bulimia nervosa
Enable an agent to recognise evidence consistent with bulimia nervosa, represent its course and risks, and support clinician-led assessment, care and recovery monitoring.
Research draft, second pass
A second pass drafted this model: the structure a model of this thing needs, and what is known about it in the world. The line under this one says how the second half was obtained - researched against sources, or recalled without web access, in which case nothing here was read anywhere and every claim is a lead to verify. Unreviewed either way.
recalled by Codex without web access - no source was read
Researched by: Codex
Purpose and description
Enable an agent to recognise evidence consistent with bulimia nervosa, represent its course and risks, and support clinician-led assessment, care and recovery monitoring.
Bulimia nervosa is an eating disorder characterized by recurrent binge-eating episodes involving loss of control, recurrent inappropriate compensatory behaviours intended to prevent weight gain, and self-evaluation unduly influenced by body shape or weight, with the disturbance not occurring exclusively during anorexia nervosa.
It can be Organise reported symptoms into a clinician-reviewable assessment with explicit missing evidence.; Compare evidence against a named diagnostic framework without making an autonomous diagnosis.; Flag condition-related safety concerns for the appropriate clinical pathway.; Summarise binge eating, compensation, distress and functioning across comparable intervals.; Link the person's agreed treatment and recovery goals to follow-up observations.; Identify discrepancies or gaps that require sensitive clarification rather than treating missing reports as absent symptoms..
Distinguishing features
Assess loss of control alongside the amount and context of eating; eating more than intended alone does not establish a diagnostic binge episode.
Establish recurrent compensatory behaviour intended to prevent weight gain; this distinguishes the pattern from binge-eating disorder, and compensation need not involve vomiting. [NIMH](https://www.nimh.nih.gov/health/publications/eating-disorders)
Under DSM-5, assess undue weight or shape influence on self-evaluation and whether binge eating and compensation each average at least weekly for three months. [SAMHSA diagnostic comparison](https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t16/)
Determine whether the disturbance occurs exclusively during anorexia nervosa; such presentations are excluded from DSM-5 bulimia nervosa. [SAMHSA diagnostic comparison](https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t16/)
Distinguish intentional compensation from involuntary vomiting or regurgitation, and distinguish purging without qualifying binges from bulimia nervosa under the selected diagnostic framework.
Scope
+ Evidence for recurrent binge eating and compensatory behaviours
+ Influence of weight and shape on self-evaluation
+ Diagnostic framework, differential assessment and uncertainty
+ Physical complications, psychological distress and functional impairment
+ Treatment engagement, response, remission and recurrence
- Independent models of anorexia nervosa, binge-eating disorder and other specified feeding or eating disorders
- General nutrition, weight management and athletic training
- Standalone models of electrolyte disorders, dental disease and gastrointestinal disease
- Independent models of co-occurring psychiatric conditions
- Medication prescribing protocols and psychotherapy manuals
Characteristics
- Diagnostic assessment status
- suspected | under assessment | clinician-confirmed | not supported | historical; framework and version recorded Separates reported symptoms from a documented clinical diagnosis.
- Binge episode frequency
- episodes/week over a dated observation interval; unknown permitted Supports threshold assessment and change tracking without conflating episodes with days.
- Loss-of-control experience
- reported | denied | uncertain | not assessed; linked to an eating episode Distinguishes binge experiences from overeating without loss of control.
- Compensatory behaviour pattern
- vomiting | medication misuse | fasting | excessive exercise | other | unknown; multiple values allowed Captures non-purging compensation and supports behaviour-specific risk assessment.
- Compensatory behaviour frequency
- events/week by behaviour with explicit counting rules and observation dates Supports assessment while avoiding double-counting linked behaviours.
- Pattern duration
- weeks or months; estimated onset and uncertainty Distinguishes persistent patterns from short-duration presentations.
- Weight and shape influence
- clinically significant | not clinically significant | uncertain | not assessed Records the role of weight and shape in self-evaluation.
- Current medical risk assessment
- not assessed | assessed without urgent concern | urgent concern | emergency concern; assessor and date Keeps immediate safety separate from diagnostic certainty and symptom frequency.
- Functional impact
- documented effects on meals, relationships, education, employment and daily activities Represents burden beyond episode counts.
- Related conditions
- links to assessed complications, co-occurring conditions and differential diagnoses Coordinates care without duplicating neighbouring condition models.
- Course status
- active | improving | partial remission | full remission | recurrence | uncertain; criteria and interval required Makes recovery claims interpretable and traceable.
Also called
Where this came from
wikidata · CC0 1.0
Drafted structure
Bundle to layer to finding to question, as the second pass will find it: 6 bundles · 11 layers · 19 findings · 29 questions.
Diagnostic identity and boundaries Represent the evidence and exclusions that support this specific eating-disorder classification.
Binge eating, vomiting and body dissatisfaction alone do not establish bulimia nervosa.
Diagnostic framework
Anchor assessment to an identified classification and its edition.
