Rosh Psychiatry Board Practice Exam

Which physical exam finding in a young woman would suggest bulimia nervosa instead of anorexia nervosa?

1. Low body mass index

2. Thinning hair

3. Dental caries

4. Hypotension

The correct answer is: Dental caries

The presence of dental caries is a significant physical exam finding that suggests bulimia nervosa rather than anorexia nervosa. This connection arises from the behaviors typically associated with bulimia, particularly the episodes of binge eating followed by purging—often through vomiting. The regurgitation of stomach acid can lead to erosion of dental enamel, resulting in an increase in cavities (dental caries). While anorexia nervosa is characterized by severe weight loss and associated physical findings such as low body mass index, thinning hair, and hypotension, these findings do not specifically indicate bulimia nervosa. Instead, the dental health issues stemming from the compensatory behaviors in bulimia provide a more definitive clue to that disorder. Thus, dental caries would be a hallmark physical finding that contrasts with the typical presentation of anorexia nervosa, highlighting the unique pathology associated with bulimia.