Bulimia nervosa

DSM-5-TR[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.

DSM-5-TR criteria require the episodes of bingeing to have the following characteristics:

• Eating must be in a discrete period of time and must be of an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.

• There must be a sense of lack of control over the eating during the episode.

The following factors are also considered part of DSM-5-TR criteria:

• There is recurrent inappropriate compensatory behaviour to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; excessive exercise.

• The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for 3 months.

• Self-evaluation is unduly influenced by body shape and weight.

• The disturbance does not occur exclusively during episodes of anorexia nervosa.

International classification of diseases, 11th revision (ICD-11)[3]World Health Organization. International Classification of Diseases, 11th Revision (ICD-11). 2022 [internet publication]. https://icd.who.int/en

• ICD-11 has a section on feeding or eating disorders. Within this, it characterises bulimia nervosa (6B81) as frequent, recurrent episodes of binge eating (once a week or more for over 1 month). Binge eating is defined as a period of time where the individual has loss of control over their eating behaviour and feels unable to stop. In bulimia nervosa, binge eating episodes are accompanied by compensatory behaviours to prevent weight gain, for example laxative use or vomiting. The individual is also preoccupied by weight or shape and does not meet the diagnostic criteria for anorexia.

• ICD-11 has a separate category for binge eating disorder (6B82), characterised, like in bulimia, with periods of loss of control over eating. Unlike bulimia nervosa, however, these episodes are not followed by compensatory behaviours to prevent weight gain.

• Another category in ICD-11 is rumination-regurgitation disorder (6B85). This disorder is characterised by the intentional and repeated bringing up of previously swallowed food back to the mouth (i.e., regurgitation), which may be re-chewed and re-swallowed (i.e. rumination), or may be deliberately spat out (but, differentiating it from bulimia nervosa, is not vomited). The regurgitation behaviour is frequent (at least several times per week) and sustained over a period of at least several weeks. It is only diagnosed in those at least 2 years old.