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recurrent episodes of binge eating (eating an amount (>1000 Calories) that is larger than most people would eat during a similar period of time, and a sense of lack of control over eating during the episode;
recurrent, inappropriate compensatory behavior in order to prevent weight gain (e.g. self-induced vomiting, misuse of laxatives or diuretics, fasting or excessive exercise);
these behaviors must occur, on average, at least twice a week for 3 months;
body shape and weight unduly influence self-evaluation and self-esteem. The criteria also state that the disorder must not occur only during episodes of anorexia nervosa.
Bulimia nervosa can be either:
purging type, in which the patient regularly engages in self-induced vomiting or misuses laxatives, diuretics or enemas; or
non-purging type, in which there is no history of regular self-induced vomiting or misuses of laxatives, diuretics or enemas.
The ICD-10 diagnostic criteria for bulimia nervosa are very similar. The only significant difference is in the relationship between bulimia nervosa and anorexia nervosa - DSM-IV gives precedence to anorexia nervosa over bulimia nervosa, whereas ICD-10 specifically excludes a diagnosis of anorexia nervosa if binge-eating is present.
Signs and symptoms
The typical patient with bulimia nervosa is within the normal weight range for age and height.
Behavioral signs of bulimia nervosa include:
surreptitious behavior (e.g. hiding food, spending long periods in the bathroom with vague excuses);
outwardly restrictive meal patterns or over-concern with dieting and nutrition but with little change in weight or appearance;
dissatisfaction with body size and shape.
Many of the physical signs and abnormalities that are associated with bulimia nervosa are due to recurrent vomiting, and so are more likely to be seen in patients with purging-type bulimia nervosa:
tooth decay caused by loss of dental enamel as a result of recurrent vomiting - this loss of enamel affects the inner aspects of the front teeth in particular;
dehydration;
fatigue;
swollen salivary glands;
scars on the dorsum of hand (Russell's sign) caused by manual stimulation of the gag reflex to induce vomiting;
electrolyte disturbances;
esophageal or gastric tears;
side effects of emetics, diuretics or purgatives.
Patients with bulimia nervosa often have features of depression (30-70% lifetime rates are reported), especially low self-esteem. They may also have features of anxiety (again, 30-70% lifetime rates are reported). Patients also have high rates of anxiety disorder and panic disorder, and post-traumatic stress disorder is common. Deliberate self harm and alcohol and substance misuse are also common. Approximately half the clinical sample report stealing.
(from PsychiatryMatters.MD)
