Last reviewed: June 2018
Last updated: November  2017



History and exam

Key diagnostic factors

  • recurrent episodes of binge eating
  • recurrent inappropriate compensatory behavior
  • 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 sign
  • arrhythmia

Other diagnostic factors

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

Risk factors

  • female gender
  • personality disorder
  • body image dissatisfaction
  • hx of sexual abuse
  • impulsivity
  • FHx alcoholism
  • FHx depression
  • FHx eating disorder
  • childhood overweight or obesity
  • exposure to media pressure
  • early onset of puberty
  • urbanization
  • FHx obesity

Diagnostic investigations

1st investigations to order

  • serum electrolytes
  • serum creatinine
  • serum magnesium
  • urine pregnancy test
  • serum LFTs
  • serum CK
  • CBC
  • U/A
Full details

Investigations to consider

  • ECG
  • serum ferritin
  • serum B12
  • serum RBC folate
  • DEXA scan for bone density
Full details

Treatment algorithm


Authors VIEW ALL

Associate Professor

Co-Director of Stanford Eating and Weight Disorders Program

Stanford University School of Medicine

Department of Psychiatry & Behavioral Sciences




DLS declares that she has no competing interests.

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

Peer reviewers VIEW 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 monograph.

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