Patients with bulimia nervosa tend to be more aware of and remorseful or guilty about their behavior than those with anorexia nervosa and are more likely to admit their concerns when questioned by a sympathetic physician. They also appear less introverted and more prone to impulsive behavior, drug and alcohol abuse, and overt depression. Diagnosis Bulimia nervosa may be suspected in patients who express marked concern about weight gain and have wide fluctuations in weight, especially if there is evidence of excessive laxative use or unexplained hypokalemia. However, the diagnosis depends on the patient's description of binge-purge behavior. Typically, a binge involves rapid consumption of food, especially high-calorie foods, such as ice cream and pastries.
Binges vary in amount of food consumed, sometimes involving thousands of calories.
They tend to be episodic, are often triggered by psychosocial stress, may occur as often as several times a day, and are done in secret. Although bulimic patients express concern about becoming obese and some are obese, most tend to fluctuate around a normal body weight. Antidepressants help, even in the absence of depression, but psychotherapy has better long-term results. There is some evidence that the combination of cognitive-behavioral therapy and antidepressants is superior to either modality alone. Because treatment requires expertise and experience, referral to a specialist is desirable.