3. Bulimia (Nervosa) is an eating disorder that involves
episodic. uncontrolled, compulsive, rapid ingestion of
large quantity of food over a short period of time
(binging), followed by the inappropriate compensatory
behaviours to get rid of the body (purging) of the calories.
4.
5. EPIDEMIOLOGY
Lifetime prevalence – 1.5% (women)
0.5%(men)
Survey in 11-16yrs- 10% normal weight, 15% overweight,
23% obese.
Girls- ½ and Boys- 1/3 engage in unhealthy weight control
behaviour.
6. Bulimia
Nervosa (BN)
BN Purging type
BN Non-purging type
-Majority of cases.
-Binging followed by
self induced vomiting
-Abuse of laxatives,
diuretics, enemas
- Binging followed by
use of other
appropriate use of
other purging like
Fasting, exercising
CLASSIFICATION
7. Sex predilection- females> males
Genetic factors
Age- common in teenage and early adulthood.
Associated comorbodities- ADHD, GAD, PTSD, OCD, alcohol
and drug abuse, phobic and panic disorders.
Early puberty
Society and cultural influences.
8. ETIOLOGICAL FACTORS
Genetic factors- common in first degree, biological relatives.
Specific area of chromosome 10p linked to families.
Biological Factors- Altered levels of serotonin levels in brain.
Psychological and emotional issues- Impulsive behavior, OCD,
anxiety disorders, depression.
Societal Pressure
Sexual abuse
Social Factors
9. Pre-Disposing Factors
Precipitating Stressors of Individual
( Loss, Rejection, Failure)
Appraisal of stressors
Coping Mechanisms
(Denial, Avoidance, Isolation of effect, Intellectualization)
Constructive Destructive
Continuum of eating regulation responses
Adaptive Responses Maladaptive Responses
Balanced eating
patterns
Occasional
overeating,
skipping meals
Overeating/
fasting under
stress
Frequent
binging,
night
eating
Bulimia
nervosa
10. CLINICAL FEATURES
Physical
Manifestations
• Frequent
changes in
weight
• Oral
manifestation
s
• Bloating,
Constipation,
Intolerance to
food
• Menstrual
abnormalities
• Dizziness
• Fatigue
• Insomnia
Psychological
Manifestations
• Pre-
occupation
with eating
food, body
shape and
weight
• Sensitivity to
comments
• Low self
esteem
• Feelings of
shame, guilt
• Distorted
body image
• Obsession
with food
• Depression
• Anxiety
Behavioural
Manifestations
• Evidences of
binge eating
• Eating in
private
• Repetitive and
obsessive
behaviour
related to body
shape and
weight
• Excessive
exercising
• Dieting
• Frequent trips
to washroom
after meals
11. Medical evaluation to rule out presence of any upper GI
disorders
Psychological evaluation and Beck Depression Inventory
Laboratory investigations-
Serum electrolytes
Blood glucose
Baseline ECG
Signs and symptoms based on ICD-10 criteria
12. Cognitive Behavior Therapy (CBT)-
Most effective for adults.
It helps in identification and changing the distorted thoughts that
underlie their compulsive behaviors
It helps in finding better ways to cope with life stressors.
Psychodynamic psychotherapy-
Aims to improve the insight of patient into dynamics driving the
eating disorder so that it can be resolved and eradicated as
motivations for maladaptive behavior.
13. Interpersonal psychotherapy-
Helps patient by identifying and modifying the current
interpersonal problems which can draw focus away from eating.
Dialectical behavior therapy-
It works by individual therapy sessions and skill training
sessions.
Process Interactional Technique-
Includes group activities- role playing, psychodrama and use of
group interactions to facilitate proper development of insight.
Family therapy
Health weight programs
15. NURSING MANAGEMENT
Nursing Assessment
History of the patient-
--Chief complaint by patient with verification by informant.
--Pre-disposing , Precipitating factors
--Potential or history of suicide and harms
Mental status examination-
--Assess for labile and depressed moods corresponding
to Bulimia.
--Assess for thought process and pre-occupation ideas.
--Assess the level of self concept, judgment.
--Assess the level of judgement and insight.
Physical Examination
16. Imbalanced nutrition: less than body requirements related to self-
induced vomiting and chronic use of laxatives as evidenced by low
body weight .
Goal- --To establish a good dietary pattern.
--To demonstrate weight gain.
Interventions-
--Causes for nutritional deficits should be assessed.
--Body weight should be monitored regularly.
--Signs and symptoms of impaired tissue integrity should be monitored.
--Mealtimes should be supervised.
--Intake of meals at periodic intervals should be reinforced.
--Patterns of elimination should be assesses.
--Patient should be encouraged for cessation of use of laxatives.
--Strict dietary regimen should be maintained with nutrients and required
calories.
--Exercise and physical patterns should be monitored.
17. Fluid volume deficit related to consistent induced vomiting as evidenced
by decreased skin turgor.
Goal- To maintain improved fluid balance and good skin turgor.
Interventions-
--Signs of dehydration, vital signs, capillary refill should be monitored.
--Serum electrolytes should be assessed periodically.
--I/O chart should be maintained.
--Urine output should be monitored.
--Strategies to stop vomiting should be adopted.
--IV fluids, as per order should be administered.
--Reassessment.
18. Disturbed thought process related to psychological conflicts ( perceived
loss of control) as evidenced by inability to make decisions and altered
attention span.
Goal- --To bring in changes in behaviours that helps in building attention span.
--To improve patient’s ability to frame decisions.
Interventions-
--Factors that causes distraction should be identified.
--Non-verbal cues and gestures should be closely observed.
--Patient should be attentively observed and listened to.
--Strict adherence to nutritional regimen should be encouraged.
--Decisions involving ALDs should be encouraged with.
--Patients should be encouraged to ventilate out grieving and concerns.
--Relaxation strategies should be adopted.
19. Impaired parenting related to maturational and situational crises
secondary to issues and conflicts in family as evidenced by inability
to fulfil family developmental process and dissonance among family
members.
Goal- To improve participation in problem solving process directed at
encouraging independence.
Interventions-
--Patterns of interactions amongst family members should be
assessed.
--Non-verbal cues and gestures should be closely monitored.
--Message of separation that is acceptable to both patient and
family members should be communicated.
--Situations that cause sabotage behaviours should be eliminated.
--Patient along with family members should be assisted with group
therapy sessions.
20. Risk for injury related to past suicidal attempts and increased
apprehension.
Goal- To develop self acceptance in patient.
Interventions-
--Causes and reasons should be assessed and indentified.
--Tools and articles that may be used should be kept away.
--Environment should be manipulated.
--Medications and chemicals should be kept out of reach
--Patient should be kept under close observation.
--Non-verbal cues should be closely observed.
--Realistic goals should be assigned to the patient.
--Adoption of relaxation strategies should be encouraged with.
--Patient should be encouraged for adopting self care habits.
--Participation in group activities should be encouraged.
22. Statistics and researchers show that approximately half of all person
with bulimia nervosa will fully recover with appropriate treatments.
Although 30% experience a partial recovery while 10-20% continue
to battle with symptoms.
Since the true reason for development of BN is not known,
preventive measures are tough to portray.
However educators, mental heath nurses can help adolescents and
teenagers understand that the “ ideal” body type and “ normal
adaptive” behaviours.
24. BULIMIA NERVOSA is an eating disorder which a person
creates a destructive patterns of eating in order to control
their weight with repetitive cycles of BINGING and
PURGING.
