para>Maternal and fetal problems if pregnant á
- Binging/purging behaviors may persist, increase, or decrease with pregnancy.
- Increased risk for preterm delivery, operative delivery, and infants with low birth weight should be managed as high risk.
REFERENCES
11 Raevuori áA. Genetic etiology of eating disorders. Duodecim. 2013;129(20):2126-2132.22 Stice áE, Shaw áH, Marti áCN. A meta-analytic review of eating disorder prevention programs: encouraging findings. Annu Rev Clin Psychol. 2007;3:207-231.33 Cotton áMA, Ball áC, Robinson áP. Four simple questions can help screen for eating disorders. J Gen Intern Med. 2003;18(1): 53-56.44 Hay áPP, Bacaltchuk áJ, Stefano áS, et al. Psychological treatments for bulimia nervosa and binging. Cochrane Database Syst Rev. 2009;(4):CD000562.55 Shapiro áJR, Berkman áND, Brownley áKA, et al. Bulimia nervosa treatment: a systematic review of randomized controlled trials. Int J Eat Disord. 2007;40(4):321-336.66 Bacaltchuk áJ, Hay áP, Trefiglio áR. Antidepressants versus psychological treatments and their combination for bulimia nervosa. Cochrane Database Syst Rev. 2001;(4):CD003385.77 Bellini áM, Merli áM. Current drug treatment of patients with bulimia nervosa and binge-eating disorder: selective serotonin reuptake inhibitors versus mood stabilizers. Int J Psychiatry Clin Pract. 2004;8(4):235-243.
ADDITIONAL READING
- American Psychiatric Association. Practice Guideline for the Treatment of Patients with Eating Disorders. 3rd ed. Washington, DC: American Psychiatric Association. http://www.psychiatry.org/
- National Institute for Clinical Excellence. Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders (NICE Guidelines). London, United Kingdom: National Institute for Clinical Excellence; 2004. http://www.nice.org.uk.
SEE ALSO
- Anorexia Nervosa; Hyperkalemia; Laxative Abuse; Salivary Gland Tumors
- Algorithm: Weight Loss
CODES
ICD10
F50.2 Bulimia nervosa á
ICD9
307.51 Bulimia nervosa á
SNOMED
- 78004001 Bulimia nervosa (disorder)
- 32721004 Bulimia nervosa, purging type
- 59645001 Bulimia nervosa, nonpurging type
- 231523004 Atypical bulimia nervosa
CLINICAL PEARLS
- Asking "Are you satisfied with your eating patterns?"Ł and/or "Do you worry that you have lost control over how much you eat?"Ł may help to screen for an eating problem.
- Weight is not severely lowered as in anorexia nervosa.
- Consider using a stepped care approach. Start with a guided self-help program using instructional aids; next, begin CBT (e.g., 16 to 20 sessions over 4 to 5 months).
- SSRIs, particularly fluoxetine (60 mg daily), may be helpful as a first step or as an adjunctive treatment with CBT.