Bulimia nervosa and binge-eating disorder in adolescents

Bulimia nervosa (BN) and binge-eating disorder (BED) are separate entities with the common denominator of binge eating. In this chapter, Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for BN are reviewed, including both recurrent episodes of binge eating and inappropriate compensatory behaviors to prevent weight gain in one whose self-evaluation is unduly influenced by body weight and shape. Two percent of adolescent females and 0.3% of adolescent males fulfill criteria for BN. Risk factors, medical complications of binge eating (vomiting, use of ipecac, diet pills, diuretics, and laxatives), physical and laboratory findings, and treatment options and outcome are discussed. BED is seen in 1-2% of adolescents. The DSM-IV lists BED under Eating Disorder Not Otherwise Specified. DSM-IV research criteria for BED is reviewed, including binge eating, distress over binge eating, and absence of regular extreme compensatory behaviors. The mean age of onset is 17.2 years. Up to 30% of obese patients have BED. Risk factors are discussed. Because most patients with BED are obese, medical evaluation is similar to that for obesity. Treatment goals must be geared not only toward decreased binge eating but toward weight loss. Outcome is discussed.