The syndrome of bulimia nervosa has been associated with a high rate of comorbidity with other psychiatric disorders. In particular, high rates of affective disorders, chemical dependency problems, anxiety disorders, and personality disorders have been described among these patients and, in some studies, among their relatives. The reasons for this elevated comorbidity remain unclear. It is frequently difficult to tell which condition develops first. Bulimia nervosa has also been associated with significant medical complications. Most patients with bulimia evidence metabolic and endocrine changes suggestive of a state of semistarvation. Fluid and electrolyte abnormalities are common, as are dental complications. Gastrointestinal complications are rare, but can be quite serious. A careful physical assessment is indicated for each bulimic patient.