A young lady presented with repeated episodes of excessive eating followed by purging by use of laxatives, which is the most appropriate 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 byMaking yourself throw up Taking laxative - pills or liquids that speed up the movement of foodExercising a lotEating very little or not at allTaking water pills to urinateDiagnosisAccording 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 areRecurrent episodes of binge eating. An episode of binge eating is characterized by the followingEating 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 vomiting, misuse of laxative, diuretics or other medications, fasting, excessive 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 Nervosa Purging 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. irately 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").
Bulimia nervosa
Anorexia
Binge eating disorder
Psychogenic vomiting
Sleep Disorders