The 6 types of Bulimia: causes, symptoms and treatment

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 in order to make the diagnosis are the presence of recurrent binge eating, the performance of compensation, compliance with criteria at least once a week for three months and a self-assessment or self-assessment highly influenced by weight and image bodily.

Likewise, a characteristic pattern of the presence of the pathology is observed, frequently linked to a repetition in the form of a loop. A binge phase is performed, followed by a compensatory behavior phase and finally a phase of vigilance and increased restrictions. 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 obesity or variable weight, if symptoms are still shown or if 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.

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What is bulimia?

Bulimia is an eating 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. food in a short period of time, less than that used by the majority of the subject and a feeling of loss of control over eating behavior.

Criterion B that must also be shown is 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.

In addition, self-assessment and self-assessment is greatly 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.

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phases of bulimia

Now that we know the necessary criteria that must be met in order to make a diagnosis of bulimia, we it will be easier to understand the phases that bulimia goes through and the loop in which subjects enter with this pathology. It is possible to divide the behavior of bulimia into three phases, we must contemplate these as a circle or loop.

1. binge

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.

2. compensatory behavior

Another criterion that this disorder presents is the performance of compensatory behaviors, which They try to counteract binge eating 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.

3. surveillance phase

In this phase, the discomfort for having carried out the binge behavior continues, so the subject marks an exercise plan and very strict eating, this restriction added to the continuous ruminative, repetitive thoughts about his lack of control about eating increase the risk that they increase their state of anxiety and stress, thus making it more likely that they will return to show a binge

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 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 the severity of the symptomatology.

1. Purging or purging type bulimia

As the name indicates, this type of bulimia is characterized by the presence of a purging behavior as a compensatory behavior and with the purpose of reversing the binge carried out. In the same way, that binge eating is not planned and responds more to impulsive behavior, in the case of behavior purgative the same thing happens the subject does it without thinking, without taking into account the negative consequences that behaves.

Purging behaviors are harmful to health and even more so if they are carried out repeatedly. These behaviors can range from provocation of vomiting, which if they occur continuously can damage the digestive tract due to the rise in gastric acids, until the use of laxatives, diuretics or enemas Taking drugs to treat hypothyroidism, that is, taking thyroid hormone without prescription or discontinuation of insulin by individuals with type I diabetes who need their management.

At the end these behaviors obviously 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, greater alteration in eating patterns. In short, greater severity of psychopathology, especially related to depressive and obsessive symptoms.

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2. Non-purging or restrictive type bulimia

In the case of restrictive bulimia, purging behavior is not observed, that is, it does not show a compensatory behavior as such but there are also dangerous behaviors for the health of the individual. Restrictive behaviors usually consist of fasts, that is, the subject dangerously reduces the amount of food consumed and/or excessive physical exercise, exceeding the recommended limits. The intent of these behaviors is 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.

3. 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 superior), although these are not necessary conditions and we can make the diagnosis of 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.

4. Bulimia linked to variable weight

This type of bulimia is usually associated with Subjects who show a tendency to carry out very restrictive diets that are inappropriate that generate a yo-yo effect, which consists of a rapid weight loss that leads to a regaining weight even greater than the initial weight, that is, it can weigh more than before doing the diet. This type of highly variable pattern has been seen as more detrimental than being slightly overweight, which actually poses less of a health risk.

Also, subjects with this type of bulimia are usually described or defined as thin subjects, which It means that they do not consider themselves obese people 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 follow and comply with the treatment properly.

5. Bulimia according to referral

We will consider that bulimia is in partial remission when, after fulfilling all the criteria required for the diagnosis, currently some of them are shown but not all. Therefore we will speak of bulimia in total remission when after showing all the necessary criteria for diagnosis, for a considerable period of time and at present, no criterion.

6. Bulimia Nervosa According to Current Severity

Another way to classify bulimia is to assess the current severity shown by the subject, what state it is in. Severity will be scored based on the number of inappropriate compensatory behaviors per week.

A) Yes 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 is 8 to 13 behaviors compensatory in a period of one week or extreme bulimia provided that the average calculated in the period of one week exceeds 14 behavioral episodes compensatory.