Clinical features

• Physical: bouts of eating vast quantities of food (bingeing) occur in response to an uncontrollable psychological urge. Self-induced vomiting often follows such episodes. Patients may have abrasions on the back of the hands where they have caught themselves on the teeth trying to induce vomiting. Between binges, most patients follow strict diets and may also abuse purgatives or take excessive exercise, so managing to keep their weight within the normal range.

• Mental: preoccupation with food and weight dominates patients' lives, but unlike many with AN, bulimic patients show good insight into their abnormal attitudes and behaviour. Depressive symptoms are common. Some patients abuse alcohol and a subgroup shows impulsive behaviour affecting many aspects of life.

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