Bulimia nervosa, commonly known as bulimia

Bulimia nervosa, commonly known as bulimia by Arthur Buchanan

Bulimia nervosa, 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. This purging is done in order to compensate for the excessive intake of the food and to prevent weight gain. Purging typically takes the form of vomiting; inappropriate use of laxatives, enemas, diuretics or other medication; and excessive physical exercise.

New research suggests that some sufferers may have a hormonal imbalance of testosterone; however, this research is in its early stages. The word bulimia comes from the the Latin (būlīmia) from the Greek βουλῑμια (boulīmia), ravenous hunger, compounded from βους (bous), ox + λῑμος (līmos), hunger.

Contents

* 1 DSM-IV-TR criteria * 2 History of bulimia nervosa * 3 Causes * 4 Environmental factors * 5 Patterns of bulimic cycles * 6 Subtypes of bulimia * 7 Consequences of bulimia nervosa * 8 Diagnosis * 9 Related psychological disorders * 10 Differences between anorexia nervosa and bulimia nervosa * 11 Treatment of bulimia nervosa * 12 Mortality risk * 13 At-risk groups * 14 Prevention * 15 See also * 16 References * 17 External links

DSM-IV-TR criteria

The following five criteria should be met for a patient to be diagnosed with bulimia nervosa:

1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

1. Eating, in a fixed 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.

2. 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).

2. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics or other medications; fasting; or excessive exercise.

3. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for three months.

4. Self-evaluation is unduly influenced by body shape and weight.

5. The disturbance does not occur exclusively during episodes of anorexia nervosa

History of bulimia nervosa Bulimia nervosa was first described by Gerald Russell in 1977 while 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 [2]. The word "bulimia" is Latin, getting its roots from the Greek word "boulimia" which directly translates to mean "extreme hunger" .

Causes

Bulimia is often less about food, and more to do with deep psychological issues and profound feelings of lack of control. Binge/purge episodes can be severe, sometimes involving rapid and out of control feeding that can stop when the sufferers "are interrupted by another person" or when their stomach hurts from over-extension. This cycle may be repeated several times a week or, in serious cases, several times a day.[4] Sufferers can often "use the destructive eating pattern to gain control over their lives"[5].

Environmental factors

The disorder is more prevalent in Caucasian groups, but is becoming a rising problem in the African American and Hispanic communities. Women account for 90% of the patients that suffer from the disorder. There are higher rates of eating disorders in groups involved in activities that put an emphasis on thinness and body type (such as gymnastics, dance and cheerleading,figure skating and other sports). [6]

Patterns of bulimic cycle

The frequency of bulimic cycles will vary from person to person; the severely ill might binge and purge several times a day. Some people may vomit automatically after they have eaten any food. Others will eat socially but may be bulimic in private. Some people do not regard their illness as a problem, while others despise and fear the vicious and uncontrollable cycle they are in.

Subtypes of bulimia

The specific subtypes of bulimia are distinguished by the way the bulimic relieves themselves of the binge.

Purging type

The purging type involves self-induced vomiting, laxatives, diuretics, tapeworms, enemas, or ipecac, as a means of rapidly extricating the contents from their body. This type is generally more found, and can use one or more of the above methods. [8] Non-Purging Type

This type of bulimia is rarely found (occurring in only approximately 6%-8% of cases), as it is a less effective means of ridding the body of such a large number of calories. This type of bulimia involves engaging in excessive exercise or fasting following a binge in order to counteract the large amount of calories previously ingested. This is frequently observed in purging-type bulimics as well, however this method is, by definition, not their primary form of weight control following a binge.

Consequences of bulimia nervosa

Bulimia can result in following health problems: * 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 binging * 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; lung collapse; internal bleeding, stroke, kidney failure, liver failure; pancreatitis, gastric rupture, perforated ulcer, depression and suicide.

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. Likewise, the person is less likely to drop a significant amount of weight on a continual basis as does the anorexic, making the physical symptoms less noticeable, despite the fact that internal bodily functions are suffering.

Because this disorder carries a great deal of shame, the bulimic will desperately try to hide their symptoms from family and friends. This disorder is more likely to span over a lifetime unnoticed, causing a great deal of isolation and stress for the suffering individual. 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. If any of the symptoms above are noticed one should consult with a doctor or psychologist for further assistance

[edit] 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. Also prominent in bulimic patients are mood disorders, most commonly depression as well as substance abuse issues. However recent research suggest that depression is a consequence of the eating disorder itself, rather than the other way around. [11]. They are also more likely to attempt suicide, and engage in impulsive behaviors.

[edit] 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 < 18.5, though to be diagnosed with anorexia, the patient generally must have a BMI of less than 17.5).

Typically an anorexic is defined by the refusal to maintain a normal weight by self-starvation. Another criterion which must usually be met is amenorrhea, the loss of a female's menstrual cycle not caused by the normal cessation of menstruation during menopause for a period of three months. Generally the anorexic does not engage in regular binging and purging sessions, though they may occur. In the rare instance that this is observed, that is, 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 criterion being met and cessation of menstruation.
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