ED: Bulimia Nervosa

Question 1

Define bulimia nervosa.

Answer 1

ED characterised by uncontrolled binge eating with vomiting/laxative abuse. Preoccupation with body weight and shape.

Question 2

Explain the aetiology/risk factors for bulimia. Summarise the epidemiology of bulimia nervosa.

Answer 2

Personal and family hx of eating disorder, affective disorder, substance misuse.

Half have previous anorexia.

High prevalence of depression, self harm and substance abuse comorbidity. 3% young females

~18y/o

Question 3

What are the symptoms of bulimia nervosa?

Answer 3

Persistent preoccupation with eating and craving food.

Binge eating up to 20k Kcal per session may occur.

Followed by vomiting, starvation etc.

Question 4

How would a bulimia patient appear on examination?

Answer 4

Weight may be normal

Dental erosion

Finger calluses

Callus on dorsum of hand (Russel sign)

Parotid swelling

Menstrual abnormalities

Low mood

Self loathing

More insight than anorexia and keen for help

Question 5

What are the investigations for bulimia nervosa?

Answer 5

FBCs

U+Es

Amylase

Ca2+

LFTs

TFTs

Mg2+

K+

Phosphate

ECG

Question 6

What is the management for bulimia nervosa?

Answer 6

Nearly all OP management

Medical stabilisation

CBT

Psychotherapy

SSRI may be useful (fluroxetine) can be antibulimic separately from antidepressant.

Question 7

What are complications associated with bulimia nervosa?

Answer 7

Arrhythmias

MW tears

Renal failure

Osteoporosis

Pancreatitis

Oesophagitis

Secondary amenorrhoea

Question 8

What is the prognosis of bulimia nervosa?

Answer 8

Most patients make full recovery.