Bulimia Nervosa

Eating disorder characterised by repeated episodes of uncontrolled overeating (binges) followed by compensatory weight loss behaviours

Aetiology

  • Peak age of onset 15-25 years

Clinical presentation

  • Eating out of/over controlled, binge and purge cycles
  • Exercise maybe obsessive
  • Relationships isolated or popular, often conflict-attracted but can be avoidant
  • Common traits: often impulsive, can be obsessional, often independent high achievers, pursue heightened mood states

Investigations

  • These are usually normal apart from serum potassium, which is often low

Management

Management in adults

  • Guided self help
  • Individual eating-disorder-focused CBT (CBT-ED) should be offered to adults with bulimia nervosa if self-help is ineffective or not an option
  • Fluoxetine (SSRI) - up to 60mg daily
  • Inpatient treatment is not recommended except if there are serious complications e.g. very low weight, cardiac effects associated with hypokalaemia

Management in under 18s

  • First line - bulimia-nervosa-focused family therapy
  • Inpatient treatment is not recommended except if there are serious complications e.g. very low weight, cardiac effects associated with hypokalaemia