Bulimia is a term that means "binge eating." This behavior has become a common practice among female students in universities and, more recently, in high schools. Not all persons who engage in binge eating require a psychiatric diagnosis. Bulimia can occur in anorexia nervosa; when this happens, the patient, under the DSM-IV-TR system, should have a diagnosis of anorexia nervosa, binge-eating/purging type. Bulimia also can occur in a normal-weight condition associated with psychological symptomatology. In that case, a diagnosis of bulimia nervosa applies (Table 23–7). Normal-weight bingeing and purging patients can fall into two categories: 1) normal-weight bulimic patients who have never had a history of anorexia nervosa and 2) those who have had a history of anorexia nervosa. Unfortunately, the DSM-IV-TR classification system does not separate these two subgroups of bulimic patients. The term bulimia nervosa implies a psychiatric impairment and therefore is a better label than simply bulimia.