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Bulimia Nervosa

Onset is usually in late adolescence or early adulthood and is more prevalent in females than in males. As many as 17% of college-aged women engage in bulimic behaviors. Bulimics tend to be of normal weight to slightly overweight. Associated dysphoria or depression is common. 30% to 80% of bulimics have a history of anorexia nervosa.

Diagnostic Criteria

  1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
    • a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
  2. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.
  3. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
  4. Self-evaluation is unduly influenced by body shape and weight.
  5. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Specify if:

  • Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
  • Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Evaluation

Laboratory tests: No single lab test helps with the diagnosis; however, to check for complications, several tests should be performed: general screen (to include electrolytes, glucose, calcium, phosphate, BUN, and Cr), Mg, and amylase.

Potential medical complications:

Erosion of dental enamel, dental caries, parotitis, menstrual irregularity, laxative dependence, electrolyte disturbances, gastric rupture, cardiac arrhythmias, and chronic pancreatitis.

Treatment Options

  • Should include medical stabilization, routine monitoring of serum K+ and Mg++, education about medical complications, supportive and cognitive behavioral therapy and nutritional counseling.
  • Prozac 20 to 60 mg PO Qa.m. May lessen the number of binge episodes and associated dysphoria (not yet FDA approved). Treat comorbid depression if present. Hospitalization in a minority of patients (admission criteria similar to those of anorexia nervosa except for weight loss).

Associated Feature

  • Depressed Mood
  • Somatic or Sexual Dysfunction
  • Addiction
  • Dramatic or Erratic or Antisocial Personality

Differential Diagnosis

Some disorders display similar or sometimes even the same symptom. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which one needs to be ruled out to establish a precise diagnosis.

  • Anorexia Nervosa;
  • Binge-Eating/Purging Type;
  • Kleine-Levin syndrome;
  • Major Depressive Disorder, With Atypical Features;
  • Borderline Personality Disorder.