How To Conduct a Physical Exam to Detect Bulimia

Bulimia Nervosa or Bulimia is a psychological eating disorder marked by periods of excessive eating or binging followed by severe methods of trying to control the weight through forced vomiting or purging and the use of laxatives and excessive exercise. It is estimated that about five to six percent of American women have suffered from this condition.

A trained physician can detect this condition in patients using several methods. Here’s how to conduct a physical exam to detect bulimia.

• Get the patient vital statistics. Measure the body mass index, height and weight of the patient. A bulimic may fall well below his percentile, in some cases as much as fifteen percent below.
• Get the blood pressure and heart rate of the patient. Bulimics may suffer from very low blood pressure. Also, an irregular heart rate may signify low potassium levels in the body due to malnutrition.
• Perform an oral inspection. Check the patient’s teeth for signs of enamel erosion. This is because constant purging will bring the stomach acids in constant contact with the teeth, slowly eroding the protective enamel. The teeth may appear clear. There may also be some scarring at the back of the throat as a result of the patient constantly putting her finger down the back of the throat to induce vomiting.
• Check for swelling, which is a sign of excessive vomiting. In bulimic patients, the parotid glands in the cheeks get swollen causing a swollen appearance in the cheeks and jaw.
• Check for damage to the esophagus. This is the most commonly affected part of the body by bulimia. Determine if there are any ruptures or strictures in the esophagus. Colon function is also affected by bulimia. In some cases, there may be colon failure.
• Observe for any dryness on the skin. Bulimics have dry skin because of dehydration and malnutrition. Check the backs of the hands for any tooth marks or calluses, especially on the fingertips. These marks may be caused by self-induced vomiting.
• Take a blood sample to test for electrolyte levels, potassium levels and bicarbonate levels. A blood test will also reveal any blood deficiencies such as anemia.
• Conduct a urinalysis. Lab results will reveal any abnormalities in kidney, thyroid and other internal organ function.
• In severe cases of bulimia, an x-ray may be taken to check the heart and any damage to the lungs
• Determine if the patient is having a regular menstrual cycle. Missed or irregular periods are another sign because of improper dieting. The patient may be malnourished.
• Do a basic psychological reading of the patient. Ask about the patient’s body image, as well as eating habits and patterns. Be aware the part of this condition is the element of secrecy and denial, so you may need to refer the patient to a psychologist to get a more accurate assessment. Ask if there is a previous history of substance abuse or other eating disorders.

Because bulimia nervosa is a psychological matter, the patient may need to be referred to a mental health specialist to get a thorough assessment. If patient has bulimia, professional medical intervention will be necessary to treat the patient immediately.