Bulimia Nervosa Workup

  • Author: Christine I Osterhout, MD; Chief Editor: David Bienenfeld, MD   more...
 
Updated: Nov 15, 2011
 

Laboratory Studies

  • Comprehensive blood chemistry panel: This is important in detecting possible occult metabolic complications of bulimia. With significant vomiting, hypokalemic metabolic alkalosis is possible. Among patients with significant laxative abuse, normokalemic metabolic acidosis may occur. Hyponatremia, hypocalcemia, hypophosphatemia, and hypomagnesemia should be ruled out. Those who have significant intravascular depletion may have elevated blood urea nitrogen levels.
  • Complete blood cell count: This is used to exclude anemia or other occult hematologic abnormalities.
  • Urinalysis: Urine specific gravity may reflect the state of hydration. Some patients may water load in an attempt to gain some weight before their health care visit.
  • Urine toxicology: Comorbid substance abuse should be ruled out with a urine toxicology screen.[53]
  • Pregnancy test: This should always be obtained to rule out pregnancy in female patients presenting with amenorrhea.
  • Amylase: Hyperamylasemia is found in up to 30% of persons with significant vomiting because of hypersecretion from the salivary glands. This may offer a rough measure of purging activity or suggest the presence of purging in patients who are suspected of purging but who deny doing it. However, serial amylase levels are not sufficiently sensitive to offer a useful clinical marker to follow the course of purging.
Next

Other Tests

  • Because of the potential for arrhythmias and cardiomyopathy as possible complications, an electrocardiogram (ECG) should be performed in patients who are very thin, complaining of palpitations, or have other signs or symptoms suggestive of cardiovascular concern. Prolonged QTc, especially in the setting of hypokalemia, heighten the risk for cardiac decompensation in this population.[54]
  • Because of the potential for osteoporosis, a dual energy absorptiometry (DEXA) scan may be useful, particularly for patients with irregular menses, mood disorders, and/or who smoke cigarettes.
  • Routine neuropsychological testing is not indicated. When specific abnormalities are found in mental status testing, or when histories of learning impairment are present, neuropsychological testing may show decision-making abnormalities, as well as impairment in word recall, abstraction, attention, visuospatial functioning, and problem solving.[55, 56]
Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Christine I Osterhout, MD  Resident Physician, Department of Psychiatry and Behavioral Sciences, University of California, Davis Health System

Christine I Osterhout, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Child and Adolescent Psychiatry, American Academy of Psychiatry and the Law, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Coauthor(s)

Lorin M Scher, MD  Health Sciences Assistant Clinical Professor, Department of Psychiatry and Behavioral Sciences, University of California, Davis, School of Medicine

Lorin M Scher, MD is a member of the following medical societies: Academy of Psychosomatic Medicine, Alpha Omega Alpha, American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Donald M Hilty, MD  Professor of Clinical Psychiatry, Vice-Chair of Faculty Development, Department of Psychiatry and Behavioral Sciences, University of California, Davis School of Medicine

Donald M Hilty, MD is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Technology in Psychiatry, American Psychiatric Association, and Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Joel Yager  MD, Professor of Psychiatry, University of Colorado Health Sciences Center; Professor of Psychiatry Emeritus, University of California, Los Angeles, David Geffen School of Medicine; Professor of Psychiatry Emeritus, University of New Mexico School of Medicine

Joel Yager is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry

Disclosure: Gurze publishers Salary editing; Massachusetts Medical Society Salary Writing

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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 None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Chief Editor

David Bienenfeld, MD  Professor of Psychiatry, Vice-Chair and Director of Residency Training, Department of Psychiatry, Wright State University, Boonshoft 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.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Gabriel I Uwaifo, MBBS and Robert C Daly, MB, ChB, MPH to the development and writing of this article.

