Bulimia Nervosa Differential Diagnoses

Updated: Jun 06, 2016
  • Author: Gagandeep Randhawa, MBBS; Chief Editor: David Bienenfeld, MD  more...
  • Print
DDx

Diagnostic Considerations

Differential Diagnosis of Bulimia Nervosa [1] (Open Table in a new window)

Anorexia Nervosa AN and BN Bulimia Nervosa
Restriction of energy intake relative to requirement, leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health   Recurrent episodes of binge eating: a) eating in a discrete period of time, within a 2-hour period, an amount that is definitely larger than what most would eat in that time period; b) a sense of lack of control over eating
Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight   Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise
  Disturbance in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months
Two types: Restrictive and Purge/Bing-Eating type   The disturbance does not occur exclusively during episodes of AN
Body Dysmorphic Disorder BDD and BN BN
Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others Disturbance in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation Recurrent episodes of binge eating: a) eating in a discrete period of time, within a 2-hour period, an amount that is definitely larger than what most would eat in that time period; b) a sense of lack of control over eating
At some point during the course of the disorder, the individual has performed repetitive behaviors or mental acts in response to the appearance concerns The preoccupation causes significant distress or impairment in social, occupational, or other important areas of functioning Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise
The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder   The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months

 

Differential Diagnoses