By: Aminah Al NaIisah

A 20-year-old college
student is reIerred by her
dentist because oI multiple
dental caries. She is
normal Ior her weight but
Ieels that 'she needs to
lose 15 pounds.
She reluctantly admits to
eating a large quantity oI
Iood in a short period oI
time and then inducing
gagging!!
P Bulimia nervosa involves binge eating combined with
behaviors intended to counteract weight gain, such as
vomiting, use oI laxatives or diuretics, or excessive
exercise.
P Patients are embarrassed by their bingeing and are
overly concerned with body weight. However, unlike
patients with anorexia, they usually maintain a normal
weight (and may be overweight).
P There are two subcategories oI bulimia:
-Purging typeinvolves vomiting, laxatives, or diuretics
-4npurging type involves excessive exercise or Iasting
P#ecurrent episodes oI binge eating
P#ecurrent, inappropriate attempts to
compensate Ior overeating and prevent weight
gain (such as laxative abuse, vomiting,
diuretics, or excessive exercise)
PThe binge eating and compensatory behaviors
occur at least twice a week Ior 3 months.
PPerception oI selI-worth is excessively
inIluenced by body weight and shape.
P Hypochloremic
hypokalemic alkalosis
(with or without
arrhythmias)
P Esophagitis
P Dental erosion
P Calloused knuckles (Irom
selI-induced vomiting)
|#ussell's Sign|
P Salivary gland
hypertrophy
P AIIects 1 to 3 oI adolescent and young
Iemales.
PSigniIicantly more common in women than
men.
PMore common in developed countries.
PHigh incidence oI comorbid mood disorders,
impulse control disorders, and alcohol
abuse/dependence.
PBetter prognosis than anorexia nervosa.
PSymptoms usually exacerbated by stressIul
conditions.
POne halI recover Iully with treatment; one halI
have chronic course with Iluctuating
symptoms.
Treatment may include individual
psychotherapy, cognitivebehavioral therapy,
group therapy, and pharmacotherapy
(selective serotonin reuptake inhibitors |SS#s|
are Iirst-line, then tricyclic antidepressants
|TCAs|).
#084:7.0irst aid psychiatry
clerkship