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Bulimia NervosaAka: Bulimia

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  1. Epidemiology
    1. Onset in adolescence or early adulthood
    2. Affects women much more than men by ratio of 10-20:1
  2. Symptoms
    1. Bloating or abdominal fullness sensation
    2. Gastroesophageal Reflux disease
    3. Abdominal Pain
    4. Pharyngitis
    5. Severe Constipation (withdrawal from Laxatives)
  3. Signs
    1. Disordered eating and distorted body image
      1. See DSM IV Diagnosis below
    2. Patients are most often of normal weight
      1. Contrast with under-weight in Anorexia Nervosa
    3. Poor impulse control
    4. Physical signs of bulimia
      1. Callused knuckles
      2. Dental Erosions
      3. Salivary Gland hypertrophy
      4. Mallory-Weiss Tear
  4. Evaluation Tools
    1. See SCOFF Questionnaire
  5. Diagnosis: DSM IV
    1. Major Criteria
      1. Recurrent Binge Eating
        1. Eating more than most people eat per time period
        2. Perceived lack of control during eating episode
      2. Compensatory behaviors to prevent weight gain
        1. Purging
          1. Self-induced Vomiting
          2. Medication misuse (see purging behavior above)
            1. Diet pills
            2. Laxatives or enemas
            3. Diuretics
        2. Other inappropriate weight loss control
          1. Fasting
          2. Excessive Exercise
      3. Binging and weight loss twice weekly over 3 months
      4. Overconcern with body shape and weight
      5. Episodes not limited to Anorexia Nervosa episodes
    2. Subtypes
      1. Purging Type
        1. Regular, ongoing purging behaviors (see above)
      2. Non-purging type
        1. No purging behaviors
        2. Weight controlled with fasting, excessive Exercise
  6. Associated Conditions
    1. Female Athlete Triad
    2. Oligomenorrhea (50% of cases)
      1. No associated bone loss (contrast with anorexia)
      2. Weight bearing Exercise protective of bone in Bulimia
    3. Psychiatric illness
      1. See Anorexia
      2. Personality Disorder (confers worse prognosis)
        1. Cluster B - dramatic, erratic
        2. Borderline Personality Disorder
        3. Narcissistic Personality Disorder
        4. Antisocial Personality Disorder
      3. Self deprecation and low self esteem
      4. Major Depression with suicidal ruminations
      5. Anxiety Disorder
    4. Risk-taking behaviors
      1. Substance Abuse
      2. Unprotected sexual activity
      3. Self mutilation
  7. Differential Diagnosis
    1. See Anorexia
  8. Labs
    1. Chemistry panel
      1. Hypochloremic Metabolic Alkalosis
      2. Hypokalemia
    2. Serum Amylase increased
  9. Diagnostics: Electrocardiogram
    1. Same as in anorexia
  10. Management: General
    1. Hypokalemia management if present
    2. Prevention of secondary complications
      1. Fluoridated Mouthwash and Toothpaste
      2. Sour candy to decrease Salivary Gland swelling
      3. Antacid medications for Reflux Esophagitis
  11. Management: Psychiatric
    1. Cognitive behavior therapy
      1. Cognitive behavior therapy is first line management
      2. Effective in only 40 to 50% of bulimic patients
      3. Indications to consider alternative therapy
        1. Purging not reduced 70% by sixth session
    2. Antidepressant agents are effective adjuncts to therapy
      1. Effexor
      2. Serzone
      3. Fluoxetine and other Selective Serotonin Reuptake Inhibitors (SSRI)
      4. Avoid Wellbutrin (due to Seizure risk)
  12. Management: Oligomenorrhea
    1. History and physical examination
      1. Consistent with Anovulation
    2. Laboratory evaluation for significant oligomenorrhea
      1. Urine Pregnancy Test
      2. Luteinizing hormone (LH)
      3. Follicle Stimulating Hormone (FSH)
      4. Thyroid Stimulating Hormone (TSH)
      5. Prolactin
      6. Total Testosterone and Free Testosterone
      7. Consider Serum Dehydroepiandrosterone sulfate level
        1. Indicated for signs of androgenization
    3. Suspected unopposed Estrogen management
      1. Patient characteristics
        1. Normal weight patient
        2. Anovulation
        3. Elevated androgen levels
        4. Withdrawal bleed after Provera 10 mg x7 days trial
      2. Protocol for Endometrial Cancer prevention
        1. Provera 10 mg qd for 7 days repeated q3 months or
        2. Oral Contraceptive cycling
  13. References
    1. (1994) DSM IV, APA, p. 544-5
    2. Agras (2000) Am J Psychiatry 157:1302
    3. McGilley (1998) Am Fam Physician 57(11):2743
    4. Mehler (2003) N Engl J Med 349:875
    5. Seidenfeld (2001) Am Fam Physician 64(3):445
    6. Sundgot-Borgen (1998) J Clin Endocrinol Metab 83:3144
    7. Walsh (2004) Am J Psychiatry 161:556
    8. Yanovski (1991) Am Fam Physician 44(4):1231
  14. Resources
    1. Jackson (1991) Dieting: Dry Drunk- Dieting Recovery

Bulimia (C0006370)

Definition (MSH)Eating an excess amount of food in a short period of time, as seen in the disorder of BULIMIA NERVOSA. It is caused by an abnormal craving for food, or insatiable hunger also known as "ox hunger".
ConceptsMental or Behavioral Dysfunction (T048) , Sign or Symptom (T184)
MSHD002032
EnglishBinge eating, Binge overeating, Bingeing, Binges, Binging, Bouts of overeating, Bulimia, Bulimias, Episodes of overeating
Spanishbulimia, episodios de ingestion compulsiva y excesiva, parrandear
Parent ConceptsHyperphagia (C0020505), Mental disorders (C0004936), Eating Disorders (C0013473), Finding of quantity of eating (C0566560)
SourcesAOD, COSTAR, CST, DXP, LCH, MEDLINEPLUS, MSH, MTH, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Binge eating disorder (C0596170)

Definition (CSP)episodes of binge eating with a sense of lack of control; most individuals exhibiting this behavior are obese and usually do not use compensatory behaviors (such as purging, fasting, misuse of laxatives and other medications, or excessive exercise) that are characteristic of bulimia nervosa.
Definition (CSP)eating disorder that involves eating massive quantities of food (binge eating) and then eliminating the food by inappropriate compensatory methods to prevent weight gain, such as self induced vomiting or strong laxatives.
Definition (MSH)An eating disorder that is characterized by a cycle of binge eating (BULIMIA or bingeing) followed by inappropriate acts (purging) to avert weight gain. Purging methods often include self-induced VOMITING, use of LAXATIVES or DIURETICS, excessive exercise, and FASTING.
ConceptsMental or Behavioral Dysfunction (T048)
ICD9307.51
MSHD052018
EnglishBinge eating disorder, Binge-Eating Disorder, Binge-Eating Disorders, BN - Bulimia nervosa, Bulimia Nervosa
Spanishbulimia nerviosa
Parent ConceptsEating Disorders (C0013473), Other eating disorders (C0029587)
SourcesAOD, CSP, ICD9CM, MSH, MTH, NCI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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