Last reviewed: 16 Dec 2020
Last updated: 01 Apr 2020



History and exam

Key diagnostic factors

  • presence of risk factors
  • recurrent episodes of binge eating
  • recurrent inappropriate compensatory behaviour
  • eating disturbance not exclusively during periods of anorexia nervosa
  • depression and low self-esteem
  • concern about weight and body shape
  • dental erosion
  • parotid hypertrophy
  • Russell's sign
  • arrhythmia

Other diagnostic factors

  • age 20 to 35 years
  • menstrual irregularity
  • drug-seeking behaviour
  • deliberate misuse of insulin
  • self-injurious behaviour
  • GI symptoms
  • history of dieting
  • marked fluctuations in weight
  • shoplifting behaviour
  • use of ipecac
  • needle marks on skin
  • vomiting in pregnancy

Risk factors

  • female sex
  • personality disorder
  • body-image dissatisfaction
  • history of sexual abuse
  • impulsivity
  • family┬áhistory of alcoholism
  • family history of depression
  • family history of eating disorder
  • childhood overweight or obesity
  • exposure to media pressure
  • early onset of puberty
  • urbanisation
  • family history of obesity

Diagnostic investigations

1st investigations to order

  • serum electrolytes
  • serum creatinine
  • serum magnesium
  • urine pregnancy test
  • serum LFTs
  • serum creatine kinase
  • FBC
  • urinalysis
More 1st investigations to order

Investigations to consider

  • ECG
  • serum ferritin
  • serum B12
  • serum RBC folate
  • DEXA scan for bone density
More investigations to consider

Treatment algorithm


Associate Professor

Co-Director of Stanford Eating and Weight Disorders Program

Stanford University School of Medicine

Department of Psychiatry & Behavioral Sciences




DLS receives royalties from Guilford Press as a co-author on two books about evidence-based adaptations of dialectical behaviour therapy for binge eating/bulimia.

Dr Debra L. Safer would like to gratefully acknowledge Dr David C.W. Lau and Dr C. Laird Birmingham, the previous contributors to this topic. DCWL declares that he has no competing interests. CLB is an author of several references cited in this topic.

Peer reviewersVIEW ALL

Chair of Psychiatry

McGill University




MI declares that she has no competing interests.


Department of Psychiatry

University of New Mexico School of Medicine




JY is an author of a reference cited in this topic.

Use of this content is subject to our disclaimer