Highlights & Basics
- Bulimia nervosa is an eating disorder, characterized by severe preoccupation about weight and body shape. Includes recurrent episodes of binge eating with compensatory mechanisms, such as self-induced vomiting to prevent weight gain.
- Most common in women in their 20s and 30s.
- Patients usually appear physically normal, although they may have low self-esteem and depressive thoughts, as well as lack of confidence.
- Parotid hypertrophy and erosion of the teeth are the most common physical signs and may prompt diagnosis.
- Cognitive behavioral therapy (CBT) is considered optimal primary treatment for bulimia, but it may not always be available.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
Academy for Eating Disorders. Eating disorders: critical points for early recognition and medical risk management in the care of individuals with eating disorders. 2021 [internet publication].[Full Text]
Lock J, La Via MC, American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). Practice parameter for the assessment and treatment of children and adolescents with eating disorders. J Am Acad Child Adolesc Psychiatry. 2015 May;54(5):412-25.[Abstract][Full Text]
Carl RL, Johnson MD, Martin TJ; Council on Sports Medicine and Fitness. Promotion of healthy weight-control practices in young athletes. Pediatrics. 2017 Sep;140(3): e20171871.[Abstract][Full Text]
Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ. 1999 Dec 4;319(7223):1467-8.[Abstract][Full Text]
National Institute for Health and Care Excellence (UK). Eating disorders: recognition and treatment. 16 December 2020 [internet publication].[Full Text]
1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
2. van Hoeken D, Veling W, Sinke S, et al. The validity and utility of subtyping bulimia nervosa. Int J Eat Disord. 2009 Nov;42(7):595-602.[Abstract][Full Text]
3. World Health Organization. International Classification of Diseases, 11th Revision (ICD-11). 2022 [internet publication].[Full Text]
4. Academy for Eating Disorders. Eating disorders: critical points for early recognition and medical risk management in the care of individuals with eating disorders. 2021 [internet publication].[Full Text]
5. Furnham A, Davidson L. Sex differences in beliefs about bulimia nervosa. Soc Psychiatry Psychiatr Epidemiol. 2012 Jan;47(1):67-77. [Abstract]
6. Claes L, Jiménez-Murcia S, Agüera Z, et al. Male eating disorder patients with and without non-suicidal self-injury: a comparison of psychopathological and personality features. Eur Eat Disord Rev. 2012 Jul;20(4):335-8.[Abstract]
7. Mangweth-Matzek B, Rupp CI, Hausmann A, et al. Eating disorders in men: current features and childhood factors. Eat Weight Disord. 2010 Mar-Jun;15(1-2):e15-22. [Abstract]
8. Núñez-Navarro A, Agüera Z, Krug I, et al. Do men with eating disorders differ from women in clinics, psychopathology and personality? Eur Eat Disord Rev. 2012 Jan;20(1):23-31.[Abstract]
9. Stice E, Marti CN, Rohde P. Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. J Abnorm Psychol. 2013 May;122(2):445-57. [Abstract][Full Text]
10. Striegel-Moore RH, Dohm FA, Kraemer HC, et al. Eating disorders in white and black women. Am J Psychiatry. 2003 Jul;160(7):1326-31.[Abstract][Full Text]
11. Lock J, La Via MC, American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). Practice parameter for the assessment and treatment of children and adolescents with eating disorders. J Am Acad Child Adolesc Psychiatry. 2015 May;54(5):412-25.[Abstract][Full Text]
12. Swanson SA, Crow SJ, Le Grange D, et al. Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement. Arch Gen Psychiatry. 2011 Jul;68(7):714-23.[Abstract][Full Text]
