Eating disorder.

1. BULIMIA NERVOSA
Arzoo khadka
BSN 3rd year

2. GENERAL OBJECTIVES :
To gain in depth knowledge regarding bulimia Nervosa and develop the Skins, attitude
and provide comprehensive nursing case in all the Settings and community.
SPECIFIC OBJECTIVES :
At the end of the class, the student will be able to know.
 Introduce the introduction of bulimia nervosa.
 Meaning of the bulimia nervosa
 Define the definition of bulimia nervosa.
 Enumerate the incidence of bulimia nervosa.
 Enumerate the risk factors and causes of bulimia nervosa.
 Explain the types of bulimia nervosa.
 Describe the psychopathology of bulimia nervosa.
 Enlist the symptoms of bulimia nervosa.
 Enumerate the complications at bulimia nervosa.
 Describe the diagnosis of bulimia nervosa
 Explain the management of bulimia nervosa.
 Explain the nursing management of bulimia nervosa.

3. INRODUCTION :
Bulimia is a type of eating disorder that involves
extreme and harmful eating behaviour .
Bulimia is often characterized by episodes of
binge leaking large amount of food) & purging of
the food in some way.
Bulimia Nervosa was first described in 1979 by
British psychiatric gerald Rusell as the chronic
phase of anorexia nervosa in which patient
overeat and then use compensatory mechanisms
such as self-induced vomiting, laxatives of
prolonged periods of starvations.

4. MEANING :
Bulimia (boo-lee-me-uh) nervosa commonly Called bulimia is a serious, potentially life
threatening eating disorder.
→ Large amounts of eating food with a loss of control over eating and then pluge trying to
get rid of the extra calories in an unhealthy way.
DEFINITION ;
Bulimia is on eating disorders in which a person has a regular episodes Toy eating a very large
amount of food (bingeing) during which persons feels a loss of control over their eating.
~ According to Medical Encyclopedia
• Bulimia nervosa is a serious, potentially life- -threatening eating disorder characterized by a
cycle of bingeing and I compensatory behaviours such as self-induted vomiting designed to
undo or compensate for the effects of binge eating.

5. • Bulimia nervosa is a psychological eating characterized by a cycle of bingeing and
compensatory behaviour such as self induced vomiting designed to un episodes of binge
eating.
~[AIC to NEDA)
Bulimia nervosa is characterized by episodes of binge eating followed by feeling of guilt,
humilation, depression and self condemnations. Includes frequent binging consuming
abnormally large portions of food within a specific time period) in severe cases can have
several binge episodes in one day.
~Ravindra kaur
•Bulimia nervosa is a psychiatric disorder characterized by episodic, uncontrolled, rapid
ingestion of food. Bulimia may occur alone or in conjunctions with the food restricting
behaviours of anorexia nervosa. Involves recurrent use of compensatory measures to
prevent Weight gain (such as self induced, vomiting diuretics or toxatives use dieting,
fasting, or a combinations of
~Sheila L. Videback

6. INCIDENCE:
•Upto 3% of females & 1% of
males suffer worldwide.
10 times more in females reported
around 1-3% in india.
• Bulimia nervosa usually begins in
late adolescents or early childhood.
•18 or 19 years is the typical age of
onset.
• Binge eating frequently begins
during or after dieting,
Also occurs in early teens or
adolescence.

7. RISKFACTORS:
1. BiologicalRiskfactors
- Obesity
- Early Dieting
-Neurochemical imbalances (serotonin and
nonephinephrine Disturbances.)
- Altered serotonin levels.
2. DevelopmentalRiskfactors.
- Self perception of being overweight.
- undesirable dissatisfaction with body images
Sociocultural factors
- Concerned about girl weight. (social Isolations).

8. CAUSES :
1. A family history of mood or anxiety Disorders:
 Genetic traits can be inherited, grandparents to parent and parent to offspring.
2. Chaotic family with loose boundaries parentral, maltreatment including possible
physical or sexual abuse.
 High level of confusion, disorganization and hurriedness the home.
3. Family disturbances & conflict, lack of understanding.
4. Maladaptive behaviours:
 Behaviour that prevents you in making adjustment, Avoidance withdrawal, Anger.
5. Struggle for control or self-identity:
 An identity crisis, a period of uncertainty or confusions.
6. Intense Fear of weight gain:
 Fear of getting fat putting on weight.

9. 7. Impulsive behaviours:
 the uncontrollable urge to binge loss of control as a way to supress any
emotional unrest.
8. constantly talking about weight or food.
9. Distorted body image:
 perception of how someone sees their own body (dissatisfaction).
10. Excessive or new substance or alcohol use:
 Alcohol can act as appetite Stimulant.
11. Frequently weighing oneself-striving for perfectionism.

10. TYPES OF BULIMIA NERVOSA :
1} PURGING TYPE
2}NON – PURGING TYPE
1] PURGING TYPE - The person regularly engages in self induced vomiting or the
misuse of laxatives, diuretics or enema.
2] NON – PURGING TYPE - The individual uses fasting or excessive exercise to control
weight, but does not regularly purge.

