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<ul id="toc-Signs_and_symptoms-sublist" class="vector-toc-list"> <li id="toc-Interoceptive" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Interoceptive"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.1</span> <span>Interoceptive</span> </div> </a> <ul id="toc-Interoceptive-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Related_disorders" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Related_disorders"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.2</span> <span>Related disorders</span> </div> </a> <ul id="toc-Related_disorders-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Causes" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Causes"> <div class="vector-toc-text"> <span class="vector-toc-numb">2</span> <span>Causes</span> </div> </a> <button aria-controls="toc-Causes-sublist" 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class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Diagnosis</span> </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Diagnosis subsection</span> </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-Criteria" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Criteria"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1</span> <span>Criteria</span> </div> </a> <ul id="toc-Criteria-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Treatment</span> </div> </a> <button aria-controls="toc-Treatment-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Treatment subsection</span> </button> <ul id="toc-Treatment-sublist" class="vector-toc-list"> <li id="toc-Psychotherapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Psychotherapy"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Psychotherapy</span> </div> </a> <ul id="toc-Psychotherapy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Medication" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Medication"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2</span> <span>Medication</span> </div> </a> <ul id="toc-Medication-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Alternative_medicine" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Alternative_medicine"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.3</span> <span>Alternative medicine</span> </div> </a> <ul id="toc-Alternative_medicine-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Risk_factors" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Risk_factors"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.4</span> <span>Risk factors</span> </div> </a> <ul id="toc-Risk_factors-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Epidemiology</span> </div> </a> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>History</span> </div> </a> <button aria-controls="toc-History-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle History subsection</span> </button> <ul id="toc-History-sublist" class="vector-toc-list"> <li id="toc-Etymology" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Etymology"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.1</span> <span>Etymology</span> </div> </a> <ul id="toc-Etymology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Before_the_20th_century" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Before_the_20th_century"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.2</span> <span>Before the 20th century</span> </div> </a> <ul id="toc-Before_the_20th_century-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-20th_century" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#20th_century"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.3</span> <span>20th century</span> </div> </a> <ul id="toc-20th_century-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" title="Table of Contents" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Bulimia nervosa</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 59 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-59" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">59 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-af mw-list-item"><a href="https://af.wikipedia.org/wiki/Bulimie" title="Bulimie – Afrikaans" lang="af" hreflang="af" data-title="Bulimie" data-language-autonym="Afrikaans" data-language-local-name="Afrikaans" class="interlanguage-link-target"><span>Afrikaans</span></a></li><li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D9%86%D9%87%D8%A7%D9%85_%D8%B9%D8%B5%D8%A8%D9%8A" title="نهام عصبي – Arabic" lang="ar" hreflang="ar" data-title="نهام عصبي" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-an mw-list-item"><a href="https://an.wikipedia.org/wiki/Bulimia" title="Bulimia – Aragonese" lang="an" hreflang="an" data-title="Bulimia" data-language-autonym="Aragonés" data-language-local-name="Aragonese" class="interlanguage-link-target"><span>Aragonés</span></a></li><li class="interlanguage-link interwiki-az mw-list-item"><a href="https://az.wikipedia.org/wiki/Bulimiya_nervoza" title="Bulimiya nervoza – Azerbaijani" lang="az" hreflang="az" data-title="Bulimiya nervoza" data-language-autonym="Azərbaycanca" data-language-local-name="Azerbaijani" class="interlanguage-link-target"><span>Azərbaycanca</span></a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%9D%D0%B5%D1%80%D0%B2%D0%BD%D0%B0_%D0%B1%D1%83%D0%BB%D0%B8%D0%BC%D0%B8%D1%8F" title="Нервна булимия – Bulgarian" lang="bg" hreflang="bg" data-title="Нервна булимия" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target"><span>Български</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Bul%C3%ADmia" title="Bulímia – Catalan" lang="ca" hreflang="ca" data-title="Bulímia" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Bulimie" title="Bulimie – Czech" lang="cs" hreflang="cs" data-title="Bulimie" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/Bulimi" title="Bulimi – Danish" lang="da" hreflang="da" data-title="Bulimi" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target"><span>Dansk</span></a></li><li class="interlanguage-link interwiki-se mw-list-item"><a href="https://se.wikipedia.org/wiki/Bulimiija" title="Bulimiija – Northern Sami" lang="se" hreflang="se" data-title="Bulimiija" data-language-autonym="Davvisámegiella" data-language-local-name="Northern Sami" class="interlanguage-link-target"><span>Davvisámegiella</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Bulimie" title="Bulimie – German" lang="de" hreflang="de" data-title="Bulimie" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/Buliimia" title="Buliimia – Estonian" lang="et" hreflang="et" data-title="Buliimia" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target"><span>Eesti</span></a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%A8%CF%85%CF%87%CE%BF%CE%B3%CE%B5%CE%BD%CE%AE%CF%82_%CE%B2%CE%BF%CF%85%CE%BB%CE%B9%CE%BC%CE%AF%CE%B1" title="Ψυχογενής βουλιμία – Greek" lang="el" hreflang="el" data-title="Ψυχογενής βουλιμία" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target"><span>Ελληνικά</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Bulimia" title="Bulimia – Spanish" lang="es" hreflang="es" data-title="Bulimia" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-eo mw-list-item"><a href="https://eo.wikipedia.org/wiki/Bulimio" title="Bulimio – Esperanto" lang="eo" hreflang="eo" data-title="Bulimio" data-language-autonym="Esperanto" data-language-local-name="Esperanto" class="interlanguage-link-target"><span>Esperanto</span></a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Bulimia" title="Bulimia – Basque" lang="eu" hreflang="eu" data-title="Bulimia" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target"><span>Euskara</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D9%BE%D8%B1%D8%AE%D9%88%D8%B1%DB%8C_%D8%B9%D8%B5%D8%A8%DB%8C" title="پرخوری عصبی – Persian" lang="fa" hreflang="fa" data-title="پرخوری عصبی" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Boulimie" title="Boulimie – French" lang="fr" hreflang="fr" data-title="Boulimie" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ga mw-list-item"><a href="https://ga.wikipedia.org/wiki/B%C3%BAilime_n%C3%A9ar%C3%B3gach" title="Búilime néarógach – Irish" lang="ga" hreflang="ga" data-title="Búilime néarógach" data-language-autonym="Gaeilge" data-language-local-name="Irish" class="interlanguage-link-target"><span>Gaeilge</span></a></li><li class="interlanguage-link interwiki-gl mw-list-item"><a href="https://gl.wikipedia.org/wiki/Bulimia_nerviosa" title="Bulimia nerviosa – Galician" lang="gl" hreflang="gl" data-title="Bulimia nerviosa" data-language-autonym="Galego" data-language-local-name="Galician" class="interlanguage-link-target"><span>Galego</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%ED%8F%AD%EC%8B%9D%EC%A6%9D" title="폭식증 – Korean" lang="ko" hreflang="ko" data-title="폭식증" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D5%86%D5%B5%D5%A1%D6%80%D5%A4%D5%A1%D5%B5%D5%AB%D5%B6_%D5%A2%D5%B8%D6%82%D5%AC%D5%AB%D5%B4%D5%AB%D5%A1" title="Նյարդային բուլիմիա – Armenian" lang="hy" hreflang="hy" data-title="Նյարդային բուլիմիա" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target"><span>Հայերեն</span></a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Bulimija" title="Bulimija – Croatian" lang="hr" hreflang="hr" data-title="Bulimija" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target"><span>Hrvatski</span></a></li><li class="interlanguage-link interwiki-io mw-list-item"><a href="https://io.wikipedia.org/wiki/Bulimio" title="Bulimio – Ido" lang="io" hreflang="io" data-title="Bulimio" data-language-autonym="Ido" data-language-local-name="Ido" class="interlanguage-link-target"><span>Ido</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Bulimia_nervosa" title="Bulimia nervosa – Indonesian" lang="id" hreflang="id" data-title="Bulimia nervosa" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-is mw-list-item"><a href="https://is.wikipedia.org/wiki/Lotugr%C3%A6%C3%B0gi" title="Lotugræðgi – Icelandic" lang="is" hreflang="is" data-title="Lotugræðgi" data-language-autonym="Íslenska" data-language-local-name="Icelandic" class="interlanguage-link-target"><span>Íslenska</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Bulimia" title="Bulimia – Italian" lang="it" hreflang="it" data-title="Bulimia" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%91%D7%95%D7%9C%D7%99%D7%9E%D7%99%D7%94_%D7%A0%D7%A8%D7%91%D7%95%D7%96%D7%94" title="בולימיה נרבוזה – Hebrew" lang="he" hreflang="he" data-title="בולימיה נרבוזה" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-ka mw-list-item"><a href="https://ka.wikipedia.org/wiki/%E1%83%91%E1%83%A3%E1%83%9A%E1%83%98%E1%83%9B%E1%83%98%E1%83%90" title="ბულიმია – Georgian" lang="ka" hreflang="ka" data-title="ბულიმია" data-language-autonym="ქართული" data-language-local-name="Georgian" class="interlanguage-link-target"><span>ქართული</span></a></li><li class="interlanguage-link interwiki-kk mw-list-item"><a href="https://kk.wikipedia.org/wiki/%D0%91%D1%83%D0%BB%D0%B8%D0%BC%D0%B8%D1%8F" title="Булимия – Kazakh" lang="kk" hreflang="kk" data-title="Булимия" data-language-autonym="Қазақша" data-language-local-name="Kazakh" class="interlanguage-link-target"><span>Қазақша</span></a></li><li class="interlanguage-link interwiki-la mw-list-item"><a href="https://la.wikipedia.org/wiki/Bulimia_nervosa" title="Bulimia nervosa – Latin" lang="la" hreflang="la" data-title="Bulimia nervosa" data-language-autonym="Latina" data-language-local-name="Latin" class="interlanguage-link-target"><span>Latina</span></a></li><li class="interlanguage-link interwiki-lt mw-list-item"><a href="https://lt.wikipedia.org/wiki/Bulimija" title="Bulimija – Lithuanian" lang="lt" hreflang="lt" data-title="Bulimija" data-language-autonym="Lietuvių" data-language-local-name="Lithuanian" class="interlanguage-link-target"><span>Lietuvių</span></a></li><li class="interlanguage-link interwiki-lmo mw-list-item"><a href="https://lmo.wikipedia.org/wiki/Bulimia" title="Bulimia – Lombard" lang="lmo" hreflang="lmo" data-title="Bulimia" data-language-autonym="Lombard" data-language-local-name="Lombard" class="interlanguage-link-target"><span>Lombard</span></a></li><li class="interlanguage-link interwiki-hu mw-list-item"><a href="https://hu.wikipedia.org/wiki/Bulimia_nervosa" title="Bulimia nervosa – Hungarian" lang="hu" hreflang="hu" data-title="Bulimia nervosa" data-language-autonym="Magyar" data-language-local-name="Hungarian" class="interlanguage-link-target"><span>Magyar</span></a></li><li class="interlanguage-link interwiki-mk mw-list-item"><a href="https://mk.wikipedia.org/wiki/%D0%91%D1%83%D0%BB%D0%B8%D0%BC%D0%B8%D1%98%D0%B0" title="Булимија – Macedonian" lang="mk" hreflang="mk" data-title="Булимија" data-language-autonym="Македонски" data-language-local-name="Macedonian" class="interlanguage-link-target"><span>Македонски</span></a></li><li class="interlanguage-link interwiki-ms mw-list-item"><a href="https://ms.wikipedia.org/wiki/Bulimia_nervosa" title="Bulimia nervosa – Malay" lang="ms" hreflang="ms" data-title="Bulimia nervosa" data-language-autonym="Bahasa Melayu" data-language-local-name="Malay" class="interlanguage-link-target"><span>Bahasa Melayu</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Boulimie" title="Boulimie – Dutch" lang="nl" hreflang="nl" data-title="Boulimie" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E7%A5%9E%E7%B5%8C%E6%80%A7%E5%A4%A7%E9%A3%9F%E7%97%87" title="神経性大食症 – Japanese" lang="ja" hreflang="ja" data-title="神経性大食症" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Bulimia_nervosa" title="Bulimia nervosa – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Bulimia nervosa" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target"><span>Norsk bokmål</span></a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%AC%E0%AD%81%E0%AC%B2%E0%AC%BF%E0%AC%AE%E0%AC%BF%E0%AC%86_%E0%AC%A8%E0%AC%B0%E0%AD%8D%E0%AC%AD%E0%AD%8B%E0%AC%B8%E0%AC%BE" title="ବୁଲିମିଆ ନର୍ଭୋସା – Odia" lang="or" hreflang="or" data-title="ବୁଲିମିଆ ନର୍ଭୋସା" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target"><span>ଓଡ଼ିଆ</span></a></li><li class="interlanguage-link interwiki-uz mw-list-item"><a href="https://uz.wikipedia.org/wiki/Bulimiya_nevrozi" title="Bulimiya nevrozi – Uzbek" lang="uz" hreflang="uz" data-title="Bulimiya nevrozi" data-language-autonym="Oʻzbekcha / ўзбекча" data-language-local-name="Uzbek" class="interlanguage-link-target"><span>Oʻzbekcha / ўзбекча</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Bulimia" title="Bulimia – Polish" lang="pl" hreflang="pl" data-title="Bulimia" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Bulimia_nervosa" title="Bulimia nervosa – Portuguese" lang="pt" hreflang="pt" data-title="Bulimia nervosa" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/Bulimie" title="Bulimie – Romanian" lang="ro" hreflang="ro" data-title="Bulimie" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target"><span>Română</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%9D%D0%B5%D1%80%D0%B2%D0%BD%D0%B0%D1%8F_%D0%B1%D1%83%D0%BB%D0%B8%D0%BC%D0%B8%D1%8F" title="Нервная булимия – Russian" lang="ru" hreflang="ru" data-title="Нервная булимия" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-sq mw-list-item"><a href="https://sq.wikipedia.org/wiki/Bulimia" title="Bulimia – Albanian" lang="sq" hreflang="sq" data-title="Bulimia" data-language-autonym="Shqip" data-language-local-name="Albanian" class="interlanguage-link-target"><span>Shqip</span></a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Bulimia_nervosa" title="Bulimia nervosa – Simple English" lang="en-simple" hreflang="en-simple" data-title="Bulimia nervosa" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target"><span>Simple English</span></a></li><li class="interlanguage-link interwiki-sk mw-list-item"><a href="https://sk.wikipedia.org/wiki/Bul%C3%ADmia" title="Bulímia – Slovak" lang="sk" hreflang="sk" data-title="Bulímia" data-language-autonym="Slovenčina" data-language-local-name="Slovak" class="interlanguage-link-target"><span>Slovenčina</span></a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Bulimija" title="Bulimija – Slovenian" lang="sl" hreflang="sl" data-title="Bulimija" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target"><span>Slovenščina</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%91%D1%83%D0%BB%D0%B8%D0%BC%D0%B8%D1%98%D0%B0" title="Булимија – Serbian" lang="sr" hreflang="sr" data-title="Булимија" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Bulimija" title="Bulimija – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Bulimija" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target"><span>Srpskohrvatski / српскохрватски</span></a></li><li class="interlanguage-link interwiki-su mw-list-item"><a href="https://su.wikipedia.org/wiki/Bulimia_nervosa" title="Bulimia nervosa – Sundanese" lang="su" hreflang="su" data-title="Bulimia nervosa" data-language-autonym="Sunda" data-language-local-name="Sundanese" class="interlanguage-link-target"><span>Sunda</span></a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Bulimia_nervosa" title="Bulimia nervosa – Finnish" lang="fi" hreflang="fi" data-title="Bulimia nervosa" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target"><span>Suomi</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Bulimia_nervosa" title="Bulimia nervosa – Swedish" lang="sv" hreflang="sv" data-title="Bulimia nervosa" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target"><span>Svenska</span></a></li><li class="interlanguage-link interwiki-tl mw-list-item"><a href="https://tl.wikipedia.org/wiki/Bulimia_nervosa" title="Bulimia nervosa – Tagalog" lang="tl" hreflang="tl" data-title="Bulimia nervosa" data-language-autonym="Tagalog" data-language-local-name="Tagalog" class="interlanguage-link-target"><span>Tagalog</span></a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/%E0%B9%82%E0%B8%A3%E0%B8%84%E0%B8%9A%E0%B8%B9%E0%B8%A5%E0%B8%B4%E0%B9%80%E0%B8%A1%E0%B8%B5%E0%B8%A2_%E0%B9%80%E0%B8%99%E0%B8%AD%E0%B8%A3%E0%B9%8C%E0%B9%82%E0%B8%A7%E0%B8%8B%E0%B8%B2" title="โรคบูลิเมีย เนอร์โวซา – Thai" lang="th" hreflang="th" data-title="โรคบูลิเมีย เนอร์โวซา" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target"><span>ไทย</span></a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/Bulimia_nervoza" title="Bulimia nervoza – Turkish" lang="tr" hreflang="tr" data-title="Bulimia nervoza" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target"><span>Türkçe</span></a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%9D%D0%B5%D1%80%D0%B2%D0%BE%D0%B2%D0%B0_%D0%B1%D1%83%D0%BB%D1%96%D0%BC%D1%96%D1%8F" title="Нервова булімія – Ukrainian" lang="uk" hreflang="uk" data-title="Нервова булімія" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target"><span>Українська</span></a></li><li class="interlanguage-link interwiki-vi mw-list-item"><a href="https://vi.wikipedia.org/wiki/Ch%E1%BB%A9ng_h%C3%A1u_%C4%83n" title="Chứng háu ăn – Vietnamese" lang="vi" hreflang="vi" data-title="Chứng háu ăn" data-language-autonym="Tiếng Việt" data-language-local-name="Vietnamese" class="interlanguage-link-target"><span>Tiếng Việt</span></a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a href="https://zh.wikipedia.org/wiki/%E7%A5%9E%E7%BB%8F%E6%80%A7%E8%B4%AA%E9%A3%9F%E7%97%87" title="神经性贪食症 – Chinese" lang="zh" hreflang="zh" data-title="神经性贪食症" data-language-autonym="中文" data-language-local-name="Chinese" 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<div class="mw-indicators"> </div> <div id="siteSub" class="noprint">From Wikipedia, the free encyclopedia</div> </div> <div id="contentSub"><div id="mw-content-subtitle"></div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Type of eating disorder</div> <style data-mw-deduplicate="TemplateStyles:r1251242444">.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 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.ambox{display:none!important}}</style><table class="box-Update plainlinks metadata ambox ambox-content ambox-Update" role="presentation"><tbody><tr><td class="mbox-image"><div class="mbox-image-div"><span typeof="mw:File"><span><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/5/53/Ambox_current_red_Americas.svg/42px-Ambox_current_red_Americas.svg.png" decoding="async" width="42" height="34" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/53/Ambox_current_red_Americas.svg/63px-Ambox_current_red_Americas.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/53/Ambox_current_red_Americas.svg/84px-Ambox_current_red_Americas.svg.png 2x" data-file-width="360" data-file-height="290" /></span></span></div></td><td class="mbox-text"><div class="mbox-text-span">This article needs to be <b>updated</b>.<span class="hide-when-compact"> Please help update this article to reflect recent events or newly available information.</span> <span class="date-container"><i>(<span class="date">September 2024</span>)</i></span></div></td></tr></tbody></table> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Bulimia nervosa</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Bulimia</td></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:BulemiaEnamalLoss.JPG" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/5/50/BulemiaEnamalLoss.JPG/220px-BulemiaEnamalLoss.JPG" decoding="async" width="220" height="152" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/50/BulemiaEnamalLoss.JPG/330px-BulemiaEnamalLoss.JPG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/50/BulemiaEnamalLoss.JPG/440px-BulemiaEnamalLoss.JPG 2x" data-file-width="2212" data-file-height="1526" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data">Loss of enamel (<a href="/wiki/Acid_erosion" class="mw-redirect" title="Acid erosion">acid erosion</a>) from the inside of the upper front teeth as a result of bulimia</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Psychiatry" title="Psychiatry">Psychiatry</a>, <a href="/wiki/Clinical_psychology" title="Clinical psychology">clinical psychology</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data">Eating a large amount of food in a short amount of time followed by vomiting or the use of <a href="/wiki/Laxatives" class="mw-redirect" title="Laxatives">laxatives</a>, often normal weight<sup id="cite_ref-Buli2012_1-0" class="reference"><a href="#cite_note-Buli2012-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Women2012_2-0" class="reference"><a href="#cite_note-Women2012-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Complication_(medicine)" title="Complication (medicine)">Complications</a></th><td class="infobox-data">Breakdown of the teeth, <a href="/wiki/Depression_(mood)" title="Depression (mood)">depression</a>, <a href="/wiki/Anxiety" title="Anxiety">anxiety</a>, <a href="/wiki/Substance_use_disorder" title="Substance use disorder">substance use disorders</a>, <a href="/wiki/Suicide" title="Suicide">suicide</a><sup id="cite_ref-Women2012_2-1" class="reference"><a href="#cite_note-Women2012-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Sm2012_3-0" class="reference"><a href="#cite_note-Sm2012-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Causes</th><td class="infobox-data"><a href="/wiki/Genetics" title="Genetics">Genetic</a> and environmental factors<sup id="cite_ref-Women2012_2-2" class="reference"><a href="#cite_note-Women2012-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Hay2010_4-0" class="reference"><a href="#cite_note-Hay2010-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data">Based on person's medical history<sup id="cite_ref-DSM5_5-0" class="reference"><a href="#cite_note-DSM5-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Differential_diagnosis" title="Differential diagnosis">Differential diagnosis</a></th><td class="infobox-data"><a href="/wiki/Anorexia" class="mw-redirect" title="Anorexia">Anorexia</a>, <a href="/wiki/Binge_eating_disorder" title="Binge eating disorder">binge eating disorder</a>, <a href="/wiki/Kleine-Levin_syndrome" class="mw-redirect" title="Kleine-Levin syndrome">Kleine-Levin syndrome</a>, <a href="/wiki/Borderline_personality_disorder" title="Borderline personality disorder">borderline personality disorder</a><sup id="cite_ref-DSM5_5-1" class="reference"><a href="#cite_note-DSM5-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data"><a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">Cognitive behavioral therapy</a><sup id="cite_ref-Women2012_2-3" class="reference"><a href="#cite_note-Women2012-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Hay2013_6-0" class="reference"><a href="#cite_note-Hay2013-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medication" title="Medication">Medication</a></th><td class="infobox-data"><a href="/wiki/Selective_serotonin_reuptake_inhibitor" title="Selective serotonin reuptake inhibitor">Selective serotonin reuptake inhibitors</a>, <a href="/wiki/Tricyclic_antidepressant" title="Tricyclic antidepressant">tricyclic antidepressant</a><sup id="cite_ref-Hay2010_4-1" class="reference"><a href="#cite_note-Hay2010-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Mc2012_7-0" class="reference"><a href="#cite_note-Mc2012-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Prognosis" title="Prognosis">Prognosis</a></th><td class="infobox-data">Half recover over 10 years with treatment<sup id="cite_ref-Hay2010_4-2" class="reference"><a href="#cite_note-Hay2010-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">3.6 million (2015)<sup id="cite_ref-GBD2015Pre_8-0" class="reference"><a href="#cite_note-GBD2015Pre-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup></td></tr></tbody></table> <p><b>Bulimia nervosa</b>, also known simply as <b>bulimia</b>, is an <a href="/wiki/Eating_disorder" title="Eating disorder">eating disorder</a> characterized by <a href="/wiki/Binge_eating" title="Binge eating">binge eating</a> (eating large quantities of food in a short period of time, often feeling out of control) followed by compensatory behaviors, such as vomiting, excessive exercise, or fasting to prevent weight gain.<sup id="cite_ref-:0_9-0" class="reference"><a href="#cite_note-:0-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p><p>Other efforts to lose weight may include the use of <a href="/wiki/Diuretic" title="Diuretic">diuretics</a>, <a href="/wiki/Stimulant" title="Stimulant">stimulants</a>, <a href="/wiki/Water_fasting" class="mw-redirect" title="Water fasting">water fasting</a>, or excessive exercise.<sup id="cite_ref-Women2012_2-4" class="reference"><a href="#cite_note-Women2012-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Most people with bulimia are at normal weight and have higher risk for other mental disorders, such as depression, anxiety, borderline personality disorder, bipolar disorder, and problems with drugs to alcohol. There is also a higher risk of suicide and self-harm. </p><p>Bulimia is more common among those who have a close relative with the condition.<sup id="cite_ref-Women2012_2-5" class="reference"><a href="#cite_note-Women2012-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The percentage risk that is estimated to be due to genetics is between 30% and 80%.<sup id="cite_ref-Hay2010_4-3" class="reference"><a href="#cite_note-Hay2010-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Other risk factors for the disease include <a href="/wiki/Psychological_stress" title="Psychological stress">psychological stress</a>, cultural pressure to attain a certain body type, poor self-esteem, and <a href="/wiki/Obesity" title="Obesity">obesity</a>.<sup id="cite_ref-Women2012_2-6" class="reference"><a href="#cite_note-Women2012-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Hay2010_4-4" class="reference"><a href="#cite_note-Hay2010-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Living in a culture that commercializes or glamorizes <a href="/wiki/Dieting" title="Dieting">dieting</a>, and having parental figures who fixate on weight are also risks.<sup id="cite_ref-Hay2010_4-5" class="reference"><a href="#cite_note-Hay2010-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p><p>Diagnosis is based on a person's medical history;<sup id="cite_ref-DSM5_5-2" class="reference"><a href="#cite_note-DSM5-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> however, this is difficult, as people are usually secretive about their binge eating and purging habits.<sup id="cite_ref-Hay2010_4-6" class="reference"><a href="#cite_note-Hay2010-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Further, the diagnosis of <a href="/wiki/Anorexia_nervosa" title="Anorexia nervosa">anorexia nervosa</a> takes precedence over that of bulimia.<sup id="cite_ref-Hay2010_4-7" class="reference"><a href="#cite_note-Hay2010-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Other similar disorders include <a href="/wiki/Binge_eating_disorder" title="Binge eating disorder">binge eating disorder</a>, <a href="/wiki/Kleine%E2%80%93Levin_syndrome" title="Kleine–Levin syndrome">Kleine–Levin syndrome</a>, and <a href="/wiki/Borderline_personality_disorder" title="Borderline personality disorder">borderline personality disorder</a>.<sup id="cite_ref-DSM5_5-3" class="reference"><a href="#cite_note-DSM5-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Bulimiafaqdia.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/fd/Bulimiafaqdia.jpg/350px-Bulimiafaqdia.jpg" decoding="async" width="350" height="282" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/fd/Bulimiafaqdia.jpg/525px-Bulimiafaqdia.