Bulimia Nervosa (BN)

Definition

Recurrent episodes of binge eating followed by compensatory behaviors (vomiting, laxatives, fasting, excessive exercise) to prevent weight gain.

Binge Episode

Eating an objectively large amount of food in a short time (usually ≤ 2 hours) with a sense of loss of control.

Compensatory Behaviors

Inappropriate actions to “undo” binge eating (purging, fasting, or overexercising).

DSM-5-TR Criteria for Bulimia Nervosa:

• Recurrent binge eating (≥ once/week for ≥ 3 months)

• Recurrent compensatory behaviors

• Self-evaluation unduly influenced by body shape/weight

• Not occurring exclusively during episodes of anorexia nervosa

Typical Body Weight

Usually within or above normal range (unlike anorexia).

Medical Consequences:

• Electrolyte imbalance → cardiac arrhythmia, kidney failure

• Erosion of dental enamel (acid from vomiting)

• Enlarged salivary glands, facial swelling

• Intestinal problems due to laxatives

Associated Psychological Features:

• Depression and anxiety (especially after binge)

• Low self-esteem

• Perfectionism and impulsivity

Course and Onset:

• Onset: Late adolescence (16–19 years old)

• Chronic if untreated

• High comorbidity with anxiety, depression, and substance abuse

Prevalence:

Lifetime prevalence: ~1.1% in females, 0.1% in males