The authors would also like to acknowledge the contributions of Rebecca Davis, Librarian at the University of California (UC), Davis and Dr. Eric Rickin, Director for the Center for Overcoming Problem Eating (COPE) at the Western Psychiatric Institute and Clinic, University of Pittsburgh, Medical Center. Finally, the authors thank the Department of Psychiatry and Behavioral Sciences at UC Davis.

References

  1. American Psychiatric Association. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Text Revision. 4th ed. Washington, DC: 2000.

  2. Santonastaso P, Zanetti T, De Antoni C, Tenconi E, Favaro A. Anorexia nervosa patients with a prior history of bulimia nervosa. Compr Psychiatry. Nov-Dec 2006;47(6):519-22. [Medline].

  3. American Psychiatric Association DSM-5 Development. 2010. Proposed Draft Revision to DSM Disorders and Criteria. Available at http://www.dsm5.org.

  4. Hudson, JI, Hirpi, E, Pope, HG, et al. The Prevalence and Correlates of Eating Disorders in National Comorbidity Survey Replication. Biol Psychiatry. 2—7;61:348-358.

  5. Goldfield GS, Blouin AG, Woodside DB. Body image, binge eating, and bulimia nervosa in male bodybuilders. Can J Psychiatry. Mar 2006;51(3):160-8. [Medline].

  6. Johnson MD. Disordered eating in active and athletic women. Clin Sports Med. Apr 1994;13(2):355-69. [Medline].

  7. Ravaldi C, Vannacci A, Bolognesi E, Mancini S, Faravelli C, Ricca V. Gender role, eating disorder symptoms, and body image concern in ballet dancers. J Psychosom Res. Oct 2006;61(4):529-35. [Medline].

  8. Perez M, Hernandez A, Clarke A, Joiner TE Jr. Analysis of bulimic symptomatology across age and geographic locations. Eat Behav. Jan 2007;8(1):136-42. [Medline].

  9. Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies. Arch Gen Psychiatry. Jul 2011;68(7):724-31. [Medline].

  10. Chui W, Safer DL, Bryson SW, Agras WS, Wilson GT. A comparison of ethnic groups in the treatment of bulimia nervosa. Eat Behav. Dec 2007;8(4):485-91. [Medline].

  11. Franko DL, Becker AE, Thomas JJ, Herzog DB. Cross-ethnic differences in eating disorder symptoms and related distress. Int J Eat Disord. Mar 2007;40(2):156-64. [Medline]. [Full Text].

  12. Morgan CD, Marsh C. Bulimia nervosa in an elderly male: a case report. Int J Eat Disord. Mar 2006;39(2):170-1. [Medline]. [Full Text].

  13. Ruiz MC, Soler-Gonzalez J. Images in clinical medicine. Unfortunate ingestion. N Engl J Med. Nov 24 2005;353(21):2270. [Medline]. [Full Text].

  14. Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ. Dec 4 1999;319(7223):1467-8. [Medline]. [Full Text].

  15. Cotton MA, Ball C, Robinson P. Four simple questions can help screen for eating disorders. J Gen Intern Med. Jan 2003;18(1):53-6. [Medline]. [Full Text].

  16. Mintz LB, O'Halloran MS. The Eating Attitudes Test: validation with DSM-IV eating disorder criteria. J Pers Assess. Jun 2000;74(3):489-503. [Medline].

  17. Keery H, Boutelle K, van den Berg P, Thompson JK. The impact of appearance-related teasing by family members. J Adolesc Health. Aug 2005;37(2):120-7. [Medline].

  18. Poyastro Pinheiro A, Thornton LM, Plotonicov KH, et al. Patterns of menstrual disturbance in eating disorders. Int J Eat Disord. Jul 2007;40(5):424-34. [Medline]. [Full Text].

  19. Pinheiro, AP, Thornton, LH, Plotonicov, KH, et al. Patterns of Menstrual Disturbance in Eating Disorders. Intl J Eat Disord. 2007;40:424-434.

