Bulimia nervosa

Aged 16-40 years

Bulimics can be subdivided into 2 types

Purging type

They self induce vomiting and use laxatives etc to loose weight

Non-purging type

They just use fasting and exercise to control their weight

Clinical features

Recurrent episodes of binge eating beyond normally accepted amounts of food

Inappropriate compensatory behaviour to prevent weight  for example by

Vomiting;

Use of laxatives or appetite suppressants.

Self-image unduly influenced by body shape

Normal periods

Normal weight

If low BMI  then it is classified as Anorexia Nervosa.

Investigations

Check electrolytes

Management

Refer to psychologist/ psychiatrist/ Eating disorder clinic

Refer to fluoxetine

Offer support and help

Advice

Advice for patients purging

Advice patients to avoid brushing their teeth after vomiting

Rinse with a non-acid mouthwash after vomiting

Limiting acidic foods

Where laxative abuse is present, advice to slowly wean off laxatives