13. Kaye W. Neurobiology of anorexia and bulimia nervosa. Physiol Behav. 2008 Apr 22;94(1):121-35.[Abstract][Full Text]
14. Wade TD, Bulik CM. Shared genetic and environmental risk factors between undue influence of body shape and weight on self-evaluation and dimensions of perfectionism. Psychol Med. 2007 May;37(5):635-44. [Abstract]
15. Mond JM, Hay PJ, Rodgers B, et al. Beliefs of women concerning causes and risk factors for bulimia nervosa. Aust N Z J Psychiatry. 2004 Jun;38(6):463-9.[Abstract]
16. Van Son GE, van Hoeken D, Bartelds AI, et al. Urbanisation and the incidence of eating disorders. Br J Psychiatry. 2006 Dec;189:562-3. [Abstract]
17. Patton GC, Johnson-Sabine E, Wood K, et al. Abnormal eating attitudes in London schoolgirls - a prospective epidemiological study: outcome at twelve month follow-up. Psychol Med. 1990 May;20(2):383-94. [Abstract]
18. Day J, Schmidt U, Collier D, et al. Risk factors, correlates, and markers in early-onset bulimia nervosa and EDNOS. Int J Eat Disord. 2011 May;44(4):287-94. [Abstract]
19. Ousley L, Cordero ED, White S. Eating disorders and body image of undergraduate men. J Am Coll Health. 2008 May-Jun;56(6):617-21.[Abstract]
20. Brown TA, Haedt-Matt AA, Keel PK. Personality pathology in purging disorder and bulimia nervosa. Int J Eat Disord. 2011 Dec;44(8):735-40.[Abstract][Full Text]
21. Rowe SL, Jordan J, McIntosh VV, et al. Complex personality disorder in bulimia nervosa. Compr Psychiatry. 2010 Nov-Dec;51(6):592-8.[Abstract]
22. Alvarez-Moya EM, Jimenez-Murcia S, Granero R, et al. Comparison of personality risk factors in bulimia nervosa and pathological gambling. Compr Psychiatry. 2007 Sep-Oct;48(5):452-7.[Abstract]
23. Franko DL, Dorer DJ, Keel PK, et al. How do eating disorders and alcohol use disorder influence each other? Int J Eat Disord. 2005 Nov;38(3):200-7.[Abstract]
24. Lilenfeld LR, Wonderlich S, Riso LP, et al. Eating disorders and personality: a methodological and empirical review. Clin Psychol Rev. 2006 May;26(3):299-320.[Abstract]
25. Cassin SE, von Ranson KM. Personality and eating disorders: a decade in review. Clin Psychol Rev. 2005 Nov;25(7):895-916.[Abstract]
26. Jaeger B, Ruggiero GM, Edlund B, et al. Body dissatisfaction and its interrelations with other risk factors for bulimia nervosa in 12 countries. Psychother Psychosom. 2002 Jan-Feb;71(1):54-61.[Abstract]
27. Stice E. A prospective test of the dual-pathway model of bulimic pathology: mediating effects of dieting and negative affect. J Abnorm Psychol. 2001 Feb;110(1):124-35.[Abstract]
28. Preti A, Incani E, Camboni MV, et al. Sexual abuse and eating disorder symptoms: the mediator role of bodily dissatisfaction. Compr Psychiatry. 2006 Nov-Dec;47(6):475-81.[Abstract]
29. Benninghoven D, Tetsch N, Kunzendorf S, et al. Body image in patients with eating disorders and their mothers, and the role of family functioning. Compr Psychiatry. 2007 Mar-Apr;48(2):118-23.[Abstract]
30. Peterson CB, Wimmer S, Ackard DM, et al. Changes in body image during cognitive-behavioral treatment in women with bulimia nervosa. Body Image. 2004 May;1(2):139-53.[Abstract]
31. Chen LP, Murad MH, Paras ML, et al. Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clin Proc. 2010 Jul;85(7):618-29. [Abstract][Full Text]
32. Gowers SG, Shore A. Development of weight and shape concerns in the aetiology of eating disorders. Br J Psychiatry. 2001 Sep;179:236-42.[Abstract][Full Text]
33. Rosval L, Steiger H, Bruce K, et al. Impulsivity in women with eating disorders: problem of response inhibition, planning, or attention? Int J Eat Disord. 2006 Nov;39(7):590-3. [Abstract]
