Overview
Definition
An eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors (purging, fasting, or excessive exercise) to prevent weight gain, while maintaining a normal or near-normal body weight.
Epidemiology
Prevalence ~1-2% in young women. Average age of onset is late adolescence.
Etiology & Risk Factors
- Sociocultural factors, low self-esteem, serotonin dysregulation
Clinical Symptoms
- Recurrent binge eating (consuming an abnormally large amount of food with a sense of lack of control)
- Recurrent compensatory behaviors: Self-induced vomiting, misuse of laxatives/diuretics, fasting, or excessive exercise
- Binge/compensatory cycles occur at least once a week for 3 months
- Preoccupation with body shape and weight
- Physical signs of purging: Russell's sign (calluses on knuckles from inducing vomiting), dental enamel erosion (due to gastric acid), parotid gland hypertrophy ('chipmunk cheeks')
- *Note: Unlike anorexia, patients are typically normal weight or overweight*
Clinical Approach
Diagnosis
- DSM-5 criteria: Binge eating + purging once a week for 3 months with normal/high weight
- Electrolyte check (hypokalemia, hypochloremic metabolic alkalosis from vomiting)
Management
- Cognitive Behavioral Therapy (CBT-E, first-line, highly effective)
- Nutritional counseling
- Pharmacotherapy: Fluoxetine (SSRI, approved at high dose of 60mg/day to reduce binge/purge cycles)
- *Note: Bupropion is ABSOLUTELY CONTRAINDICATED due to high risk of seizures in purging patients*
Complications
- Severe hypokalemia / Cardiac Arrhythmias
- Esophageal tears (Mallory-Weiss) / Boerhaave syndrome
- Severe dental decay
- Laxative dependence