Snapshot A 24-year-old woman visits her gynecologist for an annual visit. She has no physical complaints. Her BMI is 24 kg/m2. On exam it is noted that she has enlarged parotid glands and poor dentition. Upon further questioning, she admits that she binges on junk food once or twice a week. She admits to taking laxatives or vomiting after binging and feels terrible about what she has done. Introduction Clinical definition frequent binge eating with or without purging purging commonly performed by self-induced vomiting resulting in metabolic alkalosis, urinary chloride < 20mEq, and volume depletion may abuse laxatives/diuretics may exercise excessively patients are disturbed by their behavior Epidemiology more common in females onset typically in early adulthood Associated conditions obsessive-compulsive disorder mood disorders Presentation Physical exam weight often normal or slightly above ideal body weight parotid gland enlargement "chipmunk cheeks" dental cavities Russell's sign dorsal hand calluses from inducing vomiting Laboratory findings hypochloremic, hypokalemic metabolic alkalosis results from hydrogen and chloride ion losses in vomitus activation of RAAS results in further losses of potassium and hydrogen ions Treatment Psychotherapy behavior therapy more easily engaged in therapy than anorexics Pharmacologic SSRIs Prognosis, Prevention, Complications Complications may require hospitalization if severe electrolyte disturbances develop alkalosis and hypokalemia avoid bupropion associated with lowered seizure threshold