Bulimia Nervosa
Basics
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
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Citation
Domino, Frank J., et al., editors. "Bulimia Nervosa." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116097/all/Bulimia_Nervosa.
Bulimia Nervosa. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116097/all/Bulimia_Nervosa. Accessed December 2, 2024.
Bulimia Nervosa. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116097/all/Bulimia_Nervosa
Bulimia Nervosa [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 December 02]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116097/all/Bulimia_Nervosa.
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