Bulimia nervosa is an eating disorder characterized by episodes of binge eating, where a person feels out of control and eats more than usual. This usually occurs in combination with compensatory mechanisms to prevent weight gain, including self-induced vomiting, laxative use, and excessive exercise.
Bulimia is most common in women between the ages of 20 and 30. In Europe, its prevalence is under 1-2%.
The causes of eating disorders are not fully understood, but multiple genetic, social, and psychological factors may contribute to the development of bulimia.
A number of risk factors can lead to the development of bulimia, including:
Symptoms of bulimia may include:
The term 'purging' is used to refer to binge eating followed by actions such as self-induced vomiting, heavy exercise, laxatives, enemas or diuretics. Other areas to consider in the history may include:
It is important to perform a risk assessment in all patients with suspected eating disorders. This includes assessing risk of self-harm, suicidal behavior, or self-neglect. Eating disorders are commonly accompanied by other mental health disorders such as depression and anxiety.
People with bulimia nervosa may present with a variety of clinical findings, such as weight fluctuations, tooth erosion, swollen salivary glands, mouth ulcers, gastro-oesophageal reflux, alkalosis, hypokalaemia, and Russell's sign.
Differential diagnoses for bulimia nervosa include anorexia nervosa, body dysmorphic disorder, depression, and obsessive-compulsive disorder. Anorexia nervosa is distinguished from bulimia by a low body mass index, compared to a normal body mass index in bulimia, and restrictive energy intake rather than recurrent episodes of binge eating.
Relevant bedside investigations include height and weight measurements to calculate body mass index, basic observations such as blood pressure and heart rate, urinalysis for ketones, and an electrocardiogram to detect hypokalaemia.
Laboratory investigations may include urea and electrolyte tests to measure hypokalaemia and creatinine, a full blood count, and liver function tests.
The criteria for diagnosis of bulimia nervosa according to International Classification of Diseases (ICD)-11 include a preoccupation with controlling body weight, repeated bouts of overeating, and compensatory behaviors after overeating, such as self-induced vomiting, the use of laxatives, and excessive exercise, occurring at least once weekly for at least three months.
Management of bulimia nervosa follows a biopsychosocial approach to ensure a holistic treatment plan. Biological therapies such as selective serotonin-reuptake inhibitors (SSRIs) are used in pharmacological management, most commonly fluoxetine and, if poorly tolerated, sertraline. Psychological therapies such as cognitive behavioral are the optimal first-line treatment.
Children with bulimia should be offered a family therapy that is focused on bulimia nervosa.
It is important to provide education about bulimia to the patient and their family. Online support and information can be found on the Beat website.
Complications associated with bulimia include:
