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Bulimia Nervosa
Bulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating followed by compensatory behaviors like purging to prevent weight gain. It has a lifetime prevalence of 1.5% in women and 0.5% in men. Risk factors include biological factors, psychological issues like low self-esteem, and societal pressures. Symptoms include binge eating, vomiting, abuse of laxatives, and mood changes. Complications can include electrolyte imbalances, dental problems, and even death. Treatment involves medication, psychotherapy, nutrition education, and preventing relapse.
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Presentation on Bulimia nervosa by Amit Newton, M.Sc. Final Year student.
Eating disorders involve abnormal eating habits affecting physical and mental health.
Overview of various eating disorders including Bulimia, Anorexia, and Binge Eating.
Bulimia nervosa involves uncontrolled binge eating followed by compensatory behaviors.
Lifetime prevalence of bulimia is 1.5% in women and 0.5% in men, lasting approximately 8.3 years.
Over 50% of girls and 1/3 of boys engage in unhealthy weight control behaviors.
Describes the cycle of tension, binge eating, purging, guilt, and dieting related to bulimia.
Purging methods include vomiting and laxatives; non-purging methods include over-exercising and fasting.
Factors contributing to bulimia include gender, age, genetics, and psychological issues.
Symptoms include body weight preoccupation, eating in secret, dental issues, and mood swings.
SCOFF includes five questions to assess potential bulimia symptoms.
ESP questionnaire and EAT test are used for primary care screening of eating disorders.
High prevalence of ADHD, substance abuse, and mood disorders in individuals with bulimia.
Describes DSM-5 criteria for diagnosing bulimia, focusing on binge eating and compensatory behaviors.
Medical and psychological evaluations including blood tests, urinalysis, and physical exams.
Serious health complications from bulimia include dehydration, heart problems, and digestive issues.
Management includes pharmacological, psychological, nursing, and dietary approaches.
Antidepressants like fluoxetine are used to reduce bulimia symptoms.
Therapies include cognitive behavioral, interpersonal, dialectical behavior therapy, and family-based treatment.
Self-help groups provide community support and encouragement for individuals with bulimia.
Nutrition education helps develop healthy eating habits and nutritional knowledge.
Therapies like yoga and acupuncture may help manage anxiety but lack definitive proof of effectiveness.
Parental guidance on communication, family meals, and promoting healthy body image is crucial.
Advice for managing bulimia symptoms by maintaining a healthy self-image and coping with triggers.
Nursing diagnoses focus on nutrition, body image, and psychological support for bulimia patients.
Summarizes the presentation and concludes with key takeaways regarding bulimia nervosa.
Discusses evaluation methods and provides a bibliography of sources cited in the presentation.
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Bulimia Nervosa
- 1. Presentation on Bulimia nervosa Presented by- Amitnewton M.Sc. Final Year
- 2. Eating disorders Eating disordersrefer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health.
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- 5. Bulimia nervosa isan episodic ,uncontrolled ,compulsive ,rapid ingestion of large quantity of food over a short period of time(bingeing), followed by inappropriate compensatory behaviors to rid the body of the excess calories.
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- 7. Prevalence • Lifetime prevalenceof BN = 1.5% in women and 0.5% in men. The average lifetime duration of BN is found to be approximately 8.3 year. • 4% of females in the US have bulimia during their lifetime, 3.9% of these die. Of those only 6% obtain treatment • In a survey of 11–16 year-olds, 10% of normal-weight children reported being bullied, compared to 15% of overweight and 23% of obese children
- 8. Project EAT - Morethan 1/2 of girls and 1/3 of boys engage in unhealthy weight control behaviors control appetite) - Higher weight and overweight teens are more likely to engage in both binge-eating and unhealthy weight control than normal weight teens
- 9. Continuum of eatingregulation response
- 10. Tension and craving Binge eating Weight gain Anxietyabout fatness Purging Guilt and self dislike Strict dieting Binge & purge cycle
- 11. Categories of bulimia Purging Regularlyself induced vomiting or misuse of laxatives, diuretics, enemas after binging.
