How to Diagnose Bulimia Nervosa

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Prevalence of Bulimia Nervosa in the United States is around 0.3% of the total population yet only around 16% of those affected seek treatment. This conditionis more commonly seen in young women than in men with an average age of onset of 20 years old. It is usually associated with childhood and parental obesity but is seen to have a better prognosis than Anorexia Nervosa.

Bulimia Nervosa can be classified by the manner in which the person compensates for the extra calories gained during binge eating. The first classification is called Purging Bulimia wherein the person gets rid of the calories by self-induced vomiting or by ingestion of any substance that will promote excretion of the ingested food (i.e. laxatives and diuretics). The other classification is called Nonpurging bulimia wherein the person prevents weight gain through an overly strict diet such as fasting or by exercising excessively. However, these behaviors often overlap and may be life threatening if the condition is chronic.

Diagnosis of Bulimia Nervosa

Clinical diagnosis of Bulimia Nervosa isbased on the Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria. The criteria is as follows:

  • Recurrent and uncontrollable episodes of binge eating wherein the person ingests a large amount of food in a short time
  • Recurrent and abnormal compensatory behaviors in response to the binge eating earlier such as: self induced vomiting, diuretic and laxative abuse
  • Occurrence of this binge-purge cycle at least twice weekly for at least 3 months
  • Excessive concern with self image, body shape and weight

Signs and Symptoms of Bulimia Nervosa

People with Bulimia Nervosa often has normal weight with some even being overweight which is a stark difference from people with Anorexia Nervosa who are severely underweight. Another difference is the presence of menstruation seen in people with Bulimia Nervosa which is absent in people with Anorexia Nervosa. Other signs and symptoms are as follows:

  • Presence of calluses and abrasion over the dorsum or the back of the hand that occurs when the incisors abrade that area during gag reflex stimulation
  • Salivary gland enlargement
  • Dental erosion from the acid during vomiting
  • Electrolyte imbalance¬†

Behavioral abnormalities may also be apparent that usually begin during late adolescence or early adulthood. These abnormalities are as follows:

  • Self imposed caloric restriction that makes the person more hungry and more prone to binge eat
  • Presence of compensatory behaviors: purging, laxative and diuretic abuse
  • The binge purge cycle continues with a diminished sense of control on eating
  • Associated with a more depressed mood that leads to:
    • Suicide attempts
    • Sexual promiscuity
    • Drug and alcohol abuse
  • Can develop the ability to elicit vomiting without stimulating the gag reflex with the hand
The most common symptom of bulimia nervosa is binge eating followed by self-induced vomiting and other abnormal compensatory behaviors
The most common symptom of bulimia nervosa is binge eating followed by self-induced vomiting and other abnormal compensatory behaviors

Treatment for Bulimia Nervosa

Treatment for Bulimia Nervosa will entail a more holistic approach that involves both medical and psychological interventions. These are as follows:

  • Cognitive behavioral therapy that focuses on body image and eating habits. This tries to target the abnormal thoughts and behaviors that push the person to binge eat and purge afterwards.
  • Although antidepressants are said to be less effective than cognitive behavioral therapy, they may still be recommended if there are other psychiatric abnormalities aside from Bulimia Nervosa. However, only Fluoxetine (Prozac), 60 mg/day, is approved by the United States Food and Drug Administration.

Bulimia Nervosa, or more commonly called as bulimia, is a type of eating disorder characterized by recurrent episodes of binge eating followed by abnormal compensatory behaviors such as self-induced vomiting.

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