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How is bulimia nervosa diagnosed?
"The doctor is the last place I would go if I was trying to keep bulimia a secret...In my case I was already in counseling for severe depression and became bulimic after about 5 months. I don't know how long it took the therapist to figure it out, but it was several months before I actually told her about my behavior." Single professional woman in mid-twenties with bulimia nervosa.

A medical or mental health professional who is experienced in recognizing the signs and symptoms of eating disorders can usually make a diagnosis after interviewing a patient and performing a physical examination. Often, a dentist, pediatrician, therapist, or family physician—the doctors who see the patient most often—are the first healthcare professionals with the opportunity to recognize the signs and symptoms of bulimia nervosa. The patient may not willingly describe symptoms and may be unwilling to acknowledge the observations made by a dentist or family doctor. The key to making a diagnosis is that the dentist or physician seeing the patient has to be aware of the signs and symptoms of bulimia nervosa so they recognize a possible case when they see it. They should then refer to the DSM to see if the signs and symptoms they observed fit the criteria.

Since first being described in 1979, the criteria used to make an "official" diagnosis of bulimia nervosa have changed several times. These changes reflect ongoing debate among medical and psychological professionals over the criteria that define the disorder. Early definitions focused on binge eating and the purging/non-purging activity, "irresistible urges to overeat," and a "morbid fear of becoming fat." Later definitions defined binge eating and purging/non-purging more specifically in terms of numbers of episodes within a timeframe, and added some psychiatric components. These criteria are also used to define remission and recovery from the disorder.

According to the latest edition of the DSM, the diagnostic criteria that must be met before a clinician applies a diagnosis of bulimia nervosa to a patient require that the person must have binged and engaged in purging or non-purging compensatory behavior at least twice weekly for three months, and evaluate (i.e., judge) self according to body size and shape.

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Bulimia nervosa is an eating disorder in which a person engages in binge eating (eating a lot of food in a short time) followed by some type of behavior to prevent weight gain from the food that was eaten. This behavior can take two forms: self-induced vomiting, misuse of enemas, laxatives, diet pills (called purging) and excessive exercise, fasting, or diabetic omission of insulin (called non-purging). Some people with bulimia nervosa may also starve themselves for periods of time before binge eating again. Bulimia nervosa has important mental, emotional, and physical aspects that require consideration during treatment.

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