How is bulimia nervosa diagnosed?

Your doctor will perform a complete medical history and physical examination. He or she will ask you about your diet – what and how much you eat. The doctor will ask about binge and purging frequency and elimination habits (vomiting, use of laxatives/diuretics, fasting, exercise regimen). Your current medications will also be reviewed. The doctor will also ask about family history of eating disorders, substance abuse and psychological disorders (suicidal thoughts).

Although there are no laboratory tests to specifically diagnose bulimia, the doctor might use various diagnostic tests, including laboratory values (a blood test), to evaluate the severity of illness or the effects bulimia on the body’s organs. The doctor may order an electrocardiogram (ECG) to check for slow heart rate, chest pain, abnormal heart rhythm, or heart flutter.

To be diagnosed with bulimia nervosa, the doctor will determine if these criteria have been met:

  • Does the person have repeating episodes of binge eating? Binge eating is defined as eating a larger amount of food than most other people would eat in a similar time period under similar circumstances.
  • Does the person feel they lack control over eating during an episode; they cannot control what or how much they are eating?
  • Does the person engage in inappropriate behaviors to prevent weight gain, including self-induced vomiting; misuse of laxatives, diuretics or other medications; fasting or excessive exercise?
  • Has the binge-purge behavior occurred at least once a week for 3 months?
  • Does the person’s body weight or shape have a strong influence on their self-image?

If all of the criteria are met, but the binges and/or purging behaviors have not been going on at least weekly for three months, the person may have “subclinical bulimia nervosa,” meaning they are still at risk, but the time criteria has not yet been met.

Last reviewed by a Cleveland Clinic medical professional on 12/12/2019.


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