Bulimia nervosa: Difference between revisions

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'''Bulimia nervosa''' is an [[eating disorders|eating disorder]] characterized by recurrent [[binge eating]], followed by compensatory behaviors.<ref name="dsm">{{cite book|title = [[Diagnostic and Statistical Manual of Mental Disorders]] DSM-IV-TR|year = 1994|edition = 4th|publisher = [[American Psychiatric Association]]|isbn = 0890420629}}</ref> The most common form is [[defensive vomiting]], sometimes called purging; [[fasting]], the use of [[laxative]]s, [[enema]]s, [[diuretic]]s, and over exercising are also common.<ref>{{citation|title = Overcoming Binge Eating|first1 = Christopher|last1 = Fairburn|publisher = Guilford|year = 1995|isbn = 0898621798}}</ref>
'''Bulimia nervosa''' is an [[eating disorders|eating disorder]] characterized by recurrent [[binge eating]], followed by compensatory behaviors.<ref name="dsm">{{cite book |author= |title=Diagnostic and statistical manual of mental disorders: DSM-IV |publisher=American Psychiatric Association |location=Washington, DC |year=1994 |pages= |isbn=0-89042-062-9}}{{pn}}</ref> The most common form is [[defensive vomiting]], sometimes called purging; [[fasting]], the use of [[laxative]]s, [[enema]]s, [[diuretic]]s, and over exercising are also common.<ref>{{cite book |last=Fairburn |first=Christopher G. |title=Overcoming binge eating |publisher=Guilford Press |location=New York |year=1995 |pages= |isbn=0-89862-179-8}}{{pn}}</ref>

The word ''bulimia'' derives from the Latin (''būlīmia''), which originally comes from the Greek ''βουλιμία'' (boulīmia; ravenous hunger), a compound of ''βους'' (bous), ox + ''λιμός'' (līmos), hunger.<ref>{{cite web|title = Online Etymology Dictionary: bulimia|month = November | year = 2001|accessdate = 2008-04-06|author = Douglas Harper|work = [[Online Etymology Dictionary]]|url = http://www.etymonline.com/index.php?search=bulimia&searchmode=none}}</ref>
The word ''bulimia'' derives from the Latin (''būlīmia''), which originally comes from the Greek ''βουλιμία'' (boulīmia; ravenous hunger), a compound of ''βους'' (bous), ox + ''λιμός'' (līmos), hunger.<ref>{{cite web|title = Online Etymology Dictionary: bulimia|month = November | year = 2001|accessdate = 2008-04-06|author = Douglas Harper|work = [[Online Etymology Dictionary]]|url = http://www.etymonline.com/index.php?search=bulimia&searchmode=none}}</ref>


Bulimia nervosa was named and first described by the British psychiatrist [[Gerald Russell]] in 1979.<ref>{{cite journal|title = Bulimia nervosa: an ominous variant of anorexia nervosa |url =http://www.ncbi.nlm.nih.gov/pubmed/482466?dopt=Abstract |last =Russell |first =Gerald |year = 1979 | authorlink = Gerald Russell |month = August |publisher = [[Psychological Medicine]] | volume = 9 |pages= 429–48.}}</ref><ref>{{cite journal|url=http://bjp.rcpsych.org/cgi/content/full/185/6/447|title=Bulimia nervosa: 25 years on|publisher=[[British Journal of Psychiatry]]|year=2004|volume=185|pages=447–448|first=Robert|last=Palmer}}</ref>
Bulimia nervosa was named and first described by the British psychiatrist [[Gerald Russell]] in 1979.<ref>{{cite journal |author=Russell G |title=Bulimia nervosa: an ominous variant of anorexia nervosa |journal=Psychological Medicine |volume=9 |issue=3 |pages=429–48 |year=1979 |month=August |pmid=482466}}</ref><ref>{{cite journal |author=Palmer R |title=Bulimia nervosa: 25 years on |journal=The British Journal of Psychiatry : the Journal of Mental Science |volume=185 |issue= |pages=447–8 |year=2004 |month=December |pmid=15572732 |doi=10.1192/bjp.185.6.447}}</ref>


