Bulimia Diagnosis Requires 4 Factors

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Bulimia nervosa is an eating disorder in which the person repeatedly eats too much and then takes drastic steps to compensate for that binge eating.

When many people think of bulimia, they think of "bingeing and purging" behavior — eating too much and then intentionally throwing up. But someone doesn't have to force themselves to repeatedly throw up in order to be diagnosed with bulimia.

Bulimia primarily affects adolescent girls and young adult women. Here's what clinicians look for when diagnosing bulimia nervosa.

Criteria Needed

A person must meet all of the following criteria in order to be diagnosed with bulimia nervosa:

  • Repeated episodes of binge eating, defined as eating "an amount of food that is definitely larger than most people would eat" during the same amount of time. The person also must feel as though they have lost control over eating and are unable to stop themselves or control how much they are eating.
  • Use of inappropriate behaviors (also known as "compensatory behaviors") to avoid weight gain or to compensate for the binge eating. These include self-induced vomiting (likely the best-known of bulimia behaviors), the misuse of laxatives, diuretics and/or enemas, and excessive exercise.
  • Both the binge eating and compensatory behaviors occur at least once a week for three months.
  • The person's weight and/or body shape must have a significant impact on the way the person views himself or herself.

These four requirements come from the Diagnostic & Statistical Manual of Mental Disorders, fifth edition, (DSM-V), which is published by the American Psychiatric Association. The DSM-V provides physicians and mental-health professionals with the criteria for diagnosing specific mental disorders, including bulimia nervosa.

Other Signs 

People suffering from bulimia may not be thin—in fact, unlike those suffering from anorexia nervosa, they're likely to be at a normal weight. Some may even be a bit overweight. They may feel intense shame at their bulimic behavior, and likely will try to hide it (in some cases, skillfully enough that few people would suspect a problem).

Bulimia may lead to additional symptoms over time, such as a constant sore throat or swollen salivary glands, bad teeth, and dehydration. These can result from repeated vomiting. Severe bulimia can cause a heart attack when essential minerals, such as calcium and sodium, become unbalanced due to the bingeing and purging cycles.

As many as 2 percent to 3 percent of women may suffer from bulimia in the United States, and in some vulnerable populations (college-aged women, specifically), experts estimate up to 10 percent may meet the diagnostic criteria for bulimia. Men are affected, too, but at about one-tenth the rate of women.

Young women may be especially prone to bulimia if they suffered from childhood sexual abuse, if they eat alone, if they live in a sorority house, or if they have low self-esteem. Involvement in athletics or employment in a job that focuses on weight (like modeling or acting) can predispose someone to bulimia. Gay men also have a high rate of bulimia.

If you or someone you know is suffering from some or all of the above criteria it is important to see a physician, dietitian, or mental health professional for an assessment.

Bulimia Discussion Guide

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A Word From Verywell

If you don't already see a healthcare professional who specializes in eating disorders, you can always speak to your primary care physician. The key step here is to get the discussion started (whether between you and your doctor or your loved one and his/her doctor). Since eating disorders often go unrecognized or unnoticed, those who suffer from them can find it difficult to reach out for help or return to their "normal" behaviors. Know that there are options—your eating disorder does not need to control you forever.

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Article Sources

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
  • National Institute of Mental Health. What Are Eating Disorders? fact sheet. 
  • Rushing JM et al. Bulimia Nervosa: A Primary Care Review. The Primary Care Companion to the Journal of Clinical Psychiatry. 2003; 5(5):217-224.