Criteria and evidence
Record each required criterion as supported, unsupported or unresolved, alongside its evidence and clinical assessment status.
- Which diagnostic framework and edition define the binge, compensation, duration and cognition requirements? definition
- Who assessed each criterion, when, and using which interview, report or record? provenance
Neighbouring presentations
Test alternative explanations and subthreshold presentations.
Differential resolution
Document why anorexia nervosa, binge-eating disorder, purging without qualifying binges, or non-compensatory vomiting better explains or fails to explain the presentation.
- Does the binge-compensation pattern occur exclusively during a presentation meeting anorexia nervosa criteria? boundary
- If bulimia nervosa criteria are not established, which alternative or unresolved presentation should remain linked? boundary
Binge and compensation pattern Represent the eating episodes and compensatory behaviours that constitute the presenting pattern.
Their meaning, recurrence and temporal relationship determine how the presentation is understood.
Binge episode characterisation
Separate perceived excess, contextual amount and experienced loss of control.
Qualifying binge evidence
Record episode boundaries, contextual assessment of amount and the person's account of control without requiring calorie-level surveillance.
- What evidence establishes loss of control and the applicable framework's requirement concerning amount eaten? definition
- How many qualifying and uncertain episodes occurred within the documented interval? measurement
Compensation and recurrence
Capture the intention, type and recurrence of compensation.
Compensatory pattern evidence
Record behaviours intended to offset eating or prevent weight gain, their timing and the persistence of the pattern, without operational instructions.
- Which behaviours have a compensatory purpose, and how is that purpose established? boundary
- What are their frequencies and duration, and how are multiple behaviours around one episode counted? measurement
Self-evaluation and lived impact Represent the meaning of weight and shape, individual maintaining patterns and everyday consequences.
Behaviour counts alone cannot represent the cognitive features or burden of bulimia nervosa.
Weight, shape and context
Assess self-evaluation and person-specific circumstances around symptoms.
Cognitive and contextual formulation
Record weight and shape concerns and reported links among restriction, emotions, binge eating and compensation as individual observations or hypotheses.
- How strongly does weight or shape determine the person's sense of worth? measurement
- Which proposed maintaining links come from the person's account, clinician formulation or repeated observations? provenance
Distress and participation
Capture how symptoms affect daily life and disclosure.
Burden and disclosure barriers
Record distress, disruption around eating, social withdrawal and barriers to discussing symptoms, without assuming concealment.
- Which activities or relationships are affected, and how has that changed? measurement
- What communication or assessment adjustments would make disclosure and participation easier? action
Complications and immediate safety Connect the presenting pattern to current physical and psychological safety assessments.
Diagnostic status and episode frequency do not by themselves determine immediate care needs.
Physical complications
Link symptoms and clinical observations to possible consequences of binge eating and compensation.
Physical harm assessment
Capture assessed dehydration, electrolyte disturbance, dental injury and gastrointestinal problems, including unresolved concerns. [NIMH](https://www.nimh.nih.gov/health/publications/eating-disorders)
- Which symptoms, examination findings or investigations indicate current complications, and when were they assessed? measurement
- Do the findings require urgent medical evaluation under the applicable clinical pathway? action
Psychological safety and coordination
Connect current safety concerns and co-occurring conditions to responsible care.
Safety assessment and handoff
Record assessment of self-harm or suicide risk and relevant co-occurring conditions, with a named clinician or service responsible for follow-up. [NICE assessment guidance](https://www.nice.org.uk/guidance/ng69/chapter/Recommendations)
- What current safety concerns have been assessed, and which remain unassessed? measurement
- Who owns the next safety action, and has the referral or handoff been completed? action
Care, response and recovery Represent agreed care, its accessibility and changes across the condition's course.
A usable model must support follow-up and distinguish symptom reduction from broader recovery.
Treatment fit and engagement
Link care choices to age, assessment, preferences and access.
Agreed care pathway
Record the clinician-agreed intervention and review plan; NICE describes adult guided self-help and CBT-ED pathways and family therapy for children and young people. [NICE bulimia nervosa recommendations](https://www.nice.org.uk/guidance/ng69/chapter/Recommendations)
- Which intervention was agreed, on what clinical basis, and with what participation preferences? action
- Which access barriers, adverse experiences or competing needs affect engagement and require adjustment? action
Response, remission and recurrence
Compare symptoms, distress and functioning over defined intervals.
Recovery evidence and review
Track binge eating, compensation, self-evaluation, safety and functioning separately; require explicit criteria and observation periods for remission or recurrence.
- Which domains have improved or worsened relative to a comparable baseline, and what evidence is missing? measurement
- What definition supports the recorded course status, and which changes should trigger clinical review? action
Evidence and external alignment What the world already says about this thing, gathered so the model can be checked against it.
A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.
Reported evidence
Findings from the breadth pass, kept separate from the structural claims.