== Diagnosis ==
== Diagnosis ==
The onset of bulimia nervosa is often during adolescence (between 13 and 20 years of age) and many cases have previously suffered obesity, with many sufferers relapsing in adulthood into episodic binging and purging even after initially successful treatment and remission.<ref>{{citation|last1 = Agras |first1 = W S|contribution = Disorders of eating: anorexia nervosa, bulimia nervosa and binge eating disorder|editor-last = Shader|editor-first = R I|title = Manual of psychiatric therapeutics|publisher = [[Lippincott Williams & Wilkins]]|year = 2004|isbn = 0781744598}}</ref>
The onset of bulimia nervosa is often during adolescence (between 13 and 20 years of age) and many cases have previously suffered obesity, with many sufferers relapsing in adulthood into episodic binging and purging even after initially successful treatment and remission.<ref>{{cite book |last=Shader |first=Richard I. |title=Manual of Psychiatric Therapeutics |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2004 |pages= |isbn=0-7817-4459-8}}{{pn}}</ref>


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.<ref>{{citation|title = Detection, evaluation, and treatment of eating disorders|last1 = Walsh|first1 = J M E|last2 = Wheat|first2 = M.E|last3 = Freund|first3 = K|journal = Journal of General Internal Medicine|volume = 15|number = 8|pages = 577–590|year = 2000|publisher = Springer|url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1495575|doi = 10.1046/j.1525-1497.2000.02439.x|pmid = 10940151}}</ref> The diagnostic criteria utilized by the ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' (DSM-IV TR) published by the [[American Psychiatric Association]] includes repetitive episodes of binge eating (a discrete episode of overeating during which the individual feels out of control of consumption) compensated for by excessive or inappropriate measures taken to avoid gaining weight.<ref name=BehaveNet>{{cite book |title=Diagnostic and Statistical Manual of Mental Disorders |edition=4th, text revision ([[DSM-IV-TR]]) |author=American Psychiatric Association |year=2000 |isbn=0-89042-025-4 |chapter=Diagnostic criteria for 307.51 Bulimia Nervosa |chapterurl=http://behavenet.com/capsules/ |accessdate=2010-03-14 |publisher=<!-- pacify Citation bot --> |location=<!-- pacify Citation bot --> }}</ref> The diagnosis is made only when the behavior is not a part of the symptom complex of Anorexia Nervosa and when the behavior reflects an overemphasis on physical mass or appearance.
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.<ref>{{cite journal |author=Walsh JM, Wheat ME, Freund K |title=Detection, evaluation, and treatment of eating disorders the role of the primary care physician |journal=Journal of General Internal Medicine |volume=15 |issue=8 |pages=577–90 |year=2000 |month=August |pmid=10940151 |pmc=1495575}}</ref> The diagnostic criteria utilized by the ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' (DSM-IV TR) published by the [[American Psychiatric Association]] includes repetitive episodes of binge eating (a discrete episode of overeating during which the individual feels out of control of consumption) compensated for by excessive or inappropriate measures taken to avoid gaining weight.<ref name=BehaveNet>{{cite book |title=Diagnostic and Statistical Manual of Mental Disorders |edition=4th, text revision ([[DSM-IV-TR]]) |author=American Psychiatric Association |year=2000 |isbn=0-89042-025-4 |chapter=Diagnostic criteria for 307.51 Bulimia Nervosa |chapterurl=http://behavenet.com/capsules/ |accessdate=2010-03-14 |publisher=<!-- pacify Citation bot --> |location=<!-- pacify Citation bot --> }}</ref> The diagnosis is made only when the behavior is not a part of the symptom complex of Anorexia Nervosa and when the behavior reflects an overemphasis on physical mass or appearance.


There are two sub-types of bulimia nervosa:
There are two sub-types of bulimia nervosa:
* '''Purging type''' bulimics self-induce [[vomiting]] (usually by triggering the [[gag reflex]] or ingesting [[emetic]]s such as [[syrup of ipecac]]) to rapidly remove food from the body before it can be digested, or use [[laxatives]], [[diuretics]], or [[enemas]].
* '''Purging type''' bulimics self-induce [[vomiting]] (usually by triggering the [[gag reflex]] or ingesting [[emetic]]s such as [[syrup of ipecac]]) to rapidly remove food from the body before it can be digested, or use [[laxatives]], [[diuretics]], or [[enemas]].
* '''Non-purging type''' bulimics (approximately 6%-8% of cases) exercise or fast excessively 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.<ref name="durand">{{citation|title = Abnormal Psychology: An Integrative Approach|isbn = 0534633625|first1 = David H|last1 = Barlow|first2 = V Mark|last2 = Durand|date = July 2004|publisher = [[Thomson Corporation|Thomson Wadsworth]]}}</ref>
* '''Non-purging type''' bulimics (approximately 6%-8% of cases) exercise or fast excessively 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.<ref name="durand">{{cite book |first1=David H. |last1=Barlow |first2=Vincent Mark |last2=Durand |title=Abnormal psychology: an integrative approach |publisher=Wadsworth/Thomson Learning |location=Belmont, CA |year=2002 |pages= |isbn=0-534-63362-5}}{{pn}}</ref>


