Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

NCM 109 PEDIA

ACTIVITY 4
Bulimia Nervosa
By: Catherine A. Prado BSN II – B

Bulimia Nervosa
A psychological and severe life-threatening eating disorder described by the ingestion of an abnormally
large amount of food in short time period, followed by an attempt to avoid gaining weight by purging
what was consumed.

Causes of Bulimia
The exact cause of bulimia nervosa is currently unknown; though it is thought that multiple factors
contribute to the development of this eating disorder, including genetic, environmental, psychological,
and cultural influences. Some of the main causes include:

 Stressful transitions or life changes

 History of abuse or trauma
 Negative body image
 Poor self-esteem
 Professions or activities that focus on appearance/performance

Risk factors
Girls and women are more likely to have bulimia than boys and men are. Bulimia often begins in the late
teens or early adulthood.
Factors that increase your risk of bulimia may include:

 Biology. People with first-degree relatives (siblings, parents or children) with an eating disorder
may be more likely to develop an eating disorder, suggesting a possible genetic link. Being
overweight as a child or teen may increase the risk.
 Psychological and emotional issues. Psychological and emotional problems, such as depression,
anxiety disorders or substance use disorders are closely linked with eating disorders. People with
bulimia may feel negatively about themselves. In some cases, traumatic events and environmental
stress may be contributing factors.

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  Dieting. People who diet are at higher risk of developing eating disorders. Many people with
bulimia severely restrict calories between binge episodes, which may trigger an urge to again
binge eat and then purge. Other triggers for bingeing can include stress, poor body self-image,
food and boredom.

Signs and Symptoms

Physical signs and symptoms of this eating disorder are:

 Constant weight fluctuations

 Electrolyte imbalances, which can result in cardiac arrhythmia, cardiac arrest, or ultimately death
 Broken blood vessels within the eyes
 Enlarged glands in the neck and under the jaw line
 Oral trauma, such as lacerations in the lining of the mouth or throat from repetitive vomiting
 Chronic dehydration
 Inflammation of the esophagus
 Chronic gastric reflux after eating or peptic ulcers
 Infertility
Signs and symptoms of binge eating and purging are:

 Disappearance of large amounts of food

 Eating in secrecy
 Lack of control when eating
 Switching between periods of overeating and fasting
 Frequent use of the bathroom after meals
 Having the smell of vomit

Complications
Bulimia may cause numerous serious and even life-threatening complications. Possible complications
include:

 Negative self-esteem and problems with relationships and social functioning

 Dehydration, which can lead to major medical problems, such as kidney failure
 Heart problems, such as an irregular heartbeat or heart failure
 Severe tooth decay and gum disease
 Absent or irregular periods in females
 Digestive problems
 Anxiety, depression, personality disorders or bipolar disorder
 Misuse of alcohol or drugs
 Self-injury, suicidal thoughts or suicide

Prevention

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  Education about and awareness of the disorder and associated risk factors
 Early intervention if risk factors are identified
 Knowledge and maintenance of healthy eating habits
 Cultivation of a positive self-image of the body
 Maintenance of good mental health
 Counseling as needed to identify and resolve areas of conflict and stress
 Balancing school, work, social life, rest, and exercise

Medical and Nursing Management

 Nutritional counseling.
 CBT
 Interpersonal therapy.
 SSRIs. The only FDA-approved medication for treating eating disorders is fluoxetine (Prozac).
 Patient with bulimia are aware of their problems and they want to be helped because they feel
helpless and unable to control themselves during episodes of binging. But because of their intense
desire to please and need to conform they may resort to manipulative behavior and tell half-truths
during interview to gain trust and acceptance of nurses. Create an atmosphere of trust. Accept
person as worthwhile individual. If they know that no rejection or punishment is forth coming
they disclose their problem, they will be more open and honest.
 Develop strength to cope with problems. Encourage patient to discuss positive qualities about
themselves to increase self-esteem.
 Help patient identify feelings and situations associated with or that triggers binge eating.
 Assist to explore alternative and positive ways of coping.
 Encourage making a journal of incident and feelings before-during and after a binge episode.
 Make a contract with the patient to approach the nurse when they feel the urge to binge so that
feelings and alternative ways of coping can be explored.
 Encourage adhering to meal and snack schedule of hospital. This decreases the incidence of
binging, which is often precipitated by starvation and fasting.
 Encourage participating in group activities with other persons having the same eating disorder to
gain additional support.
 For young adolescent living at home, encourage family therapy to correct dysfunctional family
patterns.
 Cognitive behavioral therapy is the ideal therapy to help the bulimic understand the problem and
explore appropriate behaviors.