Though cognitive behavior therapy is generally considered the treatment of choice for bulimia nervosa, dialectical behavior therapy (DBT) may be particularly effective in treating bulimia nervosa due to its targeting of emotional dysregulation problems, which often underlie the eating disorder. One study has shown a significant decrease in binge/purging behaviors in patients with bulimia nervosa who underwent DBT with a focus on emotional regulation, though more research into this area is necessary.

Dialectical Behavior Therapy for treating Bulimia Nervosa

Although time of onset varies from case to case, most cases of bulimia nervosa begin in adolescence or early adulthood. While bulimia nervosa is not a demographic-specific disorder, it most commonly affects women, although some research has indicated that homosexual men are also at increased risk. 

Bulimia Nervosa Onset

Several factors have been found to be correlated with either the onset or continuation of bulimia nervosa:

- Impulsivity
- Developmental transitions
- Idealization of thinness
- Weight and body image concerns
- Childhood trauma
- Comorbid psychiatric conditions

Bulimia Nervosa Predisposing and Perpetuating Factors

Diabulimia affects people with type 1 diabetes. This disorder occurs when an individual stops taking or regulating their insulin levels in order to lose weight.

Diabulimia (Eating Disorder-Diabetes Mellitus Type 1)

The severity of a case of bulimia nervosa is often based of the number of episodes of purging per week. 1 to 3 episodes of purging per week is considered mild, 4 to 7 episodes is considered moderate, while 8 to 13 episodes is considered severe, and 14 or more episodes is considered extreme. Furthermore, the case is considered more severe if multiple methods of purging are utilized and/or if it causes severe impairment to the patient's daily life.

Bulimia Nervosa Severity

Multiple methods of purging following binge-eating episodes are considered in the diagnosis of bulimia nervosa, although some methods are more commonly utilized than others:

- Self-induced vomiting
- Laxative abuse
- Diuretic abuse
- Insulin misuse (in diabetic patients)
- Stimulant abuse
- Excessive exercise
- Fasting 

Bulimia Nervosa Purging

Bulimia nervosa has potentially life-threatening consequences as it affects all the body's systems in multiple ways:

- Skin complications
- Oral complications
- Head/ear/nose/throat complications
- Cardiovascular complications
- Pulmonary complications
- Gastrointestinal complications
- Endocrine complications
- Metabolic/electrolyte complications
- Mental health complications

Bulimia Nervosa Complications

Several metanalyses with different classifications of recovery showed slightly differing results, although all generally showed that many people with bulimia nervosa did not recover fully.

Recovery Rates of Bulimia Nervosa

Individuals with bulimia nervosa utilize various methods to compensate for binge eating episodes. Common behaviors include purging, such as by inducing vomiting or using laxatives, as well as non-purging actions like engaging in excessive amounts of exercise.

Compensatory Behaviors in Bulimia Nervosa

Bulimia nervosa often co-occurs with other mental health conditions. Sufferers frequently experience anxiety and depression and also have an increased risk for substance abuse.

Comorbid Conditions in Bulimia Nervosa

The lifetime prevalence rate for bulimia nervosa is estimated to be around 1% for women and less than 0.5% for men.

Prevalence of Bulimia Nervosa

Bulimia nervosa is linked to numerous severe health problems. The compensatory behaviors associated with the disorder can lead to serious medical issues, including kidney failure, heart failure, and significant tooth decay.

Health Consequences of Bulimia Nervosa

A 20-year-old individual, who is of normal body weight, reports recurrent episodes of consuming very large quantities of food in a short time, feeling a complete loss of control during these episodes. To prevent weight gain, they engage in hours of intense, excessive exercise afterward and feel significant distress about their eating patterns. Based on this pattern of behavior, which of the following is the most likely diagnosis?

A 20-year-old individual describes recurrent episodes of consuming unusually large amounts of food in a short period, feeling a profound lack of control during these times. Following these episodes, they experience intense guilt and engage in several hours of high-intensity exercise specifically to prevent weight gain. These behaviors occur, on average, twice a week, and the individual's body weight is within the normal range for their height and age. Which of the following conditions best accounts for this specific pattern of behavior?

Bulimia nervosa is an eating disorder characterized by a cycle of binge eating—consuming a large amount of food—followed by attempts to compensate for it. These compensatory behaviors are intended to prevent weight gain.

