31st January 2024

Bulimia Nervosa

Bulimia nervosa is defined by periods of food binges, a discrete period of time (e.g., 2 hours) where a person loses control over what they eat, eating more or different foods than usual, and not feeling satiety or able to limit their intake, occurring on a regular basis (at least once a week). This is then counteracted by methods to avoid weight gain, in a similar fashion seen in Anorexia Nervosa. Binge eating is usually accompanied by emotional distress, and the patient will experience similar psychological symptoms as anorexia. Binge eating is usually triggered by stress or the hunger drive due to a period of restriction. If purging is severe, it can present with symptoms and signs of hypokalaemia due to vomiting or laxative use. However, starvation syndrome (see below) tends to be less severe but can still have risks of refeeding syndrome if compensatory behaviours are severe.

A bulimia nervosa presentation without the compensatory behaviours is termed a binge-eating disorder, and is usually accompanied by weight gain.

Purging most often associated with Bulimia but also seen in other disorders, especially anorexia, which has its own characteristic signs and symptoms that you should be aware of. 

Specific symptoms, signs and comorbidities for purging:

• Russell’s sign – Rough skin on backs of knuckles from induced vomiting
• Erosion of teeth and dental caries from stomach acid and exacerbated by immediately brushing teeth.
• Gastric and duodenal ulcers
• Oesphageal erosions
• Pancreatitis
• Arrthymias secondary to electrolyte disturbance.