Psychiatry - Bulimia Nervosa

Question 1

Defintion

Answer 1

Eating disorder characterised by episodes of binge eating followed by intentional vomiting or other purgative behaviours such as the use of laxatives or diuretics or exercise

Question 2

Features of bulimia nervous

Answer 2

• Alkalosis, due to vomiting HCl from the stomach
• Hypokalaemia
• Erosion of teeth
• Swollen salivary glands
• Gastrointestinal-oesophageal reflux and irritation
• Calluses on the knuckles where they have been scraped across the teeth. This is called Russell’s sign

Question 3

DSM-5 diagnostic criteria

Answer 3

• Recurrent episodes of binge eating
• A sense of lack of control over eating during the episode
• Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self induced vomiting, laxatives, diuretics
• Binge eating and compensatory behaviours both occur, on average, at least once a week for three months
• Self-evaluation is unduly influenced by body shape and weight.
• The disturbance does not occur exclusively during episodes of anorexia nervosa.

Question 4

Treatment

Answer 4

Referral for specialist care is appropriate in all cases
FIRST LINE: Bulimia-nervosa focused family therapy (FT-BN)
Pharmacological treatment have a limited role - trial of high-dose FLUOXETINE
Adults FL: bulimia nervosa focused guided self help
Second line: individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)

Question 5

TOM TIP

Answer 5

Look out for the teenage girl with a normal body weight that presents with swelling to the face or under the jaw (salivary glands), calluses on the knuckles and alkalosis on a blood gas. The presenting complaint may be abdominal pain or reflux.