"According to the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV), bulimia nervosa is characterized by recurrent episodes of binge eating followed by 1 or more compensatory behaviors to eliminate the calories (vomiting, laxatives, fasting, etc.) that take place on average a minimum of twice weekly for 3 or more months.5 Patients who do not meet the frequency or length criteria may be diagnosed with DSM-IV eating disorder not otherwise specified. Bulimia nervosa is also delineated into 2 distinct subtypes: purging and nonpurging. With the purging subtype, patients engage in some method to remove the binged food from their bodies. This is most often accomplished by self-induced vomiting but can include the misuse of laxatives, enemas, or diuretics. Nonpurging bulimics use fasting or excessive exercise as the primary compensation for binges but do not regularly purge. Regardless of subtype, bulimic patients have negative self-evaluations, placing inappropriate importance on weight and body image."