  20. Ribases M, Fernandez-Aranda F, Gratacos M, et al. Contribution of the serotoninergic system to anxious and depressive traits that may be partially responsible for the phenotypical variability of bulimia nervosa. J Psychiatr Res. Jan 2008;42(1):50-7. [Medline].

  21. Monteleone P, Santonastaso P, Mauri M, et al. Investigation of the serotonin transporter regulatory region polymorphism in bulimia nervosa: relationships to harm avoidance, nutritional parameters, and psychiatric comorbidity. Psychosom Med. Jan-Feb 2006;68(1):99-103. [Medline]. [Full Text].

  22. Fetissov SO, Harro J, Jaanisk M, et al. Autoantibodies against neuropeptides are associated with psychological traits in eating disorders. Proc Natl Acad Sci U S A. Oct 11 2005;102(41):14865-70. [Medline]. [Full Text].

  23. Bacanu SA, Bulik CM, Klump KL, et al. Linkage analysis of anorexia and bulimia nervosa cohorts using selected behavioral phenotypes as quantitative traits or covariates. Am J Med Genet B Neuropsychiatr Genet. Nov 5 2005;139B(1):61-8. [Medline]. [Full Text].

  24. Mercader JM, Ribases M, Gratacos M, et al. Altered brain-derived neurotrophic factor blood levels and gene variability are associated with anorexia and bulimia. Genes Brain Behav. Nov 2007;6(8):706-16. [Medline]. [Full Text].

  25. Ando T, Komaki G, Naruo T, et al. Possible role of preproghrelin gene polymorphisms in susceptibility to bulimia nervosa. Am J Med Genet B Neuropsychiatr Genet. Dec 5 2006;141B(8):929-34. [Medline]. [Full Text].

  26. Uher R, Treasure J. Brain lesions and eating disorders. J Neurol Neurosurg Psychiatry. Jun 2005;76(6):852-7. [Medline]. [Full Text].

  27. Frank GK, Bailer UF, Meltzer CC, et al. Regional cerebral blood flow after recovery from anorexia or bulimia nervosa. Int J Eat Disord. Sep 2007;40(6):488-92. [Medline]. [Full Text].

  28. Godart NT, Perdereau F, Rein Z, et al. Comorbidity studies of eating disorders and mood disorders. Critical review of the literature. J Affect Disord. Jan 2007;97(1-3):37-49. [Medline].

  29. Mazzeo SE, Slof-Op't Landt MC, Jones I, et al. Associations among postpartum depression, eating disorders, and perfectionism in a population-based sample of adult women. Int J Eat Disord. Apr 2006;39(3):202-11. [Medline]. [Full Text].

  30. Micali N, Hilton K, Natatani E, et al. Is childhood OCD a risk factor for eating disorders later in life? A longitudinal study. Psychol Med. Jun 7 2011;1-7. [Medline].

  31. Duncan AE, Neuman RJ, Kramer JR, Kuperman S, Hesselbrock VM, Bucholz KK. Lifetime psychiatric comorbidity of alcohol dependence and bulimia nervosa in women. Drug Alcohol Depend. Sep 1 2006;84(1):122-32. [Medline].

  32. Anzengruber D, Klump KL, Thornton L, et al. Smoking in eating disorders. Eat Behav. Nov 2006;7(4):291-9. [Medline].

  33. Baker JH, Mazzeo SE, Kendler KS. Association between broadly defined bulimia nervosa and drug use disorders: common genetic and environmental influences. Int J Eat Disord. Dec 2007;40(8):673-8. [Medline]. [Full Text].

  34. Striegel-Moore RH, Franko DL, Thompson D, Barton B, Schreiber GB, Daniels SR. Caffeine intake in eating disorders. Int J Eat Disord. Mar 2006;39(2):162-5. [Medline]. [Full Text].

  35. Fernandez-Aranda F, Jimenez-Murcia S, Alvarez-Moya EM, Granero R, Vallejo J, Bulik CM. Impulse control disorders in eating disorders: clinical and therapeutic implications. Compr Psychiatry. Nov-Dec 2006;47(6):482-8. [Medline].

