Bulimia Nervosa Flashcards
how many criteria are there for BN
5
criterion A for BN
recurrent episodes of binge eating
an episode of binge eating is characterized by BOTH of the following:
- 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
- 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).
criterion B for BN
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
criterion C for BN
the binge eating and inappropriate compensatory behaviours BOTH occur, on average, at least ONCE A WEEK for THREE MONTHS
criterion D for BN
self evaluation is unduly influenced by body shape and weight
criterion E for BN
disturbance does not exclusively occur during episodes of AN
what determines the minimum level of severity of BN
the frequency of the inappropriate compensatory behaviours
define mild BN
average 1-3 episodes of inappropriate compensatory behaviours per week
define moderate BN
average of 4-7 episodes of inappropriate compensatory behaviours per week
define severe BN
average of 8-13 episodes of inappropriate compensatory behaviours per week
define severe BN
average of 14+ episodes of inappropriate compensatory behaviours per week
what are the three essential features of BN
- recurrent episodes of binge eating
- recurrent inappropriate compensatory behaviours to prevent weight gain
- self evaluation that is unduly influenced by body weight and shape
what is considered a “discrete period of time” in the evaluation of BN
usually less than 2 hours
is continual snacking on small amounts of food throughout the day considered a binge?
no
is the impairment in control assoc. with binge eating absolute?
no–> someone may continue to binge while the phone rings but stop as soon as a friend enters the room
how do some people describe the sense of loss of control during binges?
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
what is the most common antecedent of binge eating
negative affect
other than negative affect, list other triggers for binge eating
interpersonal stressors
dietary restraint
negative feelings related to body weight, shape and food
boredom
how long do binges usually last
often eat until uncomfortably, or painfully, full
what is the most common inappropriate compensatory behaviour
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
what Rx medication do people sometimes take as a inappropriate compensatory behaviour
thyroid hormone–> to prevent weight gain
what Rx hormone do people with diabetes and BN sometimes omit
insulin (or reduce it) to avoid weight gain
when might exercise be considered excessive/i.e an inappropriate compensatory behaviour
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
what weight range is common for those with BN
typically within normal weight or overweight (BMI above or equal to 18.5, below 30)
*occurs but is uncommon among obese individuals
what food related behaviours are common for those with BN between binges
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
list rare but potentially fatal complications of BN
esophageal tears
gastric rupture
cardiac arrhythmias
fluid/electrolyte imbalances from purging can also be severe and dangerous
what is the 12 month prevalence rate of BN
1 - 1.5% among young females
less is known about point prevalence among males
what is the female:male ratio in BN
10:1
at what age does the disorder tend to peak
older adolescence and young adulthood
*onset before puberty of after age 40 is uncommon
what is the natural course of BN
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
does treatment impact outcome in BN
“treatment clearly impacts outcome” per DSM
what is the crude mortality rate for BN
nearly 2% per decade
in what % of cases if there diagnostic cross over from initial BN to AN
minority of cases–> 10-15%
what is the usual natural course for those who cross over from BN to AN
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
list temperamental risk factors for BN
weight concerns
low self esteem
depressive symptoms
social anxiety disorder
overanxious disorder of childhood
list environmental risk factors for BN
internalization of thin body ideal
those who experienced childhood sexual or physical abubse
list genetic and physiological risk factors for BN
childhood obesity
early pubertal maturation
familial transmission may be present
there may be genetic vulnerabilities
what lab abnormalities might be present in BN
hypokalemia –> can provoke cardiac arrhythmias
hypochloremia
hyponatremia
what metabolic disturbance can be caused by vomiting
metabolic alkalosis –> due to loss of stomach acid
what metabolic disturbance can be caused by frequent induction of diarrhea
metabolic acidosis
what is usually found on physical exam of those with BN
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
how does BN affect suicide risk
elevated
DSM doesnt give specifics
ddx BN
AN-binge/purge type
binge eating disorder
Kleine-Levin syndrome
MDD with atypical features
borderline PD
how do you distinguish between BN and binge eating disorder
in binge eating disorder there are no inappropriate compensatory behaviours
how are binge eating and borderline PD related
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
what other psychiatric disorders are commonly comorbid with BN
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
what is the lifetime prevalence of substance use (esp alcohol and stimulant use) among those with BN
30%
