The Realities and History of Bulimia Nervosa

The history, definition, and statistics of Bulimia.

I would first like to begin with one of the earliest things I learned about eating disorders, and to this day, I quote my therapist, “eating disorders fall on a continuum.” We have our most severe cases, in which we have been shown the images and told the stories dating back to Karen Carpenter. If you do not recognize the name, she was a well-known American musician whose battle with Anorexia brought the subject of eating disorders to light. Her diagnosis became the topic of discussion among medical professionals and brought about awareness. The problem was no longer ignored as a passing phase; instead, it was recognized as a disease that warranted treatment. Sadly, Karen passed away at just thirty-two years old. One pitfall is that many will compare themselves to the most severe cases they see in the media and deem they are not sick enough or don’t have a problem. This is why I bring up the continuum because even though you may not “look sick” or be severely ill and medically compromised, you still could have an eating disorder and deserve help! 

Promotional photograph of Karen Carpenter in 1973, from Wikipedia.

Some History.

 Thanks to Wikipedia, the modern day encyclopedia, we can easily dive into history and thumb through lots of facts. Even though Karen’s story brought the struggle into the spotlight in the 1970s, eating disorders can be traced back to medieval times. During this time, purification through denial of physical needs emerged as a cultural theme. In addition, many women saw food deprivation as a spiritual practice. It wasn’t until 1952 that Anorexia Nervosa was added to the Diagnostic Statistical Manual, also referred to as the DSM, the handbook used by many healthcare professionals in the United States and a guide worldwide for mental disorders—basically, a go-to for all things psychology. Anorexia was the first eating disorder to be recognized.

What about Bulimia Nervosa? That is what we are here focused on, right?! Bulimia was first thought of as a variation of Anorexia in 1979 by British psychiatrist Gerald Russell. It is documented in several publications that Russell first believed Bulimia to be a culturally bound condition and didn’t believe that historical cases of overeating and vomiting were relevant to the modern disease. You probably know, especially if you love history, that purging practices were acceptable and even encouraged by societies in ancient Egypt, Greece, and the most famous one, Rome. However, it seems that behaviors back then were driven more by preventing physical diseases that could come from the food of those times. Fast forward to the early 1900s, and some cases begin to report such behaviors plus fear of “fatness.” After Russell’s official findings, Bulimia Nervosa was added as the second eating disorder to the DSM in 1980.

Since the initial publication of the DSM, there have been subsequent editions. Revisions have been made and updated as research and our collective understanding have expanded. There are currently eight eating disorders recognized and defined in the DSM. Before I share the specific definition of Bulimia, obtained from Bulimia.com, I want to remind you of the continuum. Even if you don’t check off every box, you deserve help and the chance to heal. It is also important for me to say that we do NOT diagnose as Coaches. We also do not advise you to self-diagnosis. I share this solely for informational and educational purposes. 

Current criteria for Bulimia.

1. Recurrent episodes of binge eating, as characterized by both a and b:

2. a) Eating, within any 2-hour period, an amount of food that is definitively larger than what most individuals would eat in a similar period of time under similar circumstances.

   b) A feeling that one cannot stop eating or control what or how much one eats.

3. Recurrent inappropriate compensatory behaviors to prevent weight gain, such as “Purge Type:” self-induced vomiting and “Non-Purge Type:” misuse of laxatives, diuretics, or other medications; fasting or excessive exercise.

4. Binge eating, and inappropriate compensatory behaviors occur, on average, at least once a week for 3 months.

5. Self-evaluation is unjustifiability influenced by excessive concern about body shape and weight.

There are also subtypes of Anorexia Nervosa that can have similar behaviors to Bulimia. This means one meets the criteria for Anorexia but also engages in either c or d.

1. c) The Purging type: One regularly engages in self-induced vomiting or misusing laxatives, diuretics, or enemas.
2. d) The Non-Purging Type: One has used inappropriate compensatory behaviors, such as fasting or excessive exercise.   

Let’s look at some statistics. 

According to the Institute for the Psychology of Eating, which is where I studied and gained my first coaching certification:

• An estimated 108 million Americans are on a diet.
• 9 out of 10 women in the US are unhappy with their appearance.
• 81% of 10-year-old girls experience a fear of being fat.
• Adolescent girls are more afraid of gaining weight than getting cancer.
• 2 out of 5 women would give up 3-5 years of their life in exchange for weight loss.
• 97% of women confess they have at least one “I hate my body moment” daily.

These are sobering and very sad statistics as a collective. Now let’s look at a combination of statistics from Bulimia.com, American Addiction Centers, and ANRED, Anorexia and Related Eating Disorders when the above are combined with other environmental, psychological, temperamental, and genetic factors leading to Bulimia.  

• 1.5 percent of the US female population, which is 4.7 million, has experienced Bulimia in their lifetime.
• For men, yes, they can struggle too; it is .05 percent, which is 1.5 million. 
• Roughly 4% of college-aged women have Bulimia. 
• Yet Bulimia has also been seen in children as young as six and among senior citizens. 
• 50% of people who have had Anorexia will develop Bulimia.
• 70% of people with Bulimia have IBS, Irritable Bowel Syndrome
• 60% of people with Bulimia also have depression and/or anxiety.
• 25% of people with Bulimia shows sign of PTSD, Post Traumatic Stress Disorder 

Lastly, here are some more facts that are interesting:

• People who diet are five times more likely to develop an eating disorder than those who don’t.
• Those who diet more frequently are eighteen times more likely to develop an eating disorder.
• People who struggle with Bulimia are usually average or above weight. This last fact usually surprises people. 

While history, research, facts, and statistics tell a story, it is limited and ever evolving. We know eating disorders live and thrive in secret, especially Bulimia, and there is ambivalence in seeking help. For those reasons, and I am sure you will agree, the numbers are likely much higher than we can imagine. Merrit and I are here to help change this!

With Love & Light,

With Love & Light,

Sarah Lee

Sarah Lee is a Certified Eating Disorder Recovery Coach with four professional certifications, including one from the esteemed Carolyn Costin Institute. Since 2016, she has run a private practice currently located in Dallas, TX, assisting clients globally along with mentoring newer recovery coaches.

Posted on September 14th, 2023.

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Resources: Wikipedia, Institute for the Psychology of Eating, Bulimia.com, American Addiction Centers, ANRED, Anorexia and Related Eating Disorders