Description

An eating disorder which includes binge eating and inappropriate compensatory behaviors

• Binge eating is characterized by eating, in a discrete period of time (usually within 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and a sense of lack of control over eating during the episode, followed by recurrent inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting, misuse of laxatives or diuretics (or other medications), excessive exercise, and fasting after the binge.
• Binge eating and inappropriate compensatory behaviors both occur on average, at least once a week for 3 months.
• DSM-5 classifies bulimia nervosa severity as the following:
  • Mild: 1 to 3 episodes of inappropriate compensatory behaviors per week
  • Moderate: 4 to 7 episodes of inappropriate compensatory behaviors per week
  • Severe: 8 to 13 episodes of inappropriate compensatory behaviors per week
  • Extreme: 14 or more episodes of inappropriate compensatory behaviors per week
• System(s) affected: oropharyngeal, endocrine/metabolic, gastrointestinal, dermatologic, cardiovascular, pulmonary, psychiatric

Epidemiology

• Predominant age: adolescents and young adults but can occur in all age groups and ethnicities worldwide
• Mean age of onset: 18 to 21 years
• Predominant sex: female > male (13:1)

Incidence
18.5% to 26.9%, declining in incidence over time in recent studies (1)

Prevalence
Up to 3% of females and ~1% of males in their lifetime

Etiology and Pathophysiology

• Combination of biologic, psychological, environmental, and social factors.
• Strong evidence of serotonergic dysregulation
• Multiple studies demonstrate altered brain function and structure in bulimia nervosa.

Genetics
Heritability estimated to be up to 41% in recent studies (2)

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
• Perfectionist or obsessive thinking; environment stressing high achievement, physical fitness, (e.g., armed forces, ballet, cheerleading, gymnastics, or modeling)
• Family history of substance abuse, affective disorders, eating disorder, or obesity
• Diabetes: type 1 > type 2
• 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, bipolar disorders
• Substance use disorder
• Personality disorders: borderline, schizotypal, antisocial (3)