Bulimia nervosa

Question 1

Screening questions for bulimia

Answer 1

• Have you ever gone on eating binges when you ate abnormally large amounts of food over a short period of time?

o During the binge, did you feel you lost control of your eating?
o Did you do anything to force yourself to stop gaining weight like – exercise, vomit, strict diets, laxatives, etc

o How often did you binge? How often did you do the [compensatory behaviour]

o Did your weight or the shape of your body have a big effect on your opinion of yourself

Question 2

DSM criteria for bulimia nervosa

Answer 2

A) Recurrent episodes of binge eating as characterised by both:
- Eating a larger than normal amount of food during a short
time period
- Lack of control over eating during the period

B) Recurrent, inappropriate compensatory behaviours to prevent weight gain (vomiting, laxative abuse, meds, fasting, excessive exercise)

C) Binge eating + compensatory behaviours at least once week for 3 months

D) Self-evaluation influenced by body shape and weight

Question 3

Management of bulimia

Answer 3

Management:
o Mild / early – manage and monitor
(weekly) in primary care
o Moderate / severe = refer to Specialist
Eating Disorder Service and monitor

o Monitor weekly
o Safety (friends and family involved, MHA if needed)
o Medically unstable = admit HYPOKalaemia

o 1st line = psychotherapy (CBT)
o Food and purging diary record, regular meals
o SSRIs eg. high dose fluoxetine can reduce vomiting and binging in severe cases
- Dentist check ups
- K replacement
o Beware of re-feeding syndrome

Question 4

Physical sx of bulimia

Answer 4

• fatigue
• sore throat - eosophagitis/ gastritis , tooth decay, bad breath
• swolled or red marks no fingers or knuckles used to stimulate gag reflex
• parotitis observed as round face
  -irregular menses
• poor skin

Question 5

How to explain bulimia in laymans

Answer 5

• You came here today because someone was worried about your eating patterns/ your physical health
• It is not unusual for people to experience an eating pattern as you described where you may eat more than you intended and then compensate through … vomiting it out/overexercising/ using laxatives. This seems most consistent with a condition called Bulimia nervosa.
• The exact cause of bulimia is unclear, some say that the fashion industry and media have a hand in pressuring people to have a certain body type. There may be a genetic factor to developing bulimia which is triggered by stressful or traumatic life experiences. People with anxiety, depression and a few other mental health conditions have a higher chance of developing bulimia.
• Many people with bulimia get better with treatment. This is mainly talking therapies for example CBT can help to challenge some of the underlying beliefs about our body image and can helping people regulate and better cope with emotions, disrupting the factors maintain the binge-purge cycle.
• Treatment also involves addressing any problems with your physical health and supporting you in changing your eating pattern which may involve seeing us fairly regularly.