Description

Bulimia nervosa is an eating disorder that includes binge eating and inappropriate compensatory behaviors.

• Binge eating is characterized by eating, in a discrete period of time (within 2-hour period), an amount of food that is 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, excessive exercise, and so forth.
• Binge eating and inappropriate compensatory behaviors both occur once a week for 3 months.
• Diagnostic and Statistical Manual of Mental Disorders, 5th edition (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
• Mean age of onset: 18 to 21 years
• Predominant sex: female > male (13:1)

Incidence
28.8 women, 0.8 men per 100,000 per year

• More prevalent than anorexia nervosa
• 1.5% in women age 16 to 35 years
• 0.5% in young 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.
• Multiple studies demonstrate altered brain function and structure in bulimia nervosa.

Risk Factors

• Female gender
• History of obesity and dieting
• Body dissatisfaction: critical comments about weight, body shape, or eating: low self-esteem
• Severe life stressor
• Perfectionist or obsessive thinking
• Poor impulse control, substance abuse
• Environment stressing high achievement, physical fitness (e.g., armed forces, ballet, cheerleading, gymnastics, or modeling): perceived pressure to be thin
• Family history of substance abuse, affective disorders, eating disorder, or obesity
• Type 1 diabetes
• Childhood trauma (sexual abuse)

General Prevention

• 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