Overview

• Type of eating disorder characterised by episodes of binge eating followed by intentional vomiting or other purgative behaviours such as the use of laxatives or diuretics or exercising.

• ICD-10 Diagnostic Criteria:

  1. Binging/overeating or persistent preoccupation with eating. (MAIN SYMPTOM)
  2. Purging behaviours (excessive exercise, vomiting, laxatives, diuretics).
  3. Psychopathology (loss of control, body image distortion, dread of fatness).

  <aside> 💡 BINGING + PURGING + PSYCHOPATHOLOGY

  </aside>

AN = underweight, BN = normal/increased weight.

Making Diagnosis

Clinical Features

• Recurrent Vomiting → may lead to erosion of teeth and Russell's sign (calluses on the knuckles or back of the hand) due to repeated self-induced vomiting.
• Other Sx → absent periods, swollen salivary glands, cardiac arrhythmias, electrolyte abnormalities, osteoporosis, refractory constipation (due to excessive laxative abuse).
• NOT UNDERWEIGHT (unlike anorexia)

Binge Eating Disorder → recurrent episodes of binge eating in the absence of compensatory behaviours.

Investigations

• ECG → hypokalaemia due to vomiting. (Hypokalaemia: first-degree heart block, tall P-waves, flattened T-waves).
  • Metabolic Alkalosis (with low Cl due to loss of HCL from stomach when vomiting).
• U&Es → Deranged Electrolytes.

Management Plan

• Referral Pathways (NO WATCHFUL WAITING PERIOD EVER USED):
  • Severe (daily purging, significant electrolyte imbalance, comorbidity) → urgent referral to CEDS.
  • Moderate (frequent binging and purging >2/wk) → monitor for 8 weeks, bulimia focused guided self-help, routine referral to CEDS if failure to respond.
  • Mild (infrequent binging and purging <2/wk) → monitor for 12 weeks, bulimia focused guided self-help.
• General Management:
  • Children → first-line is bulimia focussed family therapy.
  • Adults → first-line is bulimia focused guided self-help for 4 weeks. If ineffective after 4 weeks, then CBT-ED.
  • Moderate-Severe → SSRIs (high dose 60mg fluoxetine).
  • Treat medical complications → regular dental review for acid-wear on teeth.