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The increased prevalence of bulimia has received great publicity by the news media. Such publicity predisposes individuals to self-diagnosis. A 57-year-old man with a 10-year history of food regurgitation presented to an eating disorder clinic complaining of bulimia, which he had heard discussed on a television talk show. He proved not to have bulimia but a large pharyngoesophageal (Zenker's) diverticulum. The diagnosis of bulimia may be misattributed to various symptoms by patients. The differential diagnosis of chronic regurgitation and vomiting must be considered in such patients.

Bulimia, a recently acknowledged psychiatric diagnosis, has not been reported in the pediatric literature, to the best of our knowledge. This omission is regrettable in light of the confirmed frequency of disease onset during adolescence. We report clinical and demographic data from the first eight bulimic adolescents seen at an outpatient eating disorders unit. The frequently chronic course and associated physical consequences make diagnosis and early intervention necessary. A relationship between bulimia and depressive illness may exist.

This paper describes the nature of the family involvement typically observed in anorexia nervosa and bulimia and the role of family therapy in a comprehensive treatment approach. Both the patterns of family interaction observed by clinicians and researchers and the varieties of family treatment used to address these disorders are described. The different types of relationships observed between the eating-disordered patient and the family are also described.

A clinical sample of 40 bulimic women demonstrated more social maladjustment than did normal women, alcoholic women, and schizophrenic women on the social adjustment scale both at the time of evaluation and at 1-year follow-up.

The presence of depression was assessed in 82 female outpatients with anorexia nervosa and bulimia by means of a structured interview. The Research Diagnostic Criteria for major depressive disorder were met by 55.6% of the anorexic patients and 23.6% of the bulimic patients. On the Extracted Hamilton Depression Rating Scale, 40.7% of the patients with anorexia and 23.6% of those with bulimia had scores in the moderately or severely depressed range.

In a retrospective study, 22 patients with bulimia were treated with at least one therapeutic trial of antidepressants. Most patients (77%) were clinically depressed before the drug trial. Bingeing frequency decreased in 59% of all cases, and depression improved in 58% of depressed subjects after a 4-week trial of antidepressants, although only 27% of all patients showed both an antibinge and an antidepressant response. Furthermore, during a 3-month follow-up period, several patients relapsed despite continuing medication. At the end of the follow-up period, 23% of subjects continued to show at least a 50% decrease in their bingeing. These data indicate that medication may have separate and possibly unrelated antibinge and antidepressant effects in this patient population.