Am I Experiencing Bulimia?

Bulimia (bulimia nervosa) is a condition characterized by frequent, recurrent episodes of binge eating. These are distinct periods of time when the individual experiences a subjective loss of control over their food intake, eats notably more or differently than usual, and feels unable to stop eating or limit the type or amount of food eaten. This binge eating is accompanied by repeated inappropriate compensatory behaviors aimed at preventing weight gain (e.g. self-induced vomiting, misuse of laxatives or enemas, strenuous exercise). Bulimia is experienced by between 1 and 3 people out of every 100 (van Eeden, van Hoeken, Hoek, 2021).

The DSM-5 diagnostic criteria for bulimia include:

• Recurrent episodes of binge eating, characterized by both:
• Eating, in a discrete period of time, an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
• Feeling a lack of control over eating during the episode.
• Recurrent inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, other medications, fasting, or excessive exercise.
• Binge eating and compensatory behaviors that occur, on average, at least once a week for 3 months.
• Self-evaluation that is unduly influenced by body shape and weight.

The ICD-11 diagnostic criteria for bulimia nervosa include: 

• Frequent, recurrent episodes of binge eating – defined as a discrete period of time (e.g., 2 hours) during which the individual experiences a loss of control over their eating, and eats notably more or differently than usual. Loss of control may be described by the individual as feeling like they cannot stop or limit the amount or type of food they eat, finding it hard to stop eating once they have started, or giving up even trying to control their eating because they know they will overeat.
• Repeated inappropriate compensatory behaviors to prevent weight gain. The most common compensatory behavior is self-induced vomiting, which typically occurs within an hour of binge eating. Other such behaviors include fasting or using diuretics to induce weight loss, using laxatives or enemas to reduce the absorption of food, omission of insulin doses in individuals with diabetes, and strenuous exercise to greatly increase energy expenditure.
• An excessive preoccupation with body weight or shape. When not explicitly reported, this may be manifested by behaviors such as repeatedly checking body weight using scales, repeatedly checking one’s body shape using tape measures or reflections in mirrors, constantly monitoring the calorie content of food or searching for information on how to lose weight. It can also lead to extreme avoidant behaviors, such as refusing to have mirrors at home, avoiding tight-fitting clothes, and refusing to know one’s weight or purchase clothing with specified sizing.
• A marked distress about the pattern of binge eating and inappropriate compensatory behaviors, or significant impairment in one’s personal, family, social, educational, occupational or other important area of functioning.

Am I Experiencing Bulimia? is an indicative screening tool, designed to help clients self-assess whether their experiences might warrant further investigation. It is not intended to give a formal diagnosis or provide a measure of severity.

“Some people who report similar experiences to yours have a condition called bulimia. I wonder if you might like to try a short quiz, to could give us an idea whether this problem troubles you?”

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
• Stansfeld, S., Clark, C., Bebbington, P., King, M., Jenkins, R., & Hinchliffe, S. (2016). Chapter 2: Common mental disorders. In S. McManus, P. Bebbington, R. Jenkins, & T. Brugha (Eds.), Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital. 
• van Eeden, A. E., van Hoeken, D., & Hoek, H. W. (2021). Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Current Opinion in Psychiatry, 34, 515-524. 
• World Health Organization. (2019). ICD-11: International classification of diseases (11th revision). Retrieved from https://icd.who.int/