34. Ahren-Moonga J, Holmgren S, von Knorring L, et al. Personality traits and self-injurious behaviour in patients with eating disorders. Eur Eat Disord Rev. 2008 Jul;16(4):268-75. [Abstract]
35. Peebles R, Wilson JL, Lock JD. Self-injury in adolescents with eating disorders: correlates and provider bias. J Adolesc Health. 2011 Mar;48(3):310-3. [Abstract][Full Text]
36. Pemberton AR, Vernon SW, Lee ES. Prevalence and correlates of bulimia nervosa and bulimic behaviors in a racially diverse sample of undergraduate students in two universities in southeast Texas. Am J Epidemiol. 1996 Sep 1;144(5):450-5.[Abstract][Full Text]
37. García-Vilches I, Badía-Casanovas A, Fernández-Aranda F, et al. Characteristics of bulimic patients whose parents do or do not abuse alcohol. Eat Weight Disord. 2002 Sep;7(3):232-8.[Abstract]
38. Schuckit MA, Tipp JE, Anthenelli RM, et al. Anorexia nervosa and bulimia nervosa in alcohol-dependent men and women and their relatives. Am J Psychiatry. 1996 Jan;153(1):74-82. [Abstract]
39. Lilenfeld LR, Kaye WH, Greeno CG, et al. A controlled family study of anorexia nervosa and bulimia nervosa: psychiatric disorders in first-degree relatives and effects of proband comorbidity. Arch Gen Psychiatry. 1998 Jul;55(7):603-10.[Abstract][Full Text]
40. Kennedy SH, Kaplan AS, Garfinkel PE, et al. Depression in anorexia nervosa and bulimia nervosa: discriminating depressive symptoms and episodes. J Psychosom Res. 1994 Oct;38(7):773-82. [Abstract]
41. Annus AM, Smith GT, Fischer S, et al. Associations among family-of-origin food-related experiences, expectancies, and disordered eating. Int J Eat Disord. 2007 Mar;40(2):179-86.[Abstract]
42. Kugu N, Akyuz G, Dogan O, et al. The prevalence of eating disorders among university students and the relationship with some individual characteristics. Aust N Z J Psychiatry. 2006 Feb;40(2):129-35.[Abstract]
43. Mitchell JE, Pyle RL, Eckert E, et al. Bulimia nervosa with and without a history of overweight. J Subst Abuse. 1990;2(3):369-74. [Abstract]
44. Micali N, Holliday J, Karwautz A, et al. Childhood eating and weight in eating disorders: a multi-centre European study of affected women and their unaffected sisters. Psychother Psychosom. 2007;76(4):234-41.[Abstract]
45. Mitchell JE, Pyle RL, Eckert ED, et al. Bulimia nervosa in overweight individuals. J Nerv Ment Dis. 1990 May;178(5):324-7.[Abstract]
46. Becker AE. Television, disordered eating, and young women in Fiji: negotiating body image and identity during rapid social change. Cult Med Psychiatry. 2004 Dec;28(4):533-59. [Abstract]
47. Smith GT, Simmons JR, Flory K, et al. Thinness and eating expectancies predict subsequent binge-eating and purging behavior among adolescent girls. J Abnorm Psychol. 2007 Feb;116(1):188-97.[Abstract]
48. Annus AM, Smith GT, Masters K. Manipulation of thinness and restricting expectancies: further evidence for a causal role of thinness and restricting expectancies in the etiology of eating disorders. Psychol Addict Behav. 2008 Jun;22(2):278-87.[Abstract]
49. Mutterperl JA, Sanderson CA. Mind over matter: internalization of the thinness norm as a moderator of responsiveness to norm misperception education in college women. Health Psychol. 2002 Sep;21(5):519-23. [Abstract]
50. Mazzeo SE, Trace SE, Mitchell KS, et al. Effects of a reality TV cosmetic surgery makeover program on eating disordered attitudes and behaviors. Eat Behav. 2007 Aug;8(3):390-7.[Abstract]
51. Fister SM, Smith GT. Media effects on expectancies: exposure to realistic female images as a protective factor. Psychol Addict Behav. 2004 Dec;18(4):394-7. [Abstract]