  36. Surman CB, Randall ET, Biederman J. Association between attention-deficit/hyperactivity disorder and bulimia nervosa: analysis of 4 case-control studies. J Clin Psychiatry. Mar 2006;67(3):351-4. [Medline]. [Full Text].

  37. Yates, WR, Lund, BC, Johnson, C, et al. Attention Deficit Hyperactivity Symptoms and Disorder in Eating Disorder Inpatients. Int J Eat Disord. 2009;42:375-378.

  38. Wonderlich SA, Rosenfeldt S, Crosby RD, et al. The effects of childhood trauma on daily mood lability and comorbid psychopathology in bulimia nervosa. J Trauma Stress. Feb 2007;20(1):77-87. [Medline]. [Full Text].

  39. Zeeck A, Birindelli E, Sandholz A, Joos A, Herzog T, Hartmann A. Symptom severity and treatment course of bulimic patients with and without a borderline personality disorder. Eur Eat Disord Rev. Nov 2007;15(6):430-8. [Medline]. [Full Text].

  40. Waller G, Sines J, Meyer C, Foster E, Skelton A. Narcissism and narcissistic defences in the eating disorders. Int J Eat Disord. Mar 2007;40(2):143-8. [Medline]. [Full Text].

  41. Stein KF, Corte C. Identity impairment and the eating disorders: content and organization of the self-concept in women with anorexia nervosa and bulimia nervosa. Eur Eat Disord Rev. Jan 2007;15(1):58-69. [Medline]. [Full Text].

  42. Fedorowicz VJ, Falissard B, Foulon C, et al. Factors associated with suicidal behaviors in a large French sample of inpatients with eating disorders. Int J Eat Disord. Nov 2007;40(7):589-95. [Medline]. [Full Text].

  43. Crow, SJ, Peterson CB, Swanson, SA. Increased Mortality in Bulimia Nervosa and other Eating Disorders. Am J Psychiatry. 2009;166:1343-1346.

  44. Mandel L, Abai S. Diagnosing bulimia nervosa with parotid gland swelling. J Am Dent Assoc. May 2004;135(5):613-6; quiz 655. [Medline]. [Full Text].

  45. Zachariasen RD. Oral signs and symptoms of bulimia nervosa. J Gt Houst Dent Soc. Aug 1997;69(1):31-4. [Medline].

  46. Glorio R, Allevato M, De Pablo A, et al. Prevalence of cutaneous manifestations in 200 patients with eating disorders. Int J Dermatol. May 2000;39(5):348-53. [Medline]. [Full Text].

  47. Strumia R. Dermatologic signs in patients with eating disorders. Am J Clin Dermatol. 2005;6(3):165-73. [Medline].

  48. Scherag,S, Hebebrand, J, Hinney, A. Eating disorders: the current status of molecular genetic research. Eur Child Adolesc Psychiatry. 2010;19:211-226.

  49. Kaye,W. Neurobiology of anorexia and bulimia nervosa. Physiology & Behavior 94. (2008);121-135.

  50. Bailer, UF, Kaye, WH. A Review of Neuropeptides and Neuroendocrine Dysregulation in Anorexia Nervosa and Bulimia Nervosa. CNS and Neurological Disorders. 2003;2:53-59.

  51. Sadock BJ, and Sadock VA. Eating Disorders. In: Grebb, J.A., Pataki, C.S., and Sussman, N. Synopsis of Psychiatry. 10th Edition. Lippincott, Williams, & Wilkins; 2007:Chapter 23.

  52. Howell, MJ, Schenck, CH, Crow, SJ. A review of Nighttime Eating Disorders. Sleep Medicine Reviews. 2009;13(1):23-34.

  53. Kruger D. Bulimia nervosa: easy to hide but essential to recognize. JAAPA. Jan 2008;21(1):48-52. [Medline].

  54. Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. Feb 13 2010;375(9714):583-93. [Medline].

