Bulimia nervosa occurs in about 1% of young women in Western countries. It is often chronic and adversely affects quality of life.1 The rate of diagnosis is very low, and community and primary care studies have shown that treatment is often delayed.2 3 An important contributing factor to this delay is the secrecy and shame around binge eating, self induced vomiting, and laxative misuse.4

Bulimia nervosa should be suspected in young and middle aged women who present with weight and shape concerns (whether they are normal or overweight)3 or with common comorbid conditions such as depression, anxiety, or substance …