[ Psychiatric ] Eating & Sexual Disorders 2

Eating Disorders - Bulimia Nervosa (Onset)

late adolescence/early adulthood.

Eating Disorders - Bulimia Nervosa (Diagnostic criteria: Core feature 1)

Recurrent episodes of binge eating:

Eating Disorders - Bulimia Nervosa (Diagnostic criteria: Binge amount)

Large amount of food in a discrete time period.

Eating Disorders - Bulimia Nervosa (Diagnostic criteria: Binge control)

Sense of loss of control.

Eating Disorders - Bulimia Nervosa (Diagnostic criteria: Core feature 2)

Recurrent inappropriate compensatory behaviors to prevent weight gain:

Eating Disorders - Bulimia Nervosa (Diagnostic criteria: Purging methods)

Self-induced vomiting, laxatives, diuretics, enemas.

Eating Disorders - Bulimia Nervosa (Diagnostic criteria: Non-purging methods)

Fasting, excessive exercise.

Eating Disorders - Bulimia Nervosa (Diagnostic criteria: Frequency & duration)

≥1×/week for ≥3 months.

Eating Disorders - Bulimia Nervosa (Diagnostic criteria: Exclusion)

Does not occur exclusively during anorexia nervosa.

Eating Disorders - Bulimia Nervosa (Physical signs: Glandular)

Parotid (salivary gland) enlargement (sialadenosis).

Eating Disorders - Bulimia Nervosa (Physical signs: Dental)

Dental erosion/caries (acid exposure from vomiting).

Eating Disorders - Bulimia Nervosa (Physical signs: Hands)

Russell sign: calluses/abrasions on dorsum of hand (from induced vomiting).

Eating Disorders - Bulimia Nervosa (Physical signs: Esophageal injury)

Esophageal injury: tears (Mallory-Weiss), rupture (rare, Boerhaave syndrome).

Eating Disorders - Bulimia Nervosa (Physical signs: Cutaneous)

Facial petechiae.

Eating Disorders - Bulimia Nervosa (Lab abnormalities: Laxative abuse)

metabolic acidosis.

Eating Disorders - Bulimia Nervosa (Lab abnormalities: Vomiting)

Hypokalemic hypochloremic metabolic alkalosis.

Eating Disorders - Bulimia Nervosa (Lab abnormalities: Bicarbonate)

↑ HCO3- (compensatory retention).

Eating Disorders - Bulimia Nervosa (Management: 1st line)

1st line: CBT + SSRIs.

Eating Disorders - Bulimia Nervosa (Management: First-line SSRI)

Fluoxetine is FDA-approved.

Eating Disorders - Bulimia Nervosa (Management: Fluoxetine dosage)

Effective dose: 60–80 mg/day.

Eating Disorders - Bulimia Nervosa (Management: Contraindication)

Bupropion contraindicated: ↑ risk of seizures in purging patients.

Eating Disorders - Bulimia Nervosa (Hospitalization: Electrolytes)

Severe electrolyte imbalance (especially hypokalemia).

Eating Disorders - Bulimia Nervosa (Hospitalization: Cardiac)

Cardiac arrhythmia risk.