Bulimia Nervosa — MCQs

10 questions

A young lady presents with a history of repeated episodes of overeating followed by purging using laxatives. She is probably suffering from -

A 16-year-old girl has intense cravings for food and consumes large amounts of it, followed by purging behaviors. What is the most likely diagnosis?

All of the following are true about bulimia except

All are true about Bulimia Nervosa, except which of the following?

Bulimia nervosa is treated with

Anorexia Nervosa is characterized by all EXCEPT:

A young girl hospitalised with anorexia nervosa is on treatment. Even after taking adequate food according to the recommended diet plan for last 1 week, there is no gain in weight. What is the next step in management:

Main difference between anorexia nervosa and bulimia nervosa lies in:

Best predictor of good prognosis in anorexia nervosa is:

Q10

Best predictor of good prognosis in anorexia nervosa is:

Bulimia Nervosa Indian Medical PG Practice Questions and MCQs

Question 1: A young lady presents with a history of repeated episodes of overeating followed by purging using laxatives. She is probably suffering from -

A. Binge eating disorder
B. Schizophrenia
C. Anorexia nervosa
D. Bulimia nervosa (Correct Answer)

Explanation: ***Bulimia nervosa*** - This condition is characterized by recurrent episodes of **binge eating** followed by inappropriate compensatory behaviors like **purging (e.g., laxative use)**, self-induced vomiting, excessive exercise, or fasting. - The patient's presentation of repeated overeating followed by purging with laxatives directly aligns with the diagnostic criteria for **bulimia nervosa**. *Binge eating disorder* - While it involves recurrent episodes of **binge eating**, it **does not include** the regular use of inappropriate compensatory behaviors such as purging. - Individuals with binge eating disorder typically experience significant distress about their binging but do not attempt to undo the caloric intake. *Schizophrenia* - This is a severe mental disorder characterized by **distortions in thinking, perception, emotions, language, sense of self, and behavior**, such as hallucinations and delusions. - It is a **psychotic disorder** and does not involve specific eating patterns or purging behaviors. *Anorexia nervosa* - This eating disorder is characterized by a persistent restriction of energy intake leading to a **significantly low body weight**, an intense **fear of gaining weight**, and a distorted body image. - Although some individuals with anorexia nervosa may engage in binge-purging type behavior, the primary defining feature is **significantly low body weight**, which is not mentioned in the patient's presentation.

Question 2: A 16-year-old girl has intense cravings for food and consumes large amounts of it, followed by purging behaviors. What is the most likely diagnosis?

A. Anorexia nervosa
B. Bulimia nervosa (Correct Answer)
C. Major depressive disorder
D. Binge eating disorder

Explanation: ***Bulimia nervosa*** - **Bulimia nervosa** is characterized by recurrent episodes of **binge eating** (consuming large amounts of food with a sense of lack of control), followed by inappropriate **compensatory behaviors** such as self-induced vomiting, laxative abuse, or excessive exercise. - The patient's presentation of "intense cravings for food," consuming "large amounts," and "purging behaviors" directly aligns with DSM-5 diagnostic criteria for bulimia nervosa. - Peak onset is typically in **adolescence and early adulthood**, and it is more common in females. *Anorexia nervosa* - **Anorexia nervosa** is primarily characterized by **restriction of energy intake** leading to significantly low body weight, intense fear of gaining weight, and disturbance in body image. - While the binge-eating/purging subtype of anorexia exists, the defining feature is **persistent restriction** and significantly **low body weight**, which is not mentioned in this clinical scenario. *Major depressive disorder* - **Depression** is a mood disorder with persistent sadness, anhedonia, and neurovegetative symptoms. - While depression commonly co-occurs with eating disorders and may cause appetite changes, the specific cyclical pattern of **binge eating followed by compensatory purging** is not a characteristic feature of depression itself. *Binge eating disorder* - **Binge eating disorder** involves recurrent episodes of consuming large amounts of food with a sense of lack of control, accompanied by marked distress. - The key distinguishing feature is the **absence of regular compensatory behaviors** (purging, excessive exercise, fasting) that are present in bulimia nervosa.

