Bulimia

Bulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating followed by compensatory behaviors intended to prevent weight gain. Individuals with bulimia often feel a lack of control during binges and experience distress about their eating. Unlike some other eating disorders, bulimia typically occurs within a normal weight range, though weight can be fluctuating. It affects mostly females but also occurs in males and across various ages.

A binge episode involves eating an unusually large amount of food in a short period, accompanied by a sense of loss of control. Compensatory behaviors may include self-induced vomiting, misuse of laxatives or diuretics, fasting, or excessive exercise. Self-evaluation is heavily based on body shape and weight. To meet DSM-5 criteria, these patterns occur at least once per week for three months and are not solely during episodes of anorexia nervosa.

Medical complications can include electrolyte disturbances, dehydration, kidney and heart problems, esophageal irritation, dental enamel erosion, and salivary gland enlargement. Physical signs may include dental problems, Russell's sign (calluses on the knuckles), and gastrointestinal symptoms. People with bulimia may also have mood, anxiety, or substance-use disorders; suicidality risk is increased when untreated.

Treatment is multidisciplinary, combining psychotherapy (cognitive-behavioral therapy–enhanced is evidence-based), nutritional counseling, and medical monitoring. Pharmacotherapy with selective serotonin reuptake inhibitors, particularly fluoxetine, can reduce binge-purge frequency for some patients. Recovery varies; many achieve remission with ongoing care, though relapse can occur. Early identification improves outcomes.