Bulimia Nervosa in DSM-5

Abstract

CME Educational Objectives 1. Outline the core clinical features of bulimia nervosa (BN). 2. Describe the concerns surrounding the DSM-IV criteria for BN. 3. Understand the rationale for changes in the diagnostic criteria for BN as recommended for DSM-5 . Bulimia nervosa, a disorder first introduced as “bulimia” in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition , 1 is characterized by recurrent binge eating episodes followed by inappropriate compensatory behaviors (such as, self-induced vomiting, laxative abuse, excessive exercising, and fasting) to prevent weight gain. The disorder is more common in females than in males, with onset typically in adolescence and young adulthood. 2

From DSM-IV to DSM-5

“…In addition to decreasing the threshold frequency of binge episodes and compensatory behaviors, the Eating Disorders Work Group also recommended the removal of subtypes as there is not enough evidence to suggest that subtypes have significantly different courses or responses to treatment [11]. Subtypes were not used frequently by clinicians, so this change is expected to have little clinical impact [11].…”

“…This change is based on research that suggests that individuals who exhibit binge episodes and compensatory behavior one time per week do not differ significantly in terms of clinical picture or treatment response from those who exhibit the behavior at least two times per week [11].…”

“…Subtypes were not used frequently by clinicians, so this change is expected to have little clinical impact [11].…”