Question 3: All of the following are true about bulimia except

A. Recurrent compensatory behaviors
B. Body image disturbance
C. Binge eating
D. Significant weight loss similar to anorexia nervosa (Correct Answer)

Explanation: ***Significant weight loss similar to anorexia nervosa*** - While individuals with bulimia nervosa may experience some weight fluctuations, they do not exhibit the **significant underweight status** characteristic of anorexia nervosa. - The diagnosis of bulimia nervosa requires that the individual's weight remain within the **normal range or be overweight**, distinguishing it from anorexia nervosa. - This is the key differentiating feature between the two eating disorders. *Recurrent compensatory behaviors* - **Inappropriate compensatory behaviors** to prevent weight gain are a defining diagnostic criterion of bulimia nervosa. - These include self-induced vomiting, misuse of laxatives, diuretics, enemas, fasting, or excessive exercise. - Such behaviors occur at least once weekly for 3 months per DSM-5 criteria. *Body image disturbance* - A core diagnostic criterion for bulimia nervosa is a significant **disturbance in the perception of one's body shape or weight**, heavily influencing self-evaluation. - This distorted body image often fuels the binge-purge cycle. - Patients' self-worth is excessively influenced by body shape and weight. *Binge eating* - **Recurrent episodes of binge eating** are a hallmark symptom of bulimia nervosa, involving consumption of a large amount of food in a discrete period with a sense of loss of control. - These episodes are followed by compensatory behaviors. - Must occur at least once weekly for 3 months to meet diagnostic criteria.

Question 4: All are true about Bulimia Nervosa, except which of the following?

A. Purgative abuse
B. Weight loss (Correct Answer)
C. Binge eating
D. Self-induced vomiting

Explanation: ***Weight loss*** - While individuals with bulimia nervosa may attempt to lose weight, significant **weight loss** is not a defining characteristic; they are typically of **normal weight** or overweight. - Unlike **anorexia nervosa**, which is characterized by being underweight, bulimia nervosa focuses on recurrent episodes of binge eating followed by compensatory behaviors. *Binge eating* - **Binge eating** is a core diagnostic criterion for bulimia nervosa, involving consuming a large amount of food in a short period with a sense of **loss of control**. - These episodes are often accompanied by feelings of guilt, shame, and distress. *Self-induced vomiting* - **Self-induced vomiting** is a common **purging behavior** in bulimia nervosa, used as a compensatory mechanism to prevent weight gain after binge eating. - Other compensatory behaviors include misuse of laxatives, diuretics, enemas, or excessive exercise. *Purgative abuse* - **Purgative abuse**, such as the misuse of **laxatives or diuretics**, is a type of compensatory behavior seen in bulimia nervosa to counteract the effects of binge eating. - This behavior is often driven by a desperate attempt to control weight and body shape.

Question 5: Bulimia nervosa is treated with

A. Clozapine
B. Reserpine
C. Pimozide
D. Escitalopram (Correct Answer)

Explanation: ***Escitalopram*** - **SSRIs** like escitalopram are considered first-line pharmacological treatment for **bulimia nervosa**, especially when combined with **psychotherapy**. - They help reduce the frequency of **binge-eating** and **purging** episodes by modulating serotonin levels. *Clozapine* - This is an **atypical antipsychotic** primarily used for **treatment-resistant schizophrenia**. - It has significant side effects, including **agranulocytosis**, and is not indicated for eating disorders. *Reserpine* - An **antihypertensive** and **antipsychotic** drug that depletes catecholamines and serotonin from central neurons. - Due to its severe side effects, including **depression** and **parkinsonism**, it is rarely used today and not for eating disorders. *Pimozide* - A **first-generation antipsychotic** specifically approved for treating **Tourette's syndrome** but sometimes used off-label for severe tics. - It is not indicated for the treatment of bulimia nervosa and may carry significant **cardiac side effects**.

