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Bulimia nervosa - Diagnosis & evaluation

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All six of the criteria listed in the DSM are required for a classic diagnosis of bulimia nervosa. However, these symptoms are often difficult to spot, especially since, unlike anorexia nervosa, in order to be classified as bulimic the person must be of normal or higher weight. Likewise, the person is less likely to drop a significant amount of weight on a continual basis as does the anorectic, making the physical symptoms less noticeable, despite the fact that internal bodily functions are suffering. Because this disorder carries a great deal of shame, the bulimic will desperately try to hide their symptoms from family and friends. This disorder is more likely to span over a lifetime unnoticed, causing a great deal of isolation and stress for the suffering individual. Despite the frequent lack of obvious physical symptoms, bulimia nervosa has proven to be fatal, as malnutrition takes a serious toll on every organ in your body. If any of the symptoms above are noticed one should consult with a doctor or psychologist for further assistance [1].

Differences between anorexia nervosa and bulimia nervosaEdit

The main criteria differences involve weight, as an anorexic must technically be classified as underweight (defined as a BMI < 18). Typically an anorexic is defined by the refusal to maintain a normal weight by self-starvation. Another criteria which must usually be met is amenorrhea, the loss of her menstrual cycle not caused by the normal cessation of menustration during menopause. Generally the anorexic does not engage in regular binging and purging sessions. In the rare instant that this is observed, in that the patient binges and purges as well as fails to maintain a minimum weight they are classified as a purging anorexic, due to the underweight criteria being met. [2] Characteristically, those with bulimia nervosa feel more shame and out of control with their behaviors, as the anorexic meticulously controls her intake, a symptom that calms her anxiety around food as she feel she has control of it, naïve to the notion that it, in fact, controls her. For this reason, the bulimic is more likely to admit to having a problem, as they do not feel they are in control of their behavior. The anorexic is more likely to believe they are in control of their eating and much less likely to admit to needing help, or that a problem even exists in the first place. Similarly, both anorexics and bulimics have an overpowering sense of self that is determined by their weight and their perceptions of it. They both place all their achievements and successes as the result of their body, and for this reason are often depressed as they feel they are consistently failing to achieve the perfect body. For the bulimic, because she cannot achieve the low weight she feels physically that she is a failure and this outlook infiltrates into all aspects of her life. The anorexic cannot see that she is truly underweight and is constantly working towards a goal that she will never meet. Because of this misconception she will never be thin enough, and therefore will be always working towards this unattainable goal. She too allows this failure at achieving the “perfect body” to define her self worth. As both the anorexic and bulimic never feel satisfaction in the more important part of their lives, depression often accompanies these disorders.[3]


  2. Diagnostic Statistics Manual IV
  3. Durand, Mark, Barlow, David. "Essentials of Abnormal Psychology Fourth Ed." Thomson Wadsworth, CA 2006, ISBN 0-534-60575-3

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