Definition and Diagnosis
Bulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating, marked by a sense of loss of control, followed by inappropriate compensatory behaviors such as self-induced vomiting, laxative misuse, fasting, or excessive exercise, aimed at preventing weight gain.
Epidemiology
Bulimia nervosa has a lifetime prevalence of approximately 1-2%, with onset most common in late adolescence or early adulthood. Unlike anorexia nervosa, individuals with bulimia are often at a normal or above-normal body weight, which can make the condition less visibly apparent.
Risk Factors
Risk factors include a family history of eating or mood disorders, a history of dieting, body image dissatisfaction, impulsivity, and sociocultural pressure around body shape. Co-occurring anxiety, depression, or substance use is also common.
Symptoms and Subtypes
Presentation includes recurrent binge eating episodes accompanied by a feeling of being unable to stop, followed by compensatory behaviors like vomiting or laxative use. Physical signs can include dental erosion, swelling of the salivary glands, gastrointestinal problems, and electrolyte imbalances.
Diagnosis
Diagnosis follows DSM-5-TR criteria, requiring recurrent binge eating and compensatory behaviors occurring on average at least once a week for three months, along with self-evaluation unduly influenced by body shape and weight. Medical evaluation typically screens for electrolyte disturbances and cardiac or gastrointestinal complications.
Treatment
First-line treatment is cognitive behavioral therapy adapted for eating disorders, which addresses the binge-purge cycle and related thought patterns. SSRIs, particularly fluoxetine, are also FDA-approved and may be used alongside therapy, especially when depression or anxiety co-occur.
Prognosis
With treatment, many individuals achieve significant reduction or remission of binge-purge behaviors, though relapse is possible during periods of stress. Long-term outcomes are generally more favorable than for anorexia nervosa, particularly with early, sustained treatment.
Reference
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).