Last reviewed: 21 Dec 2021
Last updated: 23 Mar 2021



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
  • gastrointestinal symptoms
  • history of dieting
  • marked fluctuations in weight
  • shoplifting behavior
  • 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┬áhistory of depression
  • family history of eating disorder
  • childhood overweight or obesity
  • exposure to media pressure
  • early onset of puberty
  • urbanization
  • family history of obesity

Diagnostic investigations

1st investigations to order

  • serum electrolytes
  • serum creatinine
  • serum magnesium
  • urine pregnancy test
  • serum LFTs
  • serum creatine kinase (CK)
  • CBC
  • urinalysis

Investigations to consider

  • ECG
  • serum ferritin
  • serum B12
  • serum red blood cell folate
  • dual-energy x-ray absorptiometry scan for bone density

Treatment algorithm



Debra L. Safer, MD

Associate Professor

Co-Director of Stanford Eating and Weight Disorders Program

Stanford University School of Medicine

Department of Psychiatry & Behavioral Sciences




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


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 reviewers

Mimi Israel, MD, FRCPC

Chair of Psychiatry

McGill University




MI declares that she has no competing interests.

Joel Yager, MD


Department of Psychiatry

University of New Mexico School of Medicine




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

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