| Domain | Recommended terms/IDs | Evidence-backed annotation | Caveat |
|---|---|---|---|
| Disease identifier | MONDO: **MONDO_0005452**; ICD-10: **F50.2**; ICD-11: **6B81**; MeSH: **Bulimia Nervosa** | BN is a psychiatric eating disorder characterized by recurrent binge eating with compensatory behaviors; DSM-style features summarized in recent BN reviews and pharmacotherapy meta-analysis (pqac-00000001, pqac-00000002, pqac-00000004) | MONDO exact match supported by Open Targets context; ICD/MeSH listed as standard identifiers but not directly validated in supplied abstracts; treat as standard ontology mappings (pqac-00000000) |
| Synonyms / labels | **Bulimia nervosa**; **BN**; suggested synonym: **binge-purge eating disorder** | Literature consistently uses “bulimia nervosa (BN)” as the preferred label (pqac-00000001, pqac-00000002) | Alternative names beyond BN abbreviation are suggested/unverified in supplied evidence |
| Core phenotype | Suggested HPO: **binge eating** [suggested/unverified HPO ID]; **self-induced vomiting** [suggested/unverified HPO ID] | Core syndrome includes recurrent binge eating plus inappropriate compensatory behaviors such as self-induced vomiting, laxative/diuretic misuse, fasting, or excessive exercise (pqac-00000001, pqac-00000002, pqac-00000004) | Exact HPO IDs were not supplied by the evidence set |
| Electrolyte phenotype | Suggested HPO: **Electrolyte abnormality** [suggested/unverified HPO ID]; **Hypokalemia** [suggested/unverified HPO ID] | Purging-related medical complications include electrolyte imbalance; hospitalization indications include dehydration, electrolyte abnormalities, and arrhythmias (pqac-00000002, pqac-00000006) | Hypokalemia is well known clinically but not quantified in supplied extracts; exact HPO IDs not supplied |
| Oral/dental phenotype | Suggested HPO: **Dental erosion** [suggested/unverified HPO ID] | Dental erosion is repeatedly cited as a complication of recurrent vomiting/purging (pqac-00000002, pqac-00000004) | Exact HPO ID not supplied |
| Salivary phenotype | Suggested HPO: **Salivary gland enlargement** [suggested/unverified HPO ID] | Salivary gland hypertrophy/enlargement is described among purging-related complications (pqac-00000002, pqac-00000004) | Exact HPO ID not supplied |
| Reproductive phenotype | Suggested HPO: **Menstrual irregularity** [suggested/unverified HPO ID] | Menstrual irregularities are reported among medical complications in BN reviews (pqac-00000004) | Less emphasized than in restrictive EDs; exact HPO ID not supplied |
| Cardiac phenotype | Suggested HPO: **Arrhythmia** [suggested/unverified HPO ID] | Cardiac arrhythmias are a recognized medical risk, especially in the context of dehydration/electrolyte disturbance from purging (pqac-00000006) | Exact HPO ID not supplied |
| Psychiatric comorbidity phenotype | Suggested HPO: **Anxiety** [suggested/unverified HPO ID]; **Depression** [suggested/unverified HPO ID] | Anxiety and mood disorders are common; meta-analysis/reviews cite anxiety disorders ~53%, mood disorders ~43%, and lifetime mood disorder burden up to 80–90% in BN cohorts (pqac-00000001, pqac-00000005) | Percentages reflect review-level synthesis and may vary across diagnostic criteria/sample ascertainment |
| Anatomy | UBERON suggested: **brain**; **frontostriatal circuitry** [structure/system mapping suggested]; **gastrointestinal tract**; **tooth/teeth**; **salivary gland**; **heart** | Neuroimaging review implicates frontostriatal circuits, insula, amygdala, orbitofrontal/anterior cingulate regions; purging complications involve GI tract, teeth, salivary glands, and heart (pqac-00000005, pqac-00000002, pqac-00000006) | Exact UBERON IDs were not provided in evidence; “frontostriatal circuitry” may need post-coordination rather than a single UBERON term |
| Cellular component / cell type | CL suggested: **neuron**; **peripheral blood mononuclear cell**; **T cell** | BN neurobiology centers on neuronal circuits; immune studies reported altered CD2/CD3/CD4/CD8/CD57 and lower CD4/CD8 ratios, including PBMC-based cytokine studies (pqac-00000007) | Exact CL IDs not supplied; immune findings are less consistent than neural findings |
| Biological process | GO suggested: **reward processing** [suggested/unverified GO term mapping]; **inhibitory control** [suggested/unverified GO term mapping]; **serotonin signaling**; **dopamine signaling**; **immune response** | Reviews implicate altered reward sensitivity, food-related attentional bias, impaired inhibitory control, and serotonergic/dopaminergic pathways; immune-response changes are mixed but T-cell alterations reported (pqac-00000005, pqac-00000008, pqac-00000007) | “Reward processing” and “inhibitory control” may require nearest GO-process approximations rather than exact labels |
