Psych · Specialty psychiatry — eating disorders
Bulimia nervosa and binge-eating disorder
Also known as Bulimia nervosa · Binge-eating disorder · BED · BN · CBT-E · Purging disorder · Eating disorders · Fluoxetine 60 mg · Lisdexamfetamine binge eating
Exam-exhaustive fellowship reference on bulimia nervosa and binge-eating disorder — DSM-5-TR and ICD-11 criteria; AN-purging differential; medical complications and electrolytes; CBT-E and guided self-help; fluoxetine 60 mg BN evidence; lisdexamfetamine for moderate–severe BED; stepped care; RANZCP/NICE/APA regional framing. FRANZCP-primary, globally tagged.
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12 MCQs with explanations
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Red flags
Meet the patient
A 23-year-old teacher sees her GP for "dental problems" and tiredness. She is a healthy weight, her potassium is 2.9, and — once you ask gently — she describes eating a loaf of bread and a tub of ice cream most nights, then vomiting, twice a day for two years. She has never told anyone.[14][15]
The first trap is the door she walked in through: dentistry, gastroenterology, or the emergency department with an electrolyte disturbance, not psychiatry. The exam question she is built to answer: "Is this BN or AN binge-purge type — and what will you prescribe (and never prescribe)?"[18][19]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.
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- [1]Russell G Bulimia nervosa: an ominous variant of anorexia nervosa Psychol Med, 1979.PMID 482466
- [2]Fluoxetine Bulimia Nervosa Collaborative Study Group Fluoxetine in the treatment of bulimia nervosa. A multicenter, placebo-controlled, double-blind trial Arch Gen Psychiatry, 1992.PMID 1550466
- [3]Romano SJ, Halmi KA, Sarkar NP, Koke SC, Lee JS A placebo-controlled study of fluoxetine in continued treatment of bulimia nervosa after successful acute fluoxetine treatment Am J Psychiatry, 2002.PMID 11772696
- [4]Hudson JI, Hiripi E, Pope HG Jr, Kessler RC The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication Biol Psychiatry, 2007.PMID 16815322
- [5]Kessler RC, Berglund PA, Chiu WT, Deitz AC, et al. The prevalence and correlates of binge eating disorder in the World Health Organization World Mental Health Surveys Biol Psychiatry, 2013.PMID 23290497
- [6]Fairburn CG, Cooper Z, Doll HA, O'Connor ME, et al. Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up Am J Psychiatry, 2009.PMID 19074978
- [7]Mitchell JE, Agras S, Crow S, Halmi K, et al. Stepped care and cognitive-behavioural therapy for bulimia nervosa: randomised trial Br J Psychiatry, 2011.PMID 21415046
- [8]Beintner I, Jacobi C, Schmidt UH Participation and outcome in manualized self-help for bulimia nervosa and binge eating disorder - a systematic review and metaregression analysis Clin Psychol Rev, 2014.PMID 24508686
- [9]Wilson GT, Grilo CM, Vitousek KM Psychological treatment of eating disorders Am Psychol, 2007.PMID 17469898
- [10]McElroy SL, Hudson JI, Mitchell JE, Wilfley D, et al. Efficacy and safety of lisdexamfetamine for treatment of adults with moderate to severe binge-eating disorder: a randomized clinical trial JAMA Psychiatry, 2015.PMID 25587645
- [11]McElroy SL, Arnold LM, Shapira NA, Keck PE Jr, et al. Topiramate in the treatment of binge eating disorder associated with obesity: a randomized, placebo-controlled trial Am J Psychiatry, 2003.PMID 12562571
- [12]Wilfley DE, Welch RR, Stein RI, Spurrell EB, et al. A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder Arch Gen Psychiatry, 2002.PMID 12150647
- [13]Brownley KA, Berkman ND, Peat CM, Lohr KN, et al. Binge-Eating Disorder in Adults: A Systematic Review and Meta-analysis Ann Intern Med, 2016.PMID 27367316
- [14]Mehler PS Medical complications of bulimia nervosa and their treatments Int J Eat Disord, 2011.PMID 21312201
- [15]Nitsch A, Dlugosz H, Gibson D, Mehler PS Medical complications of bulimia nervosa Cleve Clin J Med, 2021.PMID 34078617
- [16]Arcelus J, Mitchell AJ, Wales J, Nielsen S Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies Arch Gen Psychiatry, 2011.PMID 21727255
- [17]Crow SJ, Peterson CB, Swanson SA, Raymond NC, et al. Increased mortality in bulimia nervosa and other eating disorders Am J Psychiatry, 2009.PMID 19833789
- [18]Hay P, Chinn D, Forbes D, Madden S, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders Aust N Z J Psychiatry, 2014.PMID 25351912
- [19]Treasure J, Duarte TA, Schmidt U Eating disorders Lancet, 2020.PMID 32171414
- [20]Agras WS, Crow SJ, Halmi KA, Mitchell JE, et al. Outcome predictors for the cognitive behavior treatment of bulimia nervosa: data from a multisite study Am J Psychiatry, 2000.PMID 10910795