The OPEN minute newsletter / Bulimia
August 2, 2022


Bulimia and anorexia are eating disorders, each having strong biological, psychological, and sociocultural determinants. However, Bulimia is less common. Early recognition of bulimia and prompt intervention are associated with a better outcome.

Clinical Description
Bulimia is defined as a morbid hunger, usually manifested as episodic binge eating or the rapid ingestion of large amounts of food in a relatively short time.
Bulimia is a syndrome in which increased appetite and binge eating are usually unrelated to increased hunger per se. The exception is when the patient is also involved with prolonged fasting and caloric restriction.

Diagnostic Criteria

1. Binge-eating episodes

Both of the following characterize an episode of binge eating.

  • Eating in a discrete period of time ( e.g., within any 2-hour period) an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
  • A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).


2. Recurrent inappropriate compensatory behaviors in order to prevent weight gain (self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise).

On average, binge eating and inappropriate compensatory behaviors occur at least once a week for 3 months.

Self-evaluation is unduly influenced by body shape and weight. The disturbance does not occur exclusively during episodes of anorexia. Similar to anorexia, in cases of bulimia, parents that observe strange eating behavior of their child firstly see a pediatrician.

However, it is very difficult to diagnose bulimia only by pediatrician’s examination, given that the patient does not exhibit visible signs of the disease and often has a normal weight, except for the cases where they strictly limit the food intake and cleans the organism.

 Physical Symptoms

  • Weight may be normal, overweight, or underweight
  • Complaints of bloating, diarrhea, swelling
  • Hyperactivity (mental and/or motor)
  • Constant or extreme thirst and increased urination (hypokalemic nephropathy-hypovolemia)
  • May present with depression, anxiety, despair, and suicidal ideation

Physical Signs

  • Usually well-groomed and good hygiene; definite exceptions, especially patients with a severe character disorder or chronic addictive conditions
  • Usually normal weight or mild to moderate obesity ( exception: food restrictors or anorexia patients with associated bulimia-vomiting-purging)
  • Generalized or localized edema
  • Physical findings of extreme weight loss (self-starvation)
  • Swelling of salivary glands
  • Dental enamel dysphasia and discoloration due to gastric juices (vomiting)
  • Bruises and lacerations of the palate and posterior pharynx; lesions of fingernails, fingers, and dorsum of the hand (due to self-induced vomiting)
  • Pyorrhea and other gum disorders
  • Diminished reflexes, muscle weakness, paralysis, and infrequently, peripheral neuropathy
  • Signs of hypokalemia: cardiac dysrhythmias, hypotension, weak pulse; abdominal distention, ileus, acute gastric dilatation; Irregular breathing

Hope this helps!
Best regards,
Karine Lyulejyan, Child Psychiatrist, “ArBeS”  Healthcare Center

References and Resources

Comerci GD. Eating disorders: anorexia and bulimia. In: Levine MD, Carey WB, Crocker AC, eds. Developmental-Behavioral Pediatrics. 2nd ed. W.B. Saunders Company: Philadelphia, PA; 1992: 364-369.

Duncan MK, Martini DR, Lake M. Bulimia. In: Concise Guide to Child and Adolescent Psychiatry. 3rd ed. American Psychiatric Publishing: Washington, DC; 2003: 112-117.

Bulimia. In: Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. American Psychiatric Association: Washington, DC; 2013, 345-350.

Image Source: Medium shot blurry woman with disorder by freepik is licensed under Freepik License.

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