Bulimia

Etiology • A compulsive-eating disorder characterized by repeated
episodes of binge eating followed by vomiting or another form of purging, including laxative abuse
• Cause may be biologic (neurometabolic disturbance), psychological (societal pressure for extreme thinness), or combined (biopsychosocial)
• Nearly 1.2 million adolescent and young adult females are affected in the United States; males are considerably less affected. Up to 20% of college-age women are affected.
Clinical Presentation • Oral signs include erosion of teeth, gingivitis, xerostomia,

painless parotid gland enlargement, increased caries rate, thermal hypersensitivity of teeth
• Specific patterns of enamel destruction (perimolysis) are noted along the palatal and occlusal aspects of maxillary teeth, sparing the buccal and labial surfaces.
• Mandibular teeth usually are affected less severely.
Diagnosis • Recognition of oral signs • Coordination of oral signs with other findings including der-
matologic signs: lanugo-like body hair, brittle hair and nails, asteatotic skin, hand or finger calluses (related to self-induced vomiting)
Differential Diagnosis • Diet-induced enamel loss • Chronic gastric reflux disease
Treatment • Combined aggressive medical management, psychotherapy,
behavioral management, food intake management, and nutritional counseling

Prognosis • Fair to good • Mortality (estimates range from 1–15%) is divided equally
between medical complications (electrolyte disturbance, acute renal failure, cardiac complications) and suicide.