Bulimia Nervosa


  • Lifetime prevalence is 1.0% (higher than anorexia nervosia)

  • Like anorexia, it is more common in females

Main Concepts:

  • Recurrent episodes of binge eating

  • Inappropriate compensatory behavior to prevent weight gain

  • Excess worry about body shape and weight

Notable Features:

High Yield:

  • Patients find their symptoms ego-dystonic, in contrast with anorexia nervosa




  • Binge-eating is done every 2 hours with a lack of self-control

  • Self-evaluation unduly influenced by body shape and weight

  • Recurrent inappropriate compensatory behavior following binge-eating to avoid weight gain


The finding of hypokalemia is consistent with self-induced vomiting. Other typical clinical findings include:

  • Dry skin

  • Hypotension

  • Tachycardia

  • Menstrual irregularities

  • Erosion of dental enamel

  • Parotid hypertrophy

  • Metabolic alkalosis



Treatment options:

  • Individual psychotherapy

  • Cognitive behavioral therapy (CBT)

  • Group therapy

  • Nutritional rehabilitation

  • Pharmacotherapy

    • SSRIs first-line (e.g. fluoxetine)

    • TCAs second-line

Fluoxetine has the best evidence for reducing the frequency of bingeing and purging episodes. It can be used alone, but is most effective as part of a multimodal therapy that includes nutritional rehabilitation (e.g. establishing a structured and consistent meal pattern) and CBT.

Avoid buproprion in patients with active symptoms of bulimia nervosa due to an increased risk of seizures.