Suicide risk is elevated in bulimia nervosa. Comprehensive evaluation of individuals with this disorder should include assessment of suicide-related ideation and behaviors as well as other risk factors for suicide, including a history of suicide attempts.
Functional Consequences of Bulimia Nervosa
Individuals with bulimia nervosa may exhibit a range of functional limitations associated with the disorder. A minority of individuals report severe role impairment, with the so— cial-life domain most likely to be adversely affected by bulimia nervosa.
Anorexia nervosa, binge-eating/purging type. Individuals whose binge-eating behav- ior occurs only during episodes of anorexia nervosa are given the diagnosis anorexia ner- vosa, binge-eating/purging type, and should not be given the additional diagnosis of bulimia nervosa. For individuals with an initial diagnosis of anorexia nervosa who binge and purge but whose presentation no longer meets the full criteria for anorexia nervosa, binge-eating/purging type (e.g., when weight is normal), a diagnosis of bulimia ner- 3 months.
Binge-eating disorder. Some individuals binge eat but do not engage in regular inap- propriate compensatory behaviors. In these cases, the diagnosis of binge-eating disorder should be considered.
Kleine-Levin syndrome. In certain neurological or other medical conditions, such as
Kleine-Levin syndrome, there is disturbed eating behavior, but the characteristic psycho- logical features of bulimia nervosa, such as overconcern with body shape and weight, are not present.
Major depressive disorder, with atypical features. Overeating is common in major de- pressive disorder, with atypical features, but individuals with this disorder do not engage in inappropriate compensatory behaviors and do not exhibit the excessive concern with body shape and weight characteristic of bulimia nervosa. If criteria for both disorders are met, both diagnoses should be given.
Borderline personality disorder. Binge-eating behavior is included in the impulsive be- havior criterion that is part of the definition of borderline personality disorder. If the cri- teria for both borderline personality disorder and bulimia nervosa are met, both diagnoses should be given.
Comorbidity with mental disorders is common in individuals with bulimia nervosa, with morbidities. Comorbidity is not limited to any particular subset but rather occurs across a wide range of mental disorders. There is an increased frequency of depressive symptoms (e.g., low self-esteem) and bipolar and depressive disorders (particularly depressive dis- orders) in individuals with bulimia nervosa. In many individuals, the mood disturbance begins at the same time as or following the development of bulimia nervosa, and individ- uals often ascribe their mood disturbances to the bulimia nervosa. However, in some in- dividuals, the mood disturbance clearly precedes the development of bulimia nervosa.
There may also be an increased frequency of anxiety symptoms (e.g., fear of social situa- tions) or anxiety disorders. These mood and anxiety disturbances frequently remit follow- ing effective treatment of the bulimia nervosa. The lifetime prevalence of substance use, particularly alcohol or stimulant use, is at least 30% among individuals with bulimia ner- vosa. Stimulant use often begins in an attempt to control appetite and weight. A substan- tial percentage of individuals with bulimia nervosa also have personality features that meet criteria for one or more personality disorders, most frequently borderline personality disorder.
Diagnostic Criteria 307.51 (F50.8)
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 people would eat in a similar period of time under similar circumstances.