  55. Bosanac P, Kurlender S, Stojanovska L, et al. Neuropsychological study of underweight and "weight-recovered" anorexia nervosa compared with bulimia nervosa and normal controls. Int J Eat Disord. Nov 2007;40(7):613-21. [Medline]. [Full Text].

  56. Brand M, Franke-Sievert C, Jacoby GE, Markowitsch HJ, Tuschen-Caffier B. Neuropsychological correlates of decision making in patients with bulimia nervosa. Neuropsychology. Nov 2007;21(6):742-50. [Medline].

  57. Treatment of patients with eating disorders,third edition. American Psychiatric Association. Am J Psychiatry. Jul 2006;163(7 Suppl):4-54. [Medline].

  58. Shapiro JR, Berkman ND, Brownley KA, Sedway JA, Lohr KN, Bulik CM. Bulimia nervosa treatment: a systematic review of randomized controlled trials. Int J Eat Disord. May 2007;40(4):321-36. [Medline]. [Full Text].

  59. Schembri C, Evans L. Adverse relationship processes: the attempts of women with bulimia nervosa symptoms to fit the perceived ideal of intimate partners. Eur Eat Disord Rev. Jan 2008;16(1):59-66. [Medline]. [Full Text].

  60. Mitchell JE, Agras S, Wonderlich S. Treatment of bulimia nervosa: where are we and where are we going?. Int J Eat Disord. Mar 2007;40(2):95-101. [Medline]. [Full Text].

  61. Self-help and guided self-help for eating disorders, Volume 4 [database online]. The Cochrane Database of Systematic Reviews: The Cochrane Library, The Cochrane Collaboration; 2002. Updated 2007.

  62. Treatment of patients with eating disorders,third edition. American Psychiatric Association. Am J Psychiatry. Jul 2006;163(7 Suppl):4-54. [Medline]. [Full Text].

  63. Mitchell JE, Crow S. Medical complications of anorexia nervosa and bulimia nervosa. Curr Opin Psychiatry. Jul 2006;19(4):438-43. [Medline].

  64. Mayer LE, Walsh BT. The use of selective serotonin reuptake inhibitors in eating disorders. J Clin Psychiatry. 1998;59 Suppl 15:28-34. [Medline].

  65. Milano W, Siano C, Putrella C, Capasso A. Treatment of bulimia nervosa with fluvoxamine: a randomized controlled trial. Adv Ther. May-Jun 2005;22(3):278-83. [Medline].

  66. Leombruni P, Amianto F, Delsedime N, Gramaglia C, Abbate-Daga G, Fassino S. Citalopram versus fluoxetine for the treatment of patients with bulimia nervosa: a single-blind randomized controlled trial. Adv Ther. May-Jun 2006;23(3):481-94. [Medline].

  67. Walsh BT, Sysko R, Parides MK. Early response to desipramine among women with bulimia nervosa. Int J Eat Disord. Jan 2006;39(1):72-5. [Medline]. [Full Text].

  68. Bacaltchuk J, Hay P. Antidepressants versus placebo for people with bulimia nervosa. Cochrane Database Syst Rev. 2003;CD003391. [Medline].

  69. McElroy SL, Arnold LM, Shapira NA, et al. Topiramate in the treatment of binge eating disorder associated with obesity: a randomized, placebo-controlled trial. Am J Psychiatry. Feb 2003;160(2):255-61. [Medline].

  70. Arbaizar, B, Gomez-Acebo, I, Llorca, J. Efficacy of Topiramate in bulimia nervosa an binge-eating disorder: a systematic review. General Hospital Psychiatry. 2008;30:471-475.

  71. Hsu LK, Clement L, Santhouse R, Ju ES. Treatment of bulimia nervosa with lithium carbonate. A controlled study. J Nerv Ment Dis. Jun 1991;179(6):351-5. [Medline].

