When the patient was asked about her eating habits, she admitted to a “loss of control.” She described feeling deep remorse when she eats more than she would like.On examination, she presents with bilateral parotid swelling, normal body weight and dental condition as shown in the picture below. What is the most probable diagnosis?
A. Adjustment disorder.
B. Bulimia Nervosa
C. Anorexia Nervosa.
D. Conversion reaction.
Ans: B. Bulimia Nervosa
Common eating disorders:
1. Bulimia Nervosa
2. Anorexia nervosa
- Binge-eating disorder
1. Bulimia Nervosa:
- Bulimia nervosa is characterized by recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes.
- I.e., Episodes of uncontrollable excessive eating (binge-eating)
- Followed by behavior that compensates for the overeating (vigorous weight-reducing measures) such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors.
- Episodes of binge eating occur relatively frequently (twice a week or more) for at least 3 months
- Many patients are within the normal weight range.
- In patients with significant self-induced vomiting, erosions of the lingual surface of the teeth, loss of enamel, periodontal disease, and extensive dental caries may be observed.
- Sometimes internal bleeding due to vomiting.
- Bilateral parotid enlargement, largely consequent to noninflammatory stimulation of the salivary glands, may be seen.
Differences between bulimia nervosa & anorexia nervosa:
- As in anorexia nervosa, there is an extreme preoccupation with the shape and weight of the body.
- However, bulimia nervosa differs from anorexia nervosa by,
Patients of bulimia are slightly older than those with anorexia i.e., Late adolescence.
Most of the patients with bulimia nervosa have a weight within their normal weight range
Amenorrhea is usually not present and most are sexually active, compared with anorexia nervosa patients.
Peculiar behavior about the food of anorexia nervosa is absent.
Depressive symptoms are more common – Post-binge anquish.
Differential diagnosis of bulimia nervosa:
- Important differential diagnosis of “Bulimia nervosa” is “Binge eating disorder (BED)”.
- Here, the person loses control over his or her eating.
- Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting.
- As a result, people with binge-eating disorder often are overweight or obese.
Most important points:
- I.e., Insatiable cravings that can occur anytime day or night, usually secretive, and filled with shame.
- Most importantly those with BED do not purge.
- There are no compensatory mechanisms associated with the binge to get rid of calories, so individuals with BED are more likely to be overweight or obese.
- While patients with bulimia nervosa may be underweight, normal weight or overweight.
2. Anorexia nervosa:
- Characterized by emaciation( weight loss ), a relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight, intense fear of gaining weight, distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight, lack of menstruation among girls and women, extremely restricted eating.