== Prevalence ==
== 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 0.1% and 1.4% of males, and between 0.3% and 9.4% of females.<ref name="makino">{{cite journal |author=Makino M, Tsuboi K, Dennerstein L |title=Prevalence of eating disorders: a comparison of Western and non-Western countries |journal=MedGenMed |volume=6 |issue=3 |pages=49 |year=2004 |pmid=15520673 |pmc=1435625 |url=http://www.medscape.com/viewarticle/487413}}</ref> Studies on time trends in the prevalence of bulimia nervosa have also yielded inconsistent results.<ref>{{cite journal |author=Hay PJ, Mond J, Buttner P, Darby A |title=Eating disorder behaviors are increasing: findings from two sequential community surveys in South Australia |journal=Plos One |volume=3 |issue=2 |pages=e1541 |year=2008 |pmid=18253489 |pmc=2212110 |doi=10.1371/journal.pone.0001541}}</ref>

⚫
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 0.1% and 1.4% of males, and between 0.3% and 9.4% of females.<ref name="makino">{{cite journal|title = Prevalence of eating disorders: a comparison of Western and non-Western countries|last1 = Makino|first1 = M|last2 = Tsuboi|first2 = K|last3 = Dennerstein|first3 = L|journal = Medscape General Medicine|volume = 6|number = 3|date = January 13, 2004 |url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1435625|pages = 49|pmid = 15520673|issue = 3}}</ref> Studies on time trends in the prevalence of bulimia nervosa have also yielded inconsistent results.<ref>{{citation|url = http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2212110&blobtype=pdf|doi = 10.1371/journal.pone.0001541|pmid = 18253489|title = Eating Disorder Behaviors Are Increasing: Findings from Two Sequential Community Surveys in South Australia|first1 = Phillipa J|last1 = Hay|first2 = Jonathan|last2 = Mond|first3 = Petra|last3 = Buttner|first4 = Anita|last4 = Darby|journal = PLoS ONE|volume = 3|number = 2|year = 2008|publisher = Public Library of Science}}</ref>


