For instance, in the company of family or friends, clients may choose “healthy” foods such as salads, vegetables, and fruits. Choosing these low-calorie choices looks as though the client is merely following a sensible low-calorie diet. In reality, the person with bulimia nervosa is preparing themself for the next cycle of binging and purging (Videbeck, 2017). Clients become quite adept at hiding quantities of food in various locations, including in their cars, desks, purses, briefcases, school lockers, and unusual places in their homes. They drive from one restaurant (especially fast-food restaurants) to another, purchasing normal size meals at each but stopping at many restaurants in just a few hours so that they can binge without discovery (Videbeck, 2017). Healthcare consideration : Cycles of binging and purging alternating with cycles of symptom remission can occur for years without discovery. Behaviors may be discovered by accident by unexpectedly coming upon the client when they are binging or purging or when medical complications of the disease occur (Videbeck, 2017). Healthcare professionals must be alert to behaviors that suggest clients are binging and purging. Essential Features of Bulimia Nervosa The DSM-5 describes the following essential features of bulimia nervosa (American Psychiatric Association, 2013; Mayo Clinic, 2018d; Videbeck, 2017): ● Recurrent episodes of binging and purging. ● Recurrent inappropriate compensatory behaviors to prevent weight gain. ● Binging and purging behaviors occur, on average, at least once a week for three months. ● Self-evaluation is unduly influenced by body shape and weight. ● The disturbance does not occur exclusively during episodes of anorexia nervosa. Mental Health and Neurological Disorders and Bulimia Nervosa Several mental health and neurological disorders are associated with bulimia nervosa. Here is some information to help nurses and other healthcare professionals distinguish between these disorders and bulimia nervosa. Anorexia Nervosa: Binge-Purging Type Persons whose binging and purging occur only during episodes of anorexia nervosa are given the diagnosis of anorexia nervosa: binge-eating/purging type. They should not be given the coexisting diagnosis of bulimia nervosa. An additional diagnosis of bulimia nervosa is made only when all of the diagnostic General Signs and Symptoms Following are generalized signs and symptoms of bulimia nervosa (Eating Disorder Hope, 2018b; Gersch et al., 2016; Videbeck, 2017): ● Recurrent episodes of binge eating and purging occur. Because clients often hide these behaviors from even their closest family members and friends, it is important to recognize other warning signs and symptoms even if binging and purging are not observed. ● Large supplies of laxatives and diuretics are found in the medicine chest of persons suspected of having the disorder. Clients abuse laxatives, diuretics, and enemas in their purging attempts. ● The breath of affected persons may have a strong odor of mouthwash or breath mints as they attempt to cover the bad breath smell from vomiting. ● Affected persons may eat to the point of discomfort and epigastric pain. They may eat rapidly during periods of binging. ● Affected persons may exercise excessively.
Long-term follow-up studies have revealed the following (Videbeck, 2017): ● 10 years after treatment, 30% of clients are still engaged in repeated episodes of binging and purging. ● 10 years after treatment, 40% of affected persons were fully recovered. ● 33% of those persons who were fully recovered relapsed. ● The death rate from bulimia nervosa is 3% or less. Healthcare consideration : Clients who have a “comorbid personality disorder tend to have poorer outcomes than those without” (Videbeck, 2017, p. 398). Healthcare professionals must be aware of coexisting conditions when caring for clients with bulimia.
criteria for bulimia nervosa have been met for at least three months (American Psychiatric Association, 2013). Binge-Eating Disorder Persons who binge but do not purge do not meet the criteria for bulimia nervosa. These people may meet the criteria for binge- eating disorder (American Psychiatric Association, 2013). Borderline Personality Disorder Borderline personality disorder is characterized by a consistent pattern of unstable interpersonal relationships, self-image, and affect. Persons affected by this disorder also display significant impulsivity (Videbeck, 2017). Binge-eating behaviors are part of the impulsivity criteria for borderline personality disorder. If criteria for both disorders are met, a diagnosis of bulimia nervosa, as well as borderline personality disorder, should be given (American Psychiatric Association, 2013). Major Depressive Disorder with Atypical Features Overeating behaviors are often seen in persons with major depressive disorder with atypical features. However, purging behaviors are not part of the characteristics of major depressive disorder with atypical features, nor is excessive concern with body shape and weight gain present that is part of the criteria for bulimia nervosa. If criteria for both disorders are present, both diagnoses (bulimia nervosa and major depressive disorder with atypical features) should be given (American Psychiatric Association, 2013). ● Affected persons seem to spend an unusual amount of time in the bathroom, especially after meals. ● Affected persons are preoccupied with body shape and weight. ● Affected persons are obsessed with and fearful of the idea of gaining weight. ● Affected persons often eat abnormally large amounts of food at a time, especially high-fat, high-calorie foods. The foods are often soft in consistency because these kinds of food do not irritate a throat that might already be injured because of self-induced vomiting. ● Affected persons may dislike and avoid eating in public or in front of other people. ● Affected persons may abuse alcohol or other drugs. Physical assessment reveals normal weight or slightly above normal weight. This characteristic helps to distinguish bulimia nervosa from anorexia nervosa. Symptoms of anxiety or depression may be evident.
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