Bulimia Nervosa

Recurrent episode of binge eating with compensatory behaviours for ideal body shape and weight.

Epidemiology:

Incidence – 1-1.5% of women.
Onset      – mid-adolescent

Aetiology:

1. Family h/o obesity
                 Affective Disorder
                 Substance abuse.
2.Dysregulation of eating, related to serotonergic mechanisms.

Diagnostic criteria:

1. Persistent preoccupation with eating.
2. Binges  episodes of overeating.
3. Attempts to counter fattening effects of food.
Self induced vomiting
Purgative Abuse
Periods of starvation
Use of Appetite suppressants
4. Morbid fear of fatness.

Complications:

1. Electrolyte Imbalance
2. Gastric/duodenal ulcers
3. Oesophageal erosions.
4. Dental erosions
5. Constipation/steatorrhoea
6. Pancreatitis
7. Leukopenia/lymphocytosis.

Differential Diagnosis:

1. Upper GI disorders.
2. Personality disorder
3. OCD

Treatment:

┬░Psychotherapy: CBT
┬░Pharmacotherapy
High dose SSRI, Fluoxetine 60mg
for > 1yr

Prognosis:

Good.

Reference:

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