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19. Feeding+Eating, Elimination Disorders > Bulimia Nervosa > Flashcards

Bulimia Nervosa Flashcards

1
Q

how many criteria are there for BN

A

5

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2
Q

criterion A for BN

A

recurrent episodes of binge eating

an episode of binge eating is characterized by BOTH of the following:

  1. eating, in a discrete amount of time (i.e within any two hours period) an amount of food that is DEFINITELY LARGER than what MOST people would eat in a similar period of time under similar circumstances

AND

  1. a sense of LACK OF CONTROL over eating during the episode (i.e a feeling that one cannot stop eating or control what or how much one is eating).
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3
Q

criterion B for BN

A

recurrent inappropriate compensatory behaviours in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics or other meds, fasting, or excessive exercise

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4
Q

criterion C for BN

A

the binge eating and inappropriate compensatory behaviours BOTH occur, on average, at least ONCE A WEEK for THREE MONTHS

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5
Q

criterion D for BN

A

self evaluation is unduly influenced by body shape and weight

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6
Q

criterion E for BN

A

disturbance does not exclusively occur during episodes of AN

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7
Q

what determines the minimum level of severity of BN

A

the frequency of the inappropriate compensatory behaviours

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8
Q

define mild BN

A

average 1-3 episodes of inappropriate compensatory behaviours per week

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9
Q

define moderate BN

A

average of 4-7 episodes of inappropriate compensatory behaviours per week

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10
Q

define severe BN

A

average of 8-13 episodes of inappropriate compensatory behaviours per week

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11
Q

define severe BN

A

average of 14+ episodes of inappropriate compensatory behaviours per week

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12
Q

what are the three essential features of BN

A
  1. recurrent episodes of binge eating
  2. recurrent inappropriate compensatory behaviours to prevent weight gain
  3. self evaluation that is unduly influenced by body weight and shape
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13
Q

what is considered a “discrete period of time” in the evaluation of BN

A

usually less than 2 hours

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14
Q

is continual snacking on small amounts of food throughout the day considered a binge?

A

no

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15
Q

is the impairment in control assoc. with binge eating absolute?

A

no–> someone may continue to binge while the phone rings but stop as soon as a friend enters the room

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16
Q

how do some people describe the sense of loss of control during binges?

A

some describe a dissociative quality

some describe that their binges are no longer characterized by an acute feeling of loss of control but rather by a more generalized pattern of uncontrolled eating

if individuals report they have abandoned efforts to control their eating, loss of control should be considered present

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17
Q

what is the most common antecedent of binge eating

A

negative affect

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18
Q

other than negative affect, list other triggers for binge eating

A

interpersonal stressors

dietary restraint

negative feelings related to body weight, shape and food

boredom

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19
Q

how long do binges usually last

A

often eat until uncomfortably, or painfully, full

20
Q

what is the most common inappropriate compensatory behaviour

A

vomiting

  • immediate effects = relief from physical discomfort and reduction of gaining weight
  • in some cases, vomiting will become goal in itself, with person binge eating in order to vomit
21
Q

what Rx medication do people sometimes take as a inappropriate compensatory behaviour

A

thyroid hormone–> to prevent weight gain

22
Q

what Rx hormone do people with diabetes and BN sometimes omit

A

insulin (or reduce it) to avoid weight gain

23
Q

when might exercise be considered excessive/i.e an inappropriate compensatory behaviour

A

when it significantly interferes with important activities

when it occurs at inappropriate times or in inappropriate settings

when individual continues to exercise despite injury or other medical complications

24
Q

what weight range is common for those with BN

A

typically within normal weight or overweight (BMI above or equal to 18.5, below 30)

*occurs but is uncommon among obese individuals

25
Q

what food related behaviours are common for those with BN between binges

A

typically restrict total caloric intake and preferentially select “low cal”/diet foods while avoiding foods they perceive to be fattening or likely to trigger a binge

26
Q

list rare but potentially fatal complications of BN

A

esophageal tears

gastric rupture

cardiac arrhythmias

fluid/electrolyte imbalances from purging can also be severe and dangerous

27
Q

what is the 12 month prevalence rate of BN

A

1 - 1.5% among young females

less is known about point prevalence among males

28
Q

what is the female:male ratio in BN

A

10:1

29
Q

at what age does the disorder tend to peak

A

older adolescence and young adulthood

*onset before puberty of after age 40 is uncommon

30
Q

what is the natural course of BN

A

persists for at least several years in high % of cases

course may be chronic or intermittent, with periods of remission alternating with recurrences of binge eating

over longer term follow up, symptoms of many people appear to diminish WITH OR WITHOUT treatment

31
Q

does treatment impact outcome in BN

A

“treatment clearly impacts outcome” per DSM

32
Q

what is the crude mortality rate for BN

A

nearly 2% per decade

33
Q

in what % of cases if there diagnostic cross over from initial BN to AN

A

minority of cases–> 10-15%

34
Q

what is the usual natural course for those who cross over from BN to AN

A

commonly will revert back to BN or have multiple occurrences of cross overs between the disorders

*diagnosis should be based on last 3 months of symptoms

35
Q

list temperamental risk factors for BN

A

weight concerns

low self esteem

depressive symptoms

social anxiety disorder

overanxious disorder of childhood

36
Q

list environmental risk factors for BN

A

internalization of thin body ideal

those who experienced childhood sexual or physical abubse

37
Q

list genetic and physiological risk factors for BN

A

childhood obesity

early pubertal maturation

familial transmission may be present

there may be genetic vulnerabilities

38
Q

what lab abnormalities might be present in BN

A

hypokalemia –> can provoke cardiac arrhythmias

hypochloremia

hyponatremia

39
Q

what metabolic disturbance can be caused by vomiting

A

metabolic alkalosis –> due to loss of stomach acid

40
Q

what metabolic disturbance can be caused by frequent induction of diarrhea

A

metabolic acidosis

41
Q

what is usually found on physical exam of those with BN

A

usually nothing

inspection of mouth may show–>
significant and permanent loss of dental enamel–>
teeth may become ragged and “moth eaten”–>
may be increased dental caries

salivary glands may become enlarged

may have calluses/scars on hand from inducing vomiting

42
Q

how does BN affect suicide risk

A

elevated

DSM doesnt give specifics

43
Q

ddx BN

A

AN-binge/purge type

binge eating disorder

Kleine-Levin syndrome

MDD with atypical features

borderline PD

44
Q

how do you distinguish between BN and binge eating disorder

A

in binge eating disorder there are no inappropriate compensatory behaviours

45
Q

how are binge eating and borderline PD related

A

binge eating behaviour is included int he impulsive behaviour criterion that is part of the definition of BPD

*if criteria for both are met, both dx can be given

46
Q

what other psychiatric disorders are commonly comorbid with BN

A

depressive disorders (especially)

bipolar disorders

borderline PD (or other personality disorder)

–> mood disturbances often begin at same time or following development of BN

may also have increased frequency of anxiety symptoms /disorders

–> mood and anxiety symptoms frequently remit with treatment of BN

47
Q

what is the lifetime prevalence of substance use (esp alcohol and stimulant use) among those with BN

A

30%

19. Feeding+Eating, Elimination Disorders (12 decks)

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