Question 6: Anorexia Nervosa is characterized by all EXCEPT:

A. Distortion of body image
B. Decreases 25% weight
C. Self induced vomiting
D. Amenorrhea for 3 months (Correct Answer)

Explanation: ***Amenorrhea for 3 months*** - While **amenorrhea** has historically been a common feature of anorexia nervosa due to hormonal imbalances from malnutrition, the **DSM-5 criteria no longer require it for diagnosis**. - Its presence can still suggest severe malnutrition, but its absence does not rule out anorexia nervosa. *Distortion of body image* - This is a core diagnostic criterion for anorexia nervosa, where individuals perceive themselves as **overweight** despite being underweight. - This **body image distortion** drives much of the restrictive eating and weight control behaviors. *Decreases 25% weight* - Anorexia nervosa is characterized by a **restriction of energy intake** leading to a significantly low body weight. - While there isn't a specific percentage that defines this, a significant weight loss (e.g., body weight **less than 85% of normal** for age and height) is a key feature. *Self induced vomiting* - **Self-induced vomiting** is a common compensatory behavior in the **binge-eating/purging subtype** of anorexia nervosa. - It is one of several behaviors (like laxative misuse, excessive exercise) used to prevent weight gain after food intake.

Question 7: A young girl hospitalised with anorexia nervosa is on treatment. Even after taking adequate food according to the recommended diet plan for last 1 week, there is no gain in weight. What is the next step in management:

A. Increase the caloric intake from 1500 kcal to 2000 kcal per day
B. Increase fluid intake
C. Increase the dose of anxiolytics
D. Observe patient for 2 hours after meal (Correct Answer)

Explanation: ***Observe patient for 2 hours after meal*** - Patients with **anorexia nervosa** often engage in compensatory behaviors like **purging** or extensive exercise, which would counteract the effects of increased caloric intake and lead to a lack of weight gain despite consuming an "adequate" diet. - Observing the patient post-meal helps identify these behaviors and ensures that the ingested calories are actually being retained and utilized for weight restoration. *Increase the caloric intake from 1500 kcal to 2000 kcal per day* - Increasing caloric intake is a valid long-term strategy but is not the immediate next step when there's **no weight gain despite adequate intake**; the primary concern is identifying *why* the initial intake isn't leading to weight gain. - Doing so without addressing potential compensatory behaviors might only increase patient distress or lead to more intense purging/exercise. *Increase fluid intake* - While adequate **hydration** is important, it does not directly address the issue of **lack of weight gain** in anorexia nervosa, which is fundamentally a caloric deficit problem. - Increased fluid intake would not provide the necessary calories for weight restoration. *Increase the dose of anxiolytics* - Anxiolytics may help manage **anxiety** related to eating, but they do not directly promote **weight gain** or prevent compensatory behaviors. - This step does not address the core issue of why the recommended diet is not leading to weight gain.

Question 8: Main difference between anorexia nervosa and bulimia nervosa lies in:

A. Symptomatology
B. Weight (Correct Answer)
C. Gender
D. Age

Explanation: ***Weight*** - The primary differentiator is that individuals with **anorexia nervosa** are **underweight** (BMI < 18.5 kg/m²), while those with bulimia nervosa maintain a **normal or overweight BMI**. - A persistent restriction of energy intake leading to a significantly low body weight is a diagnostic criterion for anorexia nervosa, which is not true for bulimia nervosa. *Symptomatology* - While there is overlap in symptoms like **fear of gaining weight** and body image disturbance, the **presence of significantly low body weight** in anorexia nervosa and its absence in bulimia nervosa is the key differentiating factor, making "weight" a more precise answer. - Both disorders involve **compensatory behaviors** like purging, excessive exercise, or fasting, but the underlying weight status distinguishes them. *Gender* - Both anorexia nervosa and bulimia nervosa primarily affect **females**, though rates in males are increasing for both disorders. - As such, gender is not a defining characteristic that differentiates these specific eating disorders from each other. *Age* - Both disorders typically emerge during **adolescence or young adulthood**, with slightly different peak ages of onset. - Age of onset is generally a **shared characteristic** rather than a distinguishing feature between anorexia nervosa and bulimia nervosa.

