The Diagnosis and Clinical Characteristics of Bulimia

T he DSM-III-R category of bulimia nervosa describes an eating disorder characterized by binge-eating episodes as well as other abnormal eating-related behaviors. The choice of the term bulimia to label this syndrome in the DSM-HI was in a sense unfortunate, since the term bulimia is also used simply to indicate binge eating episodes. However, this syndrome encompasses far more than binge eating episodes. Patients with this disorder usually demonstrate markedly abnormal eating patterns and eat little or no food when they are not binge eating. They also frequently self-induce vomiting or abuse laxatives in an attempt to control their weight. This chapter will begin by discussing and contrasting the diagnostic systems for bulimia and bulimia nervosa that are in widespread clinical use. We will then turn to a discussion of the behavioral characteristics of the bulimic eating pattern, the psychological and family characteristics of this group of patients, and the medical complications and laboratory abnormalities associated with bulimia nervosa.