bulimia

Question 1

define

Answer 1

uncontrollable binge (1500 - 2000 cal w/n 2 hr)
then comp behavior to avoid weight gain (vom, lax, diuretics, excessive exercise
misperception of body shape/weight

Question 2

vs anorexia

Answer 2

more prevalent, older onset, normal weight, not life threatening, out pt tm, better outcomes, decreased mortality, effective meds

Question 3

dx

Answer 3

1/wk for 3 mo
recurrent episodes of binge eating: w/n 2 hr, amount of food larger than what most would eat under similar circumstances, a sense of lack of control of overeating
recurrent inappropriate compensatory behaviors to prevent weight gain: vom, lax, diuretics, meds, fasting, excessive exercise
these behaviors occur at least 1/wk for 3 mo
self eval is unduly influences by body shape and weight
disturbance does not occur exclusively during episodes of AN

Question 4

epidemiology

Answer 4

F, onset later, co morbid mood disorder, anx, SUD (OH)

Question 5

etiology - bio

Answer 5

change in brain may be due to eating dysregulation, genetic and fam predisposition, low serotonin

Question 6

etiology - psychological and cog

Answer 6

anx or low self esteem, impulsive and compulsive, chaotic non nurturing fam, difficult relationships
triggers: stress, poor body self image, food, restrictive dieting, bored

Question 7

etiology - env

Answer 7

thin body ideal, weight based bullying, env stress, phys/sex abuse, trauma

Question 8

clinical course

Answer 8

few outward s, dont appear ill, close to normal weight, binge and purge in secret, tm delayed for years, tm initiated when control of eating is lost, typically complete recovery unless dep or personality disorders
present overwhelmed/committed, social butterflies, difficulty setting limits and est boundaries
enormous rules about food, shame and guilt and disgust about binge and purge
compulsive and impulsive in other areas of life
compulsive and impulsive in other areas of life

Question 9

rf

Answer 9

binge behavior, hx AN, dep s/s, problems with interpersonal relationships, impulsive, increased anx and compulsivity, SUD

Question 10

warning s

Answer 10

food disappear, wrappers and contianers
freq bathroom, signs/smells of vom, wrappers/packages for lax, diuretics
excessive rigid exercise regimen despite weather, fatigue, illness, injury
lifestyle/schedule around binge/purge
withdrawal from others, activities and behaviors involving food, parotid swell (cheeks, jaw, gland), dental caries, tooth erosion, discoloration, teeth stain
russell’s s -> callus/scars on back of hands and knuckles from self induced vom

Question 11

complications

Answer 11

purge: dental erosion, seizures, fatigue, weak, mild organic mental symptoms, ipecac cardiomyopathy, arrhythmias, russells, xerostomia, tooth decay

Question 12

assess

Answer 12

perception of problem, labs, PA, eating habits and fluid intake, hx dieting, daily activities, exercise, value attached to shape/weight
screen - suicide, NSSI, social functioning

Question 13

tm

Answer 13

hospital if life threatening/suicide, usually out pt
interrupt binge-purge cycle
restructure thoughts/attitudes about eating, teach boundary setting, nutrition counseling, behavioral techniques -> diary, emotions, env cues

Question 14

tm - pharm

Answer 14

SSRI, fluoxetine (plus CBT)

Question 15

tm - therapies

Answer 15

CBT is 1st line, DBT, group and support, not usually fam bc older onset
want help, est therapeutic relationship more quickly with nurse