Bulimia nervosa is an eating disorder characterized by a cycle of binge eating—consuming a large amount of food—followed by attempts to compensate for it. These compensatory behaviors are intended to prevent weight gain.

Bulimia Nervosa

Binge eating disorder (BED), officially recognized by the American Psychiatric Association in the DSM-5 since 2013, is characterized by recurrent episodes of consuming large amounts of food. Unlike bulimia nervosa, these binges are not followed by compensatory behaviors such as purging. A key diagnostic feature is the significant psychological distress, including feelings of guilt and embarrassment, that occurs after a binge, which distinguishes the disorder from simple overeating.

Binge Eating Disorder (BED)

References for Bulimia Nervosa 

Pica is an eating disorder in which an individual compulsively consumes inedible items. The inedible items consumed vary by those with the disorder.

Pica

Rumination disorder is an eating disorder where an individual unconsciously regurgitates food immediately after eating. This eating disorder is rare and is most common in children.

Rumination Disorder

A disorder commonly found in children, ARFID can be described as extremely picky eating, though fear foods differ significantly from those with anorexia nervosa and bulimia nervosa. Although ARFID involves food restriction and thus shares some features with anorexia nervosa, the fear and restriction surrounding food is not due to concerns about weight or body image. 

Avoidant/Restrictive Food Intake Disorder (ARFID)

Bulimia nervosa. Johns Hopkins Medicine. (2023, January 31). https://www.hopkinsmedicine.org/health/conditions-and-diseases/eating-disorders/bulimia-nervosa 

Cleveland Clinic. (2022). Pica. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22944-pica 

Mayo Foundation for Medical Education and Research. (2018, May 5). Binge-eating disorder. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/binge-eating-disorder/symptoms-causes/syc-20353627 

Mayo Foundation for Medical Education and Research. (2020a, October 14). Rumination syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rumination-syndrome/symptoms-causes/syc-20377330 

Meczekalski, B., Podfigurna-Stopa, A., & Katulski, K. (2013). Long-term consequences of anorexia nervosa. Maturitas, 75(3), 215–220. https://doi.org/10.1016/j.maturitas.2013.04.014

References for Eating Disorders: Consequences

Other Specified Feeding and Eating Disorder (OSFED) is a category of eating disorders in which individuals do not meet full criteria for other eating disorders. Around 30% of individuals diagnosed with an eating disorder fall into this classification.

Other Specified Feeding and Eating Disorder

Eating disorders, particularly conditions like bulimia nervosa and anorexia nervosa, are associated with a wide range of severe and adverse health consequences.

Adverse Health Consequences of Eating Disorders

Anorexia nervosa is an eating disorder defined by maintaining a body weight significantly below average, which is achieved through methods like starvation or excessive exercise. A central characteristic of this disorder is a distorted body image, a form of body dysmorphia, where individuals perceive themselves as overweight despite being underweight.

Anorexia Nervosa

A person begins a new diet and exercise regimen with the goal of losing 10 pounds. They start counting calories and increase their physical activity. Which of the following additional observations would be the strongest indicator that this behavior is evolving into a clinical eating disorder?

In contrast to the widespread issue of being overweight, a significant minority of the population suffers from eating disorders, which commonly lead to being underweight. These conditions, such as bulimia nervosa and anorexia nervosa, are often characterized by an intense fear of gaining weight and can result in numerous negative health effects.

University of Maryland, College Park

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University of Chicago

Eating is a fundamental motivated behavior driven by the biological need for survival. The regulation of hunger and eating involves complex physiological mechanisms. However, this behavior is not solely biological; it is also significantly shaped by powerful social, cultural, and economic influences. Understanding eating behavior requires examining both the physiological processes and the external factors that affect it, as well as the adverse consequences of disordered eating.

Hunger and Eating as a Motivated Behavior

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

Hunger is driven by several physiological signals that prompt feeding behavior. These include physical cues, such as stomach contractions or 'hunger pangs' that occur when the stomach is empty, and chemical messages sent to the brain. A key chemical trigger is a drop in blood glucose levels, which prompts the pancreas and liver to release signals that initiate the drive to eat.

Physiological Mechanisms of Hunger

Obesity is characterized by an individual weighing more than what's defined as a "healthy" weight for their gender and height. It can be broken into three classifications based on Body Mass Index (BMI):
- Overweight
- Obese
- Severe Obesity 

Obesity 

Eating Disorders 

Beyond the biological drive for sustenance, eating behavior is heavily influenced by a variety of non-physiological factors. These include social contexts, cultural norms and traditions related to food, and economic conditions that affect food availability and choice.

Non-Physiological Influences on Eating Behavior

Satiation, the feeling of fullness that stops eating, is controlled by several physiological signals sent to the brain. Key mechanisms include rising blood glucose levels, which cause the pancreas and liver to send 'shut-off' signals; feedback from the passage of food through the gastrointestinal tract; and the release of the satiety hormone leptin from fat cells.

Physiological Mechanisms of Satiation

The brain acts as the central command center for regulating eating by integrating the various physiological signals for both hunger and satiety. This integration process, which occurs in key areas like the hypothalamus and hindbrain, ultimately determines whether an individual engages in feeding behavior.

Brain's Integration of Hunger and Satiety Signals

The regulation of eating can be understood as a cycle that begins with hunger, a signal initiated in the brain's hypothalamus. This drive leads to the consumption of food. After eating, satiety signals, originating from the stomach, contribute to a feeling of fullness and satisfaction, which in turn stops the eating behavior.

The Hunger-Satiety Cycle

An individual's body weight is influenced by a complex interplay of factors. These include biological elements like gene-environment interactions and metabolic rate, behavioral aspects such as the balance between calories consumed and expended, and broader societal factors like socioeconomic status and the physical environment.

Factors Determining Body Weight

Analyze the individual's behavior in the following scenario. Explain which factors are likely influencing their decision to eat, distinguishing between their physiological state and other potential influences.

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