{| class="wikitable"
{| class="wikitable"
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! colspan="2" | Incidence
! colspan="2" | Incidence
|-
|-
| [[Australia]] || 2008 || 1,943 adolescents (ages 15–17) || 1.4% male || 9.4% female<ref name="patton">{{citation|title = Prognosis of adolescent partial syndromes of eating disorder|last1 = Patton|first1 = G C|last2 = Coffey|first2 = C|last3 = Carlin|first3 = J B|last4 = Sanci|first4 = L|last5 = Sawyer|first5 = S|url = http://bjp.rcpsych.org/cgi/content/abstract/192/4/294|journal = The British Journal of Psychiatry|volume = 192|number = 4|pages = 294–299|year = 2008|publisher = [[Royal College of Psychiatrists]]|doi = 10.1192/bjp.bp.106.031112|pmid = 18378993}}</ref>
| [[Australia]] || 2008 || 1,943 adolescents (ages 15–17) || 1.4% male || 9.4% female<ref name="patton">{{cite journal |author=Patton GC, Coffey C, Carlin JB, Sanci L, Sawyer S |title=Prognosis of adolescent partial syndromes of eating disorder |journal=The British Journal of Psychiatry |volume=192 |issue=4 |pages=294–9 |year=2008 |month=April |pmid=18378993 |doi=10.1192/bjp.bp.106.031112}}</ref>
|-
|-
| [[Portugal]] || 2006 || 2,028 high school students || || 0.3% female<ref>{{citation|title = The prevalence of Eating Disorders Not Otherwise Specified|first1 = Paulo|last1 = Machado|first2 = Barbara|last2 = Machado|first3 = Sónia|last3 = Gonçalves|first4 = Hans W|last4 = Hoek|url = http://repositorium.sdum.uminho.pt/bitstream/1822/5722/1/EDNOS%20IJED%20accepted.pdf|journal = International journal of eating disorders|volume = 40|number = 3|pages = 212–217|year = 2007|publisher = Wiley|doi = 10.1002/eat.20358}}</ref>
| [[Portugal]] || 2006 || 2,028 high school students || || 0.3% female<ref>{{cite journal |author=Machado PP, Machado BC, Gonçalves S, Hoek HW |title=The prevalence of eating disorders not otherwise specified |journal=The International Journal of Eating Disorders |volume=40 |issue=3 |pages=212–7 |year=2007 |month=April |pmid=17173324 |doi=10.1002/eat.20358}}</ref>
|-
|-
| [[Brazil]] || 2004 || 1,807 students (ages 7–19) || 0.8% male || 1.3% female<ref>{{citation|url = http://www.scielo.br/scielo.php?pid=S0021-75572004000100010&script=sci_arttext&tlng=en|title = Eating disorders in school children|first1 = João E M|last1 = Vilela|first2 = Joel A|last2 = LamounierII|first3 = Marcos A Dellaretti|last3 = Filho|first4 = José R Barros|last4 = Neto|first5 = Gustavo M|last5 = Horta|journal = Jornal de Pediatria|doi = 10.1590/S0021-75572004000100010|issn = 0021-7557|volume = 80|year = 2004|number = 2|pages = 49–54|publisher = Scielo}}</ref>
| [[Brazil]] || 2004 || 1,807 students (ages 7–19) || 0.8% male || 1.3% female<ref>{{cite journal |author=Vilela JE, Lamounier JA, Dellaretti Filho MA, Barros Neto JR, Horta GM |title=Transtornos alimentares em escolares |trans_title=Eating disorders in school children |language=Portuguese |journal=Jornal De Pediatria |volume=80 |issue=1 |pages=49–54 |year=2004 |pmid=14978549 |doi=10.1590/S0021-75572004000100010}}</ref>
|-
|-
| [[Spain]] || 2004 || 2,509 female adolescents (ages 13–22) || || 1.4% female<ref>{{citation|title = Incidence of eating disorders in Navarra|url = http://www.cun.es/fileadmin/Departamentos/Psiquiatria%20y%20Psicologia%20Medica/PDF/IncidenceoEatingDisorderinNavarra.pdf|first1 = Francisca|last1 = Lahortiga-Ramos|first2 = Jokin|last2 = De Irala-Estévez|first3 = Adrián|last3 = Cano-Prous|first4 = Pilar|last4 = Gual-García|first5 = Miguel Ángel|last5 = Martínez-González|first6 = Salvador|last6 = Cervera-Enguix|doi = doi:10.1016/j.eurpsy.2004.07.008|journal = European Psychiatry|volume = 20|number = 2|pages = 179–185|year = 2005|publisher = Elsevier}}</ref>
| [[Spain]] || 2004 || 2,509 female adolescents (ages 13–22) || || 1.4% female<ref>{{cite journal |author=Lahortiga-Ramos F, De Irala-Estévez J, Cano-Prous A, Gual-García P, Martínez-González MA, Cervera-Enguix S |title=Incidence of eating disorders in Navarra (Spain) |journal=European Psychiatry |volume=20 |issue=2 |pages=179–85 |year=2005 |month=March |pmid=15797704 |doi=10.1016/j.eurpsy.2004.07.008}}</ref>
|-
|-
| [[Hungary]] || 2003 || 580 [[Budapest]] residents || 0.4% male || 3.6% female<ref name="Tölgyes">{{citation|title = Epidemiological studies on adverse dieting behaviours and eating disorders among young people in Hungary|last1 = Tölgyes|first1 = T|last2 = Nemessury|first2 = J|journal = Social Psychiatry and Psychiatric Epidemiology|volume = 39|number = 8|pages = 647–654|year = 2004|publisher = Springer|doi = 10.1007/s00127-004-0783-z}}</ref>
| [[Hungary]] || 2003 || 580 [[Budapest]] residents || 0.4% male || 3.6% female<ref name="Tölgyes">{{cite journal |author=Tölgyes T, Nemessury J |title=Epidemiological studies on adverse dieting behaviours and eating disorders among young people in Hungary |journal=Social Psychiatry and Psychiatric Epidemiology |volume=39 |issue=8 |pages=647–54 |year=2004 |month=August |pmid=15300375 |doi=10.1007/s00127-004-0783-z}}</ref>
|-
|-
| [[Australia]] || 1998 || 4,200 high school students || align="center" colspan="2" | 0.3% combined<ref>{{citation|title = The epidemiology of eating disorder behaviors: An Australian community-based survey|last1 = Hay|first1 = P|journal = International Journal of Eating Disorders| volume = 23|number = 4|pages = 371–382|year = 1998|doi = 10.1002/(SICI)1098-108X(199805)23:4<371::AID-EAT4>3.0.CO;2-F}}</ref>
