Diagnosis and treatment of bulimia nervosa.

Bulimia nervosa often has an obscure presentation that requires a high level of suspicion by physicians. Awareness of subtle signs and knowledge of important questions to pursue are critical to a physician's ability to diagnose this disorder. Since bulimia nervosa may have several comorbid psychiatric disorders, such as depression, substance abuse, and personality disorders, it is important to refer patients for further evaluation and treatment. The treatment of bulimia nervosa is comprehensive and individualized and may include cognitive-behavioral therapy, group therapy, family therapy, individual psychotherapy, pharmacotherapy, or hospitalization. The comorbid disorders must also be addressed with appropriate treatment such as a drug or alcohol rehabilitation program for substance abusers. Although the prognosis can be variable, the majority of bulimic patients have a serious chronic illness with remissions and exacerbations.