Bulimia: diagnostic clues.

Bulimia is an eating disorder characterized by the ingestion of large amounts of food, usually followed by self-induced vomiting or laxative abuse. Although sometimes a symptom of obesity or anorexia nervosa, bulimia is often associated with borderline weight and nutritional status and thus may be difficult to detect. Since secrecy and shame accompany this syndrome, patients are reluctant to seek treatment. We present ten diagnostic clues for identifying bulimic patients: (1) preoccupation with weight, (2) gastrointestinal complaints, (3) dental and oropharyngeal changes, (4) salivary gland enlargement, (5) edema and bloating, (6) amenorrhea, (7) dermatologic complaints, (8) substance abuse, (9) laboratory changes, and (10) serious consequences. A case study illustrates the major features of the disorder and its treatment.