| [[Australia]] || 1998 || 4,200 high school students || align="center" colspan="2" | 0.3% combined<ref>{{cite journal |author=Hay P |title=The epidemiology of eating disorder behaviors: an Australian community-based survey |journal=The International Journal of Eating Disorders |volume=23 |issue=4 |pages=371–82 |year=1998 |month=May |pmid=9561427 |doi=10.1002/(SICI)1098-108X(199805)23:4<371::AID-EAT4>3.0.CO;2-F}}</ref>
|-
|-
| [[USA]] || 1996 || 1,152 college students || 0.2% male || 1.3% female<ref>{{citation|title = Prevalence and Correlates of Bulimia Nervosa and Bulimic Behaviors in a Racially Diverse Sample of Undergraduate Students in Two Universities in Southeast Texas|last1 = Pemberton|first1 = A R|last2 = Vernon|first2 = S W|last3 = Lee|first3 = E S|journal = American Journal of Epidemiology|volume = 144|number = 5|pages = 450–455|date = September 1, 2005 |publisher = Oxford University Press|url = http://aje.oxfordjournals.org/cgi/content/abstract/144/5/450|pmid = 8781459|issue = 5}}</ref>
| [[USA]] || 1996 || 1,152 college students || 0.2% male || 1.3% female<ref>{{cite journal |author=Pemberton AR, Vernon SW, Lee ES |title=Prevalence and correlates of bulimia nervosa and bulimic behaviors in a racially diverse sample of undergraduate students in two universities in southeast Texas |journal=American Journal of Epidemiology |volume=144 |issue=5 |pages=450–5 |year=1996 |month=September |pmid=8781459 |url=http://aje.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=8781459}}</ref>
|-
|-
| [[Norway]] || 1995 || 19,067 psychiatric patients || 0.7% male || 7.3% female<ref>{{citation|title = An epidemiological study of eating disorders in Norwegian psychiatric institutions|last1 = Götestam|first1 = K G|last2 = Eriksen|first2 = L|last3 = Hagen|first3 = H|journal = The International journal of eating disorders|volume = 18|number = 3|pages = 263–268|year = 1995|publisher = Wiley|url = http://cat.inist.fr/?aModele=afficheN&cpsidt=3704897|doi = 10.1002/1098-108X(199511)18:3<263::AID-EAT2260180308>3.0.CO;2-O}}</ref>
| [[Norway]] || 1995 || 19,067 psychiatric patients || 0.7% male || 7.3% female<ref>{{cite journal |author=Götestam KG, Eriksen L, Hagen H |title=An epidemiological study of eating disorders in Norwegian psychiatric institutions |journal=The International Journal of Eating Disorders |volume=18 |issue=3 |pages=263–8 |year=1995 |month=November |pmid=8556022}}</ref>
|-
|-
| [[Canada]] || 1995 || 8,116 (random sample) || 0.1% male || 1.1% female<ref>{{citation|last1 = Garfinkel|first1 = P E|last2 = Lin|first2 = E|last3 = Goering|first3 = P|last4 = Spegg|first4 = C|last5 = Goldbloom|first5 = D S|last6 = Kennedy|first6 = S|last7 = Kaplan|first7 = A S|last8 = Woodside|first8 = D B|title = Bulimia nervosa in a Canadian community sample: prevalence and comparison of subgroups|journal = Americal Journal of Psychiatry|volume = 152|number = 7|pages = 1052–1058|date = July 1, 1995 |url = http://ajp.psychiatryonline.org/cgi/content/abstract/152/7/1052|pmid = 7793442|issue = 7}}</ref>
| [[Canada]] || 1995 || 8,116 (random sample) || 0.1% male || 1.1% female<ref>{{cite journal |author=Garfinkel PE, Lin E, Goering P, ''et al.'' |title=Bulimia nervosa in a Canadian community sample: prevalence and comparison of subgroups |journal=The American Journal of Psychiatry |volume=152 |issue=7 |pages=1052–8 |year=1995 |month=July |pmid=7793442 |url=http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=7793442}}</ref>
|-
|-
| [[Japan]] || 1995 || 2,597 high school students || 0.7% male || 1.9% female<ref>{{citation|title = Coprevalence of bulimia with alcohol abuse and smoking among Japanese male and female high school students|last1 = Suzuki|first1 = K|last2 = Takeda|first2 = A|last3 = Matsushita|first3 = S|journal = Addiction|volume = 90|number = 7|pages = 971--976|year = 1995|publisher = Blackwell Synergy|url = http://www.blackwell-synergy.com/doi/abs/10.1046/j.1360-0443.1995.90797110.x|doi = 10.1046/j.1360-0443.1995.90797110.x}}</ref>
| [[Japan]] || 1995 || 2,597 high school students || 0.7% male || 1.9% female<ref>{{cite journal |author=Suzuki K, Takeda A, Matsushita S |title=Coprevalence of bulimia with alcohol abuse and smoking among Japanese male and female high school students |journal=Addiction |volume=90 |issue=7 |pages=971–5 |year=1995 |month=July |pmid=7663319 |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0965-2140&date=1995&volume=90&issue=7&spage=971}}</ref>
|-
|-
| [[USA]] || 1992 || 799 college students || 0.4% male || 5.1% female<ref>{{citation|title = Body weight, dieting, and eating disorder symptoms among college students, 1982 to 1992|last1 = Heatherton|first1 = T F|last2 = Nichols|first2 = P|last3 = Mahamedi|first3 = F|last4 = Keel|first4 = P|journal = American Journal of Psychiatry|volume = 152|number = 11|pages = 1623–9|year = 1995|url = http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=7485625&cmd=showdetailview}}</ref>
| [[USA]] || 1992 || 799 college students || 0.4% male || 5.1% female<ref>{{cite journal |author=Heatherton TF, Nichols P, Mahamedi F, Keel P |title=Body weight, dieting, and eating disorder symptoms among college students, 1982 to 1992 |journal=The American Journal of Psychiatry |volume=152 |issue=11 |pages=1623–9 |year=1995 |month=November |pmid=7485625 |url=http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=7485625}}</ref>
|}
|}


