Bulimia nervosa

A diagnosis of bulimia nervosa requires all three of the following:

• Binge eating
• Methods to prevent gaining weight (e.g. vomiting, purging, laxatives, etc.)
• Morbid dread of fatness (overvalued idea, not a delusion)

The incidence of bulimia is 12 per 100000, with females being affected 10 times more commonly than males. Individuals tend to be of a normal or above-normal weight. Complications are caused by starvation and vomiting, and include hypokalaemia, dehydration, enlargement of the parotid glands, dental caries, Mallory-Weiss tear, osteoporosis and Russel's sign (thick skin on the dorsum of the hands due to repeated induced vomiting by stimulating the gag reflex with the fingers). Treatment is similar to that of anorexia, but selective serotonin reuptake inhibitors may improve bingeing behaviour. Seventy percent of cases recover within 5 years and there is no increase in mortality.