Bulimia Nervosa Diagnosis
A bulimia nervosa diagnosis focuses on an analysis of the individual's bingeing and purging behaviours along with their beliefs and attitudes. Unlike anorexia nervosa, substantial weight loss is not usually a symptom of bulimia nervosa.
A medical doctor will refer to a list of symptoms (or diagnostic criteria) to help them with making a diagnosis for bulimia nervosa.
Health professionals in the United States generally use diagnostic criteria from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), while diagnostic criteria from The World Health Organisation's International Statistical Classification of Diseases and Related Health Problems (ICD-10) are most commonly used in Europe.
Diagnostic criteria for bulimia nervosa
(Adapted from DSM-IV-TR)
A. Recurring episodes of binge eating. The two characteristics of a binge eating episode are:
(1) Eating a much larger amount of food than most people would consider normal under similar circumstances and within the same time frame (eating may continue for several hours).
(2) While eating, there is a feeling of loss of control over the amount of food or type of food being consumed.
B. There are recurring efforts to compensate for bingeing episodes and to avoid gaining weight. These may take the form of self-induced vomiting, laxative abuse, diuretics, enemas, restricting calories or excessive exercise.
C. On average, binge eating and compensatory behaviours take place twice weekly, and have done so for 3 months.
D. There is an excessive influence of body weight and shape on self-worth.
E. The disorder occurs at times other than during episodes of anorexia nervosa.
There are two identifiable types of bulimia nervosa:
Purging Type: Throughout the present episode of bulimia nervosa, there has been a regular occurrence of purging behaviours in the form of self-induced vomiting, laxative abuse, diuretics, or enemas.
Non-purging Type: Throughout the present episode of bulimia nervosa, there have been other efforts to compensate, such as restricting calories or excessive exercise, but there has been no regular occurrence of self-induced vomiting, laxative abuse, diuretics, or enemas.
Diagnostic criteria for bulimia nervosa
(Adapted from ICD-10)
(a) The constant obsession with eating and the overwhelming desire for food leads to episodes of eating large amounts of food in short time periods.
(b) There are efforts made to reduce the effect of eating foods perceived as fattening in the form of self-induced vomiting and other purging techniques, alternating episodes of calorie restriction, using appetite suppressants, thyroid preparations or diuretics. People with diabetes may refrain from using their insulin treatment.
(c) There is an intense fear of becoming fat, which leads to the desire to reach a specific body weight much lower than is considered normal or healthy for height and age. In many cases, the bulimia follows an episode of anorexia nervosa, although the period of time between the two disorders may vary considerably.
ICD-10 also includes 'atypical' bulimia nervosa, which refers to individuals who show some, but not all, of the characteristics of bulimia nervosa.