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Bulemia Nervosa

DSM IV Diagnostic Criteria

The patient engages in recurrent episodes of binging, characterized by eating an excessive amount of food within a 2 hour span and by having a sense of lack of self control over eating during the episode.

The patient engages in recurrent compensatory behavior to prevent weight-gain (eg, self-induced vomiting, laxative, diuretic, exercise abuse).

The above occur on the average twice a week for three months bulemia nervosa, bulemia, bulemic, bulimic, balimia, balemia.

The patient=s self evaluation is unduly influenced by body shape and weight.

The disturbance does not occur exclusively during episodes of anorexia nervosa.


Purging TypeBulemia Nervosa. The patient regularly makes use of self-induced vomiting, and laxatives.

Nonpurging Type. The bulemia patient regularly engages in fasting or exercise, but not vomiting or laxatives.

Clinical Features

Unlike anorexia patients, bulimic patients tend to be at or above their expected weight for age. Bulimic patients tend to be ashamed of their 

There is an increased frequency of affective disorders, substance abuse (30%), and borderline personality disorder (30%) in patients.

Purging can be associated with poor dentition (consequence of acidic vomitus on teeth). Electrolyte abnormalities (hypokalemia), dehydration, and various degrees of starvation can occur. Menstrual abnormalities are

Prognosis is generally better than for anorexia nervosa, and 


It occurs primarily in industrialized countries, and the incidence is 1-3% in adolescent and young adult females and 0.1-0.3% in males.

There is a higher incidence of affective disorders in families of patients with and obesity is more common.

Differential Diagnosis

Binging Purging Type Anorexia Nervosa. Body weight is less than 85% of expected, and binging and purging behavior occurs.

Atypical Depression. Overeating occurs in the absence of compensatory purging behaviors, and concern over body shape and weight is

Medical Conditions with Disturbed Eating Behaviors. loss of control, concern with body shape, and weight are absent.


Cognitive behavioral therapy is the most effective treatment. Psychodynamic group and family therapies are also useful.


Antidepressant medications are