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Bulimia nervosa
Classification and external resources
ICD-10 F50.2
ICD-9 307.51
DiseasesDB 1770
eMedicine emerg/810 med/255
MeSH D052018

Bulimia nervosa is an eating disorder characterized by recurrent binge eating, followed by compensatory behaviors.[1] The most common form is defensive vomiting, sometimes called purging; fasting, the use of laxatives, enemas, diuretics, and over exercising are also common.[2]

The word bulimia derives from the Latin (būlīmia), which originally comes from the Greek βουλιμία (boulīmia; ravenous hunger), a compound of βους (bous), ox + λιμός (līmos), hunger.[3]

Bulimia nervosa was named and first described by the British psychiatrist Gerald Russell in 1979.[4][5]



The onset of bulimia nervosa is often during adolescence (between 13 and 20 years of age) and many cases have previously suffered obesity, with many sufferers relapsing in adulthood into episodic binging and purging even after initially successful treatment and remission.[6]

Bulimia nervosa can be difficult to detect, compared to anorexia nervosa, because bulimics tend to be of average or slightly above or below average weight. Many bulimics may also engage in significantly disordered eating and exercising patterns without meeting the full diagnostic criteria for bulimia nervosa.[7] The diagnostic criteria utilized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR) published by the American Psychiatric Association includes repetitive episodes of binge eating (a discrete episode of overeating during which the individual feels out of control of consumption) compensated for by excessive or inappropriate measures taken to avoid gaining weight.[8] The diagnosis is made only when the behavior is not a part of the symptom complex of Anorexia Nervosa and when the behavior reflects an overemphasis on physical mass or appearance.

There are two sub-types of bulimia nervosa:

  • Purging type bulimics self-induce vomiting (usually by triggering the gag reflex or ingesting emetics such as syrup of ipecac) to rapidly remove food from the body before it can be digested, or use laxatives, diuretics, or enemas.
  • Non-purging type bulimics (approximately 6%-8% of cases) exercise or fast excessively after a binge to offset the caloric intake after eating. Purging-type bulimics may also exercise or fast, but as a secondary form of weight control.[9]


There is little data on the prevalence of bulimia nervosa in-the-large, on general populations. Most studies conducted thus far have been on convenience samples from hospital patients, high school or university students. These have yielded a wide range of results: between 0.1% and 1.4% of males, and between 0.3% and 9.4% of females.[10] Studies on time trends in the prevalence of bulimia nervosa have also yielded inconsistent results.[11]

Country Year Sample size and type Incidence
Australia 2008 1,943 adolescents (ages 15–17) 1.4% male 9.4% female[12]
Portugal 2006 2,028 high school students 0.3% female[13]
Brazil 2004 1,807 students (ages 7–19) 0.8% male 1.3% female[14]
Spain 2004 2,509 female adolescents (ages 13–22) 1.4% female[15]
Hungary 2003 580 Budapest residents 0.4% male 3.6% female[16]
Australia 1998 4,200 high school students 0.3% combined[17]
USA 1996 1,152 college students 0.2% male 1.3% female[18]
Norway 1995 19,067 psychiatric patients 0.7% male 7.3% female[19]
Canada 1995 8,116 (random sample) 0.1% male 1.1% female[20]
Japan 1995 2,597 high school students 0.7% male 1.9% female[21]
USA 1992 799 college students 0.4% male 5.1% female[22]

There are higher rates of eating disorders in groups involved in activities which idealize a slim physique, such as dance,[16] gymnastics, modeling, cheerleading, running, acting, rowing and figure skating. Bulimia is more prevalent among Caucasians.[23] Exposure to mass media also appears to have an effect: a survey of 15-18 year-old high schoolgirls in Nadroga, Fiji found the self-reported incidence of purging rose from 0% in 1995 (a few weeks after the introduction of television in the province) to 11.3% in 1998.[24]