52. Fletcher A, Bonell C, Sorhaindo A. You are what your friends eat: systematic review of social network analyses of young people's eating behaviours and bodyweight. J Epidemiol Community Health. 2011 Jun;65(6):548-55.[Abstract]
53. Martinsen M, Sundgot-Borgen J. Higher prevalence of eating disorders among adolescent elite athletes than controls. Med Sci Sports Exerc. 2013 Jun;45(6):1188-97.[Abstract][Full Text]
54. Sundgot-Borgen J, Torstveit MK. Prevalence of eating disorders in elite athletes is higher than in the general population. Clin J Sport Med. 2004 Jan;14(1):25-32.[Abstract]
55. Chapa DAN, Johnson SN, Richson BN, et al. Eating-disorder psychopathology in female athletes and non-athletes: a meta-analysis. Int J Eat Disord. 2022 Jul;55(7):861-85.[Abstract]
56. Barakat S, McLean SA, Bryant E, et al. Risk factors for eating disorders: findings from a rapid review. J Eat Disord. 2023 Jan 17;11(1):8.[Abstract][Full Text]
57. Carl RL, Johnson MD, Martin TJ; Council on Sports Medicine and Fitness. Promotion of healthy weight-control practices in young athletes. Pediatrics. 2017 Sep;140(3): e20171871.[Abstract][Full Text]
58. Treasure J, Sepulveda AR, MacDonald P, et al. The assessment of the family of people with eating disorders. Eur Eat Disord Rev. 2008 Jul;16(4):247-55.[Abstract]
59. Sharpe H, Schober I, Treasure J, et al. Feasibility, acceptability and efficacy of a school-based prevention programme for eating disorders: cluster randomised controlled trial. Br J Psychiatry. 2013 Dec;203(6):428-35.[Abstract]
60. Golden NH, Schneider M, Wood C; et al. Preventing obesity and eating disorders in adolescents. Pediatrics. 2016 Sep;138(3).[Abstract][Full Text]
61. Mond JM, Arrighi A. Gender differences in perceptions of the severity and prevalence of eating disorders. Early Interv Psychiatry. 2011 Feb;5(1):41-9.[Abstract]
62. Tyler I, Birmingham CL. The interrater reliability of physical signs in patients with eating disorders. Int J Eat Disord. 2001 Nov;30(3):343-5.[Abstract]
63. Tyler I, Wiseman MC, Crawford RI, et al. Cutaneous manifestations of eating disorders. J Cutan Med Surg. 2002 Jul-Aug;6(4):345-53.[Abstract]
64. Uyeda L, Tyler I, Pinzon J, et al. Identification of patients with eating disorders: the signs and symptoms of anorexia nervosa and bulimia nervosa. Eat Weight Disord. 2002 Jun;7(2):116-23.[Abstract]
65. Mehler PS. Medical complications of bulimia nervosa and their treatments. Int J Eat Disord. 2011 Mar;44(2):95-104.[Abstract]
66. Claes L, Vandereycken W. Is there a link between traumatic experiences and self-injurious behaviors in eating-disordered patients? Eat Disord. 2007 Jul-Sep;15(4):305-15.[Abstract]
67. Mond JM, Hay PJ, Rodgers B, et al. Self-report versus interview assessment of purging in a community sample of women. Eur Eat Disord Rev. 2007 Nov;15(6):403-9.[Abstract]
68. Chizawsky LL, Newton MS. Eating disorders: identification and treatment in obstetrical patients. AWHONN Lifelines. 2006 Dec-2007 Jan;10(6):482-8.[Abstract]
69. Fairburn CG, Cooper Z, Shafran R. Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment. Behav Res Ther. 2003 May;41(5):509-28.[Abstract]
70. Fischer S, le Grange D. Comorbidity and high-risk behaviors in treatment-seeking adolescents with bulimia nervosa. Int J Eat Disord. 2007 Dec;40(8):751-3.[Abstract]
71. Mandel L, Abai S. Diagnosing bulimia nervosa with parotid gland swelling. J Am Dent Assoc. 2004 May;135(5):613-6;quiz 655.[Abstract]
72. Clare M, Gritzner S, Hlynsky J, et al. Measuring change in parotid gland size: test-retest reliability of a novel method. Eat Weight Disord. 2005 Sep;10(3):e61-5.[Abstract]
