Bulimia Nervosa: Recognizing Symptoms and Seeking Help

Bulimia nervosa is an eating disorder characterized by recurrent binge-eating episodes followed by compensatory behaviors to prevent weight gain. It carries serious medical and psychiatric morbidity.

Diagnostic Features (DSM-5)

• Recurrent binge eating: large amount + sense of loss of control.
• Recurrent inappropriate compensation: self-induced vomiting; laxative/diuretic/enema misuse; fasting; excessive exercise.
• Frequency: ≥1×/week for 3 months.
• Self-evaluation unduly influenced by body shape/weight.
• Not occurring exclusively during anorexia nervosa.

Common Signs and Symptoms

• Dental erosion, salivary gland enlargement, Russell's sign (knuckle calluses)
• Electrolyte abnormalities (hypokalemia, metabolic alkalosis)
• GI complaints: reflux, constipation, gastroparesis
• Menstrual irregularities
• Mood lability, anxiety, secrecy around eating
• Weight typically normal or slightly elevated (vs. anorexia)

Treatment Approach

• CBT-E (Enhanced Cognitive Behavioral Therapy): First-line psychotherapy.
• SSRIs (fluoxetine): FDA-approved for bulimia; reduces binge/purge frequency.
• Nutritional rehabilitation: Regularized eating, electrolyte monitoring.
• Medical stabilization for severe electrolyte disturbances or cardiac arrhythmias.

Urgency

Early intervention improves prognosis. Encourage referral to an eating disorder specialist or multidisciplinary team.