Bulimia Nervosa

Clinical Features

  • Little or no weight loss
  • Preoccupation with eating
  • Craving for food
  • Episodes of overeating
  • Patient attempts to counteract "fattening" effects of food
  • self-induced vomiting, exercise and laxative abuse
  • Morbid dread of fatness
  • patient sets weight threshold well below premorbid weight

Epidemiology

  Incidence per 100,000 per year Incidence per 100,000 young females
Community   1500
Primary care 11 170
Mental Health Care 6 87

Treatment

Detection

  • Difficult as may be normal weight
  • Young woman with concerns about
    • depression
    • weight
    • unexplained vomiting / diarrhoea
  • Patient may be unwilling to admit the problem

Self-help

  • Eating Disorders Association
  • Self-help manuals (e.g. Fairburn, Cooper, Treasure)

Treatment in primary care

  • Dietary diary
  • encourage to eat three meals a day
  • GP/Nurse/Counsellor to use same self help manual
  • Regular sessions with counsellor
  • Drug treatment (e.g. fluoxetine) may be used if severe distress caused by bulimia but psychological treatments for disease

Referral

  • All patients who do not respond within a few weeks
  • CBT
  • Inpatient or day care may be needed

Complications

as anorexia

Prognosis

  • Majority respond well in long term
  • About 50% respond to CBT