THE 2 TYPES OF BULIMIA AND THEIR CHARACTERISTICS - ECONOMÍA

There are two main types of bulimia: purgative and non-purgative. Many people consider bulimia nervosa to be an eating disorder in which people binge and then engage in compensatory behaviors, such as vomiting or using laxatives.

Although this brief description contains some truthful information, with this article I intend to give you a more real and complete view of this mental illness: characteristics, causes and types - purgative versus non-purgative.

Types of bulimia nervosa

Non-purgative bulimia nervosa

This subtype is much less common, since it only occurs in 6-8% of cases. Therefore, it is not surprising that it is also the least known. These are people who do not resort to vomiting or other compensatory methods of this type after binge eating - they do not use laxatives, edema, etc.-.

In this type of bulimia nervosa, the main method used to lose weight is intense physical exercise, as well as using fasting and dieting. These long periods of starvation are the cause of the binge to occur again, since the person experiences a voracious hunger that he is not able to control.

Once again, after this binge-eating episode, the girl will feel remorse and guilt, again depriving herself of food or exercising excessively.

These methods of weight control are very ineffective in eliminating the number of calories ingested from the body in a single binge. Intense physical exercise and subsequent fasting also usually occurs in the purgative subtype of bulimia nervosa, although in a secondary way.

The consequences produced by this subtype of bulimia nervosa in the body are much less pronounced than the purgative subtype, as we will see later.

Purgative bulimia nervosa

The vast majority of people with bulimia nervosa are classified as the purgative type, which is characterized by the presence of vomiting and the use of laxatives or enemas after bingeing.

The objective of these people is to eliminate as soon as possible the largest possible proportion of food eaten, to end the anxiety that causes them to think that they are going to gain weight. They also have irrational thoughts about the functioning of the body.

For example, some girls eat a food of a characteristic color first, such as a red tomato, and insist on vomiting until the vomit is the same color (since it was the first food ingested and it means that there is no longer any nothing in the stomach).

This and other types of completely erroneous information are transmitted daily through social networks and pages about anorexia and bulimia.

Despite the fact that these pages are continually persecuted and censored, they reappear under another name and with the same intention: to transmit information that they consider to be true, to hold competitions to see who loses more weight in a short period of time, to support each other, etc.

On the other hand, although this type of anorexia nervosa has similarities with a type of anorexia nervosa –purgative subtype-, in this type of bulimia nervosa the girls are not underweight.

In fact, in bulimia nervosa -in both types- the girls are normal weight or have some kind of overweight. This subtype is the one that produces the greatest negative effects, both in relation to the damage suffered by the body and the behaviors and thoughts that show:

These girls are seen to have a greater desire to be slim, which leads them to become obsessed with losing weight.
There is also a more serious body distortion or, what is the same, they perceive a greater difference between their real silhouette and the one they have in front of the mirror.
Furthermore, eating patterns are found to be more abnormal than in the case of non-purgative bulimia nervosa.
Finally, it is found that it is more common to find associated mental disorders in this subtype, especially those related to the state of mind

- such as depression - and those that include obsessive thoughts.

Common features

In 50% of cases, amenorrhea occurs in women (loss of menstruation as a result of the disorder). Furthermore, we found that the personality characteristics of girls who suffer from bulimia nervosa are similar, regardless of the subtype:

Emotional instability.
Impulsiveness.
They tend to have other addictions –to tobacco, alcohol, drugs, etc.-
They are very sociable.
They tend to behave in a very impulsive, uncontrolled and - in some cases - hostile.

In both subtypes of bulimia nervosa, two triggers for binge eating are:

Carrying out diets.
Experience high negative affect.

What is the nervous bulimia?

It is a mental disorder characterized by the performance of maladaptive behaviors in relation to the food environment. Following the DSM-IV-TR Diagnostic Manual, this disorder has three essential characteristics:

Loss of control over food intake ("binge eating" occurs).
Numerous attempts to control body weight.
Excessive worry about body image and weight.

It is a mental illness that mainly affects women, as occurs in anorexia nervosa (95% of patients belong to the female gender). The age of onset of the disorder ranges between 18-25 years, which is why it presents later than anorexia nervosa.

In addition, unlike anorexia, in bulimia nervosa, girls are never underweight or underweight according to their body constitution and age.

Binge Features

On the other hand, regarding the characteristics of binge eating - which is the most significant factor in this disease - the following can be highlighted:

The person does not feel pleasure during the episode of massive ingestion.
They eat highly caloric foods, which they prohibit themselves in their restrictive diets (with a caloric content of 3 to 27 times higher than recommended in a day).
They are produced in a short period of time.
These episodes are usually carried out in secret.
It causes abdominal pain and, frequently, feelings of regret or guilt also occur.
They do not occur during meal times - in which they tend to have a restrictive diet - but between meals.
It can also occur outside the home, through the purchase or theft of food.