There are higher rates of eating disorders in groups involved in activities which idealize a slim physique, such as [[dance]],<ref name="Tölgyes" /> [[gymnastics]], modeling, [[cheerleading]], running, acting, rowing and [[figure skating]]. Bulimia is more prevalent among [[Caucasian race|Caucasian]]s.<ref>{{citation|title = Cross-ethnic differences in eating disorder symptoms and related distress|first1 = Debra L|last1 = Franko|first2 = Anne E|last2 = Becker|first3 = Jennifer J|last3 = Thomas|first4 = David B|last4 = Herzog|journal = International Journal of Eating Disorders|volume = 40|number = 2|year = 2007|publisher = Wiley|doi = 10.1002/eat.20341}}</ref> Exposure to mass media also appears to have an effect: a survey of 15-18 year-old high schoolgirls in [[Nadroga]], [[Fiji]] found the self-reported incidence of purging rose from 0% in 1995 (a few weeks after the introduction of television in the province) to 11.3% in 1998.<ref>{{citation|title = Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls|first1 = Anne|last1 = Becker|first2 = Rebecca|last2 = Burwell|first3 = David|last3 = Herzog|first4 = Paul|last4 = Hamburg|first5 = Stephen|last5 = Gilman|journal = [[British Journal of Psychiatry]]|volume = 180|number = 6|pages = 509|year = 2002|url = http://bjp.rcpsych.org/cgi/content/full/180/6/509}}</ref>
There are higher rates of eating disorders in groups involved in activities which idealize a slim physique, such as [[dance]],<ref name="Tölgyes" /> [[gymnastics]], modeling, [[cheerleading]], running, acting, rowing and [[figure skating]]. Bulimia is more prevalent among [[Caucasian race|Caucasian]]s.<ref>{{cite journal |author=Franko DL, Becker AE, Thomas JJ, Herzog DB |title=Cross-ethnic differences in eating disorder symptoms and related distress |journal=The International Journal of Eating Disorders |volume=40 |issue=2 |pages=156–64 |year=2007 |month=March |pmid=17080449 |doi=10.1002/eat.20341}}</ref> Exposure to mass media also appears to have an effect: a survey of 15-18 year-old high schoolgirls in [[Nadroga]], [[Fiji]] found the self-reported incidence of purging rose from 0% in 1995 (a few weeks after the introduction of television in the province) to 11.3% in 1998.<ref>{{cite journal |author=Becker AE, Burwell RA, Gilman SE, Herzog DB, Hamburg P |title=Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls |journal=The British Journal of Psychiatry |volume=180 |issue= |pages=509–14 |year=2002 |month=June |pmid=12042229 |url=http://bjp.rcpsych.org/cgi/pmidlookup?view=long&pmid=12042229}}</ref>


