Differential Diagnosis
The DSM-IV diagnostic criteria for bulimia are listed in

Table 26-3.

If the patient also satisfies the diagnostic criteria for schizophrenia or anorexia nervosa, that should be the diagnosis. Severe weight loss does not occur in bulimia, and amenorrhea is unusual.

In diagnosing bulimia, it is necessary to rule out neurological disease, such as epileptic-equivalent seizures, central nervous system tumors, Kluver-Bucy-like syndromes, and Kleine-Levin syndrome. Kluver-Bucy syndrome includes visual agnosia, compulsive licking and biting, exploration of objects by mouth, inability to ignore any stimulus, placidity, hypersexuality, and hyperphagia. This syndrome is very rare and unlikely to present a problem in differential diagnosis. Kleine-Levin syndrome occurs chiefly in males and is characterized by hyperphagia and periods of hypersomnia lasting 2-3 weeks.

Prognosis
Bulimia nervosa is often a chronic illness characterized by multiple periods of relapse and remission. Many patients show significant improvement following brief psychotherapy and/or the administration of medication, and recovery rates (up to 85% in some series) definitely improve over time. Although outcome studies vary in their definition of recovery, and many more studies are needed, both patients and clinicians should be very encouraged by currently available data.