Bulimia Nervosa and Binge Eating Disorder

Bulimia nervosa has a prevalence of between 1% and 2% in adolescent and young adult women, with clinically significant bulimic binge eating behaviors (eating disorder not otherwise specified or binge-eating disorder) in an additional 2%-3% (Fairburn and Be-glin 1990; Fairburn et al. 2000; Flament et al. 1995; Hoek and van Hoeken 2003). The two primary features of bulimia nervosa are 1) overvaluation of body weight and shape and 2) a pattern of eating consisting of extreme dieting punctuated by episodes of binge eating and compensatory behaviors (e.g., vomiting, laxative use) (American Psychiatric Association 2000; Fairburn and Cooper 1984; Fairburn et al. 1986a, 2000; Welch and Fairburn 1996).

Like those with anorexia nervosa, many adolescents who present with disabling binge eating symptoms do not meet full DSM-IV-TR diagnostic criteria. Nevertheless, bulimia nervosa and eating disorder not otherwise specified (or partial bulimia nervosa) are similar except in the frequency of binge and purge episodes (Crow et al. 2002). Binge-eating disorder, wherein the pattern of eating consists only of binge eating without compensatory behaviors, has been proposed as a separate class of disorders (American Psychiatric Association 2000).

Common co-occurring psychiatric diagnoses include anxiety, mood, and substance abuse disorders, as well as Cluster B personality traits or disorders

(Herzog et al. 1991, 1992, 1996). Common bulimia nervosa medical complications are described in Table 10-3 (Fisher et al. 1995; Mitchell et al. 1991; Rome and Ammerman 2003; Rome et al. 2003). Although body weight is generally in the normal range, obesity is the main health risk factor associated with bulimia nervosa. Other less common consequences of bulimia nervosa include constipation, electrolyte abnormalities (particularly low potassium), and esophageal tears (Rome and Ammerman 2003).

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