How often do you think of food? … Tell me your thoughts. (Preoccupation with food)
Do you spend a long time thinking about food/meal times/cooking, etc? (Preoccupation with food)
Do you have any special rituals around meal times?
Do you ever have bingeing periods? ….What I mean is eating large quantities of food in a short span of time, more than most people would eat. (Important to clarify what you mean by a binge) (Recurrent episodes of bingeing)
Do you feel out of control when you binge?
How do you feel after that?
What do you do next? (in some cases self harm may occur due to feelings of sadness or guilt)
Do you induce vomiting or take laxatives after bingeing? (Compensatory behaviours)
Is your self esteem linked to the way you feel about your body and weight? (Self evaluation influenced by body shape and weight)
IMPORTANT POINTS IN CLINICAL PRACTICE
Physical examination is a must. (Electrolyte abnormalities, low pulse and BP can indicate medical compromise)
Brief cognitive examination, e.g. clock-drawing test with frontal lobe testing. (Compensatory behaviours can affect cognition)
High degree of co-morbidity in Bulimia Nervosa. Rule out anxiety, depression, substance misuse and personality disorder.
Personality Disorder of Borderline type is highly associated with Bulimia Nervosa. (Self identity issues and impulsivity maintain the eating disorder)
Bulimia Nervosa can be associated with shop lifting. (Impulsivity as part of personality)
Obsessional / Perfectionistic personality traits may also be present (Often linked to high levels of self criticality that are commonly found in individuals with low self esteem)
Family history of obesity or eating disorder may be present
Personal history may reveal role models, childhood sexual abuse, attachment difficulties, bullying, and obesity as a child.
History will reveal worsening of eating disorder with stressors.
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