Definition: an eating disorder characterized by restraining of food intake for a period of time followed by an over intake or binging period that results in feelings of guilt and low self-esteem. This cycle typically occurs several times a week although in serious cases can occur more.
Classification / type of disease:
There are two sub-types of bulimia nervosa:
- Purging type bulimics self-induce vomiting (usually by triggering the gag reflex or ingesting emetics such as syrup of ipecac) to rapidly remove food from the body before it can be digested, or uselaxatives, diuretics, or enemas.
- Non-purging type bulimics (approximately 6%–8% of cases) exercise or fast excessively after a binge to offset the caloric intake after eating. Purging-type bulimics may also exercise or fast, but as a secondary form of weight control.
- Average age of onset = 18yo
- F>M 9:1
- There are higher rates of eating disorders in groups involved in activities which idealize a slim physique, such as dance, gymnastics, modeling, cheerleading, running, acting, rowing and figure skating. Bulimia is more prevalent among Caucasians
Presenting symptoms / signs:
Ways in which the pt tries to reduce the amount of food they ingest…
S&S include =
- Dehydration and hypokalemia caused by frequent vomiting
- Electrolyte imbalance, which can lead to cardiac arrhythmia, cardiac arrest, and even death
- Oral trauma
- Gastroparesis or delayed emptying
- Peptic ulcers
- Calluses or scars on back of hands due to repeated trauma from incisors
- Constant weight fluctuations
Bulimia nervosa can be difficult to detect, compared to anorexia nervosa, because bulimics tend to be of average or slightly above or below average weight. Many bulimics may also engage in significantly disordered eating and exercising patterns without meeting the full diagnostic criteria for bulimia nervosa.
Consider diagnosis if = repetitive episodes of binge eating (a discrete episode of overeating during which the individual feels out of control of consumption) compensated for by excessive or inappropriate measures taken to avoid gaining weight.
- Pharmaceuticals may be of use = tricyclic antidepressants, MAO inhibitors, mianserin, fluoxetine, lithium carbonate, nomifensine, trazodone, and bupropion.
- Psychotherapy = CBT, dialectical behaviour therapy, family based therapy…