Anorexia Nervosa vs Bulimia Nervosa: Restriction vs Binge-Purge Cycle
Both are eating disorders, but the NCLEX expects you to match specific lab values, physical findings, and mortality data to the correct diagnosis. Picking the wrong electrolyte pattern or missing refeeding syndrome risk on an anorexia question can cost you the item — and in practice, the patient's life.
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- Severe caloric restriction
- Significantly low weight (BMI < 18.5)
- Binge, then purge (vomit, laxatives)
- Usually normal or slightly above weight
- ★Lanugo, hypothermia, dry/yellow skin
- Emaciation, muscle wasting
- Sees self as fat
- denies problem (ego-syntonic)
- ★Russell's sign (knuckle calluses)
- Parotid swelling
- dental enamel erosion
- Aware, ashamed (ego-dystonic)
- Hypoglycemia, hyponatremia
- Bradycardia, orthostatic hypotension
- ★Hypokalemia + metabolic alkalosis
- Hypomagnesemia if laxative abuse
- Medical stabilization first
- Slow refeeding
- Supervised meals + weights
- Interrupt binge-purge cycle
- Supervise 1 hr post-meal
- Monitor K⁺ (purging losses)
- Weight restoration, then CBT
- No FDA-approved drug
- CBT first-line
- Fluoxetine 60 mg — FDA-approved
- Refeeding risk
- realistic weight goals
- Address body-image distortion
- Stop self-induced vomiting
- dental care
- Identify binge triggers
- no ipecac
- ★Refeeding syndrome: ↓ phosphate
- Bradycardia then cardiac arrest
- Hypokalemic dysrhythmias
- Esophageal tear (Mallory-Weiss)
- Highest mortality of any psych disorder
- Osteoporosis
- cardiac arrest
- Chronic electrolyte imbalance
- esophagitis
Anorexia Nervosa
- Severe caloric restriction
- Significantly low weight (BMI < 18.5)
Bulimia Nervosa
- Binge, then purge (vomit, laxatives)
- Usually normal or slightly above weight
Anorexia Nervosa
- ★Lanugo, hypothermia, dry/yellow skin
- Emaciation, muscle wasting
- Sees self as fat
- denies problem (ego-syntonic)
Bulimia Nervosa
- ★Russell's sign (knuckle calluses)
- Parotid swelling
- dental enamel erosion
- Aware, ashamed (ego-dystonic)
Anorexia Nervosa
- Hypoglycemia, hyponatremia
- Bradycardia, orthostatic hypotension
Bulimia Nervosa
- ★Hypokalemia + metabolic alkalosis
- Hypomagnesemia if laxative abuse
Anorexia Nervosa
- Medical stabilization first
- Slow refeeding
- Supervised meals + weights
Bulimia Nervosa
- Interrupt binge-purge cycle
- Supervise 1 hr post-meal
- Monitor K⁺ (purging losses)
Anorexia Nervosa
- Weight restoration, then CBT
- No FDA-approved drug
Bulimia Nervosa
- CBT first-line
- Fluoxetine 60 mg — FDA-approved
Anorexia Nervosa
- Refeeding risk
- realistic weight goals
- Address body-image distortion
Bulimia Nervosa
- Stop self-induced vomiting
- dental care
- Identify binge triggers
- no ipecac
Anorexia Nervosa
- ★Refeeding syndrome: ↓ phosphate
- Bradycardia then cardiac arrest
Bulimia Nervosa
- Hypokalemic dysrhythmias
- Esophageal tear (Mallory-Weiss)
Anorexia Nervosa
- Highest mortality of any psych disorder
- Osteoporosis
- cardiac arrest
Bulimia Nervosa
- Chronic electrolyte imbalance
- esophagitis
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Play full screen for XPClinical Pearl
Underweight + lanugo + refeeding risk = anorexia. Normal weight + Russell's sign + metabolic alkalosis = bulimia.
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