MULTIDISCIPLINARY DIAGNOSIS AND THERAPEUTIC INTERVENTIONS FOR BULIMIA NERVOSA

Abstract

Introduction: Bulimia nervosa (BN) is an eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors, with significant clinical repercussions and high psychiatric comorbidity. Objective: To synthesize the available evidence on epidemiology, diagnostic recognition, clinical complications, neurobiological aspects, nutritional assessment and management, as well as psychotherapeutic interventions, identifying gaps for future research. Methodology: This is a narrative literature review, with searches conducted in the PubMed/MEDLINE, Scopus, and LILACS databases between August and September 2026, using a combination of MeSH descriptors and free-text terms. Eligible studies included systematic reviews, meta-analyses, randomized clinical trials, observational studies, case series, and case reports, as well as guidelines from scientific societies published in Portuguese, English, or Spanish. The synthesis adhered to the hierarchy of evidence. Results and Discussion: Prevalence estimates vary depending on the diagnostic criteria and instruments used, and are consistently higher in screening studies than in those based on structured clinical interviews. Oral and dermatological signs may facilitate early diagnostic recognition, while fluid and electrolyte complications resulting from purging behaviors represent the primary acute clinical risk. Nutritional assessment presents methodological challenges in BN, since body mass index alone does not distinguish the severity of the condition. Cognitive-behavioral psychotherapy remains the first-line intervention, whereas pharmacotherapy has a modest effect size. Evidence regarding the use of psychostimulants in BN is still preliminary and associated with frequent adverse events. Conclusion: The management of BN requires multidisciplinary and integrated care, and gaps remain regarding the isolated effects of nutritional intervention.