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/f/fd/Bulimiafaqdia.jpg 2x" data-file-width="646" data-file-height="520" /></a><figcaption>How bulimia affects the body</figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Oral_Manifestation_of_Bulimia..jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/a/aa/Oral_Manifestation_of_Bulimia..jpg/220px-Oral_Manifestation_of_Bulimia..jpg" decoding="async" width="220" height="150" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/aa/Oral_Manifestation_of_Bulimia..jpg/330px-Oral_Manifestation_of_Bulimia..jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/aa/Oral_Manifestation_of_Bulimia..jpg/440px-Oral_Manifestation_of_Bulimia..jpg 2x" data-file-width="447" data-file-height="304" /></a><figcaption>The erosion on the lower teeth was caused by bulimia. For comparison, the upper teeth were restored with porcelain veneers.<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup></figcaption></figure> <p>Bulimia typically involves rapid and out-of-control eating, which is followed by self-induced vomiting or other forms of purging.<sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:0_9-1" class="reference"><a href="#cite_note-:0-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> This cycle may be repeated several times a week or, in more serious cases, several times a day<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> and may directly cause: </p> <ul><li><a href="/wiki/Dehydration" title="Dehydration">Dehydration</a></li> <li><a href="/wiki/Water-electrolyte_imbalance" class="mw-redirect" title="Water-electrolyte imbalance">Electrolyte imbalance</a> can lead to <a href="/wiki/Cardiac_arrhythmia" class="mw-redirect" title="Cardiac arrhythmia">abnormal heart rhythms</a>, <a href="/wiki/Cardiac_arrest" title="Cardiac arrest">cardiac arrest</a>, and even death</li> <li>Oral <a href="/wiki/Physical_trauma" class="mw-redirect" title="Physical trauma">trauma</a>, lacerations to the lining of the mouth or throat due to forced throwing up movements.<sup id="cite_ref-:1_13-0" class="reference"><a href="#cite_note-:1-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Russell%27s_sign" title="Russell's sign">Russell's sign</a>: <a href="/wiki/Callus" title="Callus">calluses</a> on knuckles and back of hands due to repeated trauma from incisors<sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup></li> <li>Swollen <a href="/wiki/Salivary_gland" title="Salivary gland">salivary glands</a> (in the neck, under the jawline)<sup id="cite_ref-ada_16-0" class="reference"><a href="#cite_note-ada-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-mcgilley_17-0" class="reference"><a href="#cite_note-mcgilley-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup></li> <li>Gastrointestinal problems, like constipation and acid reflux<sup id="cite_ref-:1_13-1" class="reference"><a href="#cite_note-:1-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Constipation" title="Constipation">Constipation</a> or <a href="/wiki/Diarrhea" title="Diarrhea">diarrhea</a></li> <li><a href="/wiki/Hypotension" title="Hypotension">Hypotension</a></li> <li><a href="/wiki/Infertility" title="Infertility">Infertility</a> and/or irregular menstrual cycles</li> <li>Weight Fluctuations</li></ul> <p>These are some of the many signs that may indicate whether someone has bulimia nervosa:<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p> <ul><li>A fixation on the number of calories consumed</li> <li>A fixation on an extreme consciousness of one's weight</li> <li>Low self-esteem and/or <a href="/wiki/Self-harming" class="mw-redirect" title="Self-harming">self-harming</a></li> <li><a href="/wiki/Suicidal" class="mw-redirect" title="Suicidal">Suicidal</a> tendencies</li> <li>An irregular menstrual cycle in women</li> <li>Regular trips to the bathroom, especially soon after eating</li> <li><a href="/wiki/Depression_(mood)" title="Depression (mood)">Depression</a>, <a href="/wiki/Anxiety_disorders" class="mw-redirect" title="Anxiety disorders">anxiety disorders</a>, and <a href="/wiki/Sleep_disorders" class="mw-redirect" title="Sleep disorders">sleep disorders</a></li> <li>Frequent occurrences involving the consumption of abnormally large portions of food<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup></li> <li>The use of <a href="/wiki/Laxatives" class="mw-redirect" title="Laxatives">laxatives</a>, <a href="/wiki/Diuretic" title="Diuretic">diuretics</a>, and <a href="/wiki/Diet_pills" class="mw-redirect" title="Diet pills">diet pills</a></li> <li>Compulsive or excessive exercise</li> <li>Unhealthy/dry skin, hair, nails, and lips</li> <li><a href="/wiki/Fatigue" title="Fatigue">Fatigue</a>, or exhaustion</li></ul> <p>As with many psychiatric illnesses, delusions can occur, in conjunction with other signs and symptoms, leaving the person with a false belief that is not ordinarily accepted by others.<sup id="cite_ref-Barker03_20-0" class="reference"><a href="#cite_note-Barker03-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p><p>People with bulimia nervosa may also exercise to a point that excludes other activities.<sup id="cite_ref-Barker03_20-1" class="reference"><a href="#cite_note-Barker03-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Interoceptive">Interoceptive</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Bulimia_nervosa&action=edit&section=1" title="Edit section: Interoceptive"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>People with bulimia exhibit several <a href="/wiki/Interoception" title="Interoception">interoceptive</a> deficits, in which one experiences impairment in recognizing and discriminating between internal sensations, feelings, and emotions.<sup id="cite_ref-Bow2015_21-0" class="reference"><a href="#cite_note-Bow2015-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> People with bulimia may also react negatively to <a href="/wiki/Somatic_nervous_system" title="Somatic nervous system">somatic</a> and <a href="/wiki/Affect_(psychology)" title="Affect (psychology)">affective</a> states.<sup id="cite_ref-Bad2017_22-0" class="reference"><a href="#cite_note-Bad2017-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> Regarding interoceptive sensation, hyposensitive individuals may not detect normal feelings of fullness at the appropriate time while eating, and are prone to eating more calories in a short period of time as a result of this decreased sensitivity.<sup id="cite_ref-Bow2015_21-1" class="reference"><a href="#cite_note-Bow2015-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> </p><p>Examining from a neural basis also connects elements of interoception and emotion; notable overlaps occur in the medial <a href="/wiki/Prefrontal_cortex" title="Prefrontal cortex">prefrontal cortex</a>, anterior and posterior <a href="/wiki/Cingulate_cortex" title="Cingulate cortex">cingulate</a>, and anterior <a href="/wiki/Insular_cortex" title="Insular cortex">insula cortices</a>, which are linked to both interoception and emotional eating.<sup id="cite_ref-Barret2015_23-0" class="reference"><a href="#cite_note-Barret2015-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Related_disorders">Related disorders</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Bulimia_nervosa&action=edit&section=2" title="Edit section: Related disorders"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>People with bulimia are at a higher risk to have an affective disorder, such as depression or general anxiety disorder. One study found 70% had depression at some time in their lives (as opposed to 26% for adult females in the general population), rising to 88% for all affective disorders combined.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> Another study in the Journal of Affective Disorders found that of the population of patients that were diagnosed with an eating disorder according to the DSM-V guidelines about 27% also suffered from bipolar disorder. Within this article, the majority of the patients were diagnosed with bulimia nervosa, the second most common condition reported was binge-eating disorder.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> Some individuals with anorexia nervosa exhibit episodes of bulimic tendencies through purging (either through self-induced vomiting or laxatives) as a way to quickly remove food in their system.<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> There may be an increased risk for <a href="/wiki/Diabetes_mellitus_type_2" class="mw-redirect" title="Diabetes mellitus type 2">diabetes mellitus type 2</a>.<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> Bulimia also has negative effects on a person's teeth due to the acid passed through the mouth from frequent vomiting causing acid erosion, mainly on the posterior dental surface. </p><p>Research has shown that there is a relationship between bulimia and <a href="/wiki/Narcissism" title="Narcissism">narcissism</a>.<sup id="cite_ref-pmid21184981_28-0" class="reference"><a href="#cite_note-pmid21184981-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid9261656_29-0" class="reference"><a href="#cite_note-pmid9261656-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid9347071_30-0" class="reference"><a href="#cite_note-pmid9347071-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> According to a study by the <a href="/wiki/Australian_National_University" title="Australian National University">Australian National University</a>, eating disorders are more susceptible among <a href="/wiki/Vulnerable_narcissism" class="mw-redirect" title="Vulnerable narcissism">vulnerable narcissists</a>. This can be caused by a childhood in which inner feelings and thoughts were minimized by parents, leading to "a high focus on receiving validation from others to maintain a positive sense of self".<sup id="cite_ref-Sivanathan_et_al_2019_31-0" class="reference"><a href="#cite_note-Sivanathan_et_al_2019-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> </p><p>The medical journal <i>Borderline Personality Disorder and Emotion Dysregulation</i> notes that a "substantial rate of patients with bulimia nervosa" also have <a href="/wiki/Borderline_personality_disorder" title="Borderline personality disorder">borderline personality disorder</a>.<sup id="cite_ref-bpded.biomedcentral.com_32-0" class="reference"><a href="#cite_note-bpded.biomedcentral.com-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> </p><p>A study by the Psychopharmacology Research Program of the <a href="/wiki/University_of_Cincinnati_College_of_Medicine" class="mw-redirect" title="University of Cincinnati College of Medicine">University of Cincinnati College of Medicine</a> "leaves little doubt that <a href="/wiki/Bipolar_disorder" title="Bipolar disorder">bipolar</a> and eating disorders—particularly bulimia nervosa and bipolar II disorder—are related." The research shows that most clinical studies indicate that patients with bipolar disorder have higher rates of eating disorders, and vice versa. There is overlap in phenomenology, course, comorbidity, family history, and pharmacologic treatment response of these disorders. This is especially true of "eating dysregulation, mood dysregulation, impulsivity and compulsivity, craving for activity and/or exercise."<sup id="cite_ref-McElroy_et_al_2005_33-0" class="reference"><a href="#cite_note-McElroy_et_al_2005-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> </p><p>Studies have shown a relationship between bulimia's effect on metabolic rate and caloric intake with <a href="/wiki/Thyroid_dysfunction" class="mw-redirect" title="Thyroid dysfunction">thyroid dysfunction</a>.<sup id="cite_ref-pmid8817724_34-0" class="reference"><a href="#cite_note-pmid8817724-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> </p><p>Scientific research has shown that people suffering from bulimia have decreased volumes of brain matter, and that the abnormalities are reversible after long-term recovery.<sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Causes">Causes</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Bulimia_nervosa&action=edit&section=3" title="Edit section: Causes"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Biological">Biological</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Bulimia_nervosa&action=edit&section=4" title="Edit section: Biological"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>As with <a href="/wiki/Anorexia_nervosa" title="Anorexia nervosa">anorexia nervosa</a>, there is evidence of genetic predispositions contributing to the onset of this eating disorder.<sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> Abnormal levels of many hormones, notably <a href="/wiki/Serotonin" title="Serotonin">serotonin</a>, have been shown to be responsible for some disordered eating behaviors.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (January 2025)">citation needed</span></a></i>]</sup> <a href="/wiki/Brain-derived_neurotrophic_factor" title="Brain-derived neurotrophic factor">Brain-derived neurotrophic factor</a> (BDNF) is under investigation as a possible mechanism.<sup id="cite_ref-37" class="reference"><a href="#cite_note-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> </p><p>There is evidence that sex hormones may influence appetite and eating in women and the onset of bulimia nervosa. Studies have shown that women with <a href="/wiki/Hyperandrogenism" title="Hyperandrogenism">hyperandrogenism</a> and <a href="/wiki/Polycystic_ovary_syndrome" title="Polycystic ovary syndrome">polycystic ovary syndrome</a> have a dysregulation of appetite, along with carbohydrates and fats. This dysregulation of appetite is also seen in women with bulimia nervosa. There is evidence that there is an association between polymorphisms in the ERβ (<a href="/wiki/Estrogen_receptor" title="Estrogen receptor">estrogen receptor</a> β) and bulimia, suggesting there is a correlation between sex hormones and bulimia nervosa.<sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> </p><p>Bulimia has been compared to drug addiction, though the empirical support for this characterization is limited.<sup id="cite_ref-40" class="reference"><a href="#cite_note-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> However, people with bulimia nervosa may share dopamine D2 receptor-related vulnerabilities with those with <a href="/wiki/Substance_use_disorder" title="Substance use disorder">substance use disorders</a>.<sup id="cite_ref-41" class="reference"><a href="#cite_note-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> </p><p>Dieting, a common behaviour in bulimics, is associated with lower plasma tryptophan levels.<sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> Decreased tryptophan levels in the brain, and thus the synthesis of serotonin, such as via <a href="/wiki/Acute_tryptophan_depletion" title="Acute tryptophan depletion">acute tryptophan depletion</a>, increases bulimic urges in currently and formerly bulimic individuals within hours.<sup id="cite_ref-43" class="reference"><a href="#cite_note-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-44" class="reference"><a href="#cite_note-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> </p><p>Abnormal blood levels of peptides important for the regulation of appetite and energy balance are observed in individuals with bulimia nervosa, but it remains unknown if this is a state or trait.<sup id="cite_ref-45" class="reference"><a href="#cite_note-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> </p><p>In recent years, <a href="/wiki/Evolutionary_psychiatry" title="Evolutionary psychiatry">evolutionary psychiatry</a> as an emerging scientific discipline has been studying <a href="/wiki/Mental_disorder" title="Mental disorder">mental disorders</a> from an evolutionary perspective. If eating disorders, Bulimia nervosa in particular, have evolutionary functions or if they are new modern "lifestyle" problems is still debated.<sup id="cite_ref-pmid9875960_46-0" class="reference"><a href="#cite_note-pmid9875960-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid30429818_47-0" class="reference"><a href="#cite_note-pmid30429818-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-48" class="reference"><a href="#cite_note-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Social">Social</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Bulimia_nervosa&action=edit&section=5" title="Edit section: Social"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Media portrayals of an 'ideal' body shape are widely considered to be a contributing factor to bulimia.<sup id="cite_ref-Barker03_20-2" class="reference"><a href="#cite_note-Barker03-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> In a 1991 study by Weltzin, Hsu, Pollicle, and Kaye, it was stated that 19% of bulimics undereat, 37% of bulimics eat an average or normal amount of food, and 44% of bulimics overeat.<sup id="cite_ref-49" class="reference"><a href="#cite_note-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> A survey of 15- to 18-year-old high school girls in <a href="/wiki/Nadroga-Navosa_Province" title="Nadroga-Navosa Province">Nadroga</a>, <a href="/wiki/Fiji" title="Fiji">Fiji</a>, found the self-reported incidence of purging rose from 0% in 1995 (a few weeks after the introduction of television in the province) to 11.3% in 1998.<sup id="cite_ref-50" class="reference"><a href="#cite_note-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> In addition, the suicide rate among people with bulimia nervosa is 7.5 times higher than in the general population.<sup id="cite_ref-51" class="reference"><a href="#cite_note-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> </p><p>When attempting to decipher the origin of bulimia nervosa in a cognitive context, <a href="/wiki/Christopher_Fairburn" title="Christopher Fairburn">Christopher Fairburn</a> <i>et al.</i><span class="nowrap" style="padding-left:0.1em;">'</span>s cognitive-behavioral model is often considered the golden standard.<sup id="cite_ref-52" class="reference"><a href="#cite_note-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> Fairburn et al.'s model discusses the process in which an individual falls into the binge-purge cycle and thus develops bulimia. Fairburn <i>et al.</i> argue that extreme concern with weight and shape coupled with low self-esteem will result in strict, rigid, and inflexible dietary rules. Accordingly, this would lead to unrealistically restricted eating, which may consequently induce an eventual "slip" where the individual commits a minor infraction of the strict and inflexible dietary rules. Moreover, the cognitive distortion due to <a href="/wiki/Dichotomy" title="Dichotomy">dichotomous</a> thinking leads the individual to binge. The binge subsequently should trigger a perceived loss of control, promoting the individual to purge in hope of counteracting the binge. However, Fairburn <i>et al.</i> assert the cycle repeats itself, and thus consider the binge-purge cycle to be self-perpetuating.<sup id="cite_ref-53" class="reference"><a href="#cite_note-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup> </p><p>In contrast, Byrne and Mclean's findings differed slightly from Fairburn <i>et al.</i><span class="nowrap" style="padding-left:0.1em;">'</span>s cognitive-behavioral model of bulimia nervosa in that the drive for thinness was the major cause of purging as a way of controlling weight. In turn, Byrne and Mclean argued that this makes the individual vulnerable to binging, indicating that it is not a binge-purge cycle but rather a purge-binge cycle in that purging comes before bingeing. Similarly, Fairburn <i>et al.</i><span class="nowrap" style="padding-left:0.1em;">'</span>s cognitive-behavioral model of bulimia nervosa is not necessarily applicable to every individual and is certainly reductionist. Every one differs from another, and taking such a complex behavior like bulimia and applying the same one theory to everyone would certainly be invalid. In addition, the cognitive-behavioral model of bulimia nervosa is very culturally bound in that it may not be necessarily applicable to cultures outside of Western society. To evaluate, Fairburn <i>et al.</i>.'s model and more generally the cognitive explanation of bulimia nervosa is more descriptive than explanatory, as it does not necessarily explain how bulimia arises. Furthermore, it is difficult to ascertain cause and effect, because it may be that distorted eating leads to distorted cognition rather than vice versa.<sup id="cite_ref-54" class="reference"><a href="#cite_note-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-55" class="reference"><a href="#cite_note-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup> </p><p>A considerable amount of literature has identified a correlation between sexual abuse and the development of bulimia nervosa. The reported incident rate of unwanted sexual contact is higher among those with bulimia nervosa than anorexia nervosa.<sup id="cite_ref-56" class="reference"><a href="#cite_note-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> </p><p>When exploring the etiology of bulimia through a socio-cultural perspective, the "thin ideal internalization" is significantly responsible. The thin-ideal internalization is the extent to which individuals adapt to the societal ideals of attractiveness. Studies have shown that young women that read fashion magazines tend to have more bulimic symptoms than those women who do not. This further demonstrates the impact of media on the likelihood of developing the disorder.<sup id="cite_ref-Abnormal_57-0" class="reference"><a href="#cite_note-Abnormal-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> Individuals first accept and "buy into" the ideals, and then attempt to transform themselves in order to reflect the societal ideals of attractiveness. J. Kevin Thompson and Eric Stice claim that family, peers, and most evidently media reinforce the thin ideal, which may lead to an individual accepting and "buying into" the thin ideal. In turn, Thompson and Stice assert that if the thin ideal is accepted, one could begin to feel uncomfortable with their body shape or size since it may not necessarily reflect the thin ideal set out by society. Thus, people feeling uncomfortable with their bodies may result in body dissatisfaction and may develop a certain drive for thinness. Consequently, body dissatisfaction coupled with a drive for thinness is thought to promote dieting and negative effects, which could eventually lead to bulimic symptoms such as purging or bingeing. Binges lead to self-disgust which causes purging to prevent weight gain.<sup id="cite_ref-58" class="reference"><a href="#cite_note-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup> </p><p>A study dedicated to investigating the thin ideal internalization as a factor of bulimia nervosa is Thompson's and Stice's research. Their study aimed to investigate how and to what degree media affects the thin ideal internalization. Thompson and Stice used randomized experiments (more specifically programs) dedicated to teaching young women how to be more critical when it comes to media, to reduce thin-ideal internalization. The results showed that by creating more awareness of the media's control of the societal ideal of attractiveness, the thin ideal internalization significantly dropped. In other words, less thin ideal images portrayed by the media resulted in less thin-ideal internalization. Therefore, Thompson and Stice concluded that media greatly affected the thin ideal internalization.<sup id="cite_ref-Sage_journals_online_59-0" class="reference"><a href="#cite_note-Sage_journals_online-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup> Papies showed that it is not the thin ideal itself, but rather the self-association with other persons of a certain weight that decide how someone with bulimia nervosa feels. People that associate themselves with thin models get in a positive attitude when they see thin models and people that associate with overweight get in a negative attitude when they see thin models. Moreover, it can be taught to associate with thinner people.<sup id="cite_ref-Papies_60-0" class="reference"><a href="#cite_note-Papies-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Bulimia_nervosa&action=edit&section=6" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The onset of bulimia nervosa is often during adolescence, between 13 and 20 years of age, and many cases have previously experienced obesity, with many relapsing in adulthood into episodic bingeing and purging even after initially successful treatment and remission.<sup id="cite_ref-61" class="reference"><a href="#cite_note-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> A lifetime <a href="/wiki/Prevalence" title="Prevalence">prevalence</a> of 0.5 percent and 0.9 percent for adults and adolescents, respectively, is estimated among the United States population.<sup id="cite_ref-62" class="reference"><a href="#cite_note-62"><span class="cite-bracket">[</span>62<span class="cite-bracket">]</span></a></sup> Bulimia nervosa may affect up to 1% of young women and, after 10 years of diagnosis, half will recover fully, a third will recover partially, and 10–20% will still have symptoms.<sup id="cite_ref-Hay2010_4-8" class="reference"><a href="#cite_note-Hay2010-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p><p>Adolescents with bulimia nervosa are more likely to have self-imposed <a href="/wiki/Perfectionism_(psychology)" title="Perfectionism (psychology)">perfectionism</a> and compulsivity issues in eating compared to their peers. This means that the high expectations and unrealistic goals that these individuals set for themselves are internally motivated rather than by social views or expectations.<sup id="cite_ref-63" class="reference"><a href="#cite_note-63"><span class="cite-bracket">[</span>63<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Criteria">Criteria</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Bulimia_nervosa&action=edit&section=7" title="Edit section: Criteria"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Bulimia Nervosa is diagnosed using the <i>Diagnostic and Statistical Manual of Mental Disorders (DSM-5).</i> The diagnostic criteria includes the following:<sup id="cite_ref-:1_13-2" class="reference"><a href="#cite_note-:1-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-64" class="reference"><a href="#cite_note-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup> </p> <ul><li>Recurrent episodes of binge eating</li> <li>Recurrent inappropriate compensatory behavior to prevent weight gain, like self-induced vomiting, misuse of laxatives or other medications, fasting, or excessive exercise.</li> <li>The binge eating and compensatory behaviors both occur at least once a week for three months</li> <li>Self-evaluation is influenced by body shape and weight.</li></ul> <p>Other methods are also used to narrow down the diagnosis, such as physical exams (measuring height, weight, and vitals, or checking skin, nails, heart and lungs), or lab tests (for blood count, electrolytes, protein, or urinalysis). </p> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Bulimia_nervosa&action=edit&section=8" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are two main types of treatment given to those with bulimia nervosa; psychopharmacological and psychosocial treatments.<sup id="cite_ref-65" class="reference"><a href="#cite_note-65"><span class="cite-bracket">[</span>65<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Psychotherapy">Psychotherapy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Bulimia_nervosa&action=edit&section=9" title="Edit section: Psychotherapy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">Cognitive behavioral therapy</a> (CBT) is considered the gold standard for the treatment of bulimia nervosa. This approach focuses on helping patients identify and change distorted thought patterns related to eating, body image, and self worth<sup id="cite_ref-:2_66-0" class="reference"><a href="#cite_note-:2-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:3_67-0" class="reference"><a href="#cite_note-:3-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup> </p><p>CBT helps patients identify and challenge the distorted thinking individuals might have about food, weight and body image. It also helps by offering the chance to identify the unhelpful thoughts about food and body image.<sup id="cite_ref-:3_67-1" class="reference"><a href="#cite_note-:3-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup> </p><p>By using CBT people record how much food they eat and periods of vomiting with the purpose of identifying and avoiding emotional fluctuations that bring on episodes of bulimia on a regular basis, as a component of this therapy is food journaling.<sup id="cite_ref-Psychiatry_68-0" class="reference"><a href="#cite_note-Psychiatry-68"><span class="cite-bracket">[</span>68<span class="cite-bracket">]</span></a></sup> CBT is necessarily good for those with bulimia as it targets the binge-purge cycle, which is the hallmark of bulimia.<sup id="cite_ref-:0_9-2" class="reference"><a href="#cite_note-:0-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-69" class="reference"><a href="#cite_note-69"><span class="cite-bracket">[</span>69<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-70" class="reference"><a href="#cite_note-70"><span class="cite-bracket">[</span>70<span class="cite-bracket">]</span></a></sup> People undergoing CBT who exhibit early behavioral changes are most likely to achieve the best treatment outcomes in the long run.