Which of the following is NOT a symptom or consequence commonly associated with bulimia nervosa?

• A. Tooth decay.
• B. Dehydration and electrolyte imbalances.
• C. Russell's sign calluses on the back of the knuckles.
• D. Weight loss to extreme underweight.

Answer: (D)

Bulimia nervosa commonly shows signs tied to purging behaviors and their effects on the body. Repeated self-induced vomiting exposes teeth to stomach acid, leading to dental erosion or decay. Purging also can cause dehydration and electrolyte imbalances. The repeated vomiting and manipulation of the hands often leave a callus or skin irritation on the knuckles, known as Russell’s sign.

Weight status in bulimia is typically normal or slightly above-average, with possible fluctuations. Extreme underweight is not characteristic of bulimia and is more aligned with anorexia nervosa. So the statement describing weight loss to extreme underweight does not fit the pattern of bulimia.