Psychiatric Mental Health Nursing by Videbeck

438 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS

◗ SYMPTOMS OFBULIMIANERVOSA

Recurrent episodes of binge eating

Compensatory behavior such as self-induced vom-

iting, misuse of laxatives, diuretics, enema or

other medications, or excessive exercise

Self-evaluation overly influenced by body shape

and weight

Usually within normal weight range, possible un-

derweight or overweight

Restriction of total calorie consumption between

binges, selecting low-calorie foods while avoid-

ing foods perceived to be fattening or likely to

trigger a binge

Depressive and anxiety symptoms

Possible substance use involving alcohol or

stimulants

Loss of dental enamel

Chipped, ragged, or moth-eaten appearance of teeth

Increased dental caries

Menstrual irregularities

Dependence on laxatives

Esophageal tears

Fluid and electrolyte abnormalities

Metabolic alkalosis (from vomiting) or metabolic

acidosis (from diarrhea)

Mildly elevated serum amylase levels

tated by strong emotions and followed by guilt,
remorse, shame, or self-contempt.
The weight of clients with bulimia usually is in
the normal range, although some clients are over-
weight or underweight. Recurrent vomiting destroys
tooth enamel, and incidence of dental caries and
ragged or chipped teeth increases in these clients.
Dentists are often the first health care professionals
to identify clients with bulimia.
Bulimia nervosa usually begins in late adoles-
cence or early adulthood; 18 or 19 years is the typical
age of onset. Binge eating frequently begins during or
after dieting. Between binging and purging episodes,
clients may eat restrictively, choosing salads and other
low-calorie foods. This restrictive eating effectively
sets them up for the next episode of binging and purg-
ing, and the cycle continues.
Clients with bulimia are aware that their eating
behavior is pathologic and go to great lengths to hide
it from others. They may store food in their cars,
desks, or secret locations around the house. They
may drive from one fast-food restaurant to another,
ordering a normal amount of food at each but stop-
ping at six places in 1 or 2 hours. Such patterns may
exist for years until family or friends discover the
client’s behavior, or medical complications develop
for which the client seeks treatment.

Table 18-1

MEDICALCOMPLICATIONS OFEATINGDISORDERS

Body System Symptoms

RELATED TO WEIGHT LOSS

Musculoskeletal

Metabolic

Cardiac

Gastrointestinal

Reproductive

Dermatologic

Hematologic

Neuropsychiatric

RELATED TO PURGING (VOMITING AND LAXATIVE ABUSE)

Metabolic

Gastrointestinal

Dental

Neuropsychiatric

Loss of muscle mass, loss of fat, osteoporosis, and pathologic fractures

Hypothyroidism (symptoms include lack of energy, weakness, intolerance to cold, and

bradycardia), hypoglycemia, and decreased insulin sensitivity

Bradycardia, hypotension, loss of cardiac muscle, small heart, cardiac arrhythmias

(including atrial and ventricular premature contractions, prolonged QT interval,

ventricular tachycardia), and sudden death

Delayed gastric emptying, bloating, constipation, abdominal pain, gas, and diarrhea

Amenorrhea and low levels of luteinizing and follicle-stimulating hormones

Dry, cracking skin due to dehydration, lanugo (i.e., fine, baby-like hair over body),

edema, and acrocyanosis (i.e., blue hands and feet)

Leukopenia, anemia, thrombocytopenia, hypercholesterolemia, and hypercarotenemia

Abnormal taste sensation, apathetic depression, mild organic mental symptoms, and

sleep disturbances

Electrolyte abnormalities, particularly hypokalemia, hypochloremic alkalosis, hypo-

magnesemia, and elevated blood urea nitrogen (BUN)

Salivary gland and pancreas inflammation and enlargement with an increase in

serum amylase, esophageal and gastric erosion or rupture, dysfunctional bowel,

and superior mesenteric artery syndrome

Erosion of dental enamel (perimyolysis), particularly front teeth

Seizures (related to large fluid shifts and electrolyte disturbances), mild neuropathies,

fatigue, weakness, and mild organic mental symptoms

Adapted from Halmi, K. A. (2000). Eating disorders. In B. J. Sadock & V. A. Sadock (Eds.). Comprehensive
textbook of psychiatry,Vol. 2, (7th ed., pp. 1663–1676). Philadelphia: Lippincott Williams & Wilkins.