Binge-eating/Purging Type – Bulimia Nervosa (Nursing)

00:01 The second diagnosis of bulimia nervosa is characterized by an uncontrolled compulsive, episodic, rapid ingestion of large amounts of food which is called binging over a short period of time, followed by inappropriate behaviors to get rid of those calories that they've just eaten, which is purging.

00:29 It's the binge and purge.

00:33 It occurs in only 4% of young women.

00:36 And the onset is usually in early adulthood or late adolescence.

00:42 It is not specific only to young women however.

00:47 We've always focused on women, but young men also are experiencing all of these food related problems.

01:02 So what is the binging look like? Well, binging is uncontrolled and it is compulsive.

01:08 The person cannot stop. It is rapid ingestion.

01:12 They see it, they have to eat it.

01:15 And they may be doing it in secret.

01:19 And so a family member may not even know about it.

01:22 So they kind of hoard the food, and they hide it.

01:26 And then they end up just eating, and eating, and eating, and eating until either they are interrupted or perhaps they fall asleep.

01:39 And then they start that self-induced vomiting that might stop them from eating, or they may have eaten so much in so short a period of time that their abdomen starts to become distended and they have severe abdominal discomfort, which would stop them again, from eating that much.

02:03 Then they have to purge.

02:05 That is when they must read the body of those excess calories.

02:10 And that is done through vomiting, through exercise, through fasting, and using enemas, diuretics and laxatives.

02:22 Persons who have bulimia nervosa usually have a preoccupation with the way they look.

02:27 So their personal appearance is extremely important.

02:31 And the way others see them.

02:34 So they are consumed also with how does someone else perceive me? Do they think of me as beautiful, or thin, or perfect? Perfection often comes up for these patients.

02:50 And I often will say, don't make perfection the enemy of good.

02:55 Sometimes looking good is enough. You don't have to look perfect.

03:02 But this preoccupation takes over how they see themselves.

03:08 So when we're looking at a person who has bulimia nervosa, unlike when we were just speaking about anorexia, this person does not seem to be starving to death.

03:20 They seem to be fairly normal in their weight. Why? Because they take in the calories, and then they vomit out the calories.

03:30 So they appear to be in the normal weight range.

03:36 However, this disorder can absolutely affect their gums and their teeth.

03:43 So we see these people losing teeth and also having decayed teeth. Why? Because the vomiting, actually all that acid that when you force yourself to vomit gets into the gums, gets into the roots of the teeth.

04:00 We also find that there's esophageal scarring from the amount of vomiting that is induced.

04:06 They may have enlarged glands in their cheeks.

04:11 And unfortunately, they can develop cardiac arrhythmias.

04:16 Because think about what they are doing to all of the nutrients in their body.

04:22 Think about their potassium levels.

04:25 They are all going, their sodium levels, all of these are going to go into complete disarray through the binging and the purging.

04:34 Those electrolytes, unfortunately, will not be able to fix themselves, because they're not eating the right amount of foods.

04:43 They're not taking in what they need.

04:46 They're not providing the body with what the body requires in order for the body to function correctly.

04:53 It also gets all the hormone imbalances going.

04:58 So they have chemical imbalances, hormonal imbalances, electrolyte imbalances, especially the potassium from all of the diuretics and with the vomiting.

05:11 Just think about if you have a patient who is on medications for hypertension, maybe hydrochlorothiazide.

05:21 And what do we say to them? We say, "Well, you're on a diuretic. You're on Lasix (for example) I would like you to please remember, I'd like to eat a banana in the day." And why do we say that? Because we are going to replenish the potassium that is lost because of the diuretic.

05:40 Now, these are people who are taking diuretics, not because they have hypertension, not for any reason, to make their body healthier.

05:49 They're taking diuretics to take away the water in their body to reduce the amount of weight that they have.

05:57 They're not thinking about the fact that with that diuretic, they're also losing enormous amount of potassium, which helps our heart to be able to function correctly.

06:07 And the pancreas, think of what this does to the pancreas.

06:11 And these people, these patients end up with pancreatitis, peptic ulcers, and unfortunately because of the overuse and abuse of laxatives, they end up with long-term constipation.