Bulimia nervosa is an eating disorder, characterised by severe preoccupation about weight and body shape. Includes recurrent episodes of binge eating with compensatory mechanisms, such as self-induced vomiting, to prevent weight gain.
Most common in women in their 20s and 30s.
Patients usually appear physically normal, although they may have low self-esteem and depressive thoughts, as well as lack of confidence.
Parotid hypertrophy and erosion of the teeth are the most common physical signs and may prompt diagnosis.
Cognitive behavioural therapy (CBT) is considered optimal primary treatment for bulimia, but it may not always be available.
Selective serotonin-reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) may be used adjunctively to CBT, or as an alternative when CBT is not available.
Treatment of comorbid psychiatric disorders, such as major depressive disorder and obsessive-compulsive disorder, is necessary to optimise the chance of recovery from bulimia nervosa. SSRIs are effective in additional treatment of comorbid psychiatric disease.
Bulimia nervosa is an eating disorder characterised by recurrent episodes of binge eating, followed by behaviours aimed at compensating for the binge. Binge-eating episodes are characterised by eating an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances, and a sense of lack of control over eating during the episode. Recurrent inappropriate compensatory behaviours occur in order to prevent weight gain. These behaviours include self-induced vomiting; fasting; excessive exercise; and misuse of laxatives, diuretics, enemas, or other medication. Binge-eating episodes typically occur, on average, at least weekly for 3 months.
History and exam
Key diagnostic factors
- presence of risk factors
- recurrent episodes of binge eating
- recurrent inappropriate compensatory behaviour
- eating disturbance not exclusively during periods of anorexia nervosa
- depression and low self-esteem
- concern about weight and body shape
- dental erosion
- parotid hypertrophy
- Russell's sign
Other diagnostic factors
- age 20 to 35 years
- menstrual irregularity
- drug-seeking behaviour
- deliberate misuse of insulin
- self-injurious behaviour
- gastrointestinal symptoms
- history of dieting
- marked fluctuations in weight
- shoplifting behaviour
- use of ipecac
- needle marks on skin
- vomiting in pregnancy
- female sex
- personality disorder
- body-image dissatisfaction
- history of sexual abuse
- family history of alcoholism
- family history of depression
- family history of eating disorder
- childhood overweight or obesity
- exposure to media pressure
- early onset of puberty
- family history of obesity
1st investigations to order
- serum electrolytes
- serum creatinine
- serum magnesium
- urine pregnancy test
- serum LFTs
- serum creatine kinase (CK)
Investigations to consider
- serum ferritin
- serum B12
- serum red blood cell folate
- dual-energy x-ray absorptiometry scan for bone density
children and adolescents
- Other specified feeding or eating disorder (OSFED), or unspecified feeding or eating disorder (UFED)
- Anorexia nervosa, binge-eating/purging subtype
- Binge-eating disorder
- Eating disorders: a national clinical guideline
- Practice guideline for the treatment of patients with eating disorders
Bulimia: what is it?
Bulimia: what treatments work?More Patient leaflets
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer