Diagnostic Criteria for Bulimia Nervosa

Question 1

Diagnostic Criteria for bulimia

Answer 1

A. Recurrent episodes of binge eating characterized by both of the following.

1. Eating in a discreet time e.g. within 2 hours an amount of food that is larger than most individuals would eat.

2.lack of control over eating

B.Inappropriate behaviors to prevent weight gain.

C. Binge eating at least once a week for 3 months

D.Self evaluation is unduly influeneced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of Anorexia

Question 2

Diagnostic for Bulimia

Answer 2

Specify current severity

Mild 1-3 episodes per week.

Moderate 4-7 episode per week.

Severe 8-13 episodes a week

Extreme an average of 14 or more episodes

In appropriate compensatory behaviors ( vomiting,laxitives excessive exercise)

Question 3

Diagnostic for Binge Eating

Answer 3

A. Recurrent episodes of Binge eating

1. Within 2 hour period.
2. A sense of lack of control.

B.Binge eating is associated with 3 or more of following:

1. Eating more rapidly than normal
2. Eating until uncomfotable.
3. Eating large amounts of food when not hungry.
4. Eating alone because of feeling embarassed by how much you are eating.
5. Feeling disgusted with one self.

C.Marked distress regarding binge eating

D. Binge eating occurs on average at least once a week for 3 months

E.The binge eating is not associated with the recurrent use of inappropriate compensatory as bulimi nervosa or anorexia

Question 4

BED Criteria

Answer 4

Mild 1-3 binge eating episodes a week

Moderate 4-7 binge eating episodes

Severe 8-13

Extreme 14 or more

Question 5

Psychodynamic Influences

Answer 5

Unfullfillment sense of separation individuation. when event occur that threaten

the vulnerable ego,feelings of lack of control over ones body emerge.Behaviors associated with food and eating serve to provide feelings of control over one’s life.

Question 6

Imbalanced nutrition:

Less than body requirements

Answer 6

Refusal to eat,abuse of laxitives,diuretics and or diet pi;;s,loss of 15 percent of expected body weight,paleconjuncyiva and mucous membranes,poor muscle

tones,amenorrhea,poor skin turgor,eletrolyte imbalnces,hypothermia,hypotension,cardiac irregularities,edema

Question 7

Deficient Fluid Volume

Answer 7

Decreased fluid intake,abnormal fluid loss caused by self induced vomiting,excessive use of laxitives,enemas or diuretics,electrolyte imbalance,decreased urine output,increased urine concentration,elevated hematocrit,decreased blood pressure,increased pulse rate,dry skin,decreased skin tugor and weakness

Question 8

Denial

Answer 8

Minimizes symptoms,unable to admit impact of disease on life pattern,does not perceive personal relevance of danger

Question 9

Obesity

Answer 9

Compulsive eating,excessive intake in relation to metabolic needs,sedentary lifestyle,weight 20 percent over ideal for height and frame,BMI of 30 or more

Question 10

Disturbed body image/Low self esteem

Answer 10

Distorted body image,views self as fat,even in presence of normal body weight or severe emaciaition,lack of eye contact,depressed mood.Denies the problem with low body weight exists,difficulty accepting positive reinforcement,self destructive behavior(self induced vomiting,abuse of laxitivesor diuretics,refusal to eat) Preoccupationwith appearance and how others perceive it. (anorexia,bulima)

Verbalization of negative feelings about way he or she looks and desire to lose weight (obesity )

Question 11

Anxiety(Moderate to severe)

Answer 11

Increased tension,increased helplessness,over

excited,apprehensive,fearful,restlessness,poor eye contact,increased difficulty taking oral nourishment,inability to learn.

Question 12

Out come Criteria

Answer 12

1. Has acheived and maintained an expected BMI for age ,body build weight hx and physiological disturabnaces.
2. VS,BP,lab serum studies are WNL
3. Verbalizes importance adequate nutrition.
4. Verbalizes knowledge regarding consequences of fluid losscaused by self induced vomiting or laxitives,diuretic abuse and importance of adequate fluid intake.(anorexia nervosa,bulimia nervisa)
5. Verbailizes events that precipitate anxiety and demonstartes techniques for reduction.
6. Verbilizes ways in which he or she may gain more control of the enviornment and thereby reduce feelings of powerlessness.
7. Express less preoccupation with own apperance (anorexia nervosa ,bulimia nervosa)
8. Demonstrates the ability to take control of ones own life without resorting to maladaptive eating behaviors.(anorexia,bulimia,BED)
9. Has established a healthy eating pattern for weight controland weight losstowards a desired goal.
10. Verbalizes plan for maintenance of weight control and relapse prevention (BED)

Question 13

Reasons for Hospitalization

Answer 13

Malnutrition less than 85% body weight.

Dehydration

severe electrolyte imbalance

cardiac arrhythmia,severe bradycardia

hypothermia,hypotension,suicide ideation

Question 14

The Maudsley approach

Answer 14

Evidenced based program (teenagers)

Involves family every step of way

Intensive outpatient program

Phase 1 weight restoration Parents establish rules and guidelines around eating.

Phase 2 Contol of maintaing weight gain is restored back to adolecence. once he or she demonstrates the ability to maintain 95%body weight final phase begins.

Phase 3 focus on assiting adoleescent to identify health self idenity. This phase incorporates CBT and DBT skills .

Question 15

Fluoxetine

(Prozac)SSRI

Answer 15

Weight gain and treatment of comorbid depression.

* Black box warning of increasing suicide ideation in adolescents.

* The anticholinergic side effects of tricyclic antidepressants include orthstatic hypotension,.

It is also important to recognize that depression and other mood and cognitive symptoms can be a symptom of malnutrition and starvation. * Found to be useful in treatment of bulimia nervosa. usual dose 60 mg daily.

Question 16

Other Antidepressants

Answer 16

1. imipramine (Tofranil)

2.desipramine(Norpramine)

3.Amitriptyline(Elavil)

4.nortripline(Aventyl)

5.phenelzine(nardil)

Also shown to be effected in controll studies.

Question 17

Medication for BED

Answer 17

Weight loss is a seconday symptom

topiramate and lisdexamfetamine (dopamine-norepinephrine reuptake inhibitor.) Medication in combination with CBT is more beneficial than medication alone