Bulimia Nervosa – Diagnostic Interview
DIAGNOSTIC INTERVIEW
- 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.