Psychiatric assessment

1. Evaluation should include general personality features, characterologic disturbance and attitudes about eating, body size and weight.

2. A complete history of the patient's body weight, eating patterns and attempts at weight loss, including typical daily food intake, methods of purging and perceived ideal weight should be obtained.

3. An investigation of the patient's interpersonal history and functioning, including family dynamics, peer relationships, and present or past physical, sexual or emotional abuse should be completed.

4. An evaluation of medical and psychiatric comorbidity, as well as documentation of previous attempts at treatment should be documented.

B. Physical evaluation should include vital signs and an evaluation of height and weight relative to age. The physician should also look for general hair loss, lanugo, abdominal tenderness, acrocyanosis (cyanosis of the extremities), jaundice, edema, parotid gland tenderness or enlargement, and scars on the dorsum of the hand should be sought.

C. Laboratory tests in patients with bulimia nervosa include a complete blood count with differential, serum chemistry and thyroid profiles, and urine chemistry microscopy testing. A chest radiograph and electrocardiogram may be indicated in some cases.

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