater alteration in eating patterns. In short, greater severity of psychopathology, especially related to depressive and obsessive symptoms.
- Non-Purging Bulimia
In the case of restrictive bulimia, purging behavior is not observed, that is, compensatory behavior as such is not shown, but dangerous behaviors for the health of the individual are also present.
Restrictive behaviors usually consist of fasting, that is, the subject dangerously reduces the food consumed and/or excessive physical exercise, exceeding the recommended limits. These behaviors intend to compensate for binge eating.
We see how with this type of compensation we reduce the risk of the purging behaviors mentioned above, such as vomiting, but others are shown, such as a state of malnutrition and dehydration or fatigue or excessive muscle and physical wear, given the intense level of sport performed, also increasing the risk of suffering a cardiovascular accident.
- Bulimia Linked to Obesity or Overweight
Bulimia can be observed in subjects who are overweight (with a BMI of 25 or higher) or obese (with a BMI of 30 or higher), although these are not necessary conditions and we can diagnose bulimia in subjects with normal weight.
In these cases, we observe a predisposition to present this type of eating disorder, showing great importance given to physical appearance, weight, and body image. As we have already said, they carry out self-assessment and self-assessment depending on their physical state.
- Bulimia linked to Variable Weight
This type of bulimia is usually associated with subjects who show a tendency to carry out very restrictive and inappropriate diets that generate a yo-yo effect, which consists of a rapid weight loss that leads to weight regain even greater than the initial one, that is, You may weigh more than before you went on the diet. This type of highly variable pattern has been seen as more detrimental than being slightly overweight, which poses less of a health risk.
Likewise, subjects with this type of bulimia are normally described or defined as thin subjects, which means that they do not consider themselves to be obese since they interpret that their real state is that of thinness. For this reason, these patients are more reluctant to ask for professional help to continue and comply with the treatment adequately.
- Bulimia According to Remission
We will consider that bulimia is in partial remission when, after fulfilling all the criteria required for the diagnosis, some of them are currently shown but not all. Therefore, we will speak of bulimia in total remission when after showing all the criteria necessary for the diagnosis, for a considerable period and cur,rently, no criteria have been observed.
- Bulimia Nervosa according to Current Severity
Another way to classify bulimia is to assess the current severity shown by the subject, and what state it is in. The severity will be scored based on the number of inappropriate compensatory behaviors per week.
Thus, we will consider mild bulimia if the patient performs an average of 1 to 3 episodes of inappropriate compensatory behaviors per week, moderate bulimia if the average is 4 to 7 episodes of compensatory behaviors in a week, severe bulimia if the average amounts to 8 to 13 compensatory behaviors in one week or extreme bulimia provided that the average calculated in one week exceeds 14 episodes of compensatory behavior.