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Feeding and Eating Disorders

Bulimia Nervosa

ICD-10-CM: F50.2

1. Criteria

DSM Criteria

Criterion A

  • Recurrent episodes of binge eating occur.
  • A binge episode involves eating, in a discrete period, an amount that is definitely larger than most people would eat in similar circumstances.
  • There is also a sense of lack of control over eating during the episode.

DSM Criteria

Criterion B

  • Recurrent inappropriate compensatory behaviors occur to prevent weight gain, such as vomiting, laxatives, fasting, or excessive exercise.

DSM Criteria

Criterion C

  • The binge eating and compensatory behaviors occur at least once a week for 3 months.

DSM Criteria

Criterion D

  • Self-evaluation is unduly influenced by body shape and weight.

DSM Criteria

Criterion E

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

2. Context

  • Bulimia nervosa usually looks like a painful cycle of binge eating followed by attempts to undo the binge through purging, fasting, overexercise, or other compensatory behaviors. Shame, secrecy, and shape-weight overvaluation are often central to how the illness is experienced.
  • Binge plus compensation: Both parts matter. The diagnosis requires loss-of-control binge episodes and compensatory behavior afterward.
  • Frequency threshold: The pattern has to be recurring, not occasional. DSM threshold is at least weekly for 3 months.
  • Differential: One of the main distinctions is whether the person is currently at significantly low weight, which may shift the frame toward anorexia nervosa.
  • Clinical focus: Tracks binge, purge, restraint, and shape-weight concerns.

3. Validated scales

EDE-Q

Tracks binge, purge, restraint, and shape-weight concerns.

Eating Disorder Examination

Structured interview for severity and diagnostic detail.

4. FDA approved treatments

FDA-indicated medication for bulimia nervosa

Among antidepressants, fluoxetine has the clearest diagnosis-specific FDA indication for bulimia nervosa.

Common treatment side effects

Check drugs.com/sfx for common side effects. Direct side-effect links for the medications in this section are below when available.

Interventional psychiatry modalities

  • TMS is being studied in eating disorders but is not established standard care.
  • Ketamine remains investigational in bulimia-related symptoms.
  • ECT is not standard unless severe comorbid mood illness drives the indication.

Related Guides

5. Top management articles

  1. Management review for Bulimia Nervosa PubMed search
  2. Bulimia Nervosa treatment guideline PubMed search
  3. Bulimia Nervosa pharmacotherapy or psychotherapy review PubMed search

When to seek professional help

  • Seek urgent help if there are thoughts of suicide, self-harm, or feeling unable to stay safe.3
  • Seek urgent help if there are thoughts of harming someone else, escalating violent urges, or loss of behavioral control.3
  • Take hopelessness seriously, especially if the person feels trapped, cannot imagine staying safe, or is withdrawing from support.4
  • Use emergency services if there is immediate danger, severe agitation, psychosis, intoxication, or inability to care for basic needs. In the United States, call or text 988 for crisis support and call 911 for immediate danger. Use emergency services in your region if you are outside the U.S.3
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References