Mental health articles

Bulimia nervosa is an eating disorder characterized by episodes of binge eating. During these episodes large amounts of food are consumed over short periods. The condition should not be diagnosed in patients with a diagnosis of anorexia nervosa up to 50 per cent of whom also binge eat. Periods of binge eating are usually preceded by intense craving or preoccupation with food and intractable urges to overeat. The fattening effects of the food are countered in a number of ways, including periods of starvation following binges or by self-induced vomiting and purging. Although fear of becoming fat and concerns about body weight are common, usually body weight is close to normal. The majority of patients are female and clinical presentation is usually several years later than patients with anorexia nervosa, patients most commonly presenting between 20 and 25 years of age. Patients usually describe loss of control over eating as the most significant problem. Up to 50 per cent vomit and binge eat or both on a daily basis. As this behaviour is associated with shame and guilt, self-induced vomiting is usually secretive. Disorders of mood with depression guilt and suicidal thought may be present. Impulsiveness in the form of promiscuousness and shoplifting of food is present in some cases.

Management

Most adolescents can be treated on an outpatient basis. Cognitive behaviour therapy addressing maladaptive thought processes leading to the problems has shown to be effective.

Case study: Mr and Mrs Thomas

This case concerns a couple in their late 80s. Mr Thomas retired from running his own shop about 15 years ago. Mrs Thomas used to help out in the business and attended to all the bookkeeping, form filling and administrative tasks of the business. Mr Thomas, a wartime refugee from eastern Europe, feels that his English is not up to the task of explaining his needs and wants. He has been treated and diagnosed for throat cancer, which is in remission but which the GP expects will return and eventually result in Mr Thomas’s death. Mrs Thomas has significant memory impairment and finds it increasingly difficult to cope. She still retains responsibility for all the paperwork and finances of the household but regularly loses pension and bank books, bills and invoices and everything else that she takes responsibility for. Mrs Thomas is not willing to give up responsibility for these tasks. Mrs Thomas was assessed at the local hospital and it was confirmed that she probably has Alzheimer’s. The GP shared the diagnosis with Mrs Thomas but Mrs Thomas asked the GP not to tell her husband about it. Mr Thomas is extremely concerned about his wife but she refuses to allow the diagnosis to be shared with him; indeed, she sometimes forgets what it is the GP has told her although she is aware of her failing memory and powers to concentrate.

Tags: bulimia nervosa, case study