2.b. Bulimia Nervosa

Question 1

Bulimia nervosa

Answer 1

Uncontrollable binging followed by extreme weight loss behaviours like purging or excessive exercise

Question 2

DSM-5 Criteria

Answer 2

A. Recurrent episodes of binge eating
- Eating a huge amount of food in too short a time
- Lack of control over what/how much you’re eating

B. Recurrent inappropriate compensatory behaviours e.g. vomiting, laxatives, medication, excessive exercise

C. Once a week for 3+ months

D. Self-evaluation unduly influenced by body shape

E. Disturbance doesn’t only occur during episodes of anorexia

Question 3

Anorexia to bulimia

Answer 3

Weight gain

Question 4

Stages

Answer 4

1. Begins with restrictive behaviour
   
   1. Typically eating low calorie foods & restricting intake
2. Begin eating ‘forbidden’ foods in huge quantities & purging/engaging in other extreme weight loss activities

Question 5

Dangers

Answer 5

• Purging
  
  • Electrolyte imbalances
  • Low potassium
• Heart abnormalities
  
  • Low potassium
• Ipecac syrup
  
  • Damage to heart muscle
• Tears to the throat
  
  • Sticking toothbrush down throat to induce vomiting
• Damage to teeth
  
  • Stomach acid
• Mouth ulcers & cavities
• Blood vessels bursting in eyes due to pressure caused by throwing up
• Swollen salivary glands

Question 6

Mortality

Answer 6

2x higher than general population

Question 7

Prevalence

Answer 7

2% of population
Most common

Question 8

Comorbidity

Answer 8

OCD & erratic disorders
Substance use
<1/3 self-harm
Depression

Question 9

Genetic causes

Answer 9

• Genes on chromosome 10
  
  • May be linked to bulimia nervosa
  • Not widely replicated study

Question 10

Brain abnormalities

Answer 10

• Damage to frontal & temporal cortex
  
  • Temporal cortex - body image
  • Frontal cortex - monitoring pleasantness of stimuli e.g. smell & taste
• Lateral hypothalamus
  food intake regulation
  Info. from amygdala (emotional regulation)
  Environmental cues leading to overeating & suppressing eating in response to fear

Mostly for anorexia, sometimes bulimia

Question 11

Set points

Answer 11

• Innate ‘set point’ of weight which our bodies try to ‘defend’
• Our body uses feelings of hunger to regulate this
• Could explain binging due to intense hunger

Question 12

Serotonin

Answer 12

Managing appetite & feeding behaviours

Mostly for anorexia

Question 13

General causes

Answer 13

Family influences
Gender
Internalization of thin ideal
Negative body image
Negative emotionality
Childhood sexual abuse

Question 14

Perfectionism

Answer 14

Rigid adherence to binging/purging cycle

Question 15

Dieting

Answer 15

Dieting led to body dissatisfaction & bulimia after 1 year

Almost all EDs start with ‘normal’ dieting
- Negative body image when the diet fails
- Could be people who diet are already struggling with body image & weight

Question 16

Medication

Answer 16

Antidepressants
many patients also have mood disorders so they thought this might work

• Positive response, unlike anorexia
• Not showing early improvement means it probably won’t work for you
• Decrease in frequency of binges & improving preoccupation with shape and weight

Question 17

CBT

Answer 17

Best treatment (better results than medication & interpersonal therapy)

• Behavioural component
  
  • Focuses on normalizing eating patterns e.g. meal planning, eduction on nutrition, teaching people to eat small amounts of food regularly
  • Challenges the notion of good and bad food
• Reduces severity of symptoms
• Rarely ends with full recovery from disorder
• Treatments for borderline personality disorder are being tried out

Question 18

Treatment success

Answer 18

Around 70%
More people seem to recover from bulimia than anorexia