A young lady of twenty-eight, came to the psychiatric outpatient department with an irresistible urge to overeat followed by feelings of guilt and self-induced vomiting. She also uses laxatives to compensate for overeating. She wants to know if this is a normal pattern of behaviour or an illness?   How will you respond to her?  What is the likely diagnosis?  Outline management steps for this patient according to the NICE stepped-care approach.     It is likely you are suffering from an eating disorder, in which people repeatedly experience an irresistible urge to eat an enormous amount of food in a brief time. The associated feelings of guilt and efforts to counteract the resultant We would like to carry out a detailed assessment to confirm the diagnosis. But that you are cannot control the episodes implies that the behaviour may not be normal.   Diagnosis  Bulimia nervosa   If there was evidence of BMI being lower than 17.5, or recent severe weight loss, we would diagnose anorexia ner