Question 9: Best predictor of good prognosis in anorexia nervosa is:

A. Shorter duration (Correct Answer)
B. Supportive family
C. Early treatment
D. Higher BMI at diagnosis

Explanation: ***Shorter duration of illness*** - **Shorter duration** at the time of presentation is the most consistently cited predictor of good prognosis in anorexia nervosa across psychiatric literature. - Patients with **brief illness duration** (typically <6 months) have significantly higher rates of complete recovery and remission. - Longer duration leads to entrenchment of **maladaptive eating patterns**, more severe medical complications, and greater resistance to treatment interventions. - Early recognition and presentation inherently means shorter duration, making this the most actionable and reliable prognostic indicator. *Early treatment* - While initiating treatment early is therapeutically crucial, it is an **intervention** rather than a prognostic predictor. - Early treatment is beneficial precisely because it prevents progression to **longer illness duration**. - The effectiveness of treatment depends on multiple factors including patient motivation, comorbidities, and treatment modality. *Supportive family* - A supportive family environment facilitates recovery by providing **emotional support** and reinforcing treatment adherence. - Family-based therapy (FBT) is particularly effective in adolescents with anorexia nervosa. - However, family support alone does not predict outcome as strongly as **illness duration** or other core clinical features. *Higher BMI at diagnosis* - Higher BMI at presentation indicates less severe **malnutrition** and reduced immediate medical risk. - However, BMI alone does not correlate strongly with psychological recovery, as the underlying **eating disorder psychopathology** (body image distortion, fear of weight gain) requires addressing regardless of weight. - Some patients may maintain relatively higher BMI while still meeting diagnostic criteria and having poor outcomes.

Question 10: Best predictor of good prognosis in anorexia nervosa is:

A. Early treatment
B. Higher BMI at diagnosis
C. Shorter duration (Correct Answer)
D. Supportive family

Explanation: ***Shorter duration*** - **Shorter duration of illness** before treatment is consistently identified as one of the strongest predictors of good prognosis in anorexia nervosa. - Duration encompasses the total time the illness has existed, capturing the chronicity and entrenchment of maladaptive eating behaviors, psychological patterns, and physiological complications. - Patients with **brief illness duration** before intervention have higher rates of **full recovery** (up to 50-70% in some studies) compared to those with chronic illness (20-30% recovery rates). - Shorter duration indicates less time for the development of severe medical complications (osteoporosis, cardiac abnormalities) and entrenched psychological patterns that are harder to reverse. *Early treatment* - While **early treatment initiation** is extremely important and strongly correlated with better outcomes, it is typically a function of recognizing and intervening in an illness of short duration. - The benefit of early treatment is largely because it prevents the illness from becoming chronic; thus, duration remains the more fundamental prognostic indicator. - Both concepts overlap significantly, but duration captures the complete timeframe of illness pathology. *Higher BMI at diagnosis* - A **higher BMI at diagnosis** suggests less severe weight loss and may indicate less severe restriction, but it is not as strong a predictor as duration. - Patients can have relatively higher BMI but still have chronic illness with poor prognosis if the duration has been extended. *Supportive family* - A **supportive family** is crucial for treatment adherence, recovery, and relapse prevention, and is indeed a positive prognostic factor. - However, family support alone cannot overcome the physiological and psychological damage of prolonged illness duration. - In pediatric/adolescent populations, family-based therapy (FBT) outcomes are best when the **illness duration is short** at treatment onset.

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