Bulimia nervosa is an eating disorder characterized by binge eating followed by inappropriate compensatory behaviors designed to prevent weight gain. In addition, the self-evaluation of individuals with bulimia nervosa is excessively influenced by weight and body shape. The major change in criteria for diagnosis of bulimia nervosa is reducing the binge frequency threshold from twice per week in DSM-IV to once per week in DSM-5. The other differences include the DSM-IV differentiating between purging and nonpurging type (the DSM-5 does not) and the DSM-5 specifying criteria for partial remission, full remission, and severity, while the DSM-IV does not.
Diagnostic Criteria for Bulimia Nervosa (DSM-5)
A. Recurrent episodes of binge eating, as characterized by both:
1. Eating, within any 2-hour period, an amount of food that is definitively larger than what most individuals would eat in a similar period of time under similar circumstances.
2. A feeling that one cannot stop eating or control what or how much one is eating
B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting or excessive exercise.
C. The binge eating and inappropriate compensatory behaviors occur, on average, at least once a week for 3 months.
D. Self-evaluation is unjustifiability influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
- Partial remission: After full criteria were previously met, some but not all of the criteria have been met for a sustained period of time.
- Full remission: After full criteria were previously met, none of the criteria have been met for a sustained period of time.
- Mild: An average of 1-3 episodes of inappropriate compensatory behaviors per week.
- Moderate: An average of 4-7 episodes of inappropriate compensatory behaviors per week.
- Severe: An average of 8-13 episodes of inappropriate compensatory behaviors per week.
- Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors per week.
- Walsh BT. Diagnostic Categories for Eating Disorders: Current Status and What Lies Ahead. Psychiatr Clin North Am. 2019;42(1):1–10. [Medline]
- DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Substance Abuse and Mental Health Services Administration. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. [Medline]
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). Washington DC: APA; 2013.
Created Apr 23, 2020.