11. PSYCHOPATHOLOGY :
EVENTS AND
ASSOCIATED
MOOD CHANGES
OVER – EVALUATION EATING SHAPE
AND WEIGHT AND THEIR CONTROL
STRICT DIETING NON –
COMPENSATORY WEIGHT CONTROL
BEHAVIOUR
BINGE EATING
COMPENSATORY BEHAVIORS
VOMITING
LAXATIVE MISUSE
EXCESSIVE - EXCERCISE
CORE LOW SELF -
ESTEEM
NEGATIVE EFFECT
DIFFICULTY WITH EMOTIONAL
REGULATIONS .
DIETARY RESTRAINTS
EATING
BELIEFS

12. CLINICAL FEATURES :
 Persistent Sore throat heatburn.
 Callused or scarring on back of hands and knuckles.
 Tooth staining or discoloration, loss of dental enamel and increased dental caries.
 History of eating amount of food larger than what most people would eat.
 During binge-eating disorder. [episodes], sense of lack of control.
 Thin, normal or slightly overweight appearance with history of frequent weight
fluctuations.
 Abdominal and epigastric pain.
 Amenorrhea

13.  Fluid and electrolyte imbalance.
 Pertectionism.
 Distorted body image.
 Exaggerated sense of guilt.
 Feeling of alterations
 Poor impulse Control.
 Low tolerance for frustrations.
 Peculiar eating habits or rituals
 Excessive exercise regimen.
 Withdrawal from friends and usual activities.
 Frequent weighing.

14. COMPLICATIONS :
 Gastric rupture during period of binge eating .
 Dental Caries, erosion of tooth enamel parotitis & gum infections.
 Dehydration of electrolyte imbalances.
 Chronic, irregular bowel movements & constipations from laxative use.
 Increased risk of Sucide and psychoactive substance abuse.

15. DIAGNOSIS:
o Medical evaluation to rule out upper-gastro intestinal
Disorder.
o Psychological evaluation and Beck Depression Inventory.
o History
o Laboratory test (serum electrolyte, blood glucose, baseline
ECOT)
o Confirmed it ICD10 criteria / met.

16. TREATMENT MODALITIES:
• Cognitive-Behavioural Therapy:
• •Most effective treatment for bulimia. Strategies designed to change the client's
thinking (Cognition) and actions. (behaviour) about food focus on interrupting the Cycle
of dieting, binging and belief, thought weight body image.
• * COT enhanced with assertiveness training & self-esteem has produced positive result.
• # Psychopharmacology:
• Drugs such as desipramine, imipromine, Amitriptyline,Mortriptyline, phenelzine,
antidepressants were more effective than were the placed in reducing binge eating.

17. psychotherapy:
- psychotherapy {sometimes called talk therapy} refers to of treatment that aim to help a
persons identity and identity and change troubling emotions and behaviours or thought.
Nutritional Counselling:
- To identity Strength and weaknesses present in an individuals diet.
Cognitive therapy:
- cognitive therapy focuses on exploring and countering. The negative thought that
underlie destructive habits.
- Hospitalizations :
Patients may require hospitalization if they are severely malnourished and have lost great
deal of weight and are at risk for refeeding syndrome.

18. NURSING MANAGEMENT:
• Engage patient in therapeutic alliance to obtain commitment to treatment
• Monitor the weight of client.
• Correction of nutritional deficiency by providing nutritious diet.
• Establish contact with patent that specifies amount and type of food helshe must eat
at each meal.
• Set a time limit for each meal.
• Identity patient's eliminations pattern.
• Teach patient to keep journal to monitor. high risk situations that are binging Purging
behaviour.
• Control vomiting by making bathroom inaccessible for at least 2hr After food
• Monitor the Serum electrolysis levels.

19. • Encourage patient to recognize and verbalize her feeling about her eating .
• Explain risks of laxative, emetics and diuretics abute.
• Provide Nutritional counselling to patient.
• Provide assertiveness training.
• Assess and monitor patents Sucide potentials .

20. SUMMARY :
At the end of the topic, the students were able to know about bulimia nervosa,
meaning of bulimia nervosa, Incidience, what are risk factors of bulimia nervosa,
causes of bulimia nervosa like (family history Chaotic family, Impulsive behaviours).
Types of bulimia nervosa, psychopathology, clinical features, complications
Treatment modalities and Nursing management.

21. CONCLUSION :
The topic is concluded as bulimia nervosa are Complex disorder
are not like other disorders in today's world and how it will
affect individuals. life and we are all at risk.

22. BIBLIOGRAPHY :
 Lippincot Williams and wilkins, "A text book of "the psychiatric - "Mental health
Nursing: Fifth editions, wolter klower publications, page no : 394-380.
 Sheila L. vide bock, "A textbook of Mental health nursing fourth editions, jaypee
publications page no :400 to 410.
 K.P Neerja "Essential of Mental Health and psychiatric Nursing Second editions.
jaypee brother publishers page no. 380 to 390.
 Ravinder Kaur. A textbook of mental health Nurs second editions, lohis publishers,
page no : 164 to 175
WEBSITES:
https://.www. Slideshare.com.net
https://books.google.org.com
https://. www.bulimia nervousa.wikipedia.com