Diagnosing bulimia.

It was previously thought that weight fluctuation was the main sign of this binge eating-purging disorder, but there is now a recognized cluster of signs and symptoms. Behavioral indicators include secrecy, substance abuse and "doctor shopping." Systemic findings include a multitude of gastrointestinal complaints, menstrual abnormalities, orofacial problems and "cardiac" symptoms and signs, including electrocardiographic changes. Laboratory studies can also reveal valuable clues to this potentially life-threatening disorder.