Bulimia nervosa

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

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

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  2. Mehler PS. Bulimia nervosa. N Engl J Med 2003;349:876.
  3. Metabolic Abnormalities in Bulimia Nervosa. Am Fam Physician. 2004 Mar 15;69(6):1530-1532.