Bulimia Nervosa



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


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

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

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)

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