Clinicians who deal with patients with anorexia nervosa are well acquainted with their patients' inability to recognise their emaciation. The patients' insistence that they are normal weight or even overweight, against clear evidence to the contrary, led Bruch (1962) to state that the misperception reaches “delusional proportions”. Studies of body size perception in anorexia nervosa that have used the ‘body part’ method have invariably found that the patients overestimate their body size (Slade & Russell, 1973; Crisp & Kalucy, 1974; Pierloot & Houben, 1978; Garner et al, 1976; Button et al, 1977; Fries, 1977; Casper et al, 1979) but the majority have not found any significant difference in size estimation between patients and controls (Slade, 1985).

Body size estimation was studied in 22 patients with bulimia and 20 normal controls. Two methods of body size estimation were used, a distorting television image method (DTIM) and the image marking method (IMM). The subjects estimated body size of a dummy as well as their own body on the DTIM. When estimating body size on the DTIM the bulimics overestimated and the controls underestimated, there being a significant difference between the two groups. There was no difference between the groups when estimating the size of the dummy. On the IMM a significant difference was found between the bulimic and control groups, the bulimics overestimating body size and the controls being more accurate. Marked directional effects were found with the DTIM. The two methods of body size estimation are compared.

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The case histories of five men who met DSM-III criteria for bulimia and details of their physical characteristics are given. Various eating disorder questionnaires were administered and the results indicated that most of these instruments would not have identified the men as suffering from an eating disorder. The necessity of caution in asserting the prevalence of bulimia using these measures is emphasised.