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Bulimia nervosa
From WikEM
Contents
Background
- Usually normal BMI or slightly overweight
- Pattern of binging and purging with vomiting, laxative/diuretic abuse
- Purges from as often as 1-2/wk to 10x/day
- Most commonly late adolescent females
- Associated with borderline, narcissistic personality disorders
Clinical Features
Diagnostic Criteria
- A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:[1]
- 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
- 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
- B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
- C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
- D. Self-evaluation is unduly influenced by body shape and weight.
- E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
Signs
- Dental enamel loss
- Scarring of dorsal fingers, hand
- Salivary gland swelling
Differential Diagnosis
- Anorexia nervosa, binge eating/purging type
- Binge-eating disorder
- Klein-Levin syndrome
- Major depressive disorder, with atypical features
- Borderline personality disorder
Labs
- Dependent on type of purging
- Electrolytes[2]
| ' | Na+ | K+ | Cl- | Bicarb | pH |
| Vomiting | Variable | ↓ | ↓ | ↑ | ↑ |
| Laxatives | Nl to ↑ | ↓ | Variable | Variable | Variable |
| Diuretics | ↓ to nl | ↓ | ↓ | ↑ | ↑ |
Management[3]
- IVF volume replacement
- Potassium oral replacement 40-80 mEq/day
- Referral to psych for CBT
See Also
References
- ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- ↑ Mehler PS. Bulimia nervosa. N Engl J Med 2003;349:876.
- ↑ Metabolic Abnormalities in Bulimia Nervosa. Am Fam Physician. 2004 Mar 15;69(6):1530-1532.
