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Bulimia Nervosa: Clinical features
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Bulimia nervosa is characterised by the following clinical features:
- More than three episodes of binge eating per week (a binge being defined as a large amount of food eaten rapidly with a subjective feeling of loss of control).
- Behaviours to prevent weight gain. Two thirds of bulimics vomit but exercise, laxative abuse and amphetamine abuse are other ways in which weight is commonly controlled.
- Preoccupation with body weight and shape. Bulimia nervosa is the most common eating disorder and in community studies it has been shown to affect 1 in 50 women. Male suffers are less common with prevalence rates of 1 in 500 being found. The peak age of onset of binge eating which defines the syndrome is at 18. The usual clinical history is of a period of dieting around age 16 to 17, weight is lost and binge eating ensues followed by a compensatory mechanism to prevent weight gain. Characteristically the individual has low self-esteem their worries becoming centred on their body shape and weight. As the syndrome takes hold further lowering of self-esteem occurs secondary to the binge eating and purging behaviours.
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Bulimia Nervosa: Medical Complications
Generally speaking women with bulimia nervosa maintain their weight within a normal range. Medical consequences are secondary to purging behaviours. Self-induced vomiting may cause erosion of dental enamel, oesophagitis and severe electrolyte disturbances. Hypokalaemia is common though cardiac dysrhythmias are relatively unusual. It is thought the chronic hypokalaemia is less likely to cause cardiac dysrhythmias than an acute change in serum potassium. Other physical consequences include irregular menstruation, parotid enlargement and disturbed bowel habit.
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Bulimia Nervosa: Treatment
Studies have shown that for women suffering from bulimia nervosa, who do not have a diagnosis of personality disorder, short term focused psychotherapy is effective. Long term follow up studies have shown both cognitive behavioural psychotherapy and interpersonal psychotherapy either individually or in groups to be effective. As a basis for all these therapies health education with regard to a healthy diet is important plus exploration of the emotional triggers to binge eating. The success rate for treatment is relatively high varying between 60% and 70%.
Where bulimia nervosa is accompanied by symptoms suggestive of borderline personality disorder (multiple deliberate self-harm, rapid mood fluctuations and difficulties in relationships) more intensive long term psychotherapy is required. Often this is only effective within an in-patient setting.
The SSRI fluoxetine has been shown to be effective in reducing frequency of binge eating, when prescribed at a dose of Fluoxetine 60 mg daily. However, though this may result in dramatic improvement in symptoms, symptom recurrence is likely to occur when medication is discontinued therefore fluoxetine should generally be used as an adjunct to psychological treatment.
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