CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Eating disorders - Management
Clinical features of bulimia nervosa
Clinical features of bulimia nervosa include:
- Recurrent episodes of binge eating (eating, in a defined period of time, much more than most people would eat under similar circumstances) which occur with feelings of loss of control over how much is being eaten.
- Compensatory behaviour (any one or a combination of vomiting, purging, fasting, or excessive exercise) in order to prevent weight gain. Misuse of laxatives, diuretics, thyroxine, amphetamines, or other medication may occur.
- The World Health Organization stresses that purging behaviour (which encompasses self-induced vomiting and laxative misuse) should be categorized as bulimia nervosa. However, the DSM-IV American Classification System criteria distinguish between bulimia nervosa with purging behaviour and the non-purging type (excessive exercise or fasting occur, but not vomiting or laxative misuse). The DSM-IV criteria state that binge eating and inappropriate compensatory behaviours both occur, on average, at least twice a week for 3 months.
- Body mass index maintained above 17.5 kg/m2 in adults, although there may be a history of an earlier episode of anorexia nervosa.
- Psychological features, which typically include:
- A fear of gaining weight, with a sharply defined weight threshold set by the individual. Self-evaluation is unduly influenced by weight and body shape.
- Mood disturbance and symptoms of anxiety and tension.
- Other associated psychological symptoms including persistent preoccupation and craving for food and feelings of guilt and shame about the behaviour. Self-harm, often by scratching or cutting, is common.
- Physical symptoms such as bloating, fullness, lethargy, gastro-oesophageal reflux, abdominal pain, and sore throat (from vomiting).
- Physical signs in severe cases, such as knuckle calluses (from inducing vomiting; Russell's sign), dental enamel erosion, and salivary gland enlargement. In practice these are not seen in the majority of people presenting in primary care with bulimic disorders.
[WHO, 1992; DSM-IV, 1994; Pritts and Susman, 2003; National Collaborating Centre for Mental Health, 2004]
© NHS Institute for Innovation and Improvement