Case history
Case history #1
A 30-year-old woman presents with marked weight fluctuations. She says that her weight has changed by 3 kg over a few days, unrelated to menstruation. Physical exam is normal except for bilateral parotid hypertrophy.
Case history #2
A 25-year-old woman complains that she is obsessed with eating and weight. She has tried unsuccessfully to lose weight. She becomes so hungry that she overeats to the point of regurgitating.
Other presentations
Bulimia nervosa usually begins as an attempt at weight control. It soon becomes a compulsion that the patient considers shameful and a sign of weakness. Most commonly it presents as binge eating and purging, with marked weight fluctuation. It is associated with depression and low self-esteem. Hypokalemia or parotid hypertrophy may be found, especially with greater frequency of vomiting. Less common presentations are self-injurious behavior, shoplifting, suicidality, vomiting in pregnancy, refractory poor control of diabetes mellitus, rupture of the esophagus, or pancreatitis.
Men with bulimia nervosa may be more weight- and shape-conscious, and these patients tend to focus on muscle gain and fat loss. The research on men with bulimia nervosa is poor due to the condition not being as common in men, and because they are often excluded from research trials to reduce the number of confounding factors.[5][6][7][8]
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