14th February 2025

Bulimia nervosa

Presentation and diagnosis of bulimia nervosa

In contrast to anorexia, bulimia nervosa is associated with a personal or family history of obesity.

Its characteristic features are episodes of binge eating with compensatory behaviours to restrict weight gain, similar to those seen in anorexia nervosa. These are frequent and recurrent, at least once a week for more than a month. If the compensatory behaviours are not present, it is termed binge eating disorder.

The symptoms must not meet the diagnostic requirements for anorexia nervosa (BMI <18.5); in this case, it is termed anorexia nervosa binge-purge pattern.

The physical signs are similar to those of anorexia nervosa but usually less severe.

Management of bulimia nervosa

The management is similar to that of anorexia nervosa, with consideration of self-help programmes or eating disorder-focused CBT. As in anorexia nervosa, medication may be used as an adjunct, as per the individual’s psychopathology (e.g. an antidepressant for depressive symptoms).

References

• Semple D, Smyth R. Oxford handbook of psychiatry. Oxford; New York: Oxford University Press; 2019
• World Health Organization. ICD-11 for Mortality and Morbidity Statistics [Internet]. WHO; 2019 [cited 2022 Mar 17]. Available from: https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1707067746
• National Institute for Health and Care Excellence. Eating disorders [Internet] NICE; 2020 [cited 2022 Mar 17]. Available from: https://www.nice.org.uk/guidance/ng69/chapter/Recommendations
• Attia E, Walsh BT. Anorexia nervosa [Internet]. BMJ Best Practice; 2021 [cited 2022 Mar 17]. Available from: https://bestpractice.bmj.com/topics/en-gb/440
• Safer D. Bulimia nervosa [Internet]. BMJ Best Practice; 2021 [cited 2022 Mar 17]. Available from: https://bestpractice.bmj.com/topics/en-gb/441
• Oxford University Press. Physical Consequences of Anorexia Nervosa. Oxford Handbook of Psychiatry. 2019