Eating disorder characterised by repeated episodes of uncontrolled overeating (binges) followed by compensatory weight loss behaviours
Aetiology
Peak age of onset 15-25 years
Clinical features
Psychological symptoms
Binge eating: characterized by a loss of control, consumption of enormous amounts of food with high caloric content, often with a sense of urgency and compulsion
Purging: binge episodes often lead to feelings of shame and guilt, leading to attempts to 'undo the damage' through behaviours such as induced vomiting, misuse of laxatives or diuretics, and excessive exercise
Compensatory behaviours do not have to include self-induced vomiting for a diagnosis of bulimia nervosa to be made
Body image distortion: patients may have a distorted perception of their body, often perceiving themselves as overweight despite maintaining a normal or slightly above average weight
Relationships: isolated or popular, often conflict-attracted but can be avoidant
Common traits: often impulsive, can be obsessional, often independent high achievers, pursue heightened mood states
Physical symptoms
Dental erosion: resulting from recurrent self-induced vomiting
Parotid gland swelling: resulting from recurrent self-induced vomiting
Russell's sign: scarring on the back of the hand or knuckles caused by repeated self-induced vomiting
Investigations
A detailed medical history: to evaluate for recurrent episodes of binge eating and compensatory behaviours
A comprehensive physical examination: to identify potential physical signs of bulimia, including dental erosion, parotid gland swelling, or Russell's sign
Bloods often normal apart from serum potassium, which is often low
Psychological assessments: to evaluate for associated psychological conditions and body image distortion