Other Risk Behaviors

Eating Disorders

Bulimia Nervosa (BN)

The prevalence of bulimia nervosa among young females is approximately 1-1.5%. Again, females outnumber males 10:1. Bulimia nervosa occurs across similar populations as anorexia nervosa, and while genetic vulnerabilities for the disorder may be present among families, known

More Info: Diagnostic Criteria Anorexia

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

  1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
  2. A sense of lack of control over eating during the episodes (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

B. Recurrent inappropriate conpensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of anorexia nervosa.


risk factors include childhood obesity and early pubertal maturation. Mortality is less common in patients with bulimia compared to anorexia nervosa, though patients with bulimia also have an increased risk of suicide.

The primary features of bulimia nervosa include recurrent episodes of binge eating, recurrent inappropriate compensatory behaviors to prevent weight gain, and self-evaluation that is overly influenced by body shape and weight. Bulimics are much less likely to come to medical attention than anorexics. Occasionally, bulimics will come to the physician seeking prescriptions for laxatives or diuretics. Dentists are more likely to pick up bulimics due to the damage done to the teeth by purging. Unlike patients with anorexia, patients with bulimia may have a normal or above-normal BMI-for-age. See below for full DSM-5 criteria.

Laboratory testing is most likely to be abnormal in a patient with bulimia due to purging behaviors. Abnormalities include hypokalemia, hypochloremia, hyponatremia, and potentially life-threatening cardiac arrhythmias. Vomiting may produce a metabolic alkalosis due to loss of gastric acid, while laxative and diuretic abuse can lead to metabolic acidosis.

Treatment should be focused on the underlying self-esteem and psychiatric issues such as depression. Pharmacotherapy has more evidence-based support in bulimia than anorexia, and may provide additional benefit when combined with CBT or FBT. Common sense approaches like not stocking binge foods in the home can help. The physician should help with appropriate weight loss methods if the patient is overweight.

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