DRG Category: 887

Mean LOS: 4.7 days

Description MEDICAL: Other Mental Disorder Diagnoses

classification section:



Bulimia nervosa (BN) is an eating disorder characterized by repeated episodes of binge eating. During binges, the individual rapidly consumes large amounts of high-caloric food (upward of 2,000 to 5,000 calories), usually in secrecy. The binge is followed by self-deprecating thoughts, guilt, and anxiety over fear of weight gain. Purging is used to relieve these fears. The strict definition used by the Diagnostic and Statistical Manual of Mental Disorders indicates that persons need to have two binge-eating episodes per week for at least 3 months. Most patients who are bulimic purge by inducing vomiting or using laxatives, but some use excessive exercise and diuretics. The individual is caught in a binge–purge cycle that can recur multiple times each day, several times a week, or at an interval of up to 2 weeks to months. Patients with BN experience frequent weight fluctuations of 10 pounds or more but are usually able to maintain a near-normal weight.

As persons with anorexia nervosa (AN) mature, they may turn to bulimic behavior as a way of controlling food intake. In contrast to people with AN, individuals with BN are aware that their behavior is abnormal but conceal their illness because of embarrassment. Persons with bulimia typically have difficulty with direct expression of feelings, are prone to impulsive behavior, and may have problems with alcohol and other substance abuse. Because they can maintain a near-normal weight and, if females, have regular menstrual periods, the problem may go undetected. Bulimic behaviors have been known to persist for decades.

Depending on the severity and duration of the condition, there are significant health consequences. Chronic induced vomiting of stomach contents produces volume depletion and a hypochloremic alkalosis. Dizziness, syncope, thirst, orthostatic changes in vital signs, and dehydration occur with volume depletion. Renal compensation for the metabolic alkalosis and volume depletion leads to further electrolyte imbalances, which may predispose the BN patient to cardiac dysrhythmias, muscle cramps, and weakness. Discoloration of the teeth and dental caries are common because of chronic self-induced vomiting. Laxative abuse is a potentially dangerous form of purging, leading to volume depletion, increased colonic motility, abdominal cramping, and loss of electrolytes in a watery diarrhea. Irritation of intestinal mucosa or hemorrhoids from rapid and frequent stools may cause rectal bleeding. When laxative abuse stops, transient fluid retention, edema, and constipation are common.