The bulimic patient makes an effort to hide her illness, carrying out these compensatory binges and behaviors without her relatives noticing. These behaviors aimed at hiding the problem are characteristic of people with bulimia nervosa and are sometimes complicated by lies.

In addition, since there is no significant loss of body weight, this eating disorder often goes unnoticed by family and friends.

Common symptoms

The behaviors carried out by people with bulimia nervosa, especially vomiting, usually cause deterioration in the body. Some of the most frequent symptoms and signs are:

Feeling of fatigue and physical weakness.
Headaches
Feeling of fullness or satiation (in relation to food).
Sickness.
Gastric discomfort.
Intestinal bleeding, which is usually mild or moderate.
Signs on the back of the hand (calluses, scars, etc.).
Increase in the size of salivary glands.
Erosion in teeth.
Swollen hands and feet

These vomiting are the most recurrent compensatory mechanism in the disease - sometimes it is also accompanied by the use of laxatives - and are produced by the feeling of guilt and regret that girls suffer.

This behavior, like the intense exercise, the use of other methods to expel the ingested food or the subsequent fasting, is the only way in which these people are able to reduce the anxiety suffered after a binge.

Regarding the consequences that this disease has in their day to day, we find that there is usually a deterioration or abandonment of studies, since addiction to food takes all their time.

Causes

This mental disorder has a multicausal origin, in which the pursuit of thinness to be more attractive is not the only reason for people to develop the disease.

Genetic and family causes

It seems that there are genetic relationships that predispose a person to suffer from the disease, since there is a greater probability of developing it when a family member also has an eating disorder.

Of course, here it is difficult to delimit the cases in which the influence is merely genetic or when, on the contrary, what is acquired are the bad habits that family members learn from each other in relation to food.

Psychological causes

Among the most relevant psychological causes for developing this type of disorder is having low self-esteem, which can make the person more vulnerable and give more importance to their figure.

It has also been found that girls who have experienced a particularly traumatic experience - such as having been a victim of sexual abuse or physical violence - are more likely to present this disorder.

Socio-cultural causes

Of course, it is not by chance that there is an increase in this type of disorder in societies in which special importance is given to the slim figure.

The media, the messages we receive from the people around us - criticism for being overweight or praise for losing weight - empower us to seek this ideal of beauty in ourselves.

In addition, there are professions in which the image takes on special relevance: models, television presenters, etc.

Associated psychopathology

According to some authors, in 63% of the cases of bulimia nervosa there is a personality disorder. As you can imagine, the presence of a personality disorder complicates the course and recovery from the disease. In the case of women with bulimia nervosa, the most common is borderline personality disorder.

It is a disorder characterized by unstable social relationships, risky sexual behaviors, substance abuse (alcohol or drugs), a labile or unstable emotionality and frequent feelings of emptiness.

Authors such as Dolan (1994) have pointed out that this borderline personality disorder occurs in 24% to 44% of cases of bulimia nervosa.

Another type of associated psychopathology, which is frequently found in patients with bulimia nervosa, is depression, impulsivity, anxiety, low self-esteem and greater egocentricity.

All this influences that people with bulimia nervosa present high-risk behaviors, such as robberies and suicide attempts.

References

Echeburúa, E., & Marañón, I. (2001). Comorbidity of eating behavior disorders with personality disorders. Behavioral Psychology, 9 (3), 513-525.
Del Cioppo, GF (2006). The cyclical present of bulimic crises. Anuario de Investigaciones, 13, 15-18.
Lobera, IJ (2011). Bulimia nervosa and treatment with isoretinoin. Eating Disorders, (13), 1481-1489.
Mora Giral, M., & Raich, RM (1994). Food restriction and bulimia nervosa: A causal link?
Salorio del Moral, P., Campillo Cascales, M., Espinosa Gil, R., Pagán Acosta, G., Oñate Gómez, C., & López, I. (2011). Personality disorders and anorexia nervosa and bulimia. A study with the MCMI-III. Psychology. com, 15.
Sánchez-Carracedo, D., Mora, M., Raich, RM, & Torras, J. (1999). Bulimia nervosa Beyond DSM-IV? Anuario de psicología / The UB Journal of psychology, 30 (2), 97-116.
Sierra Puentes, M. (2005). Nervous Bulimia and its subtypes. Diversitas: Perspectives in Psychology, 1 (1), 46-62.

THE 2 TYPES OF BULIMIA AND THEIR CHARACTERISTICS - ECONOMÍA - 2025