<sup id="cite_ref-71" class="reference"><a href="#cite_note-71"><span class="cite-bracket">[</span>71<span class="cite-bracket">]</span></a></sup> </p><p>Researchers have also reported some positive outcomes for <a href="/wiki/Interpersonal_psychotherapy" title="Interpersonal psychotherapy">interpersonal psychotherapy</a> and <a href="/wiki/Dialectical_behavior_therapy" title="Dialectical behavior therapy">dialectical behavior therapy</a>.<sup id="cite_ref-72" class="reference"><a href="#cite_note-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-73" class="reference"><a href="#cite_note-73"><span class="cite-bracket">[</span>73<span class="cite-bracket">]</span></a></sup> These therapies have good outcomes for treating bulimia, especially in patients with emotional regulation difficulties or interpersonal issues. While these therapies are not as extensively research as CBT, they can be beneficial when integrated into a comprehensive treatment plan.<sup id="cite_ref-:2_66-1" class="reference"><a href="#cite_note-:2-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup> </p><p>For adolescents, Family-Based therapy (FBT) has been identified as an effective treatment. FBT involes the family in the treatment process, where parents are empowered to take an active role in helping their child recover from bulimia nervosa. This approach is particularly helpful in younger patients who are still living with their families<sup id="cite_ref-:2_66-2" class="reference"><a href="#cite_note-:2-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup> </p><p>The use of CBT has been shown to be quite effective for treating bulimia nervosa (BN) in adults, but little research has been done on effective treatments of BN for adolescents.<sup id="cite_ref-ReferenceB_74-0" class="reference"><a href="#cite_note-ReferenceB-74"><span class="cite-bracket">[</span>74<span class="cite-bracket">]</span></a></sup> Although CBT is seen as more cost-efficient and helps individuals with BN in self-guided care, Family Based Treatment (FBT) might be more helpful to younger adolescents who need more support and guidance from their families.<sup id="cite_ref-75" class="reference"><a href="#cite_note-75"><span class="cite-bracket">[</span>75<span class="cite-bracket">]</span></a></sup> Adolescents are at the stage where their brains are still quite malleable and developing gradually.<sup id="cite_ref-76" class="reference"><a href="#cite_note-76"><span class="cite-bracket">[</span>76<span class="cite-bracket">]</span></a></sup> Therefore, young adolescents with BN are less likely to realize the detrimental consequences of becoming bulimic and have less motivation to change,<sup id="cite_ref-77" class="reference"><a href="#cite_note-77"><span class="cite-bracket">[</span>77<span class="cite-bracket">]</span></a></sup> which is why FBT would be useful to have families intervene and support the teens.<sup id="cite_ref-ReferenceB_74-1" class="reference"><a href="#cite_note-ReferenceB-74"><span class="cite-bracket">[</span>74<span class="cite-bracket">]</span></a></sup> Working with BN patients and their families in FBT can empower the families by having them involved in their adolescent's food choices and behaviors, taking more control of the situation in the beginning and gradually letting the adolescent become more autonomous when they have learned healthier eating habits.<sup id="cite_ref-ReferenceB_74-2" class="reference"><a href="#cite_note-ReferenceB-74"><span class="cite-bracket">[</span>74<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Medication">Medication</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Bulimia_nervosa&action=edit&section=10" title="Edit section: Medication"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Antidepressants, particularly <a href="/wiki/Selective_serotonin_reuptake_inhibitor" title="Selective serotonin reuptake inhibitor">selective serotonin reuptake inhibitors</a> (SSRI), are often prescribed to treat bulimia nervosa, especially when comorbid depression or anxiety disorders are present. However, medications alone are generally not sufficient and are typically used in conjunction with psychotherapy<sup id="cite_ref-:1_13-3" class="reference"><a href="#cite_note-:1-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:2_66-3" class="reference"><a href="#cite_note-:2-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup> Compared to placebo, the use of a single antidepressant has been shown to be effective.<sup id="cite_ref-pmid14583971_78-0" class="reference"><a href="#cite_note-pmid14583971-78"><span class="cite-bracket">[</span>78<span class="cite-bracket">]</span></a></sup> Combining medication with counseling can improve outcomes in some circumstances.<sup id="cite_ref-79" class="reference"><a href="#cite_note-79"><span class="cite-bracket">[</span>79<span class="cite-bracket">]</span></a></sup> Some positive outcomes of treatments can include: abstinence from binge eating, a decrease in obsessive behaviors to lose weight and in shape preoccupation, less severe psychiatric symptoms, a desire to counter the effects of binge eating, as well as an improvement in social functioning and reduced relapse rates.<sup id="cite_ref-Hay2010_4-9" class="reference"><a href="#cite_note-Hay2010-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p><p>A combination of psychotherapy, especially CBT and pharmacological treatments, such as SSRIs, often lead to better outcomes for individuals with bulimia. Combining both approaches is particularly beneficial in severe or chronic cases, where behavioral modification and mood stabilization are crucial.<sup id="cite_ref-:2_66-4" class="reference"><a href="#cite_note-:2-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Alternative_medicine">Alternative medicine</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Bulimia_nervosa&action=edit&section=11" title="Edit section: Alternative medicine"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Some researchers have also claimed positive outcomes in <a href="/wiki/Hypnotherapy" title="Hypnotherapy">hypnotherapy</a>.<sup id="cite_ref-80" class="reference"><a href="#cite_note-80"><span class="cite-bracket">[</span>80<span class="cite-bracket">]</span></a></sup> <i>The first use of hypnotherapy in Bulimic patients was in 1981. When it comes to hypnotherapy, Bulimic patients are easier to hypnotize than Anorexia Nervosa patients. In Bulimic patients, hypnotherapy focuses on learning self-control when it comes to binging and vomiting, strengthening stimulus control techniques, enhancing ones ego, improving weight control, and helping overweight patients see their body differently (have a different image).</i><sup id="cite_ref-81" class="reference"><a href="#cite_note-81"><span class="cite-bracket">[</span>81<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Risk_factors">Risk factors</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Bulimia_nervosa&action=edit&section=12" title="Edit section: Risk factors"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Being female and having bulimia nervosa takes a toll on mental health. Women frequently reported an onset of anxiety at the same time of the onset of bulimia nervosa.<sup id="cite_ref-82" class="reference"><a href="#cite_note-82"><span class="cite-bracket">[</span>82<span class="cite-bracket">]</span></a></sup> The approximate female-to-male ratio of diagnosis is 10:1.<sup id="cite_ref-DSM5_5-4" class="reference"><a href="#cite_note-DSM5-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> In addition to cognitive, genetic, and environmental factors, childhood gastrointestinal problems and early pubertal maturation also increase the likelihood of developing bulimia nervosa.<sup id="cite_ref-83" class="reference"><a href="#cite_note-83"><span class="cite-bracket">[</span>83<span class="cite-bracket">]</span></a></sup> Another concern with eating disorders is developing a coexisting <a href="/wiki/Substance_use_disorder" title="Substance use disorder">substance use disorder</a>.<sup id="cite_ref-84" class="reference"><a href="#cite_note-84"><span class="cite-bracket">[</span>84<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Bulimia_nervosa&action=edit&section=13" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Eating_disorders_world_map-Deaths_per_million_persons-WHO2012.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/a/af/Eating_disorders_world_map-Deaths_per_million_persons-WHO2012.svg/290px-Eating_disorders_world_map-Deaths_per_million_persons-WHO2012.svg.png" decoding="async" width="290" height="128" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/af/Eating_disorders_world_map-Deaths_per_million_persons-WHO2012.svg/435px-Eating_disorders_world_map-Deaths_per_million_persons-WHO2012.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/af/Eating_disorders_world_map-Deaths_per_million_persons-WHO2012.svg/580px-Eating_disorders_world_map-Deaths_per_million_persons-WHO2012.svg.png 2x" data-file-width="940" data-file-height="415" /></a><figcaption>Deaths due to eating disorders per million persons in 2012 <style data-mw-deduplicate="TemplateStyles:r1184024115">.mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column}</style><div class="div-col div-col-small" style="column-width: 10em;"><style data-mw-deduplicate="TemplateStyles:r981673959">.mw-parser-output .legend{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .legend-color{display:inline-block;min-width:1.25em;height:1.25em;line-height:1.25;margin:1px 0;text-align:center;border:1px solid black;background-color:transparent;color:black}.mw-parser-output .legend-text{}</style><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffff20; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 0-0</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ff9a20; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 1-1</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#e06815; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 2-2</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#d85010; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 3-3</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#d02010; color:white;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 4–25</div></div></figcaption></figure> <p>There is little data on the percentage of people with bulimia in general populations.<sup id="cite_ref-DSM5_5-5" class="reference"><a href="#cite_note-DSM5-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Most studies conducted thus far have been on convenience samples from hospital patients, high school or university students; research on bulimia nervosa among ethnic minorities has also been limited.<sup id="cite_ref-85" class="reference"><a href="#cite_note-85"><span class="cite-bracket">[</span>85<span class="cite-bracket">]</span></a></sup> Existing studies have yielded a wide range of results: between 0.1% and 1.4% of males, and between 0.3% and 9.4% of females.<sup id="cite_ref-makino_86-0" class="reference"><a href="#cite_note-makino-86"><span class="cite-bracket">[</span>86<span class="cite-bracket">]</span></a></sup> Studies on time trends in the prevalence of bulimia nervosa have also yielded inconsistent results.<sup id="cite_ref-87" class="reference"><a href="#cite_note-87"><span class="cite-bracket">[</span>87<span class="cite-bracket">]</span></a></sup> According to Gelder, Mayou and Geddes (2005) bulimia nervosa is prevalent between 1 and 2 percent of women aged 15–40 years. Bulimia nervosa occurs more frequently in developed countries<sup id="cite_ref-Psychiatry_68-1" class="reference"><a href="#cite_note-Psychiatry-68"><span class="cite-bracket">[</span>68<span class="cite-bracket">]</span></a></sup> and in cities, with one study finding that bulimia is five times more prevalent in cities than in rural areas.<sup id="cite_ref-88" class="reference"><a href="#cite_note-88"><span class="cite-bracket">[</span>88<span class="cite-bracket">]</span></a></sup> There is a perception that bulimia is most prevalent amongst girls from middle-class families;<sup id="cite_ref-89" class="reference"><a href="#cite_note-89"><span class="cite-bracket">[</span>89<span class="cite-bracket">]</span></a></sup> however, in a 2009 study girls from families in the lowest income bracket studied were 153 percent more likely to be bulimic than girls from the highest income bracket.<sup id="cite_ref-90" class="reference"><a href="#cite_note-90"><span class="cite-bracket">[</span>90<span class="cite-bracket">]</span></a></sup> According to a study conducted in 2022 by Silen et al., which conglomerated statistics using various methods such as SCID, MRFS, EDE, SSAGA, and EDDI, the US, Finland, Australia, and the Netherlands had an estimated 2.1%, 2.4%, 1.0%, and 0.8% prevalence of bulimia nervosa among females under 30 years of age.<sup id="cite_ref-91" class="reference"><a href="#cite_note-91"><span class="cite-bracket">[</span>91<span class="cite-bracket">]</span></a></sup> This demonstrates the prevalence of bulimia nervosa in developed, Western, first-world countries, indicating an urgency in treating adolescent women. Additionally, these statistics may be misrepresentative of the true population affected with bulimia nervosa due to potential underreporting bias. </p><p>There are higher rates of <a href="/wiki/Eating_disorder" title="Eating disorder">eating disorders</a> in groups involved in activities which idealize a slim physique, such as dance,<sup id="cite_ref-Tölgyes_92-0" class="reference"><a href="#cite_note-Tölgyes-92"><span class="cite-bracket">[</span>92<span class="cite-bracket">]</span></a></sup> gymnastics, modeling, <a href="/wiki/Cheerleading" title="Cheerleading">cheerleading</a>, running, acting, swimming, diving, rowing and <a href="/wiki/Figure_skating" title="Figure skating">figure skating</a>. Bulimia is thought to be more prevalent among <a href="/wiki/White_Americans" title="White Americans">whites</a>;<sup id="cite_ref-93" class="reference"><a href="#cite_note-93"><span class="cite-bracket">[</span>93<span class="cite-bracket">]</span></a></sup> however, a more recent study showed that African-American teenage girls were 50 percent more likely than white girls to exhibit bulimic behavior, including both binging and purging.