== Effects ==
== 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,<ref>{{cibe book |title=Eating Disorders |series=Let's Talk About |isbn=0-89042-352-0 |year=2005 |publisher=[[American Psychiatric Association]] |url=http://www.healthyminds.org/Document-Library/Brochure-Library/Eating-Disorders.aspx}}</ref> and may directly cause:

⚫
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<ref>{{citation|title = Let's Talk Facts About: Eating Disorders|isbn = 0-89042-352-0 |year = 1999|publisher = [[American Psychiatric Association]]|author = }} (pamphlet)</ref>, and may directly cause:
* Chronic [[gastric reflux]] after eating
* Chronic [[gastric reflux]] after eating
* [[Dehydration]] and [[hypokalemia]] caused by frequent vomiting
* [[Dehydration]] and [[hypokalemia]] caused by frequent vomiting
Line 70: Line 69:
* Enlarged glands in the neck, under the jaw line
* Enlarged glands in the neck, under the jaw line
* [[Peptic ulcers]]
* [[Peptic ulcers]]
* [[Callus]]es or [[scar]]s on back of hands due to repeated trauma from incisors<ref>{{citation|url = http://ajp.psychiatryonline.org/cgi/reprint/142/5/655a.pdf|title = Finger calluses in bulimia|last1 = Joseph|first1 = A B|last2 = Herr|first2 = B|journal = American Journal of Psychiatry|volume = 142|number = 5|pages = 655|year = 1985|publisher = [[American Psychiatric Association]]}}</ref><ref>{{citation|title = A physical sign of bulimia|last1 = Wynn|first1 = D R|last2 = Martin|first2 = M J|journal = Mayo Clinic proceedings|publisher = [[Mayo Clinic]]|volume = 59|number = 10|pages = 722|year = 1984}}</ref>
* [[Callus]]es or [[scar]]s on back of hands due to repeated trauma from incisors<ref>{{cite journal |author=Joseph AB, Herr B |title=Finger calluses in bulimia |journal=The American Journal of Psychiatry |volume=142 |issue=5 |pages=655 |year=1985 |month=May |pmid=3857013}}</ref><ref>{{cite journal |author=Wynn DR, Martin MJ |title=A physical sign of bulimia |journal=Mayo Clinic Proceedings. Mayo Clinic |volume=59 |issue=10 |pages=722 |year=1984 |month=October |pmid=6592415}}</ref>
* Constant weight fluctuations
* Constant weight fluctuations
The frequent contact between teeth and [[gastric acid]], in particular, may cause:
The frequent contact between teeth and [[gastric acid]], in particular, may cause:
* Severe [[dental caries]]
* Severe [[dental caries]]
* [[Perimolysis]], or the erosion of tooth enamel<ref name="ada">{{citation|publisher = [[American Dental Association]]|url = http://www.ada.org/public/topics/eating_disorders.asp|title = Oral Health Topics: Eating Disorders}}</ref>
* [[Perimolysis]], or the erosion of tooth enamel<ref name="ada">{{citation|publisher = [[American Dental Association]]|url = http://www.ada.org/public/topics/eating_disorders.asp|title = Oral Health Topics: Eating Disorders}}</ref>
* Swollen [[salivary gland]]s<ref name="ada" /><ref name="mcgilley">{{citation|url = http://www.aafp.org/afp/980600ap/mcgilley.html|title = Assessment and Treatment of Bulimia Nervosa|first1 = Beth M|last1 = McGilley|first2 = Tamara L|last2 = Pryor|date = June 1998|journal = [[American Academy of Family Physicians]]}}</ref>
* Swollen [[salivary gland]]s<ref name="ada" /><ref name="mcgilley">{{cite journal |author=Mcgilley BM, Pryor TL |title=Assessment and treatment of bulimia nervosa |journal=American Family Physician |volume=57 |issue=11 |pages=2743–50 |year=1998 |month=June |pmid=9636337}}</ref>


== Related disorders ==
== Related disorders ==
⚫
Bulimics are much more likely than non-bulimics to have an [[affective spectrum|affective disorder]], such as [[clinical depression|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.<ref>{{cite journal |author=Walsh BT, Roose SP, Glassman AH, Gladis M, Sadik C |title=Bulimia and depression |journal=Psychosomatic Medicine |volume=47 |issue=2 |pages=123–31 |year=1985 |pmid=3863157 |url=http://www.psychosomaticmedicine.org/cgi/pmidlookup?view=long&pmid=3863157}}</ref> Another study by the [[Royal Children's Hospital]] in [[Melbourne]] on a [[cohort (statistics)|cohort]] of 2000 adolescents similarly found that those meeting at least two of the [[Diagnostic and Statistical Manual of Mental Disorders|DSM-IV]] criteria for bulimia nervosa or anorexia nervosa had a sixfold increase in risk of anxiety and a doubling of risk for substance dependency.<ref name="patton" />

