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What is bulimia nervosa?
Bulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating, compensatory behaviors to prevent weight gain, and self-evaluation that is significantly influenced by body shape and weight. It is significantly more common in women than in men, and the yearly prevalence in young females is 1-1.5%. Bulimia most commonly begins in adolescence or early adulthood.
What does bulimia nervosa look like?
Risk Factors
- Stressful life events
- Childhood obesity
- Early pubertal maturation
- Childhood sexual or physical abuse
- Social anxiety disorder
- Weight concerns
- Low self-esteem
- Depressive symptoms
- Childhood anxiety
- Internalization of thin body ideal
Differential Diagnosis
- Anorexia nervosa, binge-eating/purging type
- Binge-eating disorder
- Kleine-Levin syndrome
- Major depressive disorder, with atypical features
- Borderline personality disorder
How is bulimia investigated?
- Labwork: CBC, electrolytes, extended electrolytes, renal function (Cr, eGFR, BUN), albumin level, serum amylase, liver function (AST, ALT, GGT), cholesterol, and an electrocardiogram
- Oral examination - loss fo enamel, dental carries, salivary and parotid gland hypertrophy
- Calluses on back of hand
- Petichiae
- Cardiac exam - arrhythmias, edema, decreased volume status
- Gastrointestinal exam - non-focal abdominal pain, abdominal bloating, signs of constipation, rectal prolapse
Screening/Scale | Rater | Description |
Eating Disorder Diagnostic Scale (EDDS) | Client | 22-item scale that screens for several eating disorders |
How is bulimia treated?
A combination of CBT and fluoxetine has highest remission rates compared to either treatment alone.
- Selective serotonin reuptake inhibitors (SSRI)
Nursing Management
Causes & Behaviors:
- Inadequate food intake
- Self-induced vomiting
- Chronic or excessive laxative use
- Pale conjunctiva and mucous membranes
- Poor skin turgor or muscle tone
- Edema
- Excessive loss of hair, increased growth of hair on the body (lanugo)
- Amenorrhea
- Hypothermia
- Bradycardia, cardiac irregularities, hypotension
Interventions:
- Supervise the patient during mealtimes and for a specific period after meals (usually one hour)
- Establish a minimum weight goal and daily nutritional requirements; record intake
- Use a consistent approach
- Monitor for choosing lower calorie foods and beverages, hoarding food, and disposing food in various places
- Maintain a regular weighing schedule; before breakfast and in the same attire
- Weigh the client with him/her facing away from the scale
- Monitor exercise program and set limits on physical activities
References
[1] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
[2] Boyd, M. A. (2019). Psychiatric & mental health nursing for Canadian practice. Wolters Kluwer.
[3] Townsend, M. C. (2015). Psychiatric mental health nursing. F.A. Davis.