Bulimia Nervosa

Criterion A

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 (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
  2. 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).

Criterion B

Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.

Criterion C

The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.

Criterion D

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

Criterion E

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

Specifiers

  • In partial remission: After full criteria for bulimia nervosa were previously met, some, but not all, of the criteria have been met for a sustained period of time.
  • In full remission: After full criteria for bulimia nervosa were previously met, none of the criteria have been met for a sustained period of time.

Severity specifiers

The minimum level of severity is based on the frequency of inappropriate compensatory behaviors (see below). The level of severity may be increased to reflect other symptoms and the degree of functional disability.

  • Mild: An average of 1 to 3 episodes of inappropriate compensatory behaviors per week.
  • Moderate: An average of 4 to 7 episodes of inappropriate compensatory behaviors per week.
  • Severe: An average of 8 to 13 episodes of inappropriate compensatory behaviors per week.
  • Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors per week.
  • Antidepressant medications have been shown to be helpful in treating bulimia; includes the selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine. This may be based on elevating central 5-hydroxytryptamine levels. NOTE: according to guidelines, all SSRIs are first-line, although fluoxetine has FDA approval (60 mg per day); sertraline also effective
  • Antidepressant medications can reduce binge eating and purging independent of the presence of a mood disorder.
  • Combination of CBT and Fluoxetine has highest remission rates compared to either treatment alone
  • Thus, antidepressants have been used successfully for particularly difficult binge-purge cycles that do not respond to psychotherapy alone.
  • Imipramine (Tofranil), desipramine (Norpramin), trazodone (Desyrel), and monoamine oxidase inhibitors (MAOIs) have been helpful.
  • In general, most of the antidepressants have been effective at dosages usually given in the treatment of depressive disorders.
  • Dosages of fluoxetine that are effective in decreasing binge eating, however, may be higher (60 to 80 mg a day) than those used for depressive disorders.
  • Medication is helpful in patients with comorbid depressive disorders and bulimia nervosa. • #Bupropion contraindicated – seizure risk.

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