Metabolic and endocrine indices of starvation in bulimia: a comparison with anorexia nervosa.

Fifteen patients with bulimia (DSM-III) and 22 patients with anorexia nervosa (10 "restricters" and 12 "vomiters") were compared with 24 age- and sex-matched healthy controls. Serial blood samples were collected between 8:30 and 9:30 a.m. with patients in supine and standing positions. Elevated blood values of beta-hydroxybutyric acid and free fatty acids were observed in the majority of patients with bulimia and anorexia nervosa. These data indicate that many patients with bulimia showed the metabolic signs of starvation at the time of the study, a finding supported by the symptoms of endocrine adaptation to starvation, namely low triiodothyronine and a decreased noradrenaline response to an orthostatic test in many of these patients.