EpistemisPurgative conduct
Specialty: Psychiatry.
Why it occurs
- Bulimia nervosa
- Anorexia nervosa (purgative subtype)
- Borderline personality disorder (such as self-injurious or emotional regulation behavior)
- Somatization disorder or somatic symptoms with digestive focus
- Severe dissociative disorders
Initial workup
Complete serum ionogram (K, Na, Cl, Mg); venous gasometry; serum amylase; 12-lead electrocardiogram; upper gastrointestinal endoscopy if there is suspicion of mucosal injury or active bleeding; EDI-3 scale.
red flags
Presence of severe orthostatic hypotension, generalized muscle cramps, cardiac arrhythmias (QT prolongation on ECG due to hypokalemia), or hematemesis (suggestive of Mallory-Weiss tear or esophageal rupture).
Standard management
- Fluoxetine — SSRI approved specifically for bulimia nervosa at a dose of 60 mg/day, reduces the frequency of binge eating and purgative behaviors
- Topiramate — adjuvant for impulse control
- Potassium supplements orally or IV depending on severity, under close monitoring of renal and cardiac function
- *Critical note: Avoid the use of bupropion in these patients due to the increased risk of seizures due to the hydroelectrolyte alterations potentially present.*
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Psychiatry
- Listed causes
- 5
- Treatment options
- 4