As with the approach to treating anorexia nervosa, the Australian clinical practice guidelines for single disorder ED recommend that treatment for bulimia nervosa begins with a comprehensive assessment which includes [870]:
- Enquiry into behaviours; especially binge eating (i.e., uncontrolled episodes of overeating excessive amounts of food), weight control behaviours that may compensate for binge eating (e.g., self-induced vomiting, laxative/diuretic use, restricting food intake, overexercising, use of AOD to control weight).
- Cognitions of weight/shape overvaluation, and preoccupations with body image and/or eating.
The increased risk of medical complications, particularly hypokalaemia, cardiac issues, obesity, Type 2 diabetes, and hypertension, makes physical assessment among those with suspected bulimia nervosa essential [1424]. As with the physical assessment of those with anorexia nervosa, this assessment should include weight, height, pulse rate, blood pressure and BMI. Additional tests should be undertaken to assess for hypokalaemia and dehydration (associated with purging behaviours), cardiac function (e.g., electrocardiogram), glucose levels, and kidney function, as indicated [870, 1424]. If psychological treatment is being provided by a clinician without medical training, the Australian clinical practice guidelines for single disorder ED recommend the inclusion of a GP to assist with assessment and ongoing care [870].