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- A pattern of discrete periods of binge eating (within 2-hour period) along with lack of control over eating, followed by compensatory behaviors such as self-induced vomiting, misuse of laxatives, and so forth
- Both binge eating and compensatory behaviors happening at least once per week for 3 months
- DSM-5 classifies bulimia nervosa as
- Mild: 1 to 3 episodes of compensatory behaviors
- Moderate: 4 to 7 episodes of compensatory behaviors
- Severe: 8 to 13 episodes of compensatory behaviors
- Extreme: 14 or more episodes of compensatory behaviors
- System(s) affected: oropharyngeal, endocrine/metabolic, gastrointestinal, dermatologic, cardiovascular, nervous
- Predominant age: adolescents and young adults
- Mean age of onset: 18 to 21 years
- Predominant sex: female > male (10:1)
28.8 women, 0.8 men per 100,000 per year
- More prevalent than anorexia nervosa
- 1–3% in women age 16 to 35 years
- 0.5% in young men (higher among gay and bisexual men)
Etiology and Pathophysiology
- Combination of biologic, psychological, environmental, and social factors. Unique contribution of any specific factor remains unclear.
- Strong evidence of serotonergic dysregulation in bulimia nervosa
- Substantial literature shows genetic evidence for bulimia nervosa.
- Female gender
- History of obesity and dieting
- Body dissatisfaction
- Critical comments about weight, body shape, or eating
- Severe life stressor
- Low self-esteem
- Perceived pressure to be thin
- Perfectionist or obsessive thinking
- Poor impulse control, substance abuse
- 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
- Type 1 diabetes
- Sexual abuse is not causally related to bulimia.
- Prevention programs can reduce risk factors and future onset of eating disorders.
- Target adolescents and young women ≥15 years.
- Realistic and healthy weight management strategies and attitudes
- Decrease body dissatisfaction and promote self-esteem.
- Reduce focus on thin as ideal.
- Decrease anxiety/depressive symptoms and improve stress management.
Commonly Associated Conditions
- Major depression and dysthymia
- Anxiety disorders
- Substance use disorder
- Bipolar disorder
- Obsessive-compulsive disorder
- Borderline personality disorder