Bulimia Diagnosis Requires 5 Factors

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Bulimia nervosa is an eating disorder in which the person repeatedly eats too much and then takes drastic steps, including vomiting, the use of laxatives, excessive exercise, or fasting, to compensate for that binge eating. People who have bulimia often struggle with feelings of shame or guilt about their behaviors.

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

Bulimia Diagnosic Criteria

All of the following criteria must be met for a bulimia nervosa diagnosis:

  • 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.
  • Loss of control. The person must feel as though they have lost control of overeating 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.

Individuals with anorexia may display these behaviors as well. People who meet these criteria only during episodes of anorexia nervosa are not considered bulimic. 

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

Other Signs of Bulimic Behavior

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% to 3% of women may suffer from bulimia in the United States, and in some vulnerable populations (college-aged women, specifically), experts estimate up to 10% 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, especially in those that are at a normal weight or even overweight, 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.

4 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Harrington B, Jimerson M, Haxton C, Jimerson D. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. Am Fam Physician. 2015;91(1):46-52.

  2. Sardar M, Greway A, Deangelis M, Tysko E, Lehmann S, Wohlstetter M, Patel R. Cardiovascular Impact of Eating Disorders in Adults: A Single Center Experience and Literature Review. Heart Views. 2015;16(3):88-92. doi:10.4103%2F1995-705X.164463

  3. Sathyapriya B, Purushothaman L, Govindarajan S, Jinu K, Balasubramanian C, Gokulalakshmi E. Bulimia Nervosa-A Psychiatric Eating Disorder. ACTAScientific Medical Sciences. 2018;2(1)

  4. Strother E, Lemberg R, Stanford S, Turberville D. Eating disorders in men: underdiagnosed, undertreated, and misunderstood. Eat Disord. 2012;20(5):346-55. doi:10.1080%2F10640266.2012.715512

Additional Reading
  • National Institute of Mental Health. Eating Disorders. Updated February 2016. 

  • Rushing JM, Jones LE, Carney CP. Bulimia Nervosa: A Primary Care Review. Prim Care Companion J Clin Psychiatry. 2003;5(5):217-224. doi:10.4088/pcc.v05n0505

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

By Susan Cowden, MS
Susan Cowden is a licensed marriage and family therapist and a member of the Academy for Eating Disorders.