Bulimia Nervosa 349
Suicide Risk
Suicide risk is elevated in bu limia nervosa. Comprehensive ev aluation of individuals with
this disorder should include assessment of su icide-related ideation and behaviors as well
as other risk factors for suicide, including a history of suicide attempts.
Functional Consequences  of Bulimia Nervosa
Individuals with bulimia nervosa may exhibit a range of functional limitations associated
with the disorder. A minority of individuals report severe role impairment, with the so-
cial-life domain most likely to be ad versely affected by  bulimia nervosa. 
Differential Diagnosis
Anorexia nervosa, binge-eating/purging type. Individuals whose bi nge-eating behav-
ior occurs only during episodes of anorexia  nervosa are given the diagnosis anorexia ner-
vosa, binge-eating/purging type, and should  not be given the additional diagnosis of
bulimia nervosa. For individuals with an init ial diagnosis of anorexia nervosa who binge
and purge but whose presentation no longer meets the full criteria for anorexia nervosa,
binge-eating/purging type (e.g., when weight  is normal), a diagnosis of bulimia ner-
vosa should be given only when all criteria for bulimia nervosa have been met for at least
3m o n t h s .  
Binge-eating disorder. Some individuals binge eat but do  not engage in regular inap-
propriate compensatory behaviors. In these ca ses, the diagnosis of binge-eating disorder
should be considered.
Kleine-Levin syndrome. In certain neurological or other medical conditions, such as
Kleine-Levin syndrome, there is disturbed eating behavior, but the characteristic psycho-