<sup id="cite_ref-94" class="reference"><a href="#cite_note-94"><span class="cite-bracket">[</span>94<span class="cite-bracket">]</span></a></sup> </p> <table class="wikitable" style="margin-left: auto; margin-right: auto; border: none;"> <tbody><tr> <th>Country </th> <th>Year </th> <th>Sample size and type </th> <th colspan="2">% affected </th></tr> <tr> <td><a href="/wiki/Portugal" title="Portugal">Portugal</a></td> <td>2006</td> <td>2,028 high school students</td> <td></td> <td>0.3% female<sup id="cite_ref-95" class="reference"><a href="#cite_note-95"><span class="cite-bracket">[</span>95<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td><a href="/wiki/Brazil" title="Brazil">Brazil</a></td> <td>2004</td> <td>1,807 students (ages 7–19)</td> <td>0.8% male</td> <td>1.3% female<sup id="cite_ref-96" class="reference"><a href="#cite_note-96"><span class="cite-bracket">[</span>96<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td>Spain</td> <td>2004</td> <td>2,509 female adolescents (ages 13–22)</td> <td></td> <td>1.4% female<sup id="cite_ref-97" class="reference"><a href="#cite_note-97"><span class="cite-bracket">[</span>97<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td>Hungary</td> <td>2003</td> <td>580 <a href="/wiki/Budapest" title="Budapest">Budapest</a> residents</td> <td>0.4% male</td> <td>3.6% female<sup id="cite_ref-Tölgyes_92-1" class="reference"><a href="#cite_note-Tölgyes-92"><span class="cite-bracket">[</span>92<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td>Australia</td> <td>1998</td> <td>4,200 high school students</td> <td align="center" colspan="2">0.3% combined<sup id="cite_ref-98" class="reference"><a href="#cite_note-98"><span class="cite-bracket">[</span>98<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td>United States</td> <td>1996</td> <td>1,152 college students</td> <td>0.2% male</td> <td>1.3% female<sup id="cite_ref-99" class="reference"><a href="#cite_note-99"><span class="cite-bracket">[</span>99<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td>Norway</td> <td>1995</td> <td>19,067 psychiatric patients</td> <td>0.7% male</td> <td>7.3% female<sup id="cite_ref-100" class="reference"><a href="#cite_note-100"><span class="cite-bracket">[</span>100<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td>Canada</td> <td>1995</td> <td>8,116 (random sample)</td> <td>0.1% male</td> <td>1.1% female<sup id="cite_ref-101" class="reference"><a href="#cite_note-101"><span class="cite-bracket">[</span>101<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td>Japan</td> <td>1995</td> <td>2,597 high school students</td> <td>0.7% male</td> <td>1.9% female<sup id="cite_ref-102" class="reference"><a href="#cite_note-102"><span class="cite-bracket">[</span>102<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td>United States</td> <td>1992</td> <td>799 college students</td> <td>0.4% male</td> <td>5.1% female<sup id="cite_ref-103" class="reference"><a href="#cite_note-103"><span class="cite-bracket">[</span>103<span class="cite-bracket">]</span></a></sup> </td></tr></tbody></table> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Bulimia_nervosa&action=edit&section=14" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Etymology">Etymology</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Bulimia_nervosa&action=edit&section=15" title="Edit section: Etymology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The term <i>bulimia</i> comes from <a href="/wiki/Ancient_Greek" title="Ancient Greek">Greek</a> <span title="Ancient Greek (to 1453)-language text"><span lang="grc">βουλιμία</span></span> <i>boulīmia</i>, "ravenous hunger", a compound of βοῦς <i>bous</i>, "ox" and λιμός, <i>līmos</i>, "hunger".<sup id="cite_ref-104" class="reference"><a href="#cite_note-104"><span class="cite-bracket">[</span>104<span class="cite-bracket">]</span></a></sup> Literally, the scientific name of the disorder, <i>bulimia nervosa</i>, translates to "nervous ravenous hunger". </p> <div class="mw-heading mw-heading3"><h3 id="Before_the_20th_century">Before the 20th century</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Bulimia_nervosa&action=edit&section=16" title="Edit section: Before the 20th century"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Although diagnostic criteria for bulimia nervosa did not appear until 1979, evidence suggests that binging and purging were popular in certain ancient cultures. The first documented account of behavior resembling bulimia nervosa was recorded in <a href="/wiki/Anabasis_(Xenophon)" title="Anabasis (Xenophon)">Xenophon's Anabasis</a> around 370 B.C, in which Greek soldiers purged themselves in the mountains of <a href="/wiki/Asia_Minor" class="mw-redirect" title="Asia Minor">Asia Minor</a>. It is unclear whether this purging was preceded by binging.<sup id="cite_ref-Reference_1_105-0" class="reference"><a href="#cite_note-Reference_1-105"><span class="cite-bracket">[</span>105<span class="cite-bracket">]</span></a></sup> In ancient Egypt, physicians recommended purging once a month for three days to preserve health.<sup id="cite_ref-Reference_2_106-0" class="reference"><a href="#cite_note-Reference_2-106"><span class="cite-bracket">[</span>106<span class="cite-bracket">]</span></a></sup> This practice stemmed from the belief that human diseases were caused by the food itself. In ancient Rome, elite society members would vomit to "make room" in their stomachs for more food at all-day banquets.<sup id="cite_ref-Reference_2_106-1" class="reference"><a href="#cite_note-Reference_2-106"><span class="cite-bracket">[</span>106<span class="cite-bracket">]</span></a></sup> Emperors <a href="/wiki/Claudius" title="Claudius">Claudius</a> and <a href="/wiki/Vitellius" title="Vitellius">Vitellius</a> both were gluttonous and obese, and they often resorted to habitual purging.<sup id="cite_ref-Reference_2_106-2" class="reference"><a href="#cite_note-Reference_2-106"><span class="cite-bracket">[</span>106<span class="cite-bracket">]</span></a></sup> </p><p>Historical records also suggest that some saints who developed <a href="/wiki/Anorexia_nervosa" title="Anorexia nervosa">anorexia</a> (as a result of a life of asceticism) may also have displayed bulimic behaviors.<sup id="cite_ref-Reference_2_106-3" class="reference"><a href="#cite_note-Reference_2-106"><span class="cite-bracket">[</span>106<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Magdalena_de_Pazzi" class="mw-redirect" title="Magdalena de Pazzi">Saint Mary Magdalen de Pazzi</a> (1566–1607) and <a href="/wiki/Veronica_Giuliani" title="Veronica Giuliani">Saint Veronica Giuliani</a> (1660–1727) were both observed binge eating—giving in, as they believed, to the temptations of the devil.<sup id="cite_ref-Reference_2_106-4" class="reference"><a href="#cite_note-Reference_2-106"><span class="cite-bracket">[</span>106<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Catherine_of_Siena" title="Catherine of Siena">Saint Catherine of Siena</a> (1347–1380) is known to have supplemented her strict abstinence from food by purging as reparation for her sins. Catherine died from starvation at age thirty-three.<sup id="cite_ref-Reference_2_106-5" class="reference"><a href="#cite_note-Reference_2-106"><span class="cite-bracket">[</span>106<span class="cite-bracket">]</span></a></sup> </p><p>While the psychological disorder "bulimia nervosa" is relatively new, the word "bulimia", signifying overeating, has been present for centuries.<sup id="cite_ref-Reference_2_106-6" class="reference"><a href="#cite_note-Reference_2-106"><span class="cite-bracket">[</span>106<span class="cite-bracket">]</span></a></sup> The Babylon <a href="/wiki/Talmud" title="Talmud">Talmud</a> referenced practices of "bulimia", yet scholars believe that this simply referred to overeating without the purging or the psychological implications bulimia nervosa.<sup id="cite_ref-Reference_2_106-7" class="reference"><a href="#cite_note-Reference_2-106"><span class="cite-bracket">[</span>106<span class="cite-bracket">]</span></a></sup> In fact, a search for evidence of bulimia nervosa from the 17th to late 19th century revealed that only a quarter of the overeating cases they examined actually vomited after the binges. There was no evidence of deliberate vomiting or an attempt to control weight.<sup id="cite_ref-Reference_2_106-8" class="reference"><a href="#cite_note-Reference_2-106"><span class="cite-bracket">[</span>106<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="20th_century">20th century</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Bulimia_nervosa&action=edit&section=17" title="Edit section: 20th century"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Globally, bulimia was estimated to affect 3.6 million people in 2015.<sup id="cite_ref-GBD2015Pre_8-1" class="reference"><a href="#cite_note-GBD2015Pre-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> About 1% of young women have bulimia at a given point in time and about 2% to 3% of women have the condition at some point in their lives.<sup id="cite_ref-Sm2012_3-1" class="reference"><a href="#cite_note-Sm2012-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> The condition is less common in the developing world.<sup id="cite_ref-Hay2010_4-10" class="reference"><a href="#cite_note-Hay2010-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Bulimia is about nine times more likely to occur in women than men.<sup id="cite_ref-DSM5_5-6" class="reference"><a href="#cite_note-DSM5-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Among women, rates are highest in young adults.<sup id="cite_ref-DSM5_5-7" class="reference"><a href="#cite_note-DSM5-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Bulimia was named and first described by the British psychiatrist <a href="/wiki/Gerald_Russell" title="Gerald Russell">Gerald Russell</a> in 1979.<sup id="cite_ref-Russell1979_107-0" class="reference"><a href="#cite_note-Russell1979-107"><span class="cite-bracket">[</span>107<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-108" class="reference"><a href="#cite_note-108"><span class="cite-bracket">[</span>108<span class="cite-bracket">]</span></a></sup> </p><p>At the turn of the century, bulimia (overeating) was described as a clinical symptom, but rarely in the context of weight control.<sup id="cite_ref-Reference_3_109-0" class="reference"><a href="#cite_note-Reference_3-109"><span class="cite-bracket">[</span>109<span class="cite-bracket">]</span></a></sup> Purging, however, was seen in anorexic patients and attributed to gastric pain rather than another method of weight control.<sup id="cite_ref-Reference_3_109-1" class="reference"><a href="#cite_note-Reference_3-109"><span class="cite-bracket">[</span>109<span class="cite-bracket">]</span></a></sup> </p><p>In 1930, admissions of anorexia nervosa patients to the <a href="/wiki/Mayo_Clinic" title="Mayo Clinic">Mayo Clinic</a> from 1917 to 1929 were compiled. Fifty-five to sixty-five percent of these patients were reported to be voluntarily vomiting to relieve weight anxiety.<sup id="cite_ref-Reference_3_109-2" class="reference"><a href="#cite_note-Reference_3-109"><span class="cite-bracket">[</span>109<span class="cite-bracket">]</span></a></sup> Records show that purging for weight control continued throughout the mid-1900s. Several case studies from this era reveal patients with the modern description of bulimia nervosa.<sup id="cite_ref-Reference_3_109-3" class="reference"><a href="#cite_note-Reference_3-109"><span class="cite-bracket">[</span>109<span class="cite-bracket">]</span></a></sup> In 1939, Rahman and Richardson reported that out of their six anorexic patients, one had periods of overeating, and another practiced self-induced vomiting.<sup id="cite_ref-Reference_3_109-4" class="reference"><a href="#cite_note-Reference_3-109"><span class="cite-bracket">[</span>109<span class="cite-bracket">]</span></a></sup> Wulff, in 1932, treated "Patient D", who would have periods of intense cravings for food and overeat for weeks, which often resulted in frequent vomiting.<sup id="cite_ref-Reference_2_106-9" class="reference"><a href="#cite_note-Reference_2-106"><span class="cite-bracket">[</span>106<span class="cite-bracket">]</span></a></sup> Patient D, who grew up with a tyrannical father, was repulsed by her weight and would fast for a few days, rapidly losing weight. <a href="/wiki/Ellen_West" title="Ellen West">Ellen West</a>, a patient described by <a href="/wiki/Ludwig_Binswanger" title="Ludwig Binswanger">Ludwig Binswanger</a> in 1958, was teased by friends for being fat and excessively took thyroid pills to lose weight, later using laxatives and vomiting.<sup id="cite_ref-Reference_2_106-10" class="reference"><a href="#cite_note-Reference_2-106"><span class="cite-bracket">[</span>106<span class="cite-bracket">]</span></a></sup> She reportedly consumed dozens of oranges and several pounds of tomatoes each day, yet would skip meals. After being admitted to a psychiatric facility for depression, Ellen ate ravenously yet lost weight, presumably due to self-induced vomiting.<sup id="cite_ref-Reference_2_106-11" class="reference"><a href="#cite_note-Reference_2-106"><span class="cite-bracket">[</span>106<span class="cite-bracket">]</span></a></sup> However, while these patients may have met modern criteria for bulimia nervosa, they cannot technically be diagnosed with the disorder, as it had not yet appeared in the <a href="/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders" title="Diagnostic and Statistical Manual of Mental Disorders">Diagnostic and Statistical Manual of Mental Disorders</a> at the time of their treatment.<sup id="cite_ref-Reference_2_106-12" class="reference"><a href="#cite_note-Reference_2-106"><span class="cite-bracket">[</span>106<span class="cite-bracket">]</span></a></sup> </p><p>An explanation for the increased instances of bulimic symptoms may be due to the 20th century's new ideals of thinness.<sup id="cite_ref-Reference_3_109-5" class="reference"><a href="#cite_note-Reference_3-109"><span class="cite-bracket">[</span>109<span class="cite-bracket">]</span></a></sup> The shame of being fat emerged in the 1940s when teasing remarks about weight became more common. The 1950s, however, truly introduced the trend of aspiration for thinness.<sup id="cite_ref-Reference_3_109-6" class="reference"><a href="#cite_note-Reference_3-109"><span class="cite-bracket">[</span>109<span class="cite-bracket">]</span></a></sup> </p><p>In 1979, <a href="/wiki/Gerald_Russell" title="Gerald Russell">Gerald Russell</a> first published a description of bulimia nervosa, in which he studied patients with a "morbid fear of becoming fat" who overate and purged afterward.