- 12. Non purging other methodsto reduce the weight For example Over exercising Fasting Strict dieting
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- 14. Etiology Being female Girls andwomen are more prone. Age. late teens or early adulthood. Biological factors •Acc to DSM4 -increased frequency in first degree relatives. •Specific areas of chromosomes 10p linked to families with history of bulimia. •Altered serotonin level in brain. •.
- 15. Psychological and emotionalissues. • Low self-esteem •Perfectionism •Impulsive behavior • Anger management problems • Depression •Anxiety disorders • Obsessive-compulsive disorder. •Alcohol dependence •Shoplifting Societal pressure •Peer pressure •Effect of media • Neglectful and rejecting parents. •Family disturbances and conflicts Performance pressure in sports •encouraging young athletes to lose weight, •maintain a low weight •restrict eating for better performance. •.
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- 17. Clinical features Preoccupation withbody weight and shape. Eating in secret . Chronic sore throat. Dental problems. Misusing of laxatives , diuretics or enemas after eating 100% Binge eating
- 18. Contd………… Oral trauma Withdrawal fromfriends and usual activity Fluid and electrolyte imbalance Intestinal problem Irregular menstrual problems Depression and mood swings
- 19. SCOFF mnemonic questionnaire SCOFFquestionnaire includes 5 questions: • Do you make yourself Sick because you feel uncomfortably full? • Do you worry you have lost Control over how much you eat? • Have you recently lost more than One stone (about 14 lbs or 6.35 kg) in a 3-month period? • Do you believe yourself to be Fat when others say you are too thin? • Would you say that Food dominates your life
- 20. • Eating DisorderScreen for Primary Care The Eating Disorder Screen for Primary Care (ESP) questionnaire contains 5 questions: • Eating Attitudes Test (EAT) is a self-report population-based screening instrument that patients can complete in the waiting room prior to seeing the health care provider.
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- 23. Diagnostic criteria accordingto DSM- 5(307.51) A. Recurrent episodes of binge eating. Each of which is characterized by: • Eating in a discrete period of time • A sense of lack of control over eating during the episodes B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain such as self induced vomiting, misuse of laxatives ,diuretics and other medications, fasting and excessive exercise. C. Binge eating and inappropriate compensatory behaviors both occur ,on an average for once a week for 3 months. D .Self evaluation is unduely influenced by body shape and weight
- 24. Diagnostic criteria accordingto Clinical evaluation 1. A complete physical examination 2. Blood chemistry: To rule out • occult metabolic complications of bulimia. • hypokalemic metabolic alkalosis (may cause due to vomiting). • normokalemic metabolic acidosis ( may be due laxative abuse). • Hyponatremia, hypocalcemia, hypophosphatemia, and hypomagnesemia • Elevated blood urea nitrogen levels (significant in intravascular depletion) • Complete blood cell count ( to exclude anemia ) • Hyperamylasemia (significant vomiting because of hypersecretion from the salivary glands)
- 25. 3. Urinalysis Urine specificgravity may reflect the state of hydration. Urine toxicology- Comorbid substance abuse should be ruled out with a urine toxicology screen. 4. Pregnancy test This should always be obtained to rule out pregnancy in female patients presenting with amenorrhea 5. X-ray-- to check for broken bones, pneumonia or heart problems 6. Electrocardiogram (EKG)-- to look for heart irregularities. 7. Medical evaluation to rule out upper gastro intestinal disorder. 8. Psychological evaluation-- a discussion of your eating habits and attitude toward food and beck depression inventory(for MDD).
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- 27. • Dehydration-- kidneyfailure • Heart problems--irregular heartbeat and heart failure • Severe tooth decay and gum disease • Amenorrhea • Digestive problems--irregular bowel movements and constipation ,dependence on laxatives to have bowel movements. • Anxiety and depression • Increased risk of suicide and psychoactive substance use.
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- 29. Management includes: • Pharmacological •Psychological • Nursing • Dietary approach
- 30. Pharmacotherapy • Antidepressants mayhelp reduce the symptoms of bulimia • Selective serotonin reuptake inhibitor -- fluoxetine (Prozac) • TCA’s
- 31. Psychotherapy • Cognitive behavioraltherapy to help you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. • Interpersonal psychotherapy, which addresses difficulties in your close relationships, helping to improve your communication and problem-solving skills • Dialectical behavior therapy to help you learn behavioral skills to tolerate stress, regulate your emotions and improve your relationships with others — all of which can reduce the desire to binge eat. • Family-based treatment to help parents intervene to stop their teenager's unhealthy eating behaviors, then to help the teen regain control over his or her own eating, and lastly to help the family deal with problems the bulimia can have on the teen's development and the family.
