Diagnostic Criteria according to ICD-10 F50.2

1. Permanent preoccupation with food, including an uncontrollable craving for it.
2. Recurrent episodes of binge eating, where:
   1.  Large quantities of food are consumed in a short period (at least twice per week over three months).
3. Counter-regulatory behaviors to prevent weight gain from binge eating, including:
   1. Self-induced vomiting
   2. Laxative abuse
   3. Prolonged fasting
   4. Use of appetite suppressants, thyroid preparations, or diuretics. 
   5. In diabetics, intentional neglect of insulin treatment.
4. Pathological fear of gaining weight, often paired with a defined weight limit far below a healthy range.
5. A prior history of Anorexia Nervosa may precede the development of Bulimia Nervosa. This may involve significant weight loss or transient amenorrhea.

Incidence

Current studies indicate a lifetime prevalence of 1-3% in German-speaking countries. The disorder often begins in adolescence and has a mortality rate of 1.1-5.8% over the lifetime of those affected.

Risk Factors

• Dissatisfaction with body image or a strong preference for the ideal ‘slim’ aesthetic 
• Dieting history
• Previous episodes of Anorexia Nervosa
• Problems with self-esteem
• Emotional instability or excessive shame
• Increased impulsivity
• Insecure attachments, mistrust, and conflict in relationships
• Family stresses 
• traumatic experiences.

 

Associated Symptoms 

Individuals with Bulimia Nervosa often experience a range of emotional and physical consequences. Many develop depressive moods along with anxiety disorders, while a significant proportion have histories of alcohol or substance use. Physiologically, frequent vomiting can cause severe damage to tooth enamel (generating tooth decay), while even the mechanical act of inducing vomiting may lead to scars or calluses on the hands. Additionally, salivary glands, particularly the parotid gland, may become noticeably enlarged. The cycle of binge eating plus purging disrupts fluid along with electrolyte balance, potentially resulting in kidney damage, edema, and cardiac arrhythmias. Lastly, chronic complications include gastric distension, inflammation of the stomach plus esophagus, along with vitamin and other nutrient deficiencies. These issues are compounded by the constant strain on the digestive system, leading to long-term health risks.