These cycles often involve rapid and out-of-control eating, which may stop when the bulimic is interrupted by another person or the stomach hurts from overextension, followed by self-induced vomiting or other forms of purging. This cycle may be repeated several times a week or, in more serious cases, several times a day,[25] and may directly cause:

The frequent contact between teeth and gastric acid, in particular, may cause:

Related disorders

Bulimics are much more likely than non-bulimics to have an affective disorder, such as depression or general anxiety disorder: A 1985 Columbia University study on female bulimics at New York State Psychiatric Institute found 70% had suffered depression some time in their lives (as opposed to 25.8% for adult females in a control sample from the general population), rising to 88% for all affective disorders combined.[30] Another study by the Royal Children's Hospital in Melbourne on a cohort of 2000 adolescents similarly found that those meeting at least two of the DSM-IV criteria for bulimia nervosa or anorexia nervosa had a sixfold increase in risk of anxiety and a doubling of risk for substance dependency.[12] Bulimia also has negative effects on the sufferer's dental health due to the acid passed through the mouth from frequent vomiting causing acid erosion, mainly on the posterior dental surface.



Some researchers have hypothesized a relationship to mood disorders and clinical trials have been conducted with tricyclic antidepressants,[31] MAO inhibitors, mianserin, fluoxetine,[32] lithium carbonate, nomifensine, trazodone, and bupropion.

Research groups who have seen a relationship to seizure disorders have attempted treatment with phenytoin, carbamazepine, and valproic acid. Opiate antagonists naloxone and naltrexone, which block cravings for gambling, have also been used.[33]

There has also been some research characterizing bulimia nervosa as an addiction disorder, and limited clinical use of topiramate, which blocks cravings for opiates, cocaine, alcohol and food.[34] Researchers have also report positive outcomes when bulimics are treated in an addiction-disorders inpatient unit.[35]

Brain-derived neurotrophic factor (BDNF) is also under investigation as a possible cause.[36][37]


There are several empirically-supported psychosocial treatments for bulimia nervosa. Cognitive behavioral therapy (CBT), which involves teaching clients to challenge automatic thoughts and engage in behavioral experiments (e.g., in session eating of "forbidden foods") has demonstrated efficacy both with and without concurrent antidepressant medication.[38][39] Researchers have also reported some positive outcomes for interpersonal psychotherapy and dialectical behavior therapy.[40][41]

Maudsley Family Therapy or "Family Based Treatment" (FBT), developed at the Maudsley Hospital in London for the treatment of anorexia nervosa (AN) has been shown to have positive results for the treatment of bulimia nervosa. FBT has been shown through empirical research to be the most efficacious treatment of AN for patients under the age of eighteen and within three years of onset of illness. The studies to date using FBT to treat BN have been promising.[42]

Some researchers have also claimed positive outcomes in hypnotherapy treatment.[43][44][45]


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Simple English

Bulimia nervosa (bulimia) is a disease and a type of eating disorder. It is when a person wants to starve his or her self. People who have it feel that they are fat and want to be skinny. When they are hungry, they eat a lot of food. Then, they try to take it back by vomiting, exercising, or using drugs.



The person with bulimia eats large amounts of food. Then, they want to get rid of it. To do this, they vomit or use drugs. They do this at least two times a week or more often. The person always thinks about how his or her body looks, and he or she wants to be skinny. The person may also have anorexia nervosa. However, some people with bulimia have a normal weight or are overweight, which makes it difficult to know when someone has bulimia.


Bulimia nervosa can cause many health problems. Because vomit has a lot of acid in it, doing it a lot can burn the person's mouth, throat, or teeth. Someone can lose nutrients or fluids in his or her body. Glands in one's throat and face may get bigger and hurt. The immune system is weakened, and a person can get muscle or heart problems.

People who get bulimia

Most people who get bulimia are ages 10 to 25. Usually girls have bulimia, but boys can have it too. People who had bad things happen to them are more likely to get the disease too. People with obsessive compulsive disorder or perfectionism are also more likely to have bulimia.[1] People can also get bulima if, they have been through physiological trauma.


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