73. Chui W, Safer DL, Bryson SW, et al. A comparison of ethnic groups in the treatment of bulimia nervosa. Eat Behav. 2007 Dec;8(4):485-91.[Abstract]
74. Poyastro Pinheiro A, Thornton LM, Plotonicov KH, et al. Patterns of menstrual disturbance in eating disorders. Int J Eat Disord. 2007 Jul;40(5):424-34.[Abstract]
75. Fernandez-Aranda F, Jimenez-Murcia S, Alvarez-Moya EM, et al. Impulse control disorders in eating disorders: clinical and therapeutic implications. Compr Psychiatry. 2006 Nov-Dec;47(6):482-8.[Abstract]
76. Shaw A, Favazza A. Deliberate insulin underdosing and omission should be included in DSM-V criteria for bulimia nervosa. J Neuropsychiatry Clin Neurosci. 2010 Summer;22(3):352h;e13-352;e13.[Abstract]
77. Ho PC, Dweik R, Cohen MC. Rapidly reversible cardiomyopathy associated with chronic ipecac ingestion. Clin Cardiol. 1998 Oct;21(10):780-3.[Abstract][Full Text]
78. Steffen KJ, Mitchell JE, Roerig JL, et al. The eating disorders medicine cabinet revisited: a clinician's guide to ipecac and laxatives. Int J Eat Disord. 2007 May;40(4):360-8.[Abstract]
79. Grewal S, Birmingham CL. Self-phlebotomy in eating disorders. Eat Weight Disord. 2003 Dec;8(4):336-40.[Abstract]
80. Takimoto Y, Yoshiuchi K, Kumano H, et al. Bulimia nervosa and abnormal cardiac repolarization. J Psychosom Res. 2006 Jan;60(1):105-7. [Abstract]
81. Takimoto Y, Yoshiuchi K, Kumano H, et al. QT interval and QT dispersion in eating disorders. Psychother Psychosom. 2004 Sep-Oct;73(5):324-8. [Abstract]
82. Arnulf I, Lin L, Gadoth N, et al. Kleine-Levin syndrome: a systematic study of 108 patients. Ann Neurol. 2008 Apr;63(4):482-93.[Abstract]
83. US Preventive Services Task Force. Screening for eating disorders in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA. 2022 Mar 15;327(11):1061-67.[Abstract][Full Text]
84. Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ. 1999 Dec 4;319(7223):1467-8.[Abstract][Full Text]
85. Chen A, Mond JM, Kumar R. Eating disorders mental health literacy in Singapore: beliefs of young adult women concerning treatment and outcome of bulimia nervosa. Early Interv Psychiatry. 2010;4:39-46.[Abstract]
86. Hornberger LL, Lane MA, Committee on Adolescence. Identification and management of eating disorders in children and adolescents. Pediatrics. 2021 Jan;147(1):e2020040279. [Abstract][Full Text]
87. National Institute for Health and Care Excellence (UK). Eating disorders: recognition and treatment. 16 December 2020 [internet publication].[Full Text]
88. Brewerton TD, Costin C. Long-term outcome of residential treatment for anorexia nervosa and bulimia nervosa. Eat Disord. 2011 Mar-Apr;19(2):132-44.[Abstract]
89. Hay PP, Bacaltchuk J, Stefano S, et al. Psychological treatments for bulimia nervosa and binging. Cochrane Database Syst Rev. 2009 Oct 7;2009(4):CD000562.[Abstract][Full Text]
90. Katzman MA, Bara-Carril N, Rabe-Hesketh S, et al. A randomized controlled two-stage trial in the treatment of bulimia nervosa, comparing CBT versus motivational enhancement in Phase 1 followed by group versus individual CBT in Phase 2. Psychosom Med. 2010 Sep;72(7):656-63.[Abstract]
91. Sánchez-Ortiz VC, Munro C, Startup H, et al. The role of email guidance in internet-based cognitive-behavioural self-care treatment for bulimia nervosa. Eur Eat Disord Rev. 2011 Jul-Aug;19(4):342-8.[Abstract]
92. Le Grange D, Lock J, Agras WS, et al. Randomized clinical trial of family-based treatment and cognitive-behavioral therapy for adolescent bulimia nervosa. J Am Acad Child Adolesc Psychiatry. 2015 Nov;54(11):886-94;e2.[Abstract][Full Text]
