Bulimia Nervosa

Key points

• Bulimia: recurrent binge eating + compensatory behaviours (self-induced vomiting, laxatives, excessive exercise) ≥ once weekly for 3 months.
• Weight is usually normal; key sign: Russell's sign (calluses on knuckles), parotid swelling, dental erosion.
• Complications: hypokalaemia (arrhythmia risk), oesophageal tears, aspiration.
• Management: guided self-help first-line (NICE); CBT (bulimia-focused) next.
• Fluoxetine (high dose) is licensed and effective as adjunct.