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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.