93. Poulsen S, Lunn S, Daniel SI, et al. A randomized controlled trial of psychoanalytic psychotherapy or cognitive-behavioral therapy for bulimia nervosa. Am J Psychiatry. 2014 Jan;171(1):109-16.[Abstract][Full Text]
94. Vanderlinden J, Kamphuis JH, Slagmolen C, et al. Be kind to your eating disorder patients: the impact of positive and negative feedback on the explicit and implicit self-esteem of female patients with eating disorders. Eat Weight Disord. 2009 Dec;14(4):e237-42.[Abstract]
95. Zunker C, Crosby RD, Mitchell JE, et al. Weight suppression as a predictor variable in treatment trials of bulimia nervosa and binge eating disorder. Int J Eat Disord. 2011 Dec;44(8):727-30.[Abstract][Full Text]
96. Rowe S, Jordan J, McIntosh V, et al. Dimensional measures of personality as a predictor of outcome at 5-year follow-up in women with bulimia nervosa. Psychiatry Res. 2011 Feb 28;185(3):414-20.[Abstract]
97. le Grange D, Crosby RD, Rathouz PJ, et al. A randomized controlled comparison of family-based treatment and supportive psychotherapy for adolescent bulimia nervosa. Arch Gen Psychiatry. 2007 Sep;64(9):1049-56.[Abstract][Full Text]
98. Rutherford L, Couturier J. A review of psychotherapeutic interventions for children and adolescents with eating disorders. J Can Acad Child Adolesc Psychiatry. 2007 Nov;16(4):153-7.[Abstract][Full Text]
99. Munoz DJ, Israel AC, Anderson DA. The relationship of family stability and family mealtime frequency with bulimia symptomatology. Eat Disord. 2007 May-Jun;15(3):261-71. [Abstract]
100. Couturier J, Kimber M, Szatmari P. Efficacy of family-based treatment for adolescents with eating disorders: a systematic review and meta-analysis. Int J Eat Disord. 2013 Jan;46(1):3-11.[Abstract]
101. Carrard I, Fernandez-Aranda F, Lam T, et al. Evaluation of a guided internet self-treatment programme for bulimia nervosa in several European countries. Eur Eat Disord Rev. 2011 Mar-Apr;19(2):138-49. [Abstract]
102. Shapiro JR, Bauer S, Andrews E, et al. Mobile therapy: use of text-messaging in the treatment of bulimia nervosa. Int J Eat Disord. 2010 Sep;43(6):513-9. [Abstract]
103. Royal College of Psychiatrists. Guidance on recognising and managing medical emergencies in eating disorders: annexe 3: type 1 diabetes and eating disorders (T1DE). May 2022 [internet publication].[Full Text]
104. Micali N, Simonoff E, Treasure J. Risk of major adverse perinatal outcomes in women with eating disorders. Br J Psychiatry. 2007 Mar;190:255-9. [Abstract]
105. Morgan JF, Lacey JH, Chung E. Risk of postnatal depression, miscarriage, and preterm birth in bulimia nervosa: retrospective controlled study. Psychosom Med. 2006 May-Jun;68(3):487-92.[Abstract]
106. Bacaltchuk J, Hay P. Antidepressants versus placebo for people with bulimia nervosa. Cochrane Database Syst Rev. 2003;(4):CD003391.[Abstract][Full Text]
107. Sysko R, Sha N, Wang Y, et al. Early response to antidepressant treatment in bulimia nervosa. Psychol Med. 2010 Jun;40(6):999-1005.[Abstract]
108. Mischoulon D, Eddy KT, Keshaviah A, et al. Depression and eating disorders: treatment and course. J Affect Disord. 2011 May;130(3):470-7. [Abstract][Full Text]
109. Nemeroff CB, Kalali A, Keller MB, et al. Impact of publicity concerning pediatric suicidality data on physician practice patterns in the United States. Arch Gen Psychiatry. 2007 Apr;64(4):466-72.[Abstract][Full Text]
110. Bridge JA, Iyengar S, Salary CB, et al. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA. 2007 Apr 18;297(15):1683-96.[Abstract]
