An adolescent girl with low BMI, lanugo hair, parotid enlargement, and dental erosion is found to have hypokalemic metabolic alkalosis. She denies food restriction. Which eating disorder is MOST consistent with these findings?

• A Anorexia nervosa, restrictive type
• B Binge-eating disorder without compensatory behavior
• C Bulimia nervosa with regular purging behavior ✓
• D Avoidant/restrictive food intake disorder (ARFID)

Explanation

The combination of parotid enlargement (sialadenosis from repeated vomiting), dental erosion from stomach acid (perimolysis), hypokalemic metabolic alkalosis (HCl loss from vomiting), and lanugo hair is characteristic of bulimia nervosa with purging. Patients often have normal or near-normal weight (unlike anorexia). Parotid and submandibular gland hypertrophy is pathognomonic for repeated vomiting. Anorexia nervosa restrictive type lacks vomiting-related findings. Binge-eating disorder has no compensatory behaviors (purging/restriction). ARFID lacks the weight/compensatory behavior pattern.

Reference: Ghai Essential Pediatrics, 10th ed.

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