<sup id="cite_ref-Russell1979_107-1" class="reference"><a href="#cite_note-Russell1979-107"><span class="cite-bracket">[</span>107<span class="cite-bracket">]</span></a></sup> He specified treatment options and indicated the seriousness of the disease, which can be accompanied by depression and suicide.<sup id="cite_ref-Russell1979_107-2" class="reference"><a href="#cite_note-Russell1979-107"><span class="cite-bracket">[</span>107<span class="cite-bracket">]</span></a></sup> In 1980, bulimia nervosa first appeared in the <a href="/wiki/DSM-III" class="mw-redirect" title="DSM-III">DSM-III</a>.<sup id="cite_ref-Russell1979_107-3" class="reference"><a href="#cite_note-Russell1979-107"><span class="cite-bracket">[</span>107<span class="cite-bracket">]</span></a></sup> </p><p>After its appearance in the DSM-III, there was a sudden rise in the documented incidents of bulimia nervosa.<sup id="cite_ref-Reference_2_106-13" class="reference"><a href="#cite_note-Reference_2-106"><span class="cite-bracket">[</span>106<span class="cite-bracket">]</span></a></sup> In the early 1980s, incidents of the disorder rose to about 40 in every 100,000 people.<sup id="cite_ref-Reference_2_106-14" class="reference"><a href="#cite_note-Reference_2-106"><span class="cite-bracket">[</span>106<span class="cite-bracket">]</span></a></sup> This decreased to about 27 in every 100,000 people at the end of the 1980s/early 1990s.<sup id="cite_ref-Reference_2_106-15" class="reference"><a href="#cite_note-Reference_2-106"><span class="cite-bracket">[</span>106<span class="cite-bracket">]</span></a></sup> However, bulimia nervosa's prevalence was still much higher than anorexia nervosa's, which at the time occurred in about 14 people per 100,000.<sup id="cite_ref-Reference_2_106-16" class="reference"><a href="#cite_note-Reference_2-106"><span class="cite-bracket">[</span>106<span class="cite-bracket">]</span></a></sup> </p><p>In 1991, Kendler et al. documented the cumulative risk for bulimia nervosa for those born before 1950, from 1950 to 1959, and after 1959.<sup id="cite_ref-Reference_5_110-0" class="reference"><a href="#cite_note-Reference_5-110"><span class="cite-bracket">[</span>110<span class="cite-bracket">]</span></a></sup> The risk for those born after 1959 is much higher than those in either of the other cohorts.<sup id="cite_ref-Reference_5_110-1" class="reference"><a href="#cite_note-Reference_5-110"><span class="cite-bracket">[</span>110<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Bulimia_nervosa&action=edit&section=18" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Anorectic_Behavior_Observation_Scale" title="Anorectic Behavior Observation Scale">Anorectic Behavior Observation Scale</a></li> <li><a href="/wiki/Eating_recovery" title="Eating recovery">Eating recovery</a></li> <li><a href="/wiki/Evolutionary_psychiatry" title="Evolutionary psychiatry">Evolutionary psychiatry</a></li> <li><a href="/wiki/Binge_eating_disorder" title="Binge eating disorder">Binge eating disorder</a></li> <li><a href="/wiki/List_of_people_with_bulimia_nervosa" title="List of people with bulimia nervosa">List of people with bulimia nervosa</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Bulimia_nervosa&action=edit&section=19" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-Buli2012-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-Buli2012_1-0">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFBulikMarcusZerwasLevine2012" class="citation journal cs1">Bulik CM, Marcus MD, Zerwas S, Levine MD, La Via M (October 2012). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4038540">"The changing "weightscape" of bulimia nervosa"</a>. <i>The American Journal of Psychiatry</i>. <b>169</b> (10): <span class="nowrap">1031–</span>6. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1176%2Fappi.ajp.2012.12010147">10.1176/appi.ajp.2012.12010147</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4038540">4038540</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/23032383">23032383</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+American+Journal+of+Psychiatry&rft.atitle=The+changing+%22weightscape%22+of+bulimia+nervosa&rft.volume=169&rft.issue=10&rft.pages=%3Cspan+class%3D%22nowrap%22%3E1031-%3C%2Fspan%3E6&rft.date=2012-10&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4038540%23id-name%3DPMC&rft_id=info%3Apmid%2F23032383&rft_id=info%3Adoi%2F10.1176%2Fappi.ajp.2012.12010147&rft.aulast=Bulik&rft.aufirst=CM&rft.au=Marcus%2C+MD&rft.au=Zerwas%2C+S&rft.au=Levine%2C+MD&rft.au=La+Via%2C+M&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4038540&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABulimia+nervosa" class="Z3988"></span></span> </li> <li id="cite_note-Women2012-2"><span class="mw-cite-backlink">^ <a href="#cite_ref-Women2012_2-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Women2012_2-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Women2012_2-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Women2012_2-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-Women2012_2-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-Women2012_2-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-Women2012_2-6"><sup><i><b>g</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.womenshealth.gov/publications/our-publications/fact-sheet/bulimia-nervosa.html?from=AtoZ">"Bulimia nervosa fact sheet"</a>. <i>Office on Women's Health</i>. July 16, 2012. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20150619030219/http://womenshealth.gov/publications/our-publications/fact-sheet/bulimia-nervosa.html?from=AtoZ">Archived</a> from the original on June 19, 2015<span class="reference-accessdate">. Retrieved <span class="nowrap">June 27,</span> 2015</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Office+on+Women%27s+Health&rft.atitle=Bulimia+nervosa+fact+sheet&rft.date=2012-07-16&rft_id=http%3A%2F%2Fwww.womenshealth.gov%2Fpublications%2Four-publications%2Ffact-sheet%2Fbulimia-nervosa.html%3Ffrom%3DAtoZ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABulimia+nervosa" class="Z3988"></span></span> </li> <li id="cite_note-Sm2012-3"><span class="mw-cite-backlink">^ <a href="#cite_ref-Sm2012_3-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Sm2012_3-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFSminkvan_HoekenHoek2012" class="citation journal cs1">Smink FR, van Hoeken D, Hoek HW (August 2012). <a rel="nofollow" class="external text" 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"The genetic epidemiology of bulimia nervosa". <i>The American Journal of Psychiatry</i>. <b>148</b> (12): <span class="nowrap">1627–</span>37. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1176%2Fajp.148.12.1627">10.1176/ajp.148.12.1627</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/1842216">1842216</a>.</cite><span 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dd:last-child::after,.mw-parser-output .hlist dt:last-child::after,.mw-parser-output .hlist li:last-child::after{content:none}.mw-parser-output .hlist dd dd:first-child::before,.mw-parser-output .hlist dd dt:first-child::before,.mw-parser-output .hlist dd li:first-child::before,.mw-parser-output .hlist dt dd:first-child::before,.mw-parser-output .hlist dt dt:first-child::before,.mw-parser-output .hlist dt li:first-child::before,.mw-parser-output .hlist li dd:first-child::before,.mw-parser-output .hlist li dt:first-child::before,.mw-parser-output .hlist li li:first-child::before{content:" (";font-weight:normal}.mw-parser-output .hlist dd dd:last-child::after,.mw-parser-output .hlist dd dt:last-child::after,.mw-parser-output .hlist dd li:last-child::after,.mw-parser-output .hlist dt dd:last-child::after,.mw-parser-output .hlist dt dt:last-child::after,.mw-parser-output .hlist dt li:last-child::after,.mw-parser-output .hlist li dd:last-child::after,.mw-parser-output .hlist li dt:last-child::after,.mw-parser-output .hlist li li:last-child::after{content:")";font-weight:normal}.mw-parser-output .hlist ol{counter-reset:listitem}.mw-parser-output .hlist ol>li{counter-increment:listitem}.mw-parser-output .hlist ol>li::before{content:" "counter(listitem)"\a0 "}.mw-parser-output .hlist dd ol>li:first-child::before,.mw-parser-output .hlist dt ol>li:first-child::before,.mw-parser-output .hlist li ol>li:first-child::before{content:" ("counter(listitem)"\a0 "}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-label="Navbox32" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q64513386" class="extiw" title="d:Q64513386">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/F50.2">F50.2</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=307.51">307.51</a></li><li><b><a href="/wiki/Online_Mendelian_Inheritance_in_Man" title="Online Mendelian Inheritance in Man">OMIM</a></b>: <a rel="nofollow" class="external text" href="https://omim.org/entry/607499">607499</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D052018">D052018</a></li><li><b><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a></b>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb1770.htm">1770</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000341.htm">000341</a></li><li><b><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></b>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/emerg/810-overview">emerg/810</a> <a rel="nofollow" class="external text" href="https://www.emedicine.com/med/topic255.htm#">med/255</a></li><li><b><a href="/wiki/Patient_UK" title="Patient UK">Patient UK</a></b>: <a rel="nofollow" class="external text" href="https://patient.info/doctor/bulimia-nervosa">Bulimia nervosa</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Mental_disorders_(Classification)596" style="padding:3px"><table class="nowraplinks hlist mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Mental_disorders" title="Template:Mental disorders"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Mental_disorders" title="Template talk:Mental disorders"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Mental_disorders" title="Special:EditPage/Template:Mental disorders"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Mental_disorders_(Classification)596" style="font-size:114%;margin:0 4em"><a href="/wiki/Mental_disorder" title="Mental disorder">Mental disorders</a> (<a href="/wiki/Classification_of_mental_disorders" title="Classification of mental disorders">Classification</a>)</div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible mw-collapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Adult_personality_and_behavior596" style="font-size:114%;margin:0 4em">Adult personality and behavior</div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Sexual</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Ego-dystonic_sexual_orientation" title="Ego-dystonic sexual orientation">Ego-dystonic sexual orientation</a></li> <li><a href="/wiki/Paraphilia" title="Paraphilia">Paraphilia</a> <ul><li><a href="/wiki/Sexual_fetishism" title="Sexual fetishism">Fetishism</a></li> <li><a href="/wiki/Voyeurism" title="Voyeurism">Voyeurism</a></li></ul></li> <li><a href="/wiki/Sexual_anhedonia" title="Sexual anhedonia">Sexual anhedonia</a></li> <li><a href="/wiki/Sexual_anorexia" title="Sexual anorexia">Sexual anorexia</a></li> <li><a href="/wiki/Sexual_maturation_disorder" title="Sexual maturation disorder">Sexual maturation disorder</a></li> <li><a href="/wiki/Sexual_relationship_disorder" title="Sexual relationship disorder">Sexual relationship disorder</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Factitious_disorder" title="Factitious disorder">Factitious disorder</a> <ul><li><a href="/wiki/Factitious_disorder_imposed_on_self" title="Factitious disorder imposed on self">Munchausen syndrome</a></li></ul></li> <li><a href="/wiki/Fear_of_intimacy" title="Fear of intimacy">Fear of intimacy</a></li> <li><a href="/wiki/Gender_dysphoria" title="Gender dysphoria">Gender dysphoria</a></li> <li><a href="/wiki/Intermittent_explosive_disorder" title="Intermittent explosive disorder">Intermittent explosive disorder</a></li> <li><a href="/wiki/Excoriation_disorder" title="Excoriation disorder">Dermatillomania</a></li> <li><a href="/wiki/Kleptomania" title="Kleptomania">Kleptomania</a></li> <li><a href="/wiki/Pyromania" title="Pyromania">Pyromania</a></li> <li><a href="/wiki/Trichotillomania" title="Trichotillomania">Trichotillomania</a></li> <li><a href="/wiki/Personality_disorder" title="Personality disorder">Personality disorder</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible mw-collapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Childhood_and_learning596" style="font-size:114%;margin:0 4em"><a href="/wiki/Mental_disorders_diagnosed_in_childhood" title="Mental disorders diagnosed in childhood">Childhood and learning</a></div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Emotional_and_behavioral_disorders" title="Emotional and behavioral disorders">Emotional and behavioral</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Attention_deficit_hyperactivity_disorder" title="Attention deficit hyperactivity disorder">ADHD</a></li> <li><a href="/wiki/Conduct_disorder" title="Conduct disorder">Conduct disorder</a> <ul><li><a href="/wiki/Oppositional_defiant_disorder" title="Oppositional defiant disorder">ODD</a></li></ul></li> <li><a href="/wiki/Emotional_and_behavioral_disorders" title="Emotional and behavioral disorders">Emotional and behavioral disorders</a> <ul><li><a href="/wiki/Separation_anxiety_disorder" title="Separation anxiety disorder">Separation anxiety disorder</a></li></ul></li> <li><a href="/wiki/Movement_disorders" class="mw-redirect" title="Movement disorders">Movement disorders</a> <ul><li><a href="/wiki/Stereotypic_movement_disorder" title="Stereotypic movement disorder">Stereotypic</a></li></ul></li> <li>Social functioning <ul><li><a href="/wiki/Disinhibited_attachment_disorder" title="Disinhibited attachment disorder">DAD</a></li> <li><a href="/wiki/Reactive_attachment_disorder" title="Reactive attachment disorder">RAD</a></li> <li><a href="/wiki/Selective_mutism" title="Selective mutism">Selective mutism</a></li></ul></li> <li><a href="/wiki/Speech_disorder" title="Speech disorder">Speech</a> <ul><li><a href="/wiki/Cluttering" title="Cluttering">Cluttering</a></li> <li><a href="/wiki/Stuttering" title="Stuttering">Stuttering</a></li></ul></li> <li><a href="/wiki/Tic_disorder" title="Tic disorder">Tic disorder</a> <ul><li><a href="/wiki/Tourette_syndrome" title="Tourette syndrome">Tourette syndrome</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Intellectual_disability" title="Intellectual disability">Intellectual disability</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/X-linked_intellectual_disability" title="X-linked intellectual disability">X-linked intellectual disability</a> <ul><li><a href="/wiki/Lujan%E2%80%93Fryns_syndrome" title="Lujan–Fryns