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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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Cognitive Behavior Treatment of Bulimia Nervosa
From American Family Physician, 2/1/01 by Karl E. Miller

Outlining patient characteristics that predict the outcome of psychotherapy for bulimia nervosa has been an elusive goal. If patients who will or will not respond to psychotherapy could be identified, treatment could be reserved for those who will respond. If those who are not likely to respond to psychotherapy can be identified early, other treatment methods may be more effective. The most effective therapy for patients with bulimia nervosa is cognitive behavior therapy. Even though it is the most effective therapy, only about 50 percent of bulimic patients treated this way recover. Because of this low response rate, it is important to identify patients who will not respond to cognitive behavior therapy to allow an early move to another treatment strategy. Agras and colleagues studied useful predictors of attrition and the outcome of cognitive behavior therapy in patients with bulimia nervosa.

Women who met the criteria for bulimia nervosa in the Diagnostic and Statistical Manual of Mental Disorders-Revised, 3d ed. (DSM-III-R) were enrolled in the study. The pretreatment, course and outcome data were recorded for these patients. All were given 18 sessions of manual-based cognitive behavior therapy. The differences between dropouts and nondropouts and recovered and nonrecovered patients were examined descriptively. Signal detection analyses were used to evaluate clinical cutoff points predicting attrition and abstinence.

Of the 140 patients who completed the treatment course, 41 percent had stopped binge eating or purging according to the Eating Disorder Examination. Dropouts were more likely to have severe bulimic cognition and greater impulsivity, but these factors were not useful as clinical predictors. Poor social adjustment and lower body mass index characterized patients in whom treatment failed. The signal detection analysis identified poor outcomes in patients who had not reduced purging by 70 percent or more by the sixth treatment session. Using this cutoff provided a method of identifying patients who were prospective failures of cognitive behavior therapy.

The authors conclude that patients with bulimia nervosa who have not significantly reduced their purging behavior by the sixth session of cognitive behavior therapy are not likely to respond to this treatment. These patients should be transferred to a second-line treatment.

2000;157;1302-8.

COPYRIGHT 2001 American Academy of Family Physicians
COPYRIGHT 2001 Gale Group

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