- 32. Self help groups Supportgroups helpful for encouragement, hope and advice on coping. Group members can truly understand what you're going through because they've been there.
- 33. Nutrition education Dietitians andother health care providers can design an eating plan to help you achieve a healthy weight, normal eating habits and good nutrition. Patient may benefit from medically supervised weight-loss programs.
- 34. Alternative medicine • Massageand therapeutic touch may help to reduce anxiety often associated with eating disorders. • Mind-body therapies, such as meditation, yoga, biofeedback and hypnosis, may increase awareness of your body's cues for eating and fullness, as well as promote a sense of well-being and relaxation. • Acupuncture shows promise in studies on anxiety and depression, but hasn't been proved effective at this point
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- 36. For parents • Notto waste time trying to figure out why the eating disorder occurred. • Ask your child what you can do to help. For example, offer to keep certain trigger foods out of the house. Ask if your teenager would like you to plan family activities after meals to reduce the temptation to purge. • Listen. Allow your child to express feelings. • Schedule regular family mealtimes. Eating at routine times is important to help reduce binge eating. • Let your teenager know any concerns you have. But do this without placing blame. • Cultivate and reinforce a healthy body image in your children no matter what their size or shape. • Consult pediatrician. Pediatricians may be in a good position to identify early indicators of an eating disorder and help prevent its development
- 37. Coping and supportingself • It may be difficult to cope with bulimia when you're hit with mixed messages by the media, culture, coaches, family, and maybe your own friends or peers. • Remind yourself what a healthy weight is for your body. • Resist the urge to diet or skip meals, which can trigger binge eating. • Don't visit websites that advocate or glorify eating disorders. • Identify troublesome situations that are likely to trigger thoughts or behaviors that may contribute to your bulimia and develop a plan to deal with them. • Have a plan in place to cope with the emotional distress of setbacks. • Look for positive role models who can help boost your self-esteem. • Find pleasurable activities and hobbies that can help to distract you from thoughts about bingeing and purging. • Build up your self-esteem by forgiving yourself, focusing on the positive, and giving yourself credit and encouragement
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- 39. Nursing diagnosis • Imbalancednutrition less than body requirement • Deficient fluid volume • Ineffective denial • Disturbed body image ,low self esteem • Anxiety (moderate to severe)
- 40. Imbalanced nutrition less thanbody requirement •Determine needed nutritional requirements •Explain behavior modification plan •Weights and I/O daily •Assess skin turgor and mucus membrane daily •Stay with client during meals and for 1 hr following meals.
- 41. Ineffective denial •Develop trustrelationship •Give positive regards •Don’t bargain .explain how privelages and consequences are based on compliance with therapy and weight gain •Encourage client to verbalise feelings and unresolved issues. •Help her understand the negative consequences to current eating behavior.
- 42. Disturbed body image,low self esteem •Help client develop realistic perception of body image. •Allow client independent decision making •Give positive feedback •Help client accept self •Convey knowledge that perfection is unrealistic .
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- 46. Bibliography • 1.http://edresearch.stanford.edu/eating-disorders.html • 2.http://www.mayoclinic.org/diseases-conditions/bulimia/basics/risk- factors/con-20033050. •3. http://www.indianjpsychiatry.org • 4. http://emedicine.medscape.com/article • 5. http:// NEDIC.html • 6.American nursing association;diagnostic and statistical mannual of mental disorders-5;5th ed;ISBN;Arlington.USA;2013;PG-345-349. • 7.Sadock.BJ,Sadock.VA;Synopsis of Psychiatry;9th ed;William and Wilkins;USA;1972;PG-746-750. • 8. Shreevani.R;A Guide to mental health and psychiatric nursing;3rd ed;Jaypee publications;New Delhi;2004;pg-217-218. • 9. Townsend.C.M;Essentials of psychiatric mental health nursing:concepts of care in evidenced based practice;7th ed;F.A.Davis company;Philadelphia;2012;pg-738-759.