Bulimia Nervosa
ICD-10 Classification: F50.2
Section titled “ICD-10 Classification: F50.2”Guidelines
Section titled “Guidelines”Bulimia nervosa is characterized by repeated episodes of binge eating and an excessive preoccupation with controlling body weight.
This leads the patient to employ extreme measures to mitigate the fattening effect of ingested food. The term refers only to the form of the disorder that is psychopathologically comparable to anorexia nervosa.
Age and Gender Distribution
Section titled “Age and Gender Distribution”The age and gender distribution is similar to anorexia nervosa, with the age of onset being slightly higher.
Connection with Anorexia
Section titled “Connection with Anorexia”The disorder can occur after an episode of anorexia nervosa and vice versa:
- A formerly anorexic patient initially appears improved after weight gain or resumption of menstruation
- Then a harmful behavioral pattern of binge eating and vomiting develops
Diagnostic Guidelines
Section titled “Diagnostic Guidelines”1. Binge Eating
Section titled “1. Binge Eating”A persistent preoccupation with eating, an irresistible craving for food. The patient succumbs to binge eating episodes during which large amounts of food are consumed in very short periods.
2. Countermeasures
Section titled “2. Countermeasures”The patient attempts to counteract the fattening effect of food through various behaviors:
- Self-induced vomiting
- Misuse of laxatives
- Intermittent periods of fasting
- Use of appetite suppressants, thyroid preparations, or diuretics
3. Pathological Fear
Section titled “3. Pathological Fear”One of the essential psychopathological features is a pathological fear of becoming fat. The patient sets a sharply defined weight limit, clearly below the premorbid weight considered optimal or “healthy” by the physician.
4. History
Section titled “4. History”Frequently, the history reveals an episode of anorexia nervosa with an interval of several months to years. This earlier episode may have been:
- Fully developed
- A covert form with moderate weight loss
- Including a temporary amenorrhea
Diagnostic Criteria
Section titled “Diagnostic Criteria”Criterion A - Binge Eating
Section titled “Criterion A - Binge Eating”Frequent episodes of binge eating (over a period of three months, at least twice per week) during which large amounts of food are consumed in very short periods.
Criterion B - Preoccupation with Eating
Section titled “Criterion B - Preoccupation with Eating”Persistent preoccupation with eating, an irresistible craving or compulsion to eat.
Criterion C - Countermeasures
Section titled “Criterion C - Countermeasures”The patients attempt to counteract weight gain from food with one or more of the following behaviors:
- Self-induced vomiting
- Misuse of laxatives
- Intermittent periods of fasting
- Use of appetite suppressants, thyroid preparations, or diuretics
Criterion D - Self-Perception
Section titled “Criterion D - Self-Perception”Self-perception as “too fat,” with an intrusive fear of becoming fat.
Associated Terms
Section titled “Associated Terms”- Bulimia not otherwise specified
- Hyperorexia nervosa
Differential Diagnosis
Section titled “Differential Diagnosis”Bulimia nervosa must be differentiated from:
-
Disorders of the upper gastrointestinal tract with repeated vomiting (characteristic psychopathological features are absent)
-
General personality disorder - The eating disorder may be associated with alcohol dependence and minor offenses (e.g., shoplifting)
-
Depressive disorder - Bulimic patients frequently experience depressive symptoms
Atypical Bulimia Nervosa (F50.3)
Section titled “Atypical Bulimia Nervosa (F50.3)”Guidelines
Section titled “Guidelines”This diagnosis should be used for patients in whom one or more core features of bulimia nervosa are absent with an otherwise fairly typical clinical picture.
This most commonly applies to patients with:
- Normal weight or even overweight
- Typical periods of binge eating followed by vomiting and purging
Partial Syndromes
Section titled “Partial Syndromes”Partial syndromes with depressive symptoms are also common. However, if the depressive symptoms justify the diagnosis of a depressive disorder, two diagnoses should be coded.
Associated Terms
Section titled “Associated Terms”- Bulimia with normal weight
Connection with Borderline Personality Disorder
Section titled “Connection with Borderline Personality Disorder”Too often, both disorders (bulimia and anorexia) are underpinned by Borderline Personality Disorder. Please do not misunderstand this: a person with bulimia or anorexia does not necessarily have an underlying borderline disorder, even when strong indicators exist.
This is rather about the primary disturbance - the disturbed state in childhood from which the eating disorder then develops.
It must be noted that if this primary state is not worked through analytically and through behavioral therapy, treatment fails completely.