Bulimia nervosa
Definition
A chronic eating disorder involving repeated and secretive episodes of eating, characterized by uncontrolled rapid ingestion of large quantities of food over a short period of time, it is also called bulimia nervosa,It is an eating disorder occurring mainly in girls and young women, characterized by episodic binge eating followed by purging or other behaviors designed to prevent weight gain and by excessive influence of body shape and size on the patient's sense of self-worth.
Causes
there is currently no definite known cause of bulimia. Because of the complexity of the disorder, however there is evidence that bulimia and other eating disorders may be related to abnormalities in levels of chemical messengers (neurotransmitters) within the brain, specifically the neurotransmitter serotonin. Other studies of people with bulimia have found alterations in metabolic rate.Diagnosis
DIFFERENTIAL DIAGNOSIS• Schizophrenia
• GI disorders
• Neurologic disorders (seizures, Kleine-Levin syndrome, Klüver-Bucy syndrome)
• Brain neoplasms
• Psychogenic vomiting
LABORATORY TESTS
• Electrolyte abnormalities secondary to vomiting (hypokalemia and metabolic alkalosis) or to diarrhea from laxative abuse (hypokalemia and hyperchloremic metabolic acidosis)
• Hyponatremia, hypocalcemia, hypomagnesemia (caused by laxative abuse)
• Elevated cortisol, decreased LH, decreased FSH
TREATMENT
NONPHARMACOLOGIC THERAPY
• Cognitive behavioral therapy to control abnormal behaviors
• Use of food diaries, nutritional counseling, and planning meals at least a day in advance is useful to counter abnormal eating behaviors
• Correction of electrolyte abnormalities
ACUTE GENERAL Rx
• SSRIs are generally considered to be the safest medication option in these patients. They are useful in severely depressed patients and in those who fail to benefit from cognitive behavioral therapy.
• Prompt recognition and treatment of complications:
1.Ipecac cardiotoxicity from laxative abuse
2.Electrolyte abnormalities (see above)
3.Esophagitis and Mallory-Weiss tears; esophageal rupture from repeated vomiting
4.Aspiration pneumonia and pneumomediastinum
5.Menstrual irregularities (including amenorrhea)
6.GI abnormalities: acute gastric dilatation, pancreatitis, abdominal pain, constipation
CHRONIC Rx
• Psychotherapy continued for years and focused specifically on self-image and family and peer interactions is an integral part of successful recovery.
• Family therapy is also recommended, especially in younger patients.
• Cognitive behavioral therapy to control abnormal behaviors
• Use of food diaries, nutritional counseling, and planning meals at least a day in advance is useful to counter abnormal eating behaviors
• Correction of electrolyte abnormalities
ACUTE GENERAL Rx
• SSRIs are generally considered to be the safest medication option in these patients. They are useful in severely depressed patients and in those who fail to benefit from cognitive behavioral therapy.
• Prompt recognition and treatment of complications:
1.Ipecac cardiotoxicity from laxative abuse
2.Electrolyte abnormalities (see above)
3.Esophagitis and Mallory-Weiss tears; esophageal rupture from repeated vomiting
4.Aspiration pneumonia and pneumomediastinum
5.Menstrual irregularities (including amenorrhea)
6.GI abnormalities: acute gastric dilatation, pancreatitis, abdominal pain, constipation
CHRONIC Rx
• Psychotherapy continued for years and focused specifically on self-image and family and peer interactions is an integral part of successful recovery.
• Family therapy is also recommended, especially in younger patients.
REFERENCES
American Psychiatric Association: Practice guideline for the treatment of patients with eating disorders, Am J Psychiatry 157(suppl):4, 2000.
Bacaltchuk J, Hay P: Antidepressants versus placebo for people with bulimia nervosa, Cochrane Database Syst Rev (4):CD003931, 2001.
Bacaltchuk J, Hay P, Trefiglio R: Antidepressants versus psychological treatments and their combination for bulimia nervosa, Cochrane Database Syst Rev (4):CD003385, 2001.
Category: B
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