Individuals with Bulimia Nervosa typically are within the normal weight range, although some may be slightly underweight or overweight. The disorder occurs but is uncommon among moderately and morbidly obese individuals. There are suggestions that, prior to the onset of the Eating Disorder, individuals with Bulimia Nervosa are more likely to be overweight than their peers. Between binges, individuals with Bulimia Nervosa typically restrict their total caloric consumption and preferentially select low-calorie ("diet") foods while avoiding foods they perceive to be fattening or likely to trigger a binge.
There is an increased frequency of depressive symptoms (e.g., low self-esteem) or Mood Disorders (particularly Dysthymic Disorder and Major Depressive Disorder) in individuals with Bulimia Nervosa. In many or most individuals, the mood disturbance begins at the same time as or following the development of Bulimia Nervosa, and individuals often ascribe their mood disturbances to Bulimia Nervosa. However, in some individuals, the mood disturbance clearly precedes the development of Bulimia Nervosa. There may also be an increased frequency of anxiety symptoms (e.g., fear of social situations) or Anxiety Disorders. These mood and anxiety disturbances frequently remit following effective treatment of Bulimia Nervosa. Substance Abuse or Dependence, particularly involving alcohol and stimulants, occurs in about one-third of individuals with Bulimia Nervosa. Stimulant use often begins in an attempt to control appetite and weight. Probably between one-third and one-half of individuals with Bulimia Nervosa also have personality features that meet criteria for one or more Personality Disorders (most frequently Borderline Personality Disorder).
Preliminary evidence suggests that individuals with Bulimia Nervosa, Purging Type, show more symptoms of depression and greater concern with shape and weight than individuals with Bulimia Nervosa, Nonpurging Type.