Bulimia Nervosa

In 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) changed the criteria for Bulimia Nervosa. Here are the current DSM-5 criteria:

  • Recurrent episodes of binge eating
    1. Eating, in a discrete period of time, an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
    2. A sense of lack of control over eating during the episode.
  • Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
  • At least once a week for 3 months.
  • Self-evaluation is unduly influenced by body shape and weight.

Dr. Shapiro and colleagues recently published a review of the research on bulimia nervosa (Shapiro JR et. al, Int J Eat Disord 2007; 40:321-336) covering medication and psychotherapy studies. Findings suggest that:

  • Prozac 60 mg did better than 20 mg/day.
  • Other meds shown effective in single studies have included desipramine (200-300 mg/day), topiramate (100 mg/day), and odansetron. Wellbutrin should be avoided in patients with bulimia or anorexia, because one early study indicated a higher seizure risk in such patients.
  • In terms of therapy, cognitive behavioral therapy (CBT) as being the most effective psychotherapy, although the new data on family-based therapy for bulimia had not been released in time for the review.

Anorexia Nervosa versus Bulimia Nervosa

**Many people believe that those with anorexia nervosa do not eat while those with bulimia nervosa binge and purge. However, those in either category can engage in binge eating and purging. The most notable difference is that those with anorexia nervosa are at an unhealthily low body weight. One can not be diagnosed with anorexia nervosa and bulimia nervosa at the same time.**