111. Mitchell JE, Agras S, Crow S, et al. Stepped care and cognitive-behavioural therapy for bulimia nervosa: randomised trial. Br J Psychiatry. 2011 May;198(5):391-7.[Abstract][Full Text]
112. McElroy SL, Guerdjikova AI, Mori N, et al. Current pharmacotherapy options for bulimia nervosa and binge eating disorder. Expert Opin Pharmacother. 2012 Oct;13(14):2015-26. [Abstract]
113. Slotema CW, Blom JD, Hoek HW, et al. Should we expand the toolbox of psychiatric treatment methods to include Repetitive Transcranial Magnetic Stimulation (rTMS)? A meta-analysis of the efficacy of rTMS in psychiatric disorders. J Clin Psychiatry. 2010 Jul;71(7):873-84.[Abstract]
114. Van den Eynde F, Claudino AM, Mogg A, et al. Repetitive transcranial magnetic stimulation reduces cue-induced food craving in bulimic disorders. Biol Psychiatry. 2010 Apr 15;67(8):793-5.[Abstract]
115. Kröger C, Schweiger U, Sipos V, et al. Dialectical behaviour therapy and an added cognitive behavioural treatment module for eating disorders in women with borderline personality disorder and anorexia nervosa or bulimia nervosa who failed to respond to previous treatments. An open trial with a 15-month follow-up. J Behav Ther Exp Psychiatry. 2010 Dec;41(4):381-8.[Abstract]
116. Breuner CC, Alderman EM, Jewell JA, et al. The hospitalized adolescent. Pediatrics. 2023 Feb 1;151(2):e2022060647.[Abstract]
117. Crone C, Fochtmann LJ, Attia E, et al. The American Psychiatric Association practice guideline for the treatment of patients with eating disorders. 4th ed. Washington: American Psychiatric Association Publishing; 2023.[Full Text]
118. Scottish Intercollegiate Guidelines Network. Eating disorders: a national clinical guideline. Jan 2022 [internet publication].[Full Text]
119. Støving RK, Andries A, Brixen K, et al. Gender differences in outcome of eating disorders: a retrospective cohort study. Psychiatry Res. 2011;186:362-6.
120. Steinhausen HC, Weber S. The outcome of bulimia nervosa: findings from one-quarter century of research. Am J Psychiatry. 2009 Dec;166(12):1331-41.[Abstract]
121. Lavender JM, De Young KP, Franko DL, et al. An investigation of the joint longitudinal trajectories of low body weight, binge eating, and purging in women with anorexia nervosa and bulimia nervosa. Int J Eat Disord. 2011 Dec;44(8):679-86.[Abstract]
122. Keel PK, Gravener JA, Joiner TE Jr, et al. Twenty-year follow-up of bulimia nervosa and related eating disorders not otherwise specified. Int J Eat Disord. 2010 Sep;43(6):492-7.[Abstract]
123. Crow SJ, Peterson CB, Swanson SA, et al. Increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry. 2009 Dec;166(12):1342-6.[Abstract]
124. Steinberg BJ. Medical and dental implications of eating disorders. J Dent Hyg. 2014 Jun;88(3):156-9.[Abstract]
125. Tith RM, Paradis G, Potter BJ, et al. Association of bulimia nervosa with long-term risk of cardiovascular disease and mortality among women. JAMA Psychiatry. 2020 Jan 1;77(1):44-51.[Abstract][Full Text]
126. Udo T, Bitley S, Grilo CM. Suicide attempts in US adults with lifetime DSM-5 eating disorders. BMC Med. 2019 Jun 25;17(1):120.[Abstract][Full Text]
127. Preti A, Rocchi MB, Sisti D, et al. A comprehensive meta-analysis of the risk of suicide in eating disorders. Acta Psychiatr Scand. 2011 Jul;124(1):6-17.[Abstract]
128. Franko DL, Keshaviah A, Eddy KT, et al. A longitudinal investigation of mortality in anorexia nervosa and bulimia nervosa. Am J Psychiatry. 2013 Aug;170(8):917-25.[Abstract][Full Text]
129. Burgalassi A, Ramacciotti CE, Bianchi M, et al. Caffeine consumption among eating disorder patients: epidemiology, motivations, and potential of abuse. Eat Weight Disord. 2009 Dec;14(4):e212-8.[Abstract]