  72. Faris PL, Kim SW, Meller WH, et al. Effect of decreasing afferent vagal activity with ondansetron on symptoms of bulimia nervosa: a randomised, double-blind trial. Lancet. Mar 4 2000;355(9206):792-7. [Medline].

  73. Broft AI, Spanos A, Corwin RL, et al. Baclofen for binge eating: an open-label trial. Int J Eat Disord. Dec 2007;40(8):687-91. [Medline]. [Full Text].

  74. Naessen S, Carlstrom K, Bystrom B, Pierre Y, Hirschberg AL. Effects of an antiandrogenic oral contraceptive on appetite and eating behavior in bulimic women. Psychoneuroendocrinology. Jun 2007;32(5):548-54. [Medline].

  75. Psychotherapy for bulimia nervosa and binging, Volume 1 [database online]. The Cochrane Database of Systematic Reviews: The Cochrane Library, The Cochrane Collaboration; 1998. Updated 2005.

  76. Antidepressants versus psychological treatments and their combination for bulimia nervosa [database online]. The Cochrane Database of Systematic Reviews: The Cochrane Library, The Cochrane Collaboration; 1997. Updated 2005.

  77. Jacobi C, Morris L, Beckers C, et al. Maintenance of internet-based prevention: a randomized controlled trial. Int J Eat Disord. Mar 2007;40(2):114-9. [Medline].

  78. Ljotsson B, Lundin C, Mitsell K, Carlbring P, Ramklint M, Ghaderi A. Remote treatment of bulimia nervosa and binge eating disorder: a randomized trial of Internet-assisted cognitive behavioural therapy. Behav Res Ther. Apr 2007;45(4):649-61. [Medline]. [Full Text].

  79. Robinson S, Perkins S, Bauer S, Hammond N, Treasure J, Schmidt U. Aftercare intervention through text messaging in the treatment of bulimia nervosa--feasibility pilot. Int J Eat Disord. Dec 2006;39(8):633-8. [Medline]. [Full Text].

  80. Adson DE, Mitchell JE, Trenkner SW. The superior mesenteric artery syndrome and acute gastric dilatation in eating disorders: a report of two cases and a review of the literature. Int J Eat Disord. Mar 1997;21(2):103-14. [Medline].

  81. DeBate RD, Shuman D, Tedesco LA. Eating disorders in the oral health curriculum. J Dent Educ. May 2007;71(5):655-63. [Medline]. [Full Text].

  82. Haines, J, Neumark=Sztainer, D, Perry, CL, et al. V.I.K. (Very Important Kids): a school based program designed to reduce teasing and unhealthy weight-control behaviors. Health Education Research-Theory and Practic. 2006;21(6):884-895.

  83. Fichter MM, Quadflieg N. Long-term stability of eating disorder diagnoses. Int J Eat Disord. Nov 2007;40 Suppl:S61-6. [Medline]. [Full Text].

  84. Fichter, MM, Quadflieg, N, Hedlund, S. Long Term Course of Binge Eating Disorder and Bulimia Nervosa: Relevance for Nosology and Diagnostic Criteria. Int J Eat Disorders. 2008;41:577-586.

  85. Arikian, A, Keel, PK, Miler, KG. Parental Psychopathology as a Predictor of Long-Term Outcome in Bulimia Nervosa Patients. Eating Disorders. 2008;16:30-39.

  86. Von Holle, A, Pinheiro, AP, Thornton, LM, et al. Temporal Patterns of Recovery across Eating Disorder subtypes. Australia and New Zealand Journal of Psychiatry. 2008;42:108-117.

  87. Grilo CM, Pagano ME, Skodol AE, et al. Natural course of bulimia nervosa and of eating disorder not otherwise specified: 5-year prospective study of remissions, relapses, and the effects of personality disorder psychopathology. J Clin Psychiatry. May 2007;68(5):738-46. [Medline]. [Full Text].

