A young lady presents with repeated episodes of excessive eating followed by purging by use of laxatives. What is the diagnosis?
Ans. is 'a' i.e., Bulimia nervosa Bulimia nervosa is a type of eating disorder. It is often just called bulimia.A person with bulimia eats a lot of food in a short amount of time. This is called "binging".The person may feel gaining weight after a binge. Binging also can cause fear of shame and guilt. So the person tries to undo the binge by getting rid of the food. This is called purging.Purging might be done by:-Making yourself throw upTaking laxative - pills or liquids that speed up the movement of foodExercising a lotEating very little or not at allTaking water pills to urinate DiagnosisAccording to the diagnostic and statistical manual of mental disorders (DSM - IVTR) published by the American Psychological association the criteria for diagnosing a patient with bulimia are:-Recurrent episodes of binge eating.An episode of binge eating is characterized by the following:-Eating in a fixed period of time, an amount of food that is definitely larger than most people would eat under similar circumstances.A lack of control over eating during the episode. A feeling that one cannot stop eating or control what or how much one is eating.Recurrent inappropriate compensatory behaviour to prevent weight gain such as:-Self-induced vomitingMisuse of laxativeDiuretics or other medicationsFastingExcessive exercise.Self-evaluation is unduly influenced by body shape and weight.These symptoms occur at least twice a week on average and persist for at least 3 months.The disturbance does not occur exclusively during episodes of anorexia nervosa.There are two types of Bulimia NervosaPurging typeThese patients self induce vomiting (usually by triggering the gag reflex or ingesting emetics such as syrup of ipecac) to rapidly remove food from the body before it can be digested such as diuretics and enemas.Non purging typesThese bulimics (approx. imately 6-8% of cases) exercise or fast excessively after a binge to offset the caloric intake after eating purging type bulimics may also exercise or fast but as a secondary form of weight control.The onset of bulimia nervosa is often during adolescence (b/w/3-20 years of age) with many sufferers relapsing in adulthood into episodic binging and purging even after initially successful treatment and remission.TreatmentCognitive behavioural therapy which involves teaching clients to challenge automatic thoughts and engage in behavioural experiments (e.g. in session eating of 'forbidden foods").* This is a case of DonovanosisIt occurs due to infection with calymmatobacterium granulomatosis Diagnosis of Donovanosis is based onPresence of lesion in genital or perianal region QExuberant ulcer with beefy red floor with a raised Serpiginous Q margin.*Absence of lymphadenopathy(r), though pseudo bubo may be present in the inguinal region.Tissue smears show "bipolar inclusions in macrophages" Q.Clinical featuresSingle Q(sometimes multiple asymptomatic ulcers)Floor is made of beefy, exuberant granulation tissues, which bleeds easily on manipulation.Border is elevated and has serpiginous outline.Location of ulcers:-Males:Gains Q (M.C.) prepuce, shaft of the penis, perianal area and penoscrotal junction.Females:Labia majora, mons veneris and perianal area.Lymphadenopathy:-Not seenSometimes subcutaneous swelling appear in the inguinal region (pseudo buboes) Q and these may ulcerate to form typical ulcers of donovanosis.
Bulimia nervosa
Binge eating
Schizophrenia
Anorexia nervosa
Sleep Disorders