eMedicine Specialties > Psychiatry > Adult

Bulimia: Differential Diagnoses & Workup

Author: Raj K Kalapatapu, MD, Fellow, Addiction Psychiatry, Columbia University College of Physicians and Surgeons
Coauthor(s): Kelda Harris Walsh, MD, Assistant Professor of Clinical Psychiatry, Section of Child and Adolescent Psychiatry, Department of Psychiatry, Indiana University School of Medicine; Chief, Obsessive-Compulsive/Tourette/Anxiety Disorders Clinic, Riley Hospital for Children; Gabriel I Uwaifo, MBBS, Clinical and Research Attending, Assistant Professor of Medicine and Endocrinology, MedStar Clinical Research Center, MedStar Research Institute and Washington Hospital Center; Robert C Daly, MB, ChB, MPH, BCh, Senior Fellow, Department of Behavioral Endocrinology, National Institute of Mental Health, National Institutes of Health
Contributor Information and Disclosures

Updated: Aug 12, 2008

Differential Diagnoses

Anorexia Nervosa
Kleine-Levin Syndrome
Body Dysmorphic Disorder
Kluver-Bucy Syndrome
Depression
Obesity
Gastric Outlet Obstruction
Obsessive-Compulsive Disorder
Insulinoma

Other Problems to Be Considered

Binge-eating disorder

This disorder is characterized by bingeing episodes but without the compensatory behaviors attempted on a consistent basis. It is the most common eating disorder (seen in about 2% of the general population and about 10% of obese people) and is more common in men than are the other eating disorders (estimates suggest 30-40% may be male). Recent reports suggest that binge-eating disorder may be particularly common among African-American and Hispanic individuals. The mean age at diagnosis is also higher (in the late third decade of life) compared to both anorexia nervosa and bulimia nervosa.

Night eating disorder

This eating disorder is only recently defined and recognized. It is characterized by the consumption of large amounts of food (>20% of the total calorie intake) after evening meals. It is typically associated with early morning drowsiness and anorexia. No significant overlap is seen between binge-eating disorder or bulimia nervosa and night eating disorder.

Workup

Laboratory Studies

  • Comprehensive blood chemistry panels are important in detecting possible occult metabolic complications of bulimia. A complete blood cell count should be obtained to exclude anemia or other occult hematologic abnormalities. An erythrocyte sedimentation rate (ESR) test is useful to exclude any potentially unrecognized chronic medical illness because ESR levels tend to be low in patients with eating disorders.
  • Performing a urinalysis is important to evaluate urine specific gravity because patients may water load in an attempt to gain some weight before their health care visit.
  • A pregnancy test should always be obtained to rule out pregnancy in female patients presenting with amenorrhea.
  • With significant vomiting, hypokalemic metabolic alkalosis is possible.
  • Among patients with significant laxative abuse, normokalemic metabolic acidosis may occur.
  • Hyperamylasemia is found in up to 30% of persons with significant vomiting because of hypersecretion from the salivary glands.
  • Hyponatremia, hypocalcemia, hypophosphatemia, hypomagnesemia, hyperuricemia, and hypoalbuminemia are less common but should not be ruled out.
  • Those who have significant intravascular depletion may have elevated blood urea nitrogen levels.
  • Comorbid substance abuse should be ruled out with a urine toxicology screen.64

Other Tests

  • Because of the potential for arrhythmias and cardiomyopathy as possible complications, an electrocardiogram (ECG) should be performed.
  • Because of the potential for osteoporosis in this group of people, a dual energy absorptiometry (DEXA) scan may also be indicated.
  • Neuropsychological testing may show decision-making abnormalities, as well as impairment in word recall, abstraction, attention, visuospatial functioning, and problem solving.65,66

More on Bulimia

Overview: Bulimia
Differential Diagnoses & Workup: Bulimia
Treatment & Medication: Bulimia
Follow-up: Bulimia
Multimedia: Bulimia
References
Further Reading
[ CLOSE WINDOW ]

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Keywords

bulimia nervosa, BN, binge-eating/purging eating disorder, binge-eating disorder, BED, binging and purging, pathological voracity, cynorexia, kynorexia, morbid hunger, eating disorder, ED, excessive exercise, fasting, dieting, self-induced vomiting, diuretic abuse, laxative abuse, use of appetite suppressants, thyroid hormone, subjective bulimic episode

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Contributor Information and Disclosures

Author

Raj K Kalapatapu, MD, Fellow, Addiction Psychiatry, Columbia University College of Physicians and Surgeons
Raj K Kalapatapu, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

Coauthor(s)

Kelda Harris Walsh, MD, Assistant Professor of Clinical Psychiatry, Section of Child and Adolescent Psychiatry, Department of Psychiatry, Indiana University School of Medicine; Chief, Obsessive-Compulsive/Tourette/Anxiety Disorders Clinic, Riley Hospital for Children
Kelda Harris Walsh, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry and American Psychiatric Association
Disclosure: Nothing to disclose.

Gabriel I Uwaifo, MBBS, Clinical and Research Attending, Assistant Professor of Medicine and Endocrinology, MedStar Clinical Research Center, MedStar Research Institute and Washington Hospital Center
Gabriel I Uwaifo, MBBS is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Medical Association, American Society of Hypertension, and Endocrine Society
Disclosure: Nothing to disclose.

Robert C Daly, MB, ChB, MPH, BCh, Senior Fellow, Department of Behavioral Endocrinology, National Institute of Mental Health, National Institutes of Health
Disclosure: Nothing to disclose.

Medical Editor

Sarah C Aronson, MD, Associate Professor, Departments of Psychiatry and Medicine, Case Western Reserve School of Medicine/University Hospitals of Cleveland
Sarah C Aronson, MD is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

David Bienenfeld, MD, Vice-Chair, Program Director, Professor, Department of Psychiatry, Wright State University School of Medicine
David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Speaking and teaching; Northstar Grant/research funds Research; Novartis Grant/research funds research; Pfizer  Speaking and teaching; Sanofi-avetis Grant/research funds research; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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