Bulimia Nervosa

Description

An eating disorder which includes binge eating and inappropriate compensatory behaviors; symptoms include the following:

• Episodes of binge eating (approximately 2,000 kcal), lack of self-control for eating at least once a week for 3 months
• Inappropriate compensations
  • For example, caloric restriction (most common), excessive exercise, self-induced vomiting, inappropriate laxative or diuretics use
• Alternating binge eating and compensations for prolonged time not during anorexia nervosa
• Distorted self body image
• DSM-5 classifies severity based on inappropriate compensatory behaviors per week:
  • Mild (1 to 3), moderate (4 to 7), severe (8 to 13), extreme (≥14)
• System(s) affected: oropharyngeal, endocrine/metabolic, gastrointestinal, dermatologic, cardiovascular, pulmonary, psychiatric

Epidemiology

• Mean age of onset: 18 to 21 years
• Predominant sex: female > male (13:1)

Prevalence
Approximately 0.5% of females and 0.08% males in their lifetime in the United States

Etiology and Pathophysiology

Combination of biologic, psychological, environmental, and social factors

Genetics
Heritability estimated to be up to 41%

Risk Factors

• Female gender
• History of obesity and dieting
• Body dissatisfaction; critical comments about weight, body shape, or eating; low self-esteem
• Depression, social anxiety, severe life stressor
• Poor impulse control, substance abuse
• Family history of substance abuse, affective disorders, eating disorder, or obesity
• Diabetes
• Childhood trauma (sexual or physical abuse, neglect)

General Prevention

• Realistic and healthy weight management strategies and attitudes
• Decrease body dissatisfaction and promote self-esteem.
• Reduce focus on thin as ideal.

Commonly Associated Conditions

• Major depression, dysthymia, anxiety, obsessive-compulsive and bipolar disorders
• Substance use disorder
• Personality disorders: borderline, schizotypal, antisocial (1)
• Nonsuicidal self injury (33%) and suicidal attempts (21%) (2),(3)