syndrome">Lujan–Fryns syndrome</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Psychological development<br />(<a href="/wiki/Developmental_disability" title="Developmental disability">developmental disabilities</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pervasive_developmental_disorder" title="Pervasive developmental disorder">Pervasive</a></li> <li><a href="/wiki/Specific_developmental_disorder" title="Specific developmental disorder">Specific</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible mw-collapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Mood_(affective)596" style="font-size:114%;margin:0 4em"><a href="/wiki/Mood_disorder" title="Mood disorder">Mood</a> (affective)</div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bipolar_disorder" title="Bipolar disorder">Bipolar</a> <ul><li><a href="/wiki/Bipolar_I_disorder" title="Bipolar I disorder">Bipolar I</a></li> <li><a href="/wiki/Bipolar_II_disorder" title="Bipolar II disorder">Bipolar II</a></li> <li><a href="/wiki/Bipolar_disorder_not_otherwise_specified" title="Bipolar disorder not otherwise specified">Bipolar NOS</a></li> <li><a href="/wiki/Cyclothymia" title="Cyclothymia">Cyclothymia</a></li></ul></li> <li><a href="/wiki/Depression_(mood)" title="Depression (mood)">Depression</a> <ul><li><a href="/wiki/Atypical_depression" title="Atypical depression">Atypical depression</a></li> <li><a href="/wiki/Dysthymia" title="Dysthymia">Dysthymia</a></li> <li><a href="/wiki/Major_depressive_disorder" title="Major depressive disorder">Major depressive disorder</a></li> <li><a href="/wiki/Melancholic_depression" class="mw-redirect" title="Melancholic depression">Melancholic depression</a></li> <li><a href="/wiki/Seasonal_affective_disorder" title="Seasonal affective disorder">Seasonal affective disorder</a></li></ul></li> <li><a href="/wiki/Mania" title="Mania">Mania</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible mw-collapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Neurological_and_symptomatic596" style="font-size:114%;margin:0 4em">Neurological and symptomatic</div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Autism_spectrum" class="mw-redirect" title="Autism spectrum">Autism spectrum</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Autism" title="Autism">Autism</a></li> <li><a href="/wiki/Asperger_syndrome" title="Asperger syndrome">Asperger syndrome</a></li> <li><a href="/wiki/High-functioning_autism" title="High-functioning autism">High-functioning autism</a></li> <li><a href="/wiki/Pervasive_developmental_disorder_not_otherwise_specified" title="Pervasive developmental disorder not otherwise specified">PDD-NOS</a></li> <li><a href="/wiki/Savant_syndrome" title="Savant syndrome">Savant syndrome</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Dementia" title="Dementia">Dementia</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/HIV-associated_neurocognitive_disorder" title="HIV-associated neurocognitive disorder">AIDS dementia complex</a></li> <li><a href="/wiki/Alzheimer%27s_disease" title="Alzheimer's disease">Alzheimer's disease</a></li> <li><a href="/wiki/Creutzfeldt%E2%80%93Jakob_disease" title="Creutzfeldt–Jakob disease">Creutzfeldt–Jakob disease</a></li> <li><a href="/wiki/Frontotemporal_dementia" title="Frontotemporal dementia">Frontotemporal dementia</a></li> <li><a href="/wiki/Huntington%27s_disease" title="Huntington's disease">Huntington's disease</a></li> <li><a href="/wiki/Mild_cognitive_impairment" title="Mild cognitive impairment">Mild cognitive impairment</a></li> <li><a href="/wiki/Parkinson%27s_disease" title="Parkinson's disease">Parkinson's disease</a></li> <li><a href="/wiki/Pick%27s_disease" class="mw-redirect" title="Pick's disease">Pick's disease</a></li> <li><a href="/wiki/Sundowning" title="Sundowning">Sundowning</a></li> <li><a href="/wiki/Vascular_dementia" title="Vascular dementia">Vascular dementia</a></li> <li><a href="/wiki/Wandering_(dementia)" title="Wandering (dementia)">Wandering</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Delirium" title="Delirium">Delirium</a></li> <li><a href="/wiki/Organic_brain_syndrome" title="Organic brain syndrome">Organic brain syndrome</a></li> <li><a href="/wiki/Post-concussion_syndrome" title="Post-concussion syndrome">Post-concussion syndrome</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible mw-collapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Neurotic,_stress-related_and_somatoform596" style="font-size:114%;margin:0 4em"><a href="/wiki/Neurosis" title="Neurosis">Neurotic</a>, <a href="/wiki/Stress_(biology)" title="Stress (biology)">stress</a>-related and <a href="/wiki/Somatic_symptom_disorder" title="Somatic symptom disorder">somatoform</a></div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Adjustment_disorder" title="Adjustment disorder">Adjustment</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Adjustment_disorder" title="Adjustment disorder">Adjustment disorder</a> with depressed mood</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Anxiety_disorder" title="Anxiety disorder">Anxiety</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Phobia" title="Phobia">Phobia</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Agoraphobia" title="Agoraphobia">Agoraphobia</a></li> <li><a href="/wiki/Childhood_phobia" title="Childhood phobia">Childhood phobia</a></li> <li><a href="/wiki/Social_anxiety" title="Social anxiety">Social anxiety</a></li> <li><a href="/wiki/Social_anxiety_disorder" title="Social anxiety disorder">Social phobia</a> <ul><li><a href="/wiki/Anthropophobia" class="mw-redirect" title="Anthropophobia">Anthropophobia</a></li> <li><a href="/wiki/Specific_social_phobia" title="Specific social phobia">Specific social phobia</a></li></ul></li> <li><a href="/wiki/Specific_phobia" title="Specific phobia">Specific phobia</a> <ul><li><a href="/wiki/Claustrophobia" title="Claustrophobia">Claustrophobia</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Generalized_anxiety_disorder" title="Generalized anxiety disorder">Generalized anxiety disorder</a></li> <li><a href="/wiki/Obsessive%E2%80%93compulsive_disorder" title="Obsessive–compulsive disorder">OCD</a></li> <li><a href="/wiki/Panic_attack" title="Panic attack">Panic attack</a></li> <li><a href="/wiki/Panic_disorder" title="Panic disorder">Panic disorder</a></li> <li><a href="/wiki/Psychological_stress" title="Psychological stress">Stress</a> <ul><li><a href="/wiki/Acute_stress_reaction" title="Acute stress reaction">Acute stress reaction</a></li> <li><a href="/wiki/Post-traumatic_stress_disorder" title="Post-traumatic stress disorder">PTSD</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Dissociative_disorder" title="Dissociative disorder">Dissociative</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Depersonalization-derealization_disorder" title="Depersonalization-derealization disorder">Depersonalization-derealization disorder</a></li> <li><a href="/wiki/Dissociative_identity_disorder" title="Dissociative identity disorder">Dissociative identity disorder</a></li> <li><a href="/wiki/Dissociative_amnesia" title="Dissociative amnesia">Dissociative amnesia</a></li> <li><a href="/wiki/Dissociative_fugue" title="Dissociative fugue">Dissociative fugue</a></li> <li><a href="/wiki/Dissociative_disorder_not_otherwise_specified" title="Dissociative disorder not otherwise specified">Dissociative disorder not otherwise specified</a></li> <li><a href="/wiki/Other_specified_dissociative_disorder" title="Other specified dissociative disorder">Other specified dissociative disorder</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Somatic_symptom_disorder" title="Somatic symptom disorder">Somatic symptom</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Body_dysmorphic_disorder" title="Body dysmorphic disorder">Body dysmorphic disorder</a></li> <li><a href="/wiki/Conversion_disorder" title="Conversion disorder">Conversion disorder</a> <ul><li><a href="/wiki/Ganser_syndrome" title="Ganser syndrome">Ganser syndrome</a></li> <li><a href="/wiki/Globus_pharyngis" title="Globus pharyngis">Globus pharyngis</a></li> <li><a href="/wiki/Psychogenic_non-epileptic_seizure" title="Psychogenic non-epileptic seizure">Psychogenic non-epileptic seizures</a></li></ul></li> <li><a href="/wiki/False_pregnancy" title="False pregnancy">False pregnancy</a></li> <li><a href="/wiki/Hypochondriasis" title="Hypochondriasis">Hypochondriasis</a></li> <li><a href="/wiki/Mass_psychogenic_illness" title="Mass psychogenic illness">Mass psychogenic illness</a></li> <li><a href="/wiki/Nosophobia" title="Nosophobia">Nosophobia</a></li> <li><a href="/wiki/Psychogenic_pain" title="Psychogenic pain">Psychogenic pain</a></li> <li><a href="/wiki/Somatization_disorder" class="mw-redirect" title="Somatization disorder">Somatization disorder</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible uncollapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Physiological_and_physical_behavior596" style="font-size:114%;margin:0 4em">Physiological and physical behavior</div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Eating_disorder" title="Eating disorder">Eating</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anorexia_nervosa" title="Anorexia nervosa">Anorexia nervosa</a></li> <li><a class="mw-selflink selflink">Bulimia nervosa</a></li> <li><a href="/wiki/Rumination_syndrome" title="Rumination syndrome">Rumination syndrome</a></li> <li><a href="/wiki/Other_specified_feeding_or_eating_disorder" title="Other specified feeding or eating disorder">Other specified feeding or eating disorder</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Nonorganic <a href="/wiki/Sleep_disorder" title="Sleep disorder">sleep</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hypersomnia" title="Hypersomnia">Hypersomnia</a></li> <li><a href="/wiki/Insomnia" title="Insomnia">Insomnia</a></li> <li><a href="/wiki/Parasomnia" title="Parasomnia">Parasomnia</a> <ul><li><a href="/wiki/Night_terror" title="Night terror">Night terror</a></li> <li><a href="/wiki/Nightmare" title="Nightmare">Nightmare</a></li> <li><a href="/wiki/Rapid_eye_movement_sleep_behavior_disorder" title="Rapid eye movement sleep behavior disorder">REM sleep behavior disorder</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Psychiatric_disorders_of_childbirth" title="Psychiatric disorders of childbirth">Postnatal</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Postpartum_depression" title="Postpartum depression">Postpartum depression</a></li> <li><a href="/wiki/Postpartum_psychosis" title="Postpartum psychosis">Postpartum psychosis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Sexual_dysfunction#Sexual_desire_disorders" title="Sexual dysfunction">Sexual desire</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hypersexuality" title="Hypersexuality">Hypersexuality</a></li> <li><a href="/wiki/Hypoactive_sexual_desire_disorder" title="Hypoactive sexual desire disorder">Hypoactive sexual desire disorder</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible mw-collapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Psychoactive_substances,_substance_abuse_and_substance-related596" style="font-size:114%;margin:0 4em"><a href="/wiki/Psychoactive_drug" title="Psychoactive drug">Psychoactive</a> substances, <a href="/wiki/Substance_abuse" title="Substance abuse">substance abuse</a> and substance-related</div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Drug_overdose" title="Drug overdose">Drug overdose</a></li> <li><a href="/wiki/Substance_intoxication" title="Substance intoxication">Intoxication</a></li> <li><a href="/wiki/Physical_dependence" title="Physical dependence">Physical dependence</a></li> <li><a href="/wiki/Rebound_effect" title="Rebound effect">Rebound effect</a></li> <li><a href="/wiki/Stimulant_psychosis" title="Stimulant psychosis">Stimulant psychosis</a></li> <li><a href="/wiki/Substance_dependence" title="Substance dependence">Substance dependence</a></li> <li><a href="/wiki/Drug_withdrawal" title="Drug withdrawal">Withdrawal</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible mw-collapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Schizophrenia,_schizotypal_and_delusional596" style="font-size:114%;margin:0 4em"><a href="/wiki/Schizophrenia" title="Schizophrenia">Schizophrenia</a>, <a href="/wiki/Schizotypal_personality_disorder" title="Schizotypal personality disorder">schizotypal</a> and <a href="/wiki/Delusional_disorder" title="Delusional disorder">delusional</a></div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Delusional</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Delusional_disorder" title="Delusional disorder">Delusional disorder</a></li> <li><a href="/wiki/Folie_%C3%A0_deux" title="Folie à deux">Folie à deux</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Psychosis" title="Psychosis">Psychosis</a> and<br />schizophrenia-like</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Brief_reactive_psychosis" class="mw-redirect" title="Brief reactive psychosis">Brief reactive psychosis</a></li> <li><a href="/wiki/Schizoaffective_disorder" title="Schizoaffective disorder">Schizoaffective disorder</a></li> <li><a href="/wiki/Schizophreniform_disorder" title="Schizophreniform disorder">Schizophreniform disorder</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Schizophrenia</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Childhood_schizophrenia" title="Childhood schizophrenia">Childhood schizophrenia</a></li> <li><a href="/wiki/Disorganized_schizophrenia" title="Disorganized schizophrenia">Disorganized (hebephrenic) schizophrenia</a></li> <li><a href="/wiki/Pseudoneurotic_schizophrenia" title="Pseudoneurotic schizophrenia">Pseudoneurotic schizophrenia</a></li> <li><a href="/wiki/Simple-type_schizophrenia" title="Simple-type schizophrenia">Simple-type schizophrenia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Catatonia" title="Catatonia">Catatonia</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible mw-collapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Symptoms_and_uncategorized596" style="font-size:114%;margin:0 4em">Symptoms and uncategorized</div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Impulse-control_disorder" title="Impulse-control disorder">Impulse-control disorder</a></li> <li><a href="/wiki/Kl%C3%BCver%E2%80%93Bucy_syndrome" title="Klüver–Bucy syndrome">Klüver–Bucy syndrome</a></li> <li><a href="/wiki/Psychomotor_agitation" title="Psychomotor agitation">Psychomotor agitation</a></li> <li><a href="/wiki/Stereotypy" title="Stereotypy">Stereotypy</a></li></ul> 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