Bullimia Nervosa Flashcards
Who does bulimia affect?
-Lifetime prevalence is 2% among women
-More common in Western societies
-10x more common in women
-More common in adolescence and young adulthood
What causes bulimia?
-Characterised by repeated episodes of uncontrolled overeating followed by compensatory weight loss behaviours
-Features include:
–Excessive preoccupation with body weight and shape
–Undue emphasis on weight
–Feeling of lack of control over eating
–Compensatory weight control mechanisms include: self-induced vomiting, fasting, intensive exercise, abuse of medication
What risk factors are there for bulimia?
-Parental and childhood obesity
-Family dieting
-FHx of eating disorders
-History of severe life stresses and sexual / physical abuse
-Premorbid and parental psychiatric disorders
-Personal characteristics eg perfectionism, obsessions, anxiety and premorbid obesity
How does bulimia present?
-Regular binge eating associated with loss of control
-DSM-5: bingeing in bulimia should occur on average at least once a week for 3 months
-BMI maintained above 18.5
-Preoccupation with weight, body shape and image
-Rigid and ritualistic behaviours around food, deviation from planned eating causes distress
-Affected person therefore avoids eating with others
What signs might the patient have on examination?
-Physical exam usually normal and done to assess for any medical complications eg dehydration, arrhythmias (hypokalaemia)
-BMI, BP, weight
-Salivary glands may be swollen
-Oedema may be present if laxative / diuretic abuse is present
-Russel’s sign may be present (= calluses on back of hand caused by abrasion from teeth during induction of vomiting)
-Erosion of dental enamel
What are the differential diagnoses for bulimia?
-Binge eating disorder
-Sporadic bingeing caused by other psychiatric disorders eg depression
-Anorexia nervosa
-Medical cause
What treatment would you consider?
Adults:
-Recommended self-help programmes with direct HCP support
-CBT-ED should be offered if self-help is ineffective
Children / adolescents:
-Family therapy as first-line
-Individual CBT-ED is recommended if family therapy ineffective / not appropriate
