From the Guidelines
Bulimia nervosa is diagnosed when a person experiences recurrent episodes of binge eating, characterized by consuming a larger amount of food within a 2-hour period compared with peers, and a perceived lack of control during the binge, followed by repeated use of unhealthy behaviors to prevent weight gain, occurring at least once a week for 3 months, as outlined in the DSM-5 criteria 1. The diagnostic criteria for bulimia nervosa include:
- Binge eating in which a larger amount of food is eaten within a 2-hour period compared with peers, and there is a perceived lack of control during the time of the binge
- Repeated use of unhealthy behaviors after a binge to prevent weight gain, such as vomiting, abuse of laxatives, diuretics, or other medications, food restriction, or excessive exercise
- These behaviors occur at least once a week for 3 months
- Self-worth is overly based on body shape and weight
- The behaviors occur distinctly apart from anorexia nervosa It is essential to distinguish bulimia nervosa from other eating disorders, such as binge eating disorder, which lacks the compensatory behaviors, or anorexia nervosa, which involves significantly low body weight, as stated in the DSM-5 criteria 1. The severity of bulimia nervosa is based on the frequency of compensatory behaviors, ranging from mild to extreme, and early identification is crucial to prevent serious medical complications, including electrolyte imbalances, dental erosion, gastrointestinal problems, and cardiac arrhythmias, highlighting the importance of prompt diagnosis and treatment based on the most recent guidelines 1.
From the Research
Diagnostic Criteria for Bulimia Nervosa
The diagnostic criteria for bulimia nervosa are not explicitly stated in the provided studies. However, the studies mention that the participants met the DSM-III-R criteria for bulimia nervosa 2.
Treatment Options for Bulimia Nervosa
- Cognitive-behavioral therapy (CBT) is considered the psychological treatment of choice for bulimia nervosa 3, 4.
- Antidepressant medication, such as fluoxetine, has been shown to be effective in reducing symptoms of bulimia nervosa, including binge eating and vomiting 3, 2, 5, 6.
- The combination of CBT and medication has been found to be superior to medication alone in some studies 3, 2.
Response to Treatment
- Patients with bulimia nervosa who do not respond to psychotherapy or relapse after treatment may benefit from fluoxetine 5.
- Fluoxetine has been shown to be effective in treating bulimia nervosa, regardless of the presence or absence of comorbid depression 6.
- CBT has been found to be effective in reducing symptoms of bulimia nervosa, including binge eating and vomiting, in patients with and without comorbid depression 4.