Bulimia (cont.)

Medical Author:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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In this Article

• What is bulimia?
• What causes bulimia?
• How is bulimia diagnosed?
• What are signs that may suggest a person has bulimia?
• What medical complications and long-term effects can bulimia have?
• How is bulimia treated?
• Bulimia At A Glance
• Patient Comments: Bulimia - Describe Your Experience
• Patient Comments: Bulimia - Treatment
• Find a local Psychiatrist in your town
• Bulimia Index

As with anorexia, denial and secrecy complicate the diagnosis of bulimia. The individual usually does not come to the attention of the practitioner until an associated medical condition or serious psychological problem manifests itself. Truthful disclosure of behaviors is critical for an accurate diagnosis. The actual criteria for bulimia nervosa are found in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). There are five basic criteria in the diagnosis of bulimia:

1. Recurrent episodes of binge eating. This is characterized by eating within a two-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.



2. A sense of lack of control over the eating during the episode, or a feeling that one cannot stop eating.



3. In addition to the binge eating, there is an inappropriate compensatory behavior in order to prevent weight gain. These behaviors can include self-induced vomiting, misuse of laxatives, diuretics, enemas or other medications, fasting, or excessive exercise.



4. Both the binge eating and the compensatory behaviors must occur at least two times per week for three months and must not occur exclusively during episodes of anorexia.



5. Finally, there is dissatisfaction with body shape and/or weight.

The DSM-IV also identifies two subtypes of bulimia nervosa. The purging type regularly engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas. The nonpurging type engages in other inappropriate compensatory behaviors, such as fasting or excessive exercise, rather than purging methods.

It is not always possible to tell whether a person has bulimia. Those affected may be overweight, underweight, or of normal body weight. However, some warning signs may be present, although these do not confirm the diagnosis of bulimia:

• going to the bathroom after every meal (to induce vomiting)



• compulsive or excessive exercising



• physical signs arising from excessive vomiting such as swollen cheeks or jaws, broken blood vessels in the eyes, or teeth that appear clear due to damage to tooth enamel



• excessive preoccupation with body image or weight