Check these first
Recalled without web access and unsourced; every item is a lead to verify.
- This is a recall-based account; no sources were consulted.
- Diagnostic wording, binge-eating definitions and thresholds should be checked against the classification being used; DSM and ICD criteria are not identical.
- Purging and non-purging were historical DSM-IV subtypes and are not current DSM-5-TR subtypes.
- Which of these check these first hold for the sense of bulimia nervosa this model covers, and on what evidence? provenance
Kinds and varieties
Recalled without web access and unsourced; every item is a lead to verify.
- DSM-5-TR severity specifiers: mild, moderate, severe and extreme
- Partial remission
- Full remission
- Which of these kinds and varieties hold for the sense of bulimia nervosa this model covers, and on what evidence? provenance
Identifiers and schemes
Recalled without web access and unsourced; every item is a lead to verify.
- ICD-10 - F50.2 - WHO code for bulimia nervosa; national clinical modifications may add detail.
- ICD-11 - 6B81 - WHO code for bulimia nervosa.
- Which of these identifiers and schemes hold for the sense of bulimia nervosa this model covers, and on what evidence? provenance
Standards and regulation
Recalled without web access and unsourced; every item is a lead to verify.
- World Health Organization ICD-11: diagnostic classification.
- American Psychiatric Association DSM-5-TR: diagnostic criteria and severity and remission specifiers.
- National Institute for Health and Care Excellence guideline NG69, Eating disorders: recognition and treatment.
- Which of these standards and regulation hold for the sense of bulimia nervosa this model covers, and on what evidence? provenance
Real-world use
Recalled without web access and unsourced; every item is a lead to verify.
- Clinical diagnosis and distinction from other eating disorders.
- Planning psychological treatment, nutritional support and medical monitoring.
- Clinical coding and health-service reporting.
- Defining research cohorts and assessing treatment outcomes.
- Which of these real-world use hold for the sense of bulimia nervosa this model covers, and on what evidence? provenance
Typical measurements
Recalled without web access and unsourced; every item is a lead to verify.
- Frequency and duration of binge eating and inappropriate compensatory behaviours - DSM-5-TR diagnostic threshold: both occur on average at least once weekly for 3 months; this is a criterion, not a population typical range. - episodes per week; months
- Frequency of inappropriate compensatory behaviours used for DSM-5-TR severity specification - Mild: 1-3; moderate: 4-7; severe: 8-13; extreme: 14 or more. Severity may be increased to reflect other symptoms and functional disability. - episodes per week
- Which of these typical measurements hold for the sense of bulimia nervosa this model covers, and on what evidence? provenance
Failure modes and hazards
Recalled without web access and unsourced; every item is a lead to verify.
- Electrolyte disturbances, particularly hypokalaemia, can cause dangerous cardiac arrhythmias.
- Repeated vomiting can cause dental erosion and injury to the oesophagus.
- Dehydration and purging-related complications can impair kidney function.
- Depression, self-harm and suicide risk may accompany the disorder.
- Diagnosis may be delayed by secrecy, stigma or the mistaken assumption that an eating disorder requires low body weight.
- Which of these failure modes and hazards hold for the sense of bulimia nervosa this model covers, and on what evidence? provenance
Regional variation
Recalled without web access and unsourced; every item is a lead to verify.
- Health systems differ in their use of WHO ICD classifications, national ICD modifications and DSM criteria.
- Cultural context can affect symptom expression, disclosure and recognition; access to specialist treatment also varies.
- Which of these regional variation hold for the sense of bulimia nervosa this model covers, and on what evidence? provenance
Neighbouring kinds and how to tell them apart
Recalled without web access and unsourced; every item is a lead to verify.
- Binge-eating disorder - Recurrent binge eating occurs without the regular inappropriate compensatory behaviours characteristic of bulimia nervosa.
- Anorexia nervosa, binge-eating/purging type - When binge eating or purging occurs exclusively during anorexia nervosa, including its significantly low body-weight criterion, the diagnosis is anorexia nervosa rather than bulimia nervosa.
- Purging disorder - Recurrent purging to influence weight or shape occurs without binge eating; DSM-5-TR describes this under other specified feeding or eating disorder.
- Bulimia nervosa of low frequency and/or limited duration - Otherwise characteristic symptoms fall below the DSM-5-TR frequency or duration threshold and are described under other specified feeding or eating disorder.
- Which of these neighbouring kinds and how to tell them apart hold for the sense of bulimia nervosa this model covers, and on what evidence? provenance
What the second pass must settle
- Which current DSM and ICD editions should the model support, and how should differences in binge definitions and duration requirements be represented?
- Which assessment instruments are validated across the intended ages, languages and cultural contexts?
- How should uncertain episode boundaries, subjective binge experiences and incomplete recall be represented without false precision?
- Which jurisdiction-specific clinical pathways should govern medical escalation and psychological safety handoffs?
- Which remission and recurrence definitions best support comparable records while preserving patient-defined recovery goals?