Manual of Psychiatric Nursing Care Planning by Elizabeth M. Varcarolis

Author:Elizabeth M. Varcarolis
Language: eng
Format: epub, pdf
Publisher: Elsevier Inc.
Published: 2014-03-07T05:00:00+00:00

Bulimia Nervosa

Individuals with bulimia might be slightly overweight, normal weight, or slightly below. The hallmark feature of bulimia nervosa is an excessive intake of food (binge eating), with purging behaviors to maintain body weight. Purging behaviors can include self-induced vomiting or the excessive use of laxatives, diuretics, or enemas. Other behaviors directed at maintaining body weight include prolonged fasting, excessive exercise, or misuse of diet pills. Purging is used by approximately 80% to 90% of individuals who present for treatment at eating disorder clinics. Individuals with bulimia who use purging behaviors are referred to as having bulimia nervosa—purging type. Similarly, bulimia nervosa—nonpurging type represents individuals who use inappropriate compensatory behaviors (fasting, excessive exercise, misuse of diet pills) but do not engage in purging behaviors.

Those considered most at risk for bulimia nervosa in the United States are Caucasian female individuals between 14 and 40 years of age, although most are in late adolescence or their early twenties.

Depressive symptoms often complicate the picture. Suicidal or self-mutilation behaviors can be associated with depression, which usually follows the development of bulimia nervosa (up to 70% of the time). However, in some cases, depression precedes bulimia. Substance abuse is often present (particularly alcohol and stimulants such as cocaine). A substantial number of bulimic patients have features of one or more personality disorders, frequently borderline personality disorder. This might account for the prevalence of bulimic individuals who present with dysfunctional personal relationships.

Individuals with bulimia are often more socially skilled and sexually active than patients with anorexia nervosa. Bingeing is usually done alone and in secret. In one episode of bingeing, a bulimic can consume more than 5000 calories. Excessive vomiting can lead to severe dehydration and electrolyte imbalance, particularly hypokalemia. Teeth might be discolored or rotten as a result of gastric acid erosion related to excessive vomiting. Calluses on fingers result from inducing vomiting.

A sense of being out of control accompanies the excessive and/or compulsive consumption of large amounts of food. Binges are usually recurrent and are only interrupted when there is a social interruption, physical pain, or nausea. Poor impulse control can manifest itself in other impulsive behaviors as well (e.g., shoplifting and promiscuity). Following a binge, individuals often experience tremendous guilt, depression, or disgust with themselves. Young women with bulimia nervosa have an obsessive and persistent overconcern with body shape and weight and experience a distortion of body image. That is, they see themselves as too fat or large even when they are near or below normal body weight.

Treatment is provided in an outpatient setting unless there is a physical or psychological emergency. (Refer to Appendix D-8 for criteria for hospital admittance.)

The clinical course of bulimia nervosa can be either chronic or intermittent, with waxing and waning of symptoms. Many individuals experience the development of other psychiatric or medical problems. Up to 50% or more of bulimics recover; although relapse does sometimes occur. In addition to suicide, death can occur after severe bingeing.

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