Bulimia Nervosa

Key Features

• Uncontrolled episodes of binge eating at least once weekly for 3 months

• Recurrent inappropriate compensatory behavior to prevent weight gain

  • Self-induced vomiting

  • Laxatives

  • Diuretics

  • Fasting

  • Excessive exercise

• Excessive concern with body weight and body shape, with undue influence of weight on self-worth

• Occurs predominantly in young, white, middle- and upper-class women

Clinical Findings

• Consuming large quantities of easily ingested high-calorie foods, usually in secrecy, followed by vomiting, cathartics, or diuretics accompanied by feelings of guilt or depression

• Body weight fluctuates but generally within 20% of normal BMI

• Menstruation is usually preserved

Diagnosis

• History and identification of behavioral features

• Differential diagnosis

  • Anorexia nervosa

  • Depression

  • Obsessive-compulsive disorder

  • Personality disorder

  • Substance abuse

Treatment

• Antidepressant medications such as fluoxetine and other selective serotonin reuptake inhibitors

• Psychotherapy (individual, group, family, and behavioral)