Recurrent episodes of binge eating, which is characterized by the consumption of a large amount of food in a short period of time and a feeling that the eating is out of control. Recurrent inappropriate behavior to compensate for the binge eating, such as self-induced vomiting. The occurrence of both the binge eating and the inappropriate compensatory behavior at least twice weekly, on average, for 3 months. Overconcern with body shape and weight. Note: If the diagnostic criteria for anorexia nervosa are simultaneously met, only the diagnosis of anorexia nervosa is given The physical abnormalities associated with BN primarily result from the purging behavior | Chapter 076. Eating Disorders Part 6 Table 76-3 Diagnostic Features of Bulimia Nervosa Recurrent episodes of binge eating which is characterized by the consumption of a large amount of food in a short period of time and a feeling that the eating is out of control. Recurrent inappropriate behavior to compensate for the binge eating such as self-induced vomiting. The occurrence of both the binge eating and the inappropriate compensatory behavior at least twice weekly on average for 3 months. Overconcern with body shape and weight. Note If the diagnostic criteria for anorexia nervosa are simultaneously met only the diagnosis of anorexia nervosa is given The physical abnormalities associated with BN primarily result from the purging behavior. Painless bilateral salivary gland hypertrophy sialadenosis may be noted. A scar or callus on the dorsum of the hand may develop due to repeated trauma from the teeth among patients who manually stimulate the gag reflex. Recurrent vomiting and the exposure of the lingual surfaces of the teeth to stomach acid lead to loss of dental enamel and eventually to chipping and erosion of the front teeth. Laboratory abnormalities are surprisingly infrequent but hypokalemia hypochloremia and hyponatremia are observed occasionally. Repeated vomiting may lead to alkalosis whereas repeated laxative abuse may produce a mild metabolic acidosis. Serum amylase may be slightly elevated due to an increase in the salivary isoenzyme. Serious physical complications resulting from BN are rare. Oligomenorrhea and amenorrhea are more frequent than among women without eating disorders. Arrhythmias occasionally occur secondary to electrolyte disturbances. Tearing of the esophagus and rupture of the stomach have been reported and constitute lifethreatening events. Some patients who chronically abuse laxatives or diuretics develop transient peripheral edema when this behavior ceases presumably due to high levels of aldosterone secondary to persistent fluid and
