Bulimia Nervosa

1. Recurrent episodes of binge eating characterized by BOTH of the following:
   1. Eating in a discrete amount of time (within a 2 hour period) large amounts of food.
   2. Sense of lack of control over eating during an episode.
2. Recurrent inappropriate compensatory behavior in order to prevent weight gain (purging).
3. The binge eating and compensatory behaviors both occur, on average, at least once a week for three months.
4. Self-evaluation is unduly influenced by body shape and weight.
5. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

(May Include)

• Bingeing and purging
• Lack of control over eating
• Secretive eating and/or missing food
• Visits to the bathroom after meals
• Preoccupation with food
• Weight fluctuations
• Self-injury
• Excessive and compulsive exercise regimes
• Abuse of laxatives, diet pills, and/or diuretics
• Swollen parotid glands in cheeks and neck
• Discoloration and/or staining of the teeth
• Broken blood vessels in eyes and/or face
• Calluses on the back of the hands/knuckles
• Sore throat
• Heartburn/acid reflux
• Self-criticism and feelings of shame and guilt
• High levels of anxiety and/or depression

(May Include)

• Fatigue and lack of energy
• Anemia (iron deficiency)
• Irregular menstruation or Amenorrhea
• Low blood pressure
• Dizziness
• Edema (swelling of hands and feet)
• Dehydration
• Gastric rupture
• Inflammation and possible rupture of the esophagus
• Development of peptic ulcers
• Pancreatitis (inflammation of the pancreas)
• Stomach pain and bloating
• Constipation and diarrhea
• Cathartic colon (caused from laxative abuse)
• Hemorrhoids
• Tooth decay/gum disease
• Kidney and liver damage
• Electrolyte imbalances that can lead to irregular heartbeat and seizures
• Cardiac arrest