| Genetics / inheritance | Suggested annotation: **multifactorial, polygenic psychiatric disorder** | BN is described as multifactorial with genetic predisposition, environmental factors, and psychological traits; risk review cites serotonin/dopamine receptor-related polymorphisms, glucocorticoid pathway variants, and 5-HTTLPR involvement (pqac-00000001, pqac-00000008) | No single causal gene/variant is established for routine clinical use in supplied evidence |
| Gene–environment interaction | Suggested annotation: **childhood trauma × glucocorticoid/5-HTTLPR risk background** | Childhood trauma/abuse interacting with glucocorticoid receptor polymorphisms and 5-HTTLPR is reported as increasing BN risk; lower cortisol after maltreatment was noted in BN cases vs controls (pqac-00000008) | Evidence is review-level and not sufficient for deterministic biomarker use |
| Immune / inflammatory annotation | Suggested annotation: **immune dysregulation with inconsistent cytokine signal; T-cell alterations reported** | BN does not show a consistent pro-inflammatory cytokine signature across studies, but reduced CD4/CD8 ratios and lower T-cell markers have been reported (pqac-00000007) | Confounding by adiposity, comorbidity, treatment, and illness severity limits interpretation |
| Neurobiology | Suggested annotation: **frontostriatal hypoactivity; aberrant insula/amygdala/OFC/ACC responses** | Neuroimaging synthesis found frontostriatal hypoactivity, altered inhibitory control, and abnormal responses to food/disorder-related cues; illness severity correlates with greater neural changes (pqac-00000005) | Evidence base is heterogeneous and often underpowered |
| Epidemiology / onset | Suggested annotation: **adolescent onset; female predominance** | Reviews cite average onset around 16–17 years and median onset around 12.4 years; lifetime prevalence estimates include ~1.5% in females and 0.5% in males, with treatment non-engagement/delay in 85–94% (pqac-00000001, pqac-00000002) | Onset/prevalence values vary by source, age window, and ascertainment method |
| Prognosis / outcomes | Suggested annotation: **remission possible; relapse and mortality remain concerns** | Review-level evidence suggests remission is achievable, with one review citing up to 80% remission with proper treatment; suicide risk and SMR elevations are noted (pqac-00000002, pqac-00000004) | Outcome definitions are inconsistent across studies |
| MAXO treatment concepts | MAXO suggested: **cognitive behavioral therapy (CBT/CBT-E)**; **family-based therapy (FBT)**; **nutritional therapy**; **electrolyte monitoring**; **electrocardiographic monitoring (ECG)** | CBT is consistently first-line; FBT has supportive evidence in adolescents; nutritional therapy and medical monitoring are part of standard care; hospitalization may be required for dehydration/electrolyte disturbance/arrhythmia (pqac-00000003, pqac-00000004, pqac-00000006) | Exact MAXO IDs were not supplied in evidence |
| Pharmacotherapy | Suggested term: **fluoxetine**; broader classes: **SSRIs**, **TCAs**, **MAOIs**, **topiramate** | Meta-analysis of 33 studies found modest benefit of pharmacotherapy for binge frequency, vomiting frequency, weight, and depressive symptoms; SSRIs/fluoxetine are commonly referenced in guideline-style reviews (pqac-00000001) | Medication effects are modest overall; exact preferred agent hierarchy depends on guideline context |
| Diagnostic workup | Suggested terms: **clinical interview/DSM criteria**, **electrolytes**, **ECG**, **medical assessment for purging complications** | Diagnosis is clinical, based on binge eating plus compensatory behaviors occurring at least weekly for 3 months; medical workup should assess dehydration, electrolyte abnormalities, and arrhythmias (pqac-00000001, pqac-00000004, pqac-00000006) | No validated BN-specific molecular biomarker is established in supplied evidence |


*Table: This compact table organizes bulimia nervosa into ontology-ready disease, phenotype, anatomy, mechanism, and treatment annotations using only evidence available in the retrieved context. It is useful as a starting point for knowledge-base population, while clearly marking suggested or unverified ontology IDs where the supplied evidence did not provide exact identifiers.*