Bulimia Nervosa

Detailed Diagnostic Criteria

Detailed diagnostic criteria are taken from the Diagnostic Statistical Manual, 4th edn. (DSM-IV).

  1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: (1) Eating, in a discrete period of time a large amount of food (2) A sense of lack of control over eating during the episode
  2. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas or other medications; fasting or excessive exercise.
  3. At least 2 binge/purge episodes a week for more than 3 months
  4. Self-evaluation is unduly influenced by body shape and weight.
  5. The disturbance does not occur exclusively during episodes of anorexia nervosa.
  6. Subtypes:
    • Purging type: The person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics or enemas.
    • Non-purging type:  The person has used inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics or enemas.

Prevalence of Eating Disorders

 According to Keel (2005) and Wilson, Grilo & Vitousek (2007), the prevalence of eating disorders is as follows:

  • The lifetime prevalence for women is between 1-3%
  • The lifetime prevalence for men is between 0.1-0.3%

Typical Course of Eating Disorders

Keel (2005), Steinhausen (2002) and Wilson, Grilo & Vitousek (2007) describe the typical onset and course of eating disorders:

  • Onset: late adolescence to early adulthood
  • 50% of individuals recover and maintain recovery
  • 30% improve but remain symptomatic
  • 20% of individuals continue to meet full criteria for bulimia
  • The rate of relapse is 30%
  • Cross-over rates to either anorexia or binge-eating are very low, because those with bulimia are more likely to continue to suffer from bulimia