Chapter 10 • Psychiatric Diagnoses and Related Treatments Behavioral Science

Feeding and Eating Disorders

9.1 Bulimia Nervosa

Recurrent episodes of binge eating
Eating within a small time period (e. g., two hours ) an amount
much larger than most would eat in the same period
Feeling of a lack of control during eating episode
Compensating behaviors to prevent weight gain
Vomiting, excessive laxatives, diuretics, medications,
excessive exercise
Self- evaluation strongly linked to body weight/ shape
Binge / purge occurs one time per week for three months
Mild: lx to 3 x per week
Extreme: > 14 x per week
" Binge and purge "
Prevalence: 4% females and 0.5 % males
Presentation is usually during teenage years
Body weight is usually normal or above normal Important Concept
Sexual adjustment is usually normal
Clinical signs: Both bulimia and anorexia can
have purging.
• Scars on back of hand, callouses on fingers
• Esophageal tears
• Enlarged parotid gland
• Cooking preoccupation
• Minimal public eating
• Often associated with taking on responsibility
Dental cavities common
Electrolyte imbalances possible
Low baseline serotonin concentrations
Treatment options :
• Cognitive - behavioral therapy
• Group therapy
SSRIs/ SSNRIs
• TCAs are second line (e. g., imipramine )

9.2 Binge Eating Disorder 1 Important Concept

Recurrent episodes of binge eating
Eating within a small time period (e. g., two hours ) an amount Binge eating disorder does not
much larger than most would eat in the same period have purging.
Feeling of a lack of control during eating episode
Three or more of the following :
• Eating faster than normal
• Eating until uncomfortably full
• Eating a lot when not hungry
Eating alone due to embarrassment of how much one is eating
Feeling disgusted with self, depressed, or guilty

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