A physician who suspects bulimia looks for signs and symptoms established by the American Psychiatric Association:

• Recurrent episodes of binge eating

• A feeling of a lack of control over eating behavior during the binges

• Regular self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise in order to prevent weight gain

• A minimum average of two binge eating episodes a week for at least three months

• Persistent excessive concern with body shape and weight