Table 3.

Bulimia nervosa.

Bulimia Nervosa
Bulimia Nervosa (BN) is an eating disorder characterized as a cycle of recurrent binge eating and compensatory purging, laxative abuse, diuretic abuse, extra exercising, fasting, or strict dieting. Bulimia nervosa may occur in approximately 3% of adults (mostly female), and reportedly has a higher occurrence rate (as high as 10%) among college-aged females. Bulimia nervosa may be indicated by Russell's sign: calluses and abrasions on the dorsum of the hands caused by repeated contact with the teeth during self-induced vomiting; it is also associated with enamel erosion of the teeth (usually lingual surfaces) and sialadenosis (i.e., enlargement of the salivary glands, commonly the parotid glands). Laboratory abnormalities may include hypokalemia (promoted by hypomagnesemia), hypochloremia, or metabolic alkalosis. Elevated amylase suggests possible vomiting and salivary gland irritation.	Screen for Disordered Eating (SDE) SCOFF: Sick (vomiting), Control (loss of control), One stone (loss of approximately 15 pounds in 3 months), Fat (disturbance in body fat image), and Food (obsession with eating behavior) Eating Disorder Inventory (EDI) Eating Attitudes Test (EAT) Eating Disorders Screen for Primary Care (EDS-PC)	Treatment for bulimia nervosa includes cognitive behavior therapy, possibly in combination with drug treatment. Fluoxetine is an FDA-approved pharmacotherapy for bulimia nervosa; although not FDA-indicated for this use, topiramate and naltrexone may also be efficacious in treating bulimia nervosa.	[40,[45], [46], [47]] [39,41,42,48,49]