A case study
Sarah, a 26 year old female patient, suffered with bulimia since high school. Her body mass index was 20 kg/m2. She went through periods of excessive bingeing after which she would hide all of her food wrappers under her bed. This behavior would be followed by excessive vomiting and laxative abuse. It was only at her most recent dentist appointment that the dentist picked up the abnormal eating behaviors.
In many ways, bulimia nervosa represents the inability of the person to sustain prolonged starvation or semi starvation such as the classic anorexia nervosa. Unlike anorexia nervosa, these patients normally stay within the normal weight range or may sometimes be overweight.
The eating binges provoke terrible feelings of guilt and are then followed by attempts to compensate by purging or excessive exercise.
Social interruption or feelings of immense discomfort will often terminate the binge and this will be followed by feelings of self-disgust, guilt and depression.
Definition of Bulimia Nervosa
Presents when one episode of binge eating occurs relatively frequently (twice a week or more) for at least 3 months; compensatory behaviors are practiced after binge eating to prevent weight gain – primarily self-induced vomiting, laxative abuse, diuretics, or abuse of emetics and in less than 20% severe dieting and strenuous exercise.
The weight does not drop as much as in anorexia nervosa. The patients had a morbid fear of fatness, a relentless drive for thinness, or both. A disproportionate amount of self-evaluation depends on body weight and shape.
Bulimia nervosa is more prevalent than anorexia nervosa and is more common in woman than men. A total of 2 – 4 % of young woman sufferfrom bulimia nervosa. However, onset is often earlier than in anorexia nervosa.
Clinical Presentation of Bulimia Nervosa
- Falls within a normal body weight range or may be overweight;
- Enlargement of the parotid gland resulting in typical “chipmunk face”;
- Serum amylase levels raised;
- Erosion of dental enamel;
- Dehydration and electrolyte changes;
- Tears in the gastric mucosa, and bleeding;
- Laxatives can lead to large bowel problems;
- Often scratches on the back of palate and hands from inducing vomiting.
Treatment of Bulimia Nervosa
Most patients with uncomplicated bulimia nervosa do not require hospitalization. If behavior is accompanied by suicidal tendencies or self-harming behavior or there is a physiological cause then hospitalization may be required.
Psychotherapy is frequently stormy and may be prolonged.
Bulimia Nervosa is characterized by higher rates of partial and full recovery as with anorexia nervosa.
Two-thirds of the patients will benefit from treatment. Poor prognostic factors include the presence of a personality disorder and substance abuse. Patients are vulnerable to relapse after discharge.
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