Eating disorders: Bulimia nervosa


Dr Sacrifice Chirisa Mental Health Matters
Among the eating disorders, bulimia nervosa and anorexia nervosa are far more common in young females, while the binge-eating disorder, which is the most common eating disorder, is largely more common in adults. Bulimia nervosa includes regularly occurring compensatory behaviours that are intended to rid the body of the excess calories consumed during eating binges. Compensatory behaviours may include purging and or non-purging behaviours.

Up to 60 percent of patients with bulimia nervosa report prior histories of anorexia nervosa. People with bulimia nervosa are more typically of normal weight. Bulimia nervosa is characterised by frequent episodes of binge eating associated with emotional distress and a sense of loss of control. Binge eating is defined as eating, in a discrete period of time (e.g, 2 hours) an amount of food that is significantly larger than is typical for most people during the same defined period. This behaviour is associated with a perceived loss of control of eating during this time.

Compensatory behaviours used by individuals with bulimia nervosa include:

  • · Self-induced vomiting
  • · Laxative abuse
  • · Excessive exercise generally experienced as being joyless and or compulsive
  • · Episodes of fasting
  • · Strict dieting
  • · Diuretic abuse
  • · Use of appetite suppressants
  • · Use of medications intended to speed up metabolism

The diagnostic criteria requires episodes of binge eating to occur at least once weekly for three months and associated with dissatisfaction with their body shape, weight, or both. Severity is based on the frequency of inappropriate compensatory behaviours;

Mild: An average of 1-3 episodes of inappropriate compensatory behaviours per week

Moderate: An average of 4-7 episodes of inappropriate compensatory behaviours per week

Severe: An average of 8–13 episodes of inappropriate compensatory behaviours per week

Extreme: An average of 14 or more episodes of inappropriate compensatory behaviours per week

Physical findings in these persons may include the following:

Bilateral parotid gland enlargement hypertrophy.

Dental damage

Cutaneous manifestations, including sudden, diffuse hair loss, acne, dry skin, nail dystrophy.

Clinical obesity

Management of this condition involves at the core non-pharmacologic interventions including but not limited to the following psychological treatments:

Cognitive-behavioral therapy (CBT)

Interpersonal psychotherapy (IPT)

Nutritional rehabilitation counselling

Family therapy

Pharmacologic agents used in the treatment of bulimia nervosa are use to treat concurrent psychiatric illnesses that accompany most eating disorders and includes the use of Fluoxetine (Prozac) the main drug used in treatment.

Antidepressants are the mainstay of pharmacotherapy for bulimia nervosa; they may help patients with substantial concurrent symptoms of depression, anxiety, obsessions, or certain impulse disorder symptoms. The main reason why I have written these last two articles is due to the increase of eating disorders in the name of weight loss and exercise. I believe it is time to seek professional help when it comes to your weight loss issues and for those in the medical fraternity to refer people for psychiatric and psychological evaluations when there is a great indication or suspicion of any or the related eating disorders we have been discussing.


This column contains information about mental health related issues. However, the information is not advice, and should not be treated as such. The writer accepts no responsibility for misuse and misrepresentation caused by the use or misunderstanding of this article. No warranties or assurances are made in relation to the safety and content of this article and attachments. Sender accepts no liability for any damage caused by or contained in any attachments. No liability is accepted for any consequences arising from this article.

  • Dr S.M. Chirisa is a passionate mental health specialist who holds an undergraduate medical degree and post graduate Master’s degree in psychiatry both from the University of Zimbabwe. He is currently working as a Senior Registrar in the Department of Psychiatry at Parirenyatwa Group of Hospitals and is also the current national treasurer of the Zimbabwe Medical association (ZiMA). He can be reached at [email protected]

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