Patients with bulimia nervosa typically consume large quantities of easily ingested high-calorie foods, usually in secrecy. Some patients may have several such episodes a day over multiple days; others report regular and persistent patterns of binge eating. Binging is usually followed by vomiting, cathartics, or diuretics and accompanied by feelings of guilt or depression. Periods of binging may be followed by intervals of self-imposed starvation. Body weight may fluctuate but generally is within 20% of normal BMI.
Family and psychological conditions are generally similar to those of patients with anorexia nervosa. Patients with bulimia, however, have a higher incidence of obesity, greater use of cathartics and diuretics, and more impulsive or antisocial behavior. Menstruation is usually preserved.
Medical complications are numerous. Gastric dilatation and pancreatitis have been reported after binges. Vomiting can result in poor dentition, pharyngitis, esophagitis, aspiration, and electrolyte abnormalities. Cathartic and diuretic abuse can also cause electrolyte abnormalities or dehydration. Constipation is common.