Bulimia Nervosa Definition Characterised by recurrent binge eating episodes and inappropriate weight compensatory behaviours. Epidemiology • • • More common in females. Peaks at 20 to 24 years. The vast majority of those affected are females. Aetiology • • • Not well understood Multifactorial Obesity during childhood and early puberty Clinical features • • • • • • • • • • • • • Recurrent binge eating episodes associated with inappropriate weight compensatory behaviours. BMI: ➔Normal or slightly elevated Seizures Arrythmias Hypotension Esophagitis Gastritis Bilateral parotid gland swelling Calluses on the knuckles -> Russel sign Dry skin and brittle nails Caries Perimylopids due to frequent vomit Amenorrhea Key Info Associated with an increased risk of suicide Management • Psychotherapy - • First line Adolescents and young adults ➔Family based therapy with an involved caregiver - Adults ➔CBT Pharmacotherapy - Fluoxetine -> preferred ➔Can reduce binge eating episodes and purging Prognosis • • • Chronic with relapses Mortality -> 2 to 6 times higher than the general population Increase risk of psychological comorbidities - Most commonly depression, anxiety and panic disorders esp. social phobias.