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Bulimia nervosa

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 intentionally doing one or more of the following in order to compensate for the intake of the food and prevent weight gain: more...

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  • vomiting,
  • inappropriate use of laxatives, enemas, diuretics or other medication,
  • excessive exercising,

The five DSM-IV critera

The following five criteria must all be met for a patient to be diagnosed with bulimia:

  • 1) The patient feels incapable of controlling the urge to binge, even during the binge itself; and he or she consumes a larger amount of food than a person would normally consume at one sitting
  • 2) The patient purges him or herself of the recent intake, resorting to vomiting, laxatives, diuretics, exercising, etc.
  • 3) The patient engages in such behavior occurs at least twice per week for three months.
  • 4) The patient is focused upon body image and the desperate desire to appear thin.
  • 5) The patient does not meet the diagnostic criteria for anorexia nervosa. (Some anorectics may demonstrate bulimic behaviours in their illness: binge-eating and purging themselves of food on a regular or infrequent basis at certain times during the course of their disease. Alternatively, some individuals might switch from having anorexia to having bulimia. The mortality rate for anorectics who practice bulimic behaviors is twice that of anorectics who do not. )
  • 6) The patient is of normal weight or overweight.

Please note that these diagnosis criteria are only a guide, and many doctors will diagnose bulimia nervosa if only one is not present.

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 their stomach hurts from over-extension . . . This cycle may be repeated several times a week or, in serious cases, several times a day." Sufferers can often "use the destructive eating pattern to gain control over their lives".

Patterns of bulimic cycles

The frequency of bulimic cycles will vary from person to person. Some will suffer from an episode every few months while others who are more severely ill may 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.

Consequences of bulimia nervosa

  • Electrolyte imbalance, heart arrhythmia, heart failure
  • Teeth erosion and cavities
  • Sialadenosis (salivary gland swelling)
  • Potential for gastric rupture during periods of bingeing
  • Acid Reflux
  • Irritation, inflammation, and possible rupture of the esophagus
  • Laxative dependence
  • Peptic ulcers and pancreatitis
  • Emetic toxicity due to ipecac abuse
  • Potentially death

Read more at Wikipedia.org


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Bulimia Nervosa
From Gale Encyclopedia of Childhood and Adolescence, 4/6/01 by Gail B. Slap, M.D. University of Pennsylvania School of Medicine

An eating disorder marked by episodes of binge eating followed by one or more behaviors to control weight, most commonly self-induced vomiting, laxative abuse, fasting, or excessive exercise.

Bulimia tends to appear in late adolescence or early adulthood, and most cases occur among middle- and upper-class females. The binge-purge episodes are almost always kept secret, and they tend to follow a recurrent pattern with at least two episodes per week. Like anorexia nervosa , bulimia has its roots in complex social and emotional issues. The family histories of bulimic youth often include emotional chaos, excessive anger, depression , substance abuse, and physical or sexual abuse .

Physical effects

Although bulimia is not associated with the severe weight loss of anorexia nervosa, it does cause a number of serious health risks, the most significant of which are gastrointestinal. Consequences of frequent vomiting include damage to the esophagus, stomach, pancreas, and small intestine. Eventually, a bulimic patient may have trouble keeping down any food for more than a few minutes, and laxative abuse can lead to chronic abdominal pain and constipation . Dehydration, kidney stones, hypoglycemia , and irregularities in heart rhythm are some of the effects of bulimia. A dentist may notice gum disease, numerous cavities, and damaged tooth enamel caused by the acid content of vomitus.

Psychological effects

Bulimia, like anorexia nervosa, is related to anxiety or conflict. However, while the anorectic individual denies she has an eating disorder, the bulimic individual is aware that she has a problem. She feels controlled by food and views her eating habits (and therefore her self) as repulsive to others. She finds comfort in the act of eating, even while dreading the inevitable purge that is to follow.

A bulimic adolescent may experience mood swings, anxiety, or irritability. Normal sleep patterns are often disrupted by amphetamine-induced insomnia, middle-of-the-night eating binges, or bouts of laxative-induced diarrhea. Bulimia is usually marked by secretive behaviors, and bulimic adolescents will often steal food or money to buy food.

Treatment and prognosis

Because a bulimic individual's overall body weight remains normal, it is sometimes years before her family or friends realize that she is struggling with the illness. If an adolescent girl exhibits any signs of an eating disorder, a doctor should be alerted immediately. Effective treatment for bulimia incorporates psychotherapy , nutritional counseling, and medical care if physical problems are present. Antidepressant medication is sometimes prescribed to regulate mood, and support groups are often sources of information and encouragement.

Reliable information is not available on the long-term prognosis for adolescents with bulimia. Studies seem to indicate that relapses are fairly common later in life, especially during periods of stress.

See alsoAnorexia Nervosa ; Eating Disorders .

Further Reading

For Your Information

Books

  • Jablow, Martha M. A Parent's Guide to Eating Disorders and Obesity . New York: Delta Publishing, 1992.
  • Maloney, Michael, and Rachel Kranz. Straight Talk about Eating Disorders . New York: Facts on File, 1991.

Gale Encyclopedia of Childhood & Adolescence. Gale Research, 1998.

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