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Clinical Evaluation
Bulimia nervosa is characterized by secretive binge-eating episodes that are followed by self-induced vomiting, abuse of laxatives or diuretics, or excessive exercise.
Diagnostic Criteria for Bulimia Nervosa
Recurrent episodes of binge eating in a discrete period of time involving more food than most people would eat.
Recurrent inappropriate behavior to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics.
Both binge eating and inappropriate purging behaviors occur on average at least twice a week for
Self-evaluation is unduly influenced by body shape and weight.
The disturbance does not occur exclusively during episodes of bulimia nervosa.
Purging Type: During the episode of bulimia nervosa, the patient regularly engages in self-induced vomiting or misuse.
Nonpurging Type: During the episode of bulimia nervosa, the patient uses other inappropriate compensatory behaviors.
Bulimia is more common than anorexia, affecting at least 3-10% of adolescent and college-age women; men account for 10% of bulimic patients. The disorder typically begins in late adolescence.
The incidence of affective disorders and other impulsive behavior, such as alcohol and drug abuse, is increased in patients with bulimia. Bulimic patients experience marked fluctuations of weight.
II. Complications of Bulimia
A. The medical complications of bulimia are due to bingeing and purging behaviors. Bulimic patients may appear to be healthy.
2. Esophageal Complications. Esophageal involvement is found in patients who purge through self-induced vomiting, resulting in esophagitis or esophageal ulcers, strictures, or rupture.
4. Treatment. The hypokalemia associated with self-induced vomiting or abuse of diuretics or laxatives it can result in cardiac conduction defects and arrhythmias.
5. Abuse of Diet Pills. Bulimic patients may infrequently abuse diet pills. Diet pills may cause elevated blood pressure.