A condition typified by repeated episodes of binge eating and frequent vomiting and purging, associated with a preoccupation with control of body weight and a feeling of lack of control over eating behaviour. The vast majority of patients are female, and patients report a high incidence of relatives who are obese and/or who have had a depressive illness. It is the reverse of anorexia nervosa, with which curiously it is occasionally associated in cycles. In rare cases it results from disturbance of the hypothalamus.
Bulimia nervosaClassifications and external resources
| ICD-10 | F50.2 |
|---|---|
| ICD-9 | 307.51 |
Bulimia nervosa, more commonly known as bulimia, is an eating disorder. It is a psychological condition in which the subject engages in recurrent binge eating followed by an intentional purging.
DSM-IV-TR criteria
The following five criteria should be met for a patient to be diagnosed with Bulimia Nervosa:
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any two-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B.
C. The binge eating and inappropriate compensatory behaviours both occur, on average, at least twice a week for three months.
D.
E.
Special type: Purging type: During the current episode of bulimia nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diurretics, or enemas.
Nonpurging type: During the current episode of bulimia nervosa, the person has used other inappropriate compensatory behariours, such as fasting or exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
History of bulimia nervosa
Bulimia nervosa was first described by Professor Gerald Russell in 1979 whilst he worked at the Royal Free Hospital, London. Bulimia nervosa has been recognized as an autonomous eating disorder by the American Psychiatric Association since 1980 .
Causes
Bulimia is often less about food, and more to do with deep psychological issues and profound feelings of lack of control. Sufferers can often "use the destructive eating pattern to gain control over their lives".
Environmental factors
Rates of bulimia are much more prevalent in western civilizations, to the point that the disorder is almost non-existent in eastern cultures. As western civilization is becoming a more prominent figure in other cultures, through movies and television primarily, we are seeing a dramatic increase in the incidence of eating disorders in these cultures. Females involved in activities that put an extreme emphasis on thinness and body type (such as gymnastics, dance and cheerleading) are at the greatest risk for the development of eating disorders.
Patterns of bulimic cycles
The frequency of bulimic cycles will vary from person to person. Some people may vomit automatically after they have eaten any food. Others will eat socially but may be bulimic in private.
Subtypes of bulimia
The specific subtypes differ in the way the bulimic relieves themself of the binge.
Purging type - The purging type uses self-induced vomiting, laxatives, diuretics, enemas, or ipecac, as a means of rapidly extricating the contents from their body.
Non-Purging Type - This type of bulimic is very rarely found (only approximately 6%-8%), as it is a less effective means of ridding the body of such a large number of calories. This is frequently observed in purging type bulimics as well, however this method is not their primary form of weight control following a binge .
Consequences of bulimia nervosa
Malnutrition Dehydration Electrolyte imbalance Hyponatremia Damaging of the voice Vitamin and mineral deficiencies Teeth erosion and cavities, gum disease Sialadenosis (salivary gland swelling) Potential for gastric rupture during periods of bingeing Esophageal reflux Irritation, inflammation, and possible rupture of the esophagus Laxative dependence Peptic ulcers and pancreatitis Emetic toxicity due to ipecac abuse Swelling of the face and cheeks, especially apparent in the lower eyelids due to the high pressure of blood in the face during vomiting. Callused or bruised fingers Dry or brittle skin, hair, and nails, or hair loss Lanugo Edema Muscle atrophy Decreased/increased bowel activity Digestive problems that may be triggered, including Celiac, Crohn's Disease Low blood pressure, hypotension Orthostatic hypotension High blood pressure, hypertension Iron deficiency, anemia Hormonal imbalances Hyperactivity Depression Insomnia Amenorrhea Infertility Polycystic Ovary Syndrome High risk pregnancy, miscarriage, still-born babies Diabetes Elevated blood sugar or hyperglycemia Ketoacidosis Osteoporosis Arthritis Weakness and fatigue Chronic Fatigue Syndrome Cancer of the throat or voice box Liver failure Kidney infection and failure Heart failure, heart arrhythmia, angina Seizure Paralysis Potential death caused by heart attack or heart failure;Diagnosis
As mentioned earlier, all six of the criteria listed in the DSM are required for a classic diagnosis of bulimia nervosa. However, these symptoms are often difficult to spot, especially since, unlike anorexia nervosa, in order to be classified as bulimic the person must be of normal or higher weight. Despite the frequent lack of obvious physical symptoms, bulimia nervosa has proven to be fatal, as malnutrition takes a serious toll on every organ in your body.
Related psychological disorders
It is not uncommon that a patient with bulimia nervosa will also have some anxiety or mood disorder as well. Most commonly associated with bulimia is the incidence of anxiety, one study noted this in 75% of bulimic patients. However recent research suggest that depression is a consequence of the eating disorder itself, rather than the other way around.
Differences between anorexia nervosa and bulimia nervosa
The main criteria differences involve weight, as an anorexic must technically be classified as underweight (defined as a BMI < In the rare instant that this is observed, in that the patient binges and purges as well as fails to maintain a minimum weight they are classified as a purging anorexic, due to the underweight criteria being met. Characteristically, those with bulimia nervosa feel more shame and out of control with their behaviors, as the anorexic meticulously controls her intake, a symptom that calms her anxiety around food as she feels she has control of it, naïve to the notion that it, in fact, controls her. The anorexic is more likely to believe they are in control of their eating and much less likely to admit to needing help, or that a problem even exists in the first place.
Treatment of bulimia nervosa
Treatment is most effective when it is implemented early on in the development of the disorder. Unfortunately, since this disorder is often easier to hide and less physically noticeable, diagnosis and treatment often come when the disorder has already become a static part of the patient’s life.
There are several residential treatment centers across the country, which offer long term support, counseling, and symptom interruption. Anti-depressants come in different forms, and the most promising drug to respond to bulimia has been Prozac. In a study done with 382 bulimia patients those who took between 20-60 mg of the drug reduced their symptoms from 45% to 67%, respectively.
Anti-psychotics are also used, but in smaller doses than are used for treating schizophrenia. With an eating disorder, the patient perceives reality differently and has difficulty grasping what it is like to eat normally.
The rate in which the patient receives treatment is the most important factor affecting prognosis.
Mortality risk
Eating disorders have one of the highest death rates of all mental illnesses. The Eating Disorders Association (UK) estimates a 10% mortality rate. In addition to the risk of suicide, “death can occur after severe binging in bulimia nervosa as well”.
At-risk groups
Risk factors for bulimia are similar to those of other eating disorders, such as anorexia nervosa:
those of age 10 through to 25 athletes people who are active in dancing, modeling or gymnastics students who are under heavy workloads those who have suffered traumatic events in their lifetime such as child abuse and sexual abuse those positioned in the higher echelons of the socioeconomic scale. perfectionistsThe majority of bulimic patients are young females from 10 to 25 years old, although the disorder can occur in people of all ages and both sexes.
There can be a popular assumption that eating disorders are ‘female diseases’, but the illnesses do not discriminate based on gender, and males can also suffer from them: “even if only 5% of sufferers are male, hundreds of thousands of young men are affected…Studies have been conducted within the homosexual subculture, and have also focused on males who suffer from anorexia and bulimia. These point to a direct connection between gender identity conflict and eating disorder in males but not in females. This does not indicate that only gender-conflicted males suffer from eating disorders, but there is a tendency for eating disorders in males to go unrecognised or undiagnosed, due to reluctance among males to seek treatment for these stereotypically female conditions."
Prevention
Currently, there is no known way to prevent the onset of bulimia nervosa.
User Comments Add a comment…