From the Guidelines
Compensatory actions in bulimia and anorexia are behaviors that individuals engage in to prevent weight gain or promote weight loss, including self-induced vomiting, misuse of laxatives or diuretics, fasting, and excessive exercise in bulimia, and extreme calorie restriction, excessive exercise, and sometimes purging in anorexia. These behaviors are driven by an intense fear of weight gain and distorted body image, as noted in the American Psychiatric Association's practice guideline for the treatment of patients with eating disorders 1.
Key Compensatory Actions
- In bulimia, compensatory actions typically include:
- Self-induced vomiting
- Misuse of laxatives or diuretics
- Fasting
- Excessive exercise following binge eating episodes
- In anorexia, compensatory behaviors focus on:
- Extreme calorie restriction
- Excessive exercise
- Sometimes purging through vomiting or laxative abuse, even without binge eating
According to the guideline, treatment for these conditions should involve a comprehensive, individualized, and person-centered treatment plan that incorporates medical, psychiatric, psychological, and nutritional expertise 1. For adults with bulimia nervosa, the APA recommends eating disorder-focused cognitive-behavioral therapy and a serotonin reuptake inhibitor, such as 60 mg fluoxetine daily 1. For anorexia nervosa, the APA recommends individualized goals for weekly weight gain and target weight, as well as eating disorder-focused psychotherapy for adults, and family-based treatment for adolescents and emerging adults with involved caregivers 1.
Treatment Considerations
- Psychotherapy, particularly cognitive-behavioral therapy, is a crucial component of treatment
- Nutritional counseling is essential for addressing nutritional deficiencies and promoting healthy eating habits
- Medications like SSRIs, such as fluoxetine, may be prescribed to help manage symptoms of bulimia and other eating disorders 1
From the Research
Compensatory Actions in Bulimia and Anorexia
- Compensatory behaviors in eating disorders, such as bulimia and anorexia, include extreme dieting, skipping meals, self-induced vomiting, excessive exercise, and misuse of laxatives and diuretics for the purpose of maintaining or reducing body weight 2.
- These behaviors are used to prevent weight gain after binge eating episodes, which are characteristic of bulimia nervosa, and are also seen in individuals with anorexia nervosa 3.
- The presence of these compensatory behaviors is a key diagnostic criterion for bulimia nervosa, and they can have serious medical complications, such as electrolyte imbalances and gastrointestinal problems 3.
- Individuals with anorexia nervosa may also exhibit compensatory behaviors, such as excessive exercise, in an attempt to maintain a low body weight 2.
- Research has shown that eating disordered patients, including those with anorexia and bulimia, exhibit a significantly higher incidence of compensatory behaviors compared to healthy controls 2.
Forms of Compensatory Behaviors
- Vomiting is a common compensatory behavior in individuals with bulimia nervosa, and can lead to serious medical complications, such as tooth decay and esophageal damage 2, 3.
- Misuse of laxatives and diuretics is also a common compensatory behavior, and can lead to electrolyte imbalances and other medical problems 2, 3.
- Excessive exercise is another form of compensatory behavior, and can be seen in individuals with both anorexia and bulimia nervosa 2.
- Extreme dieting and skipping meals are also common compensatory behaviors, and can lead to malnutrition and other medical problems 2.