Summary
Definition
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
- history 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
- history of sexual abuse
- impulsivity
- family history of alcoholism
- family history 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 CK
- CBC
- U/A
Investigations to consider
- ECG
- serum ferritin
- serum B12
- serum RBC folate
- DEXA scan for bone density
Treatment algorithm
Contributors
Authors
Associate Professor
Co-Director of Stanford Eating and Weight Disorders Program
Stanford University School of Medicine
Department of Psychiatry & Behavioral Sciences
Stanford
CA
Disclosures
DLS receives royalties from Guilford Press as a co-author on two books about evidence-based adaptations of dialectical behavior 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 reviewers
Chair of Psychiatry
McGill University
Quebec
Canada
Disclosures
MI declares that she has no competing interests.
Professor
Department of Psychiatry
University of New Mexico School of Medicine
Albuquerque
NM
Disclosures
JY is an author of a reference cited in this topic.
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