  88. Björck C, Clinton D, Sohlberg S, Norring C. Negative self-image and outcome in eating disorders: results at 3-year follow-up. Eat Behav. Aug 2007;8(3):398-406. [Medline].

  89. Fosse GK, Holen A. Childhood maltreatment in adult female psychiatric outpatients with eating disorders. Eat Behav. Nov 2006;7(4):404-9. [Medline].

  90. Micali N, Holliday J, Karwautz A, et al. Childhood eating and weight in eating disorders: a multi-centre European study of affected women and their unaffected sisters. Psychother Psychosom. 2007;76(4):234-41. [Medline].

  91. Fernandez-Aranda F, Krug I, Granero R, et al. Individual and family eating patterns during childhood and early adolescence: an analysis of associated eating disorder factors. Appetite. Sep 2007;49(2):476-85. [Medline].

  92. Mikami AY, Hinshaw SP, Patterson KA, Lee JC. Eating pathology among adolescent girls with attention-deficit/hyperactivity disorder. J Abnorm Psychol. Feb 2008;117(1):225-35. [Medline].

  93. Eddy KT, Dorer DJ, Franko DL, Tahilani K, Thompson-Brenner H, Herzog DB. Should bulimia nervosa be subtyped by history of anorexia nervosa? A longitudinal validation. Int J Eat Disord. Nov 2007;40 Suppl:S67-71. [Medline]. [Full Text].

  94. Woodside BD, Staab R. Management of psychiatric comorbidity in anorexia nervosa and bulimia nervosa. CNS Drugs. 2006;20(8):655-63. [Medline].

  95. Goebel-Fabbri, AE, Fikkan, J, Franko, DL, et al. Insulin Restriction and Associated Morbidity and Mortality in Women with Type 1 Diabetes. Diabetes Care. 2008;31:415-419.

  96. Micali N, Treasure J, Simonoff E. Eating disorders symptoms in pregnancy: a longitudinal study of women with recent and past eating disorders and obesity. J Psychosom Res. Sep 2007;63(3):297-303. [Medline].

  97. [Best Evidence] Micali N, Simonoff E, Treasure J. Risk of major adverse perinatal outcomes in women with eating disorders. Br J Psychiatry. Mar 2007;190:255-9. [Medline]. [Full Text].

  98. Marsden P, Karagianni E, Morgan JF. Spirituality and clinical care in eating disorders: a qualitative study. Int J Eat Disord. Jan 2007;40(1):7-12. [Medline]. [Full Text].

  99. Graap H, Bleich S, Herbst F, Trostmann Y, Wancata J, de Zwaan M. The needs of carers of patients with anorexia and bulimia nervosa. Eur Eat Disord Rev. Jan 2008;16(1):21-9. [Medline]. [Full Text].

  100. Button E, Aldridge S. Season of birth and eating disorders: patterns across diagnoses in a specialized eating disorders service. Int J Eat Disord. Jul 2007;40(5):468-71. [Medline].

  101. Lehoux PM, Howe N. Perceived non-shared environment, personality traits, family factors and developmental experiences in bulimia nervosa. Br J Clin Psychol. Mar 2007;46:47-66. [Medline].

  102. Morgan JF, Lacey JH. Season of birth and bulimia nervosa. Int J Eat Disord. May 2000;27(4):452-8. [Medline]. [Full Text].

  103. Wolcott, RB, Yager, J, Gordon, G. Dental sequelae to the binge-purge syndrome (bulimia): report of cases. JADA. 1984;109:723-725.

