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Bulimia nervosa
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Bulimia nervosa is an eating disorder characterized by recurrent binge eating, followed by compensatory behaviors. The most common form—practiced by more than 75% of people with bulimia nervosa—is self-induced vomiting, sometimes called purging; fasting, the use of laxatives, enemas, diuretics, and over exercising are also common.
The word bulimia derives from the Latin (bulimia) from the Greek ß????µ?a (boulimia; ravenous hunger), a compound of ß??? (bous), ox + ??µ?? (limos), hunger.
Bulimia nervosa was named and first described by the British psychiatrist Gerald Russell in 1979.
rding to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR) published by the American Psychological Association, the criteria for diagnosing a patient with bulimia are:
There are two sub-types of bulimia nervosa: purging and non-purging.
The onset of bulimia nervosa is often during adolescence (between 13 and 20 years of age), with many sufferers relapsing in adulthood into episodic binging and purging even after initially successful treatment and remission.
Bulimia nervosa can be difficult to detect, compared to anorexia nervosa , because bulimics tend to be of average or slightly above or below average weight.
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Encyclopedia
Bulimia nervosa is an eating disorder characterized by recurrent binge eating, followed by compensatory behaviors. The most common form—practiced by more than 75% of people with bulimia nervosa—is self-induced vomiting, sometimes called purging; fasting, the use of laxatives, enemas, diuretics, and over exercising are also common.
The word bulimia derives from the Latin (bulimia) from the Greek ß????µ?a (boulimia; ravenous hunger), a compound of ß??? (bous), ox + ??µ?? (limos), hunger.
Bulimia nervosa was named and first described by the British psychiatrist Gerald Russell in 1979.
Diagnosis
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR) published by the American Psychological Association, the criteria for diagnosing a patient with bulimia are:
- Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a fixed period of time, an amount of food that is definitely larger than most people would eat under similar circumstances.
- A lack of control over eating during the episode: a feeling that one cannot stop eating or control what or how much one is eating.
- Recurrent inappropriate compensatory behavior to prevent weight gain, such as: self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; excessive exercise.
- Self-evaluation is unduly influenced by body shape and weight.
- These symptoms occur at least twice a week on average and persist for at least 3 months.
- The disturbance does not occur exclusively during episodes of anorexia nervosa.
There are two sub-types of bulimia nervosa: purging and non-purging.
- Purging Type: the patient uses self-induced vomiting (which may include use of emetics such as syrup of ipecac) and other ways to rapidly remove food from the body before it can be digested, such as laxatives, diuretics, and enemas.
- Non-purging Type: occurring in approximately 6%-8% of cases, in which the patient uses excessive exercise or fasting after a binge to offset the caloric intake after eating. Purging-type bulimics may also exercise or fast, but as a secondary form of weight control.
The onset of bulimia nervosa is often during adolescence (between 13 and 20 years of age), with many sufferers relapsing in adulthood into episodic binging and purging even after initially successful treatment and remission.
Bulimia nervosa can be difficult to detect, compared to anorexia nervosa , because bulimics tend to be of average or slightly above or below average weight. Many bulimics may also engage in significantly disordered eating and exercising patterns without meeting the full diagnostic criteria for bulimia nervosa.
Prevalence
There is little data on the prevalence of bulimia nervosa in-the-large, on general populations. Most studies conducted thus far have been on convenience samples from hospital patients, high school or university students. These have yielded a wide range of results: between 0% and 2.1% of males, and between 0.3% and 9.4% of females.
| Country | Year | Sample size and type | Incidence |
|---|
| Australia | 2008 | 1943 adolescents (ages 15-17) | 1.4% male | 9.4% female | | Portugal | 2006 | 2028 high school students | | 0.3% female | | Brazil | 2004 | 1807 students (ages 7-19) | 0.8% male | 1.3% female | | Spain | 2004 | 2509 female adolescents (ages 13-22) | | 1.4% female | | Hungary | 2003 | 580 Budapest residents | 0.4% male | 3.6% female | | Australia | 1998 | 4200 high school students | 0.3% combined | | USA | 1996 | 1152 college students | 0.2% male | 1.3% female | | Norway | 1995 | 19067 psychiatric patients | 0.7% male | 7.3% female | | Canada | 1995 | 8116 (random sample) | 0.1% male | 1.1% female | | Japan | 1995 | 2597 high school students | 0.7% male | 1.9% female | | USA | 1992 | 799 college students | 0.4% male | 5.1% female |
There are higher rates of eating disorders in groups involved in activities which idealize a slim physique, such as dance, gymnastics, modeling, cheerleading, running, acting, rowing and figure skating. Bulimia is more prevalent among Caucasians.
Effects
These cycles often involve rapid and out-of-control eating, which may stop when the bulimic is interrupted by another person or the stomach hurts from overextension, followed by self-induced vomiting or other forms of purging. This cycle may be repeated several times a week or, in more serious cases, several times a day, and may directly cause:
The frequent contact between teeth and gastric acid, in particular, may cause:
Related disorders
Bulimics are much more likely than non-bulimics to have an affective disorder, such as depression or general anxiety disorder: A 1985 Columbia University study on female bulimics at New York State Psychiatric Institute found 70% had suffered depression some time in their lives (as opposed to 25.8% for adult females in a control sample from the general population), rising to 88% for all affective disorders combined. Another study by the Royal Children's Hospital in Melbourne on a cohort of 2000 adolescents similarly found that those meeting at least two of the DSM-IV criteria for bulimia nervosa or anorexia nervosa had a six-fold increase in risk of anxiety and a doubling of risk for substance dependency.
Treatment
There is no generally-accepted treatment for bulimia. Generally treatment is predicated on a real or hypothetical relationship to other disorders, Some researchers have hypothesized a relationship to mood disorders. In consequence, clinical trials have been conducted with tricyclic antidepressants
, MAO inhibitors, mianserin, fluoxetine, lithium carbonate, nomifensine, trazodone, and bupropion.
Research groups who have seen a relationship to seizure disorders have attempted treatment with phenytoin, carbamazepine, and valproic acid. Opiate antagonists naloxone and naltrexone, which block cravings for gambling, have also been used. There has also been limited use of topiramate which blocks cravings for opiates, cocaine, alcohol and food. Some researchers also report positive outcomes when bulimics are treated in an addiction-disorders inpatient unit. None of these approaches have been consistently effective.
There have been promising results with the use of dialectical behavioral therapy among people with bulimia nervosa in particular among eating disorders. Patients are taught to practise mindfulness and to observe their urges non-judgementally, and to make decisions based on "wise mind" rather than "emotional" or "rational" minds, which can invalidate one another.
In popular culture
In April 2008, former British Deputy Prime Minister John Prescott revealed he became bulimic during the stress of his first years as deputy prime minister.
See also
Informational links
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