Bulimia nervosa (from Greek "Bulimia" meaning "Ravenous hunger" is characterized by binge eating (i.e. consuming large amounts of food in a short amount of time) followed by purging (i.e. attempt to rid oneself of the food consumed), due to extensive concern for body weight. Purging can include:

• Vomiting
• Drugs (laxative, diuretic, stimulant)
• Excessive exercise
• Fasting over an extended period of time

This practice can become habitious as the Pt tries to keep their weight under a self-imposed threshold

• Majority at normal weight
• Slightly older than Pt's with anorexia nervosa
• May be of any weight, weight fluctuates
• More histrionic
• Extroverted, more social
• Turns to food to cope with stress
• Recognizes binging/purging are abnormal
• Impulsive, unstable
• Family Hx of alcohol and substance abuse, mood and eating disorders
• The forced vomiting may cause Russell's sign (i.e. thickened skin on the knuckles) and breakdown of the teeth

• A) Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
  • 1) Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
  • 2) A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
• B) Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
• C) The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
• D) Self-evaluation is unduly influenced by body shape and weight.
• E) The disturbance does not occur exclusively during episodes of anorexia nervosa.

Source: Heda HK

• Potassium loss
• Depressive Sx, often severe, and lead to high risk of suicide
• Considered less life threatening than anorexia
• Common comorbidities include Mood disorders, Anxiety, Impulse control (Overspending, Sexual behaviors), Substance-misuse disorders
• Associated behaviors include Stealing, drug use, sexual promiscuity
• Can Die with Electrolyte abnormalities, Cardiomyopathy, Suicide

• Media projection of a thin (cf. healthy) ideal, causing women to work towards having a thin body even if it means purging
• Genetic component, demonstrated in Twin studies (between 50-80%)
• Casual dieting can trigger an ED

• Pt's can alternate between Bulimia and Anorexia
• Prevalence is greater than anorexia
• Bulimia is 9 times more common in women than men
• Adolescents most at risk

• Antidepressants, especially SSRI's

• Eating disorder