The diagnosis of bulimia nervosa is made on the ia basis of a physical examination, a psychiatric assess- n ment, the patient's eating history, and the findings of lab- v oratory studies. Patients who do not meet the full criteria S for bulimia nervosa may be given the diagnosis of sub-syndromal bulimia or of eating disorder not otherwise specified (EDNOS).
Patients suspected of having bulimia nervosa should be given a complete physical examination because the disorder has so many potential medical complications. In addition, most bulimics are close to normal weight or only slightly overweight, and so do not look outwardly different from most people of their sex in their age group. The examination should include not only vital signs and an assessment of the patient's height and weight relative to age, but also checking for such signs of bulimia as general hair loss, abdominal soreness, swelling of the parotid glands, telltale scars on the back of the hand, petechiae, edema, and teeth that look ragged or "moth-eaten."
Psychiatric assessment of patients with bulimia usually includes four components:
• A thorough history of body weight, eating patterns, diets, typical daily food intake, methods of purging (if used), and concept of ideal weight.
• A history of the patient's significant relationships with parents, siblings, and peers, including present or past physical, emotional, or sexual abuse.
• A history of previous psychiatric treatment (if any) and assessment of comorbid (occurring at the same time as the bulimia) mood, anxiety, substance abuse, or personality disorders.
• Administration of standardized instruments that measure attitudes toward eating, body size, and weight. Common tests for eating disorders include the Eating Disorder Examination; the Eating Disorder Inventory; the Eating Attitude Test, or EAT; and the Kids Eating Disorder Survey.
Laboratory tests ordered for patients suspected of having bulimia usually include a complete blood cell count, blood serum chemistry, thyroid tests, and urinaly-sis. If necessary, the doctor may also order a chest x ray and an electrocardiogram (EKG). Typical findings in
5 patients with bulimia include low levels of chloride and
> potassium in the blood, and higher than normal levels of c amylase, a digestive enzyme found in saliva. .2
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