University of Rochester

Grinnell College

Kalamazoo College

Google

University of Chicago

In contrast to the widespread issue of being overweight, a significant minority of the population suffers from eating disorders, which commonly lead to being underweight. These conditions, such as bulimia nervosa and anorexia nervosa, are often characterized by an intense fear of gaining weight and can result in numerous negative health effects.

Eating Disorders 

The DSM-5-TR separates Feeding and Eating disorders into the following specific disorders:
-	Pica
-	Rumination Disorder
-	Avoidant / Restrictive Food Intake Disorder
-	Anorexia Nervosa
-	Bulimia Nervosa
-	Binge-Eating Disorder
-	Other Specified Feeding or Eating Disorder
-	Unspecified Feeding or Eating Disorder


[DSM-5-TR] List of Feeding and Eating Disorders

Petre, A. (2019, October 30). Learn about 6 common types of eating disorders and their symptoms. Healthline. https://www.healthline.com/nutrition/common-eating-disorders#what-they-are. 

Eating disorders general summary

Rudlin, K. (2020, November 18). What to Do If Your Teen Shows Signs of Bulimia. Verywell Mind. https://www.verywellmind.com/signs-and-symptoms-of-bulimia-in-teens-2609258. 

VeryWellMind Bulimia Signs

Johnson, J. (2018, August 23). Physical and emotional side effects of bulimia on the body. Medical News Today. https://www.medicalnewstoday.com/articles/322853. 

What are the effects of bulimia on the body?

Nitsch, A., Dlugosz, H., Gibson, D., & Mehler, P. S. (2021). Medical complications of bulimia nervosa. Cleveland Clinic Journal of Medicine, 88(6), 333-343.

Medical Complications of Bulimia Nervosa

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

Bulimia Nervosa

Binge eating disorder (BED), officially recognized by the American Psychiatric Association in the DSM-5 since 2013, is characterized by recurrent episodes of consuming large amounts of food. Unlike bulimia nervosa, these binges are not followed by compensatory behaviors such as purging. A key diagnostic feature is the significant psychological distress, including feelings of guilt and embarrassment, that occurs after a binge, which distinguishes the disorder from simple overeating.

Binge Eating Disorder (BED)

References for Bulimia Nervosa 

Pica is an eating disorder in which an individual compulsively consumes inedible items. The inedible items consumed vary by those with the disorder.

Pica

Rumination disorder is an eating disorder where an individual unconsciously regurgitates food immediately after eating. This eating disorder is rare and is most common in children.

Rumination Disorder

A disorder commonly found in children, ARFID can be described as extremely picky eating, though fear foods differ significantly from those with anorexia nervosa and bulimia nervosa. Although ARFID involves food restriction and thus shares some features with anorexia nervosa, the fear and restriction surrounding food is not due to concerns about weight or body image. 

Avoidant/Restrictive Food Intake Disorder (ARFID)

Bulimia nervosa. Johns Hopkins Medicine. (2023, January 31). https://www.hopkinsmedicine.org/health/conditions-and-diseases/eating-disorders/bulimia-nervosa 

Cleveland Clinic. (2022). Pica. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22944-pica 

Mayo Foundation for Medical Education and Research. (2018, May 5). Binge-eating disorder. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/binge-eating-disorder/symptoms-causes/syc-20353627 

Mayo Foundation for Medical Education and Research. (2020a, October 14). Rumination syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rumination-syndrome/symptoms-causes/syc-20377330 

Meczekalski, B., Podfigurna-Stopa, A., & Katulski, K. (2013). Long-term consequences of anorexia nervosa. Maturitas, 75(3), 215–220. https://doi.org/10.1016/j.maturitas.2013.04.014

References for Eating Disorders: Consequences

Other Specified Feeding and Eating Disorder (OSFED) is a category of eating disorders in which individuals do not meet full criteria for other eating disorders. Around 30% of individuals diagnosed with an eating disorder fall into this classification.

Other Specified Feeding and Eating Disorder

Eating disorders, particularly conditions like bulimia nervosa and anorexia nervosa, are associated with a wide range of severe and adverse health consequences.

Adverse Health Consequences of Eating Disorders

Anorexia nervosa is an eating disorder defined by maintaining a body weight significantly below average, which is achieved through methods like starvation or excessive exercise. A central characteristic of this disorder is a distorted body image, a form of body dysmorphia, where individuals perceive themselves as overweight despite being underweight.

Anorexia Nervosa

A person begins a new diet and exercise regimen with the goal of losing 10 pounds. They start counting calories and increase their physical activity. Which of the following additional observations would be the strongest indicator that this behavior is evolving into a clinical eating disorder?

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