F50.2·ICD-10-CM

Bulimia Nervosa

Recurrent binge eating accompanied by recurrent inappropriate compensatory behaviors intended to prevent weight gain. Both occur on average at least once per week for 3 months.

Recommended screener

Validated screener
Eating Disorder Examination Questionnaire (EDE-Q)

DSM-5-TR diagnostic criteria summary

Bulimia Nervosa requires:

  • Recurrent episodes of binge eating, characterized by both eating an unusually large amount in a discrete period AND a sense of lack of control during the episode.
  • Recurrent inappropriate compensatory behaviors to prevent weight gain, self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
  • Frequency: Both binge eating and compensatory behaviors occur on average at least once per week for 3 months.
  • Self-evaluation is unduly influenced by body shape and weight.
  • Does NOT occur exclusively during episodes of anorexia nervosa (if both criteria are met, anorexia binge-purge subtype is coded instead).

Severity (based on average compensatory episodes/week): Mild 1–3, Moderate 4–7, Severe 8–13, Extreme 14+.

Source: American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), p. 387–393.

Differential diagnosis

  • F50.81 Binge Eating Disorder, recurrent binge eating WITHOUT compensatory behaviors.
  • F50.0 Anorexia Nervosa, Binge-Purge Subtype (F50.02), when significantly low body weight is also present, anorexia binge-purge takes precedence.
  • F50.89 Other Specified Feeding/Eating Disorder, bulimia of low frequency or limited duration (less than once weekly or less than 3 months).
  • F33, F32 Major Depressive Disorder with Atypical Features, increased appetite and weight gain in depression, lacking the body-image disturbance and compensatory behaviors of bulimia.
  • Substance-induced binge eating, methamphetamine withdrawal or marijuana use can produce binge-like eating.

Common comorbidities

Bulimia Nervosa has very high lifetime psychiatric comorbidity. Common co-occurring conditions: Major Depressive Disorder (F33, F32), Generalized Anxiety Disorder (F41.1), Substance Use Disorders (F10–F19, particularly alcohol), Borderline Personality Disorder (F60.3), and Bipolar Disorders (F31.x). Medical comorbidities include hypokalemia, esophageal complications, dental erosion, dehydration, cardiac arrhythmias.

Sources

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), F50.2, p. 387–393.
  • Morgan, J. F., Reid, F., & Lacey, J. H. (1999). The SCOFF questionnaire. British Medical Journal, 319(7223), 1467–1468.
  • Centers for Disease Control and Prevention. ICD-10-CM Official Coding Guidelines.

Frequently asked questions

What is ICD-11 code F50.2?

F50.2 is the ICD-11-CM code for Bulimia Nervosa, characterized by recurrent binge eating accompanied by recurrent inappropriate compensatory behaviors (self-induced vomiting, laxatives, diuretics, fasting, excessive exercise) intended to prevent weight gain.

What are the diagnostic criteria for F50.2?

DSM-5-TR Bulimia Nervosa requires: (A) recurrent binge eating; (B) recurrent inappropriate compensatory behaviors to prevent weight gain; (C) both occur on average at least once per week for 3 months; (D) self-evaluation is unduly influenced by body shape and weight; (E) does not occur exclusively during anorexia nervosa episodes.

What scale is used to screen for F50.2?

The Eating Disorder Examination Questionnaire (EDE-Q) is the comprehensive 28-item self-report. The SCOFF Questionnaire (5 yes/no items) is a brief primary care screener for any eating disorder. The Bulimia Test-Revised (BULIT-R) is bulimia-specific. A positive screen warrants a full clinical evaluation including medical assessment.

What is the difference between F50.2 and F50.81?

F50.2 Bulimia Nervosa requires recurrent binge eating WITH compensatory behaviors. F50.81 Binge Eating Disorder requires recurrent binge eating WITHOUT compensatory behaviors. Same loss-of-control eating; presence/absence of compensation is the key distinguisher. Many patients move between presentations over time.

How is F50.2 severity classified?

DSM-5-TR severity for bulimia is based on average frequency of inappropriate compensatory behaviors per week: Mild (1–3 episodes/week), Moderate (4–7), Severe (8–13), Extreme (14+). Severity may be increased to reflect functional disability or other clinical features.

Is F50.2 a billable ICD-11-CM code?

Yes, F50.2 is a billable ICD-11-CM code as of the 2025 official tabular list. It is the standard reimbursed code for Bulimia Nervosa and stands at maximum specificity in its hierarchy with no further fifth-character subdivisions. Severity (mild, moderate, severe, extreme) is documented in the chart rather than the code itself.

What are the symptoms of bulimia nervosa?

Bulimia nervosa produces recurrent binge eating plus compensatory behaviors aimed at preventing weight gain. Core symptoms include eating unusually large amounts in a short period with a sense of loss of control, followed by self-induced vomiting, laxative or diuretic misuse, fasting, or excessive exercise. Self-evaluation is unduly influenced by body shape and weight. Episodes occur on average at least once weekly for three months. Body weight is typically normal or slightly above, distinguishing bulimia from anorexia nervosa.

How is bulimia nervosa diagnosed?

Bulimia nervosa is diagnosed by a clinician using DSM-5-TR criteria, which require recurrent binge eating with compensatory behaviors at least once weekly for three months, plus self-evaluation unduly influenced by body shape and weight. Diagnosis typically follows a positive EDE-Q, BULIT-R, or SCOFF screen, structured clinical interview, medical assessment for electrolyte and dental complications, and ruling out anorexia nervosa binge-purge subtype when low weight is present.

What causes bulimia nervosa?

Bulimia nervosa arises from a combination of genetic, neurobiological, and sociocultural factors. Heritability estimates from twin studies range from 30% to 80% depending on the population. Neurobiological contributors include altered serotonin signaling, reduced dopamine reward responses, and dysregulated appetite hormones. Sociocultural triggers include thin-ideal internalization, dieting history, weight-related teasing, perfectionism, early puberty, and trauma exposure.

Can bulimia nervosa be cured?

Bulimia nervosa is highly treatable and many patients achieve full and lasting remission. Cognitive behavioral therapy adapted for eating disorders (CBT-E) is the first-line treatment, with roughly 40% to 50% of patients achieving full remission and another 20% to 30% showing substantial improvement. Fluoxetine at 60 mg is the only FDA-approved medication and is typically combined with therapy. Recovery improves with longer treatment and address of comorbid mood, anxiety, and substance-use conditions.

How is F50.2 severity classified · Is F50.2 a billable ICD-11-CM… · What are the symptoms of… · How is bulimia nervosa diagnosed
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