According to the American Psychiatric Association–

“Eating disorders are behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions. They can be severe conditions that affect physical, psychological, and social functioning. Types of eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder, other specified feeding and eating disorder, pica, and rumination disorder.”

The DSM5 classifies eating disorders in the following categories:

Individuals with bulimia nervosa typically alternate dieting or eating only low-calorie “safe foods” with binge eating on “forbidden” high-calorie foods. Binge eating is defined as eating a large amount of food in a short period associated with a sense of loss of control over what or how much one is eating. Binges may be massive, and food is often consumed rapidly, beyond fullness to nausea and discomfort. Binge behavior is usually secretive and associated with feelings of shame or embarrassment.

As in anorexia nervosa, persons with bulimia nervosa are excessively preoccupied with thoughts of food, weight, or shape, which negatively affect and disproportionately impact their self-worth. Binges occur at least weekly and are typically followed by what are called “compensatory behaviors” to prevent weight gain. These can include fasting, vomiting, laxative misuse, or compulsive exercise.

Individuals with bulimia nervosa can be slightly underweight, average, overweight, or obese. If they are malnourished, however, they are considered to have anorexia nervosa, binge-eating/purging type, not bulimia nervosa. Family members or friends may not know that a person has bulimia nervosa because they do not appear underweight and because their behaviors are hidden and may go unnoticed by those close to them. Possible signs that someone may have bulimia nervosa include:

• Frequent trips to the bathroom right after meals
• Large amounts of food disappearing or unexplained empty wrappers and food containers
• Chronic sore throat
• Swelling of the salivary glands in the cheeks
• Dental decay resulting from erosion of tooth enamel by stomach acid
• Heartburn and gastroesophageal reflux
• Laxative or diet pill misuse
• Recurrent unexplained diarrhea
• Misuse of diuretics (water pills)
• Feeling dizzy or fainting from excessive purging behaviors resulting in dehydration.

Bulimia can lead to rare but potentially fatal complications including esophageal tears, gastric rupture, and dangerous cardiac arrhythmias. Medical monitoring in severe bulimia nervosa is essential to identify and treat possible complications.

Outpatient cognitive behavioral therapy for bulimia nervosa is the treatment with the most substantial evidence. It helps patients normalize their eating behavior and manage thoughts and feelings that perpetuate the disorder. Antidepressants can also help decrease urges to binge and vomit.

Binge Eating Disorder

As with bulimia nervosa, people with binge eating disorder have episodes of binge eating in which they consume large quantities of food in a brief period, experience a sense of loss of control over their eating, and are distressed by the binge behavior. However, people with bulimia nervosa do not regularly use compensatory behaviors to eliminate the food by inducing vomiting, fasting, exercising, or laxative misuse. Binge eating is chronic and can lead to serious health complications, including obesity, diabetes, hypertension, and cardiovascular diseases.

The diagnosis of binge eating disorder requires frequent binges (at least once a week for three months), associated with a sense of lack of control, and with three or more of the following features:

• Eating more rapidly than normal
• Eating until uncomfortably full
• Eating large amounts of food when not feeling hungry
• Eating alone because of feeling embarrassed by how much one is eating
• Feeling disgusted with oneself, depressed, or very guilty afterward

As with bulimia nervosa, the most effective treatment for binge eating disorder is cognitive-behavioral psychotherapy for binge eating. Interpersonal therapy has also been shown to be effective, as have several antidepressant medications.