Presenting Complaints

• Patient may present with concern over binge eating or extreme weight control measures such as self-induced vomiting, excessive use of diet pills, and laxative abuse.
• Family may ask for help because of patients loss of weight; refusal to eat; vomiting or amenorrhoea

Diagnostic Features

• Common features
  • Unreasonable fear of being fat or gaining weight
  • Extensive efforts to lose weight (strict dieting, vomiting, purgatives, excessive exercise)
  • May deny that weight or eating habits are a problem
    
    
• Patients with bulimia typically show:
  • Binge eating - eating large amounts of food in a few hours
  • Purging - attempts to eliminate food by self-induced vomiting, diuretic or laxative use
    
    
• Patients with Anorexia Nervosa typically show
  • severe dieting despite very low weight
  • distorted body image (unreasonable belief that one is overweight)
    
    
• A patient may show both anorexic and bulimic patterns at different times.
  

Differential Diagnosis

• Depression may occur along with bulimia or anorexia. See section on Depression.
• Both anorexia and bulimia may cause physical disorders (amenorrhea, hypokalemia, seizures, cardiac arrhythmias) that require monitoring or treatment.