 
Previous
Next
 
Parotid hypertrophy. Reprinted with permission from Mandel, L and Siamak, A. Diagnosing bulimia nervosa with parotid gland swelling. J Am Dent Assoc 2004, Vol 135, No 5, 613-616.
Dental caries. Reprinted with permission from Wolcott, RB, Yager, J, Gordon, G. Dental sequelae to the binge-purge syndrome (bulimia): report of cases. JADA. 1984; 109:723-725.
Russell sign. Reprinted with permission from Glorio R, et al. Prevalence of cutaneous manifestations in 200 patients with eating disorders. Int J Derm, 2000, 39(5), 348-353.
This chest radiograph demonstrates pneumomediastinum, which can occur in association with esophageal rupture from forceful vomiting.
Water-soluble contrast esophagram from a patient with esophageal perforation after esophageal dilation shows contrast leak (arrowheads) and normal esophageal lumen (arrows).
Mallory-Weiss tear. Typical longitudinal mucosal tear with overlying fibrinous exudate extending from the distal esophagus to the gastric cardia. Courtesy of C.J. Gostout, MD.
Table. Self-Help Books and Internet Resources on Eating Disorders
CBT-oriented workbooksAgras WS, Apple RF: Overcoming Eating Disorders: A Cognitive-Behavioral Treatment for Bulimia Nervosa and Binge-Eating Disorder. New York, Oxford University Press, 1997 (client workbook)
Agras WS, Apple RF: Overcoming Eating Disorders: A Cognitive-Behavioral Treatment for Bulimia Nervosa and Binge-Eating Disorder. New York, Oxford University Press, 1997 (therapist workbook)
Cash TF: The Body Image Workbook: An 8-Step Program for Learning to Like Your Looks. Oakland, CA, New Harbinger, 1997
Fairburn C: Overcoming Binge Eating. New York, Guilford, 1995
Goodman LJ, Villapiano M: Eating Disorders:The Journey to Recovery Workbook. New York, Brunner-Routledge, 2001 (client workbook)
Goodman LJ, Villapiano M: Eating Disorders: Time for Change. Plans, Strategies, and Worksheets. New York, Brunner-Routledge, 2001 (therapist workbook)
Schmidt U, Treasure J: Getting Better Bit(e) by Bit(e): A Survival Kit for Sufferers of Bulimia Nervosa and Binge Eating Disorder. East Sussex, UK, Psychology Press, 1993
Other books reported to be helpful by patients/familiesBulik CM, Taylor N: Runaway Eating: The 8-Point Plan to Conquer Adult Food and Weight Obsessions. New York, Rodale Books, 2005
Ellis A, Abrams M, Dengelegi L: The Art and Science of Rational Eating. Fort Lee, NJ, Barricade Books, 1992
Goodman LJ, Villapiano M: Eating Disorders: The Journey to Recovery Workbook. New York, Brunner-Routledge, 2001 (client workbook)
Hall L: Full Lives: Women Who Have Freed Themselves From Food and Weight Obsessions. Carlsbad, CA, Gürze Books, 1993
Lock J, le Grange D: Help Your Teenager Beat an Eating Disorder. New York, Guilford, 2005
Michel DM, Willard SG: When Dieting Becomes Dangerous. New Haven, CT, Yale University Press, 2003
Walsh BT, Cameron VL: If Your Child Has an Eating Disorder: An Essential Resource for Parents. New York, Guilford, 2005
Zerbe K: The Body Betrayed: A Deeper Understanding of Women, Eating Disorders, and Treatment. Carlsbad, CA, Gürze Books, 1995
Books reported to be helpful for male patientsAndersen AE, Cohn L, Holbrook T: Making Weight: Men's Conflicts With Food, Weight, Shape and Appearance. Carlsbad, CA, Gürze Books, 2000
Internet resources for health care professionalsAcademy for Eating Disorders (http://www.aedweb.org)
Internet resources for patients, families, and professionalsNational Eating Disorders Association (http://www.nationaleatingdisorders.org)National Association of Anorexia Nervosa and Associated Disorders (http://www.anad.org/site/anadweb/)
Eating Disorder Referral and Information Center (http://www.edreferral.com)
Something Fishy (http://www.something-fishy.org; a well-monitored advocacy site)
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.