health

The Diagnostic and Statistical Manual of Mental Disorders, fourth edition
(DSM-IV), the reference that doctors use to diagnose mental illness, specifies
that a person must have an eating binge and try to compensate for
it on average twice a week for three months to meet the diagnostic criteria
for bulimia. A binge is an episode in which someone consumes a
larger amount of food within a limited period of time than most people
would eat in similar circumstances. Most bulimics report feelings of loss
of control associated with bingeing. A second criterion of bulimia is
excessive concern with one’s body shape and weight.
There are two subtypes of bulimia, purging and nonpurging,
according to the methods used by the patient to prevent gaining weight
after a binge. People who have the purging subtype use vomiting, laxatives,
enemas, or diuretics to keep from gaining weight; in the nonpurging
subtype, the person fasts or overexercises to prevent weight gain. The
important point is that bulimics do something after a binge to compensate
for their eating. There is another type of eating disorder called
binge eating disorder, in which the person has eating binges but does not
try to vomit, exercise, or do anything else to prevent gaining weight.

Princess Diana and Bulimia

Princess Diana (1961–1997) is sometimes credited with bringing bulimia
out into the open by talking to the press about her own struggles with
the disorder. The princess gave an interview in 1995 in which she described
her bulimia: “I had bulimia for a number of years. And that’s like a
secret disease. You inflict it upon yourself because your self-esteem is at
a low ebb, and you don’t think you’re worthy or valuable. You fill your
stomach up four or five times a day—some do it more—and it gives you
a feeling of comfort. It’s like having a pair of arms around you, but it’s
temporary, temporary. Then you’re disgusted at the bloatedness of
your stomach, and then you bring it all up again. . . . It was a symptom of what
was going on in my marriage.”
When asked by the interviewer whether she had asked for help from
anyone else in the royal family, Diana said, “You have to know that when
you have bulimia you’re very ashamed of yourself and you hate yourself
and people think you’re wasting food—so you don’t discuss it with
people. And the thing about bulimia is your weight always stays the same,
whereas with anorexia you visibly shrink. So you can pretend
the whole way through. There’s no proof.”