Bulimia nervosa

This disorder shares many psychological features with anorexia nervosa, including the overconcern with body shape and weight. The main feature is a binge-purge cycle which repeats itself. There is often, but not always, a history of anorexia nervosa. Patients tend to have comorbid depression.

• Disturbances of body electrolytes and physical complications
• History of an earlier episode of anorexia nervosa

Weight and measure the patient and carry out a full physical examination.

Inquire about Anorexia nervosa in the Past Psychiatric History

• An excessive preoccupation with the control of body weight

'What do you think of your weight / ‘body image’ at the moment?'

'How important is body image to you?’

‘How often do you think about your weight / ‘body image’?’

‘If you gained some weight how would you feel about that?’

'What is your target weight / ‘body image’?'

• Repeated bouts of overeating

'Do you ever eat alot more than you normally would short space of time? How often does this happen?'

'Have you ever felt that your eating was out of control?'

• Pattern of overeating (binge) followed by vomiting or use of purgatives (purge)

'How does this make you feel? What do you do afterwards'

'Have you ever used excessive exercise, induced vomiting appetite suppressants or diuretics to bring down your weight?'