Bulimia Nervosa

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
    • 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).
  • 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.
  • The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
  • Self-evaluation is unduly influenced by body shape and weight.
  • The disturbance does not occur exclusively during episodes of anorexia nervosa.

Other Signs and Symptoms:

  • Shows unusual swelling of the cheeks or jaw area  
  • Has calluses on the back of the hands and knuckles from self- induced vomiting 
  • Teeth are discolored, stained  
  • Creates lifestyle schedules or rituals to make time for binge-and-purge sessions  
  • Frequently diets  
  • Shows extreme concern with body weight and shape  

Co-occurring conditions are common, such as:

  • Self-injury (cutting and other forms of self-harm without suicidal intention)
  • Substance abuse
  • Impulsivity (risky sexual behaviors, shoplifting, etc.)
  • Diabulimia (intentional misuse of insulin for type 1 diabetes)


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