Bulimia Nervosa

BASICS

BASICS

BASICS

DESCRIPTION

DESCRIPTION

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 three 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

EPIDEMIOLOGY

EPIDEMIOLOGY

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

Prevalence

Prevalence

Prevalence

Approximately 0.5% of females and 0.08% males in the United States.

ETIOLOGY AND PATHOPHYSIOLOGY

ETIOLOGY AND PATHOPHYSIOLOGY

ETIOLOGY AND PATHOPHYSIOLOGY

Combination of biologic, psychological, environmental, and social factors.

Genetics

Genetics

Genetics

Heritability estimated to be up to 41%

RISK FACTORS

RISK FACTORS

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

GENERAL PREVENTION

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

COMMONLY ASSOCIATED CONDITIONS

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).

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