Physical features

There are few physical abnormalities in bulimia nervosa.(2,24) Body weight is unremarkable in the majority of patients and thus features of starvation are rarely seen. Nevertheless, menstrual abnormalities or amenorrhoea are present in about a quarter of patients. These are likely to be secondary to the disturbed eating since they generally respond to the successful correction of the eating disorder. On laboratory testing endocrine abnormalities are sometimes encountered and these tend to be mild versions of those found in anorexia nervosa.

Frequent purging, and especially the combination of vomiting and laxative misuse, results in fluid and electrolyte abnormalities in some patients. These abnormalities are varied in nature but most often consist of some combination of hypokalaemia, hyponatraemia, and hypochloraemia. The patients appear to accommodate to these abnormalities since medically serious complications (e.g. cardiac arrhythmias) are much less common than might otherwise be expected given the laboratory findings. Some patients experience intermittent oedema, particularly if there is a sudden decrease in the extent of their purging.

Localized physical abnormalities include erosion of the dental enamel (especially from the lingual surfaces of the front teeth) among those who have vomited for many years, traumatic calluses on the knuckles of the hand of those who use their fingers to induce the gag reflex (Russell's sign), and enlargement of the salivary glands, especially the parotids, probably as a result of chronic inflammation. A small proportion of patients have raised serum amylase levels usually due to an increase in the salivary isoenzyme.

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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