Bulimia Flashcards
DSM-V Criteria for Bulimia
A. Recurrent episodes of binge eating characterized by:
● Eating in a discrete period of time (within a 2 hour period) an amount of food that is larger than most people would eat under same period
○ Sense of lack of control of eating during the episode
B. Recurrent inappropriate compensatory behavior in order to prevent weight gain such as Vomiting, laxatives, fasting, excessive exercise
C. Binge eating & compensatory behaviors occur at least once a week for 3 months
- 3 months - similarity w bulimia and anorexia
D. Self-evaluation is unduly influenced by shape & weight
E. Disturbance does not occur exclusively during episodes of anorexia nervosa
- Bulimia does not have restrictive intake, anorexia restricts intake
- Main difference - when excessively low it leans toward anorexia
Specifiers
Specify if:
● In partial remission: After full criteria was met, some but not all criteria have been met for a sustained period of time
● In full remission: After full criteria was met, none of the criteria have been met
Specify Current Severity
● Mild: An average of 1-3 episodes of inappropriate compensatory behaviors a week
● Moderate: An average of 4-7 episodes of inappropriate compensatory behaviors a week
● Severe: An average of 8-13 episodes of inappropriate compensatory behaviors a week
● Extreme: An average 14 or more episodes of inappropriate compensatory behaviors a week
Prevalence
● 12 month prevalence of young females is 1-1.5% (more than anorexia)
● Less frequently found in males than females
○ 10:1 ratio female to male ratio
Development and course
● Commonly begins in adolescence or young adulthood
● Less common before puberty or after age 40
● Usually begins during an episode to lose weight
● Multiple stressful life events
● Can be chronic and intermittent
● Remission of 1 year is associated with better outcome
● Some may go back and forth between other eating disorders
Culture
● Similar rates across most industrialized countries
Gender
● More common in females than males; males may be under-represented
Associated Features
● Normal body weight or overweight range
● Avoidance of fattening foods
○ Binge tends to take place with carbs like chips, snacks, could be mcdonalds or the whole pizza but not necessarily
Associated Feature
Binge Eating
● Binges: can consume between 1000-2000 calories in a binge and involve foods with high fat and sugar content
● Marked with guilt and shame regarding eating behaviors
● Effects of binging/purging depend on: ○ Method of facilitating purging ○ Frequency of the purge behavior ○ General health of the binger ○ Type of binge food being consumed ● Emetine destroys heart muscle and could induce heart failure ● Can result in non-responsive bowels which leads to laxative dependency ● Loss of potassium can lead to death
● Maintains a façade of social interaction (whereas in anorexia its more isolation)
● More anxiety than anorexics
● Dermatologic:
○ Callous on back of hand from sticking finger down throat
○ Callous on ribs from pushing to induce vomit
○ Skin on hand & around mouth red
● Salivary glands blocked or enlarged—swelling near ears
● Dental cavities due to the erosion of tooth enamel
Comorbidity
● Comorbidity is common with most individuals experiencing at least one other disorder
○ Depressive symptoms & disorders
○ Anxiety symptoms & disorders
○ Substance Use (alcohol / stimulant)
○ Personality features – Borderline Personality Disorder
Etiology
Diagnostic Markers
● No specific medical diagnostic test exists
● Laboratory markers found as a result of purging
○ Fluid & electrolyte abnormalities
■ Hypokalemia: low potassium in blood. Can cause heart arrhythmias
■ Hypocholremia: low chloride in blood
■ Hypontremia: low sodium ion concentration in blood can lead to liver, kidney and heart failure
○ Metabolic alkalosis (elevated serum bicarbonate due to loss of gastric acid)
○ Diarrhea or dehydration due to laxatives & diuretic use
Suicide Risk
● Suicide risk is elevated for those with Bulimia Nervosa
○ Comprehensive evaluation should assess suicide related ideation and behaviors, as well as previous attempts at suicide or self-harm
Treatment: Bulimia
Address purging first then eating
● CBT with response prevention of vomiting
● CBT reduces binge eating & vomiting
● Treatment involves
○ Full disclosure of problem to significant others
○ Shaping of dietary behaviors to 3 meals a day
○ Gradual introduction of binge food into diet
○ Identification of faulty cognitions & challenging them
○ Reinforcement of behavior changes of behaviors designed to reduce relapse
● Pharmacology: Tricyclics & MAOI’s
Implications for SP
● Educate personnel & staff
● Students
○ Provide info about social norms (educate before puberty)
○ Promote moderate exercise regimens
○ Illustrate age height/ weight ratios
● Parents
● Psycho-education & resources for treatments
● Acceptance of child disorders
● Establish reasonable expectations
● Develop security & trust
● Assessment & direct instruction
● Refer out for serious cases
● Collaborate with multi-disciplinary team
● Flexibility- class scheduling, attendance, & monitoring of eating/health
● Accommodations
Assessment
● Medical evaluation**
○ Not where you do an IQ test; paid by for school and results get to schools; however most schools can’t treat this
● Attention to risk factors (age, family history, weight reduction/ fear of gain, binge eating, concern with weight, body & shape, ego deficits & perceptual disturbances)
● 4 general areas for assessment
○ Self-regulation
○ Interpersonal skills & relationships
○ Self-esteem
○ Distorted beliefs & cognitions
● Social History & Assessment tools
○ Questionnaires assess specific eating behaviors & attitudes, medical/treatment histories, self-injurious behaviors
○ Interviews
● Associated features / comorbid conditions
● Willingness to change
● Eating behaviors
● Nutrition
● Comorbid conditions and personality
Assessment Considerations
● Many times do not self-refer / ambivalent about treatment
● Hide weight loss or maladaptive behaviors
● Confidentiality & disclosure
Etiology
for ALL
Individual factors ○ Norepinephrine & serotonin abnormalities ○ Childhood sexual abuse ○ Negative life events ○ Low self-esteem ○ Perfectionism ○ Need for control ○ Internalization of the thin ideal ○ Mood disturbances / emotional regulation ○ Early dieting or food restriction ○ Physiological tendencies ● Disturbed Familial characteristics ○ Lack of emotional validation ○ Focus on image or appearance
