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Bulimia nervosa

Bulimia nervosa

Bulimia nervosa is a type of eating disorder characterised by episodes of binge eating followed by intentional vomiting or other purgative behaviours such as the use of laxatives or diuretics or exercising.

DSM 5 diagnostic criteria for a diagnosis of bulimia nervosa:
  • recurrent episodes of binge eating (eating an amount of food that is definitely larger than most people would eat during a similar period of time and circumstances)
  • a sense of lack of control over eating during the episode
  • recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
    • recurrent vomiting may lead to erosion of teeth and Russell's sign - calluses on the knuckles or back of the hand due to repeated self-induced vomiting
  • the binge eating and compensatory behaviours both occur, on average, at least once a week for three months.
  • self-evaluation is unduly influenced by body shape and weight.
  • the disturbance does not occur exclusively during episodes of anorexia nervosa.

Management
  • referral for specialist care is appropriate in all cases
  • NICE recommend bulimia-nervosa-focused guided self-help for adults
  • If bulimia-nervosa-focused guided self-help is unacceptable, contraindicated, or ineffective after 4 weeks of treatment, NICE recommend that we consider individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
  • children should be offered bulimia-nervosa-focused family therapy (FT-BN)
  • pharmacological treatments have a limited role - a trial of high-dose fluoxetine is currently licensed for bulimia but long-term data is lacking
+PassMedicine Notes

Bulimia nervosa is a type of eating disorder characterised by episodes of binge eating followed by intentional vomiting or other purgative behaviours such as the use of laxatives or diuretics or exercising.

DSM 5 diagnostic criteria for a diagnosis of bulimia nervosa:
  • recurrent episodes of binge eating (eating an amount of food that is definitely larger than most people would eat during a similar period of time and circumstances)
  • a sense of lack of control over eating during the episode
  • recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
    • recurrent vomiting may lead to erosion of teeth and Russell's sign - calluses on the knuckles or back of the hand due to repeated self-induced vomiting
  • the binge eating and compensatory behaviours both occur, on average, at least once a week for three months.
  • self-evaluation is unduly influenced by body shape and weight.
  • the disturbance does not occur exclusively during episodes of anorexia nervosa.
Management
  • referral for specialist care is appropriate in all cases
  • NICE recommend bulimia-nervosa-focused guided self-help for adults
  • If bulimia-nervosa-focused guided self-help is unacceptable, contraindicated, or ineffective after 4 weeks of treatment, NICE recommend that we consider individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
  • children should be offered bulimia-nervosa-focused family therapy (FT-BN)
  • pharmacological treatments have a limited role - a trial of high-dose fluoxetine is currently licensed for bulimia but long-term data is lacking


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