What is non-purging bulimia?

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Non-purging bulimia is a type of bulimia nervosa (BN) in which excessive exercise or fasting follows binge episodes to compensate for food consumed, instead of self-induced vomiting. Using diet pills is another option. 

People who have bulimia consume  large amounts of food over a short period of time with no self-control and then purge the food by vomiting, exercising excessively, fasting, or using laxatives, diuretics, or appetite restriction medication. They have a negative body image and are obsessed with their body weight and shape.

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In this article

How does non purging bulimia present differently? 

The differences between purging and non purging bulimia are as follows:

Bulimia with purging symptoms

  • Body image distortion.
  • Disordered eating.
  • Anxiety.
  • Perfectionism.
  • Shame and distress after binging.
  • Low self-esteem.
  • Self hatred.
  • Binging episode: followed by self-induced vomiting or misuse of laxative.
  • Obsession with weight loss.
  • Privacy surrounding behaviors: both binging and purging are done privately.
  • No self control during binges.

Non-purging bulimia symptoms

  • Body image distortion.
  • Disordered eating.
  • Anxiety.
  • Perfectionism.
  • Shame and distress after binging: after binging but not the excessive exercise.
  • Low self-esteem.
  • Self hatred.
  • Binging episode: followed by excessive exercise or fasting.
  • Obsession with weight loss.
  • Privacy surrounding behaviors: only the binging is done privately. Other compensatory behaviors are not done privately.
  • No self control during binges.

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Signs and symptoms of non-purging bulimia

There are many signs of non-purging bulimia, including: (1,2)

  • Behaviors and views focused on weight loss, dieting, and physical appearance
  • Rigid rituals surrounding food and eating
  • Eliminating or only eating certain foods or food groups
  • Avoiding eating with other people
  • Eating in secret
  • Hiding or hoarding food
  • Disappearance of large amounts of food
  • Hiding empty food containers and packaging
  • Skipping meals
  • Fluctuating weight
  • Mood swings
  • Gastrointestinal pains
  • Dizziness, fatigue, weakness
  • Feeling cold
  • Sleep problems
  • Dry skin, brittle nails, thinning hair
  • Swelling

Treatment for non-purging bulimia

Like other eating disorders and mental health conditions, non-purging bulimia is very complex with many risk factors and co-occurring conditions, such as childhood trauma, dysfunctional personal relationships and family dynamics, anxiety, and depression. Non-purging bulimia is best addressed with a comprehensive treatment plan with a multidisciplinary approach that can include psychotherapy, medical care to address medical complications, nutrition therapy, movement therapy, and experiential therapies. Treatment programs are individualized to suit each person’s needs.

Cognitive behavioral therapy (CBT) is one type of psychotherapy that can be effective for non-purging bulimia. One study found a full remission rate of 35.5% with this type of group therapy over the course of 22 weekly sessions.(3) However, there are other therapies that have had positive outcomes in treating eating disorders. 

They include:

  • Acceptance and commitment therapy (ACT)
  • Cognitive behavioral therapy (CBT)
  • Cognitive remediation therapy (CRT)
  • Dialectical behavioral therapy (DBT)
  • Emotionally focused therapy (EFT)
  • Exposure therapy
  • Internal family systems (IFS)
  • Interpersonal therapy (IPT)

Experiential treatments for bulimia can help a person heal by getting them out of their mind and into their body. They include:

  • Art therapy
  • Dance therapy
  • Music therapy
  • Psychodrama
  • Wilderness therapy
  • Recreational therapy
  • Yoga therapy
  • Adventure therapy

Always remember it’s not your fault. An eating disorder can be a way to cope with difficult feelings or situations and society’s sometimes unrealistic expectations about appearance. But there are healthier ways to deal with hard things. An individualized treatment plan can help you learn how to love your body and how to feel good about yourself and how  to have a healthy relationship with food, eating, movement, yourself, and others. These are some things treatment for eating disorders will address. 

Many programs have high success rates. (11) Asking for help if you think you or someone you love may be struggling with an eating disorder is not easy. But help is available. Reach out to our team today to learn more about our virtual program.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Harrington BC,Jimerson M,Haxton C,Jimerson DC, Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. American family physician. 2015 Jan 1;     [PubMed PMID: 25591200]
  2. Bulimia Nervosa. (n.d.). National Eating Disorder Association. Retrieved April 13, 2022 from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bulimia 
  3. Aguera Z, Riesco N, Jimenez-Murcia S, et al. Cognitive behaviour therapy response and dropout rate across purging and nonpurging bulimia nervosa and binge eating disorder: DSM-5 implications. BMC Psychiatry. 2013;13:285. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4226246/ 
  4. Manlick, C.F., Cochran, S.V. & Koon, J. Acceptance and Commitment Therapy for Eating Disorders: Rationale and Literature Review. Journal of Contemporary Psychotherapy 43, 115–122 (2013). https://doi.org/10.1007/s10879-012-9223-7
  5. Huurne, E.D.T., de Haan, H.A., Postel, M.G., et al. Long-term effectiveness of web-based cognitive behavioral therapy for patients with eating disorders. Eating & Weight Disorders. 2021 Apr;26(3):911-919. https://pubmed.ncbi.nlm.nih.gov/32449152/ 
  6. Kass, A. E., Kolko, R. P., & Wilfley, D. E. (2013). Psychological treatments for eating disorders. Current Opinion in Psychiatry, 26(6), 549–555. https://doi.org/10.1097/YCO.0b013e328365a30e
  7. Iryna Ivanova & Jeanne Watson (2014) Emotion-focused therapy for eating disorders: enhancing emotional processing. Person-Centered & Experiential Psychotherapies, 13:4, 278-293, DOI: 10.1080/14779757.2014.910132
  8. Butler, R.M., Heimberg, R.G. (2020). Exposure therapy for eating disorders: A systematic review. Clinical Psychology Review, Volume 78. https://doi.org/10.1016/j.cpr.2020.101851. (https://www.sciencedirect.com/science/article/pii/S0272735820300398)
  9. Lester, R. J. (2017). Self-governance, psychotherapy, and the subject of managed care: Internal Family Systems therapy and the multiple Self in a US eating-disorders treatment center. American Ethnologist, 44(1) 23-35.
  10. Miniati, M., Callari, A., Maglio, A., & Calugi, S. (2018). Interpersonal psychotherapy for eating disorders: Current perspectives. Psychology Research and Behavior Management, 11, 353-369.
  11. Keel, P. K., & Mitchell, J. E. (1997). Outcome in bulimia nervosa. The American Journal of Psychiatry, 154(3), 313–321. https://doi.org/10.1176/ajp.154.3.313

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