⚫
Bulimics are much more likely than non-bulimics to have an [[affective spectrum|affective disorder]], such as [[clinical depression|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.<ref>{{citation|last1 = Walsh|first1 = B T|last2 = Roose|first2 = S P|last3 = Glassman|first3 = A H|last4 = Gladis|first4 = M|last5 = Sadik|first5 = C|title = Bulimia and depression|journal = Psychosomatic Medicine|volume = 47|number = 2|pages = 123–131|year = 1985|url = http://www.psychosomaticmedicine.org/cgi/reprint/47/2/123.pdf|format=PDF}}</ref> Another study by the [[Royal Children's Hospital]] in [[Melbourne]] on a [[cohort (statistics)|cohort]] of 2000 adolescents similarly found that those meeting at least two of the [[Diagnostic and Statistical Manual of Mental Disorders|DSM-IV]] criteria for bulimia nervosa or anorexia nervosa had a sixfold increase in risk of anxiety and a doubling of risk for substance dependency.<ref name="patton" />
Bulimia also has negative effects on the sufferer's dental health due to the acid passed through the mouth from frequent vomiting causing acid erosion, mainly on the posterior dental surface.
Bulimia also has negative effects on the sufferer's dental health due to the acid passed through the mouth from frequent vomiting causing acid erosion, mainly on the posterior dental surface.


== Treatment ==
== Treatment ==
=== Pharmacological ===
=== Pharmacological ===
⚫
Some researchers have hypothesized a relationship to mood disorders and clinical trials have been conducted with tricyclic antidepressants,<ref>{{cite journal |author=Mitchell JE, Raymond N, Specker S |title=A review of the controlled trials of pharmacotherapy and psychotherapy in the treatment of bulimia nervosa |journal=The International Journal of Eating Disorders |volume=14 |issue=3 |pages=229–47 |year=1993 |month=November |pmid=8275060}}</ref> [[MAO inhibitors]], [[mianserin]], [[fluoxetine]],<ref>{{cite book |last1=Walsh |first1=B T |year=1995 |chapter=Pharmacotherapy of eating disorders |editor-last1=Brownell |editor-first1=K D |editor-last2=Fairburn |editor-first2=C G |title=Eating Disorders and Obesity: A Comprehensive Handbook |location=New York |publisher=Guilford |pages=329–40 |isbn=978-0-89862-850-0}}</ref> 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.<ref>{{cite journal |author=Mitchell JE, Christenson G, Jennings J, ''et al.'' |title=A placebo-controlled, double-blind crossover study of naltrexone hydrochloride in outpatients with normal weight bulimia |journal=Journal of Clinical Psychopharmacology |volume=9 |issue=2 |pages=94–7 |year=1989 |month=April |pmid=2656781}}</ref>
⚫
Some researchers have hypothesized a relationship to mood disorders and clinical trials have been conducted with tricyclic antidepressants,<ref>{{citation|title = A review of the controlled trials of pharmacotherapy and psychotherapy in the treatment of bulimia nervosa|last1 = Mitchell|first1 = J E|last2 = Raymond|first2 = N|last3 = Specker|first3 = S|journal = International Journal of Eating Disorders|volume = 14|number = 3|year = 1993|publisher = Wiley}|doi = 10.1002/1098-108X(199311)14:3<229::AID-EAT2260140302>3.0.CO;2-X}}</ref> [[MAO inhibitors]], [[mianserin]], [[fluoxetine]],<ref>{{citation|last1 = Walsh|first1 = B T|year = 1995|title = Pharmacotherapy of eating disorders|editor-last1 = Brownell|editor-first1 = K D|editor-last2 = Fairburn|editor-first2 = C G|work = Eating Disorders and Obesity: A Comprehensive Handbook|place = New York|publisher = Guilford|pages = 329–340}}</ref> lithium carbonate, nomifensine, trazodone, and bupropion.


There has also been some research characterizing bulimia nervosa as an addiction disorder, and limited clinical use of [[topiramate]], which blocks cravings for opiates, cocaine, alcohol and food.<ref>{{cite book |last=Slaby |first=Andrew Edmund |title=The eating disorders |publisher=Springer-Verlag |location=Berlin |year=1993 |pages= |isbn=0-387-94002-2}}{{pn}}</ref> Researchers have also report positive outcomes when bulimics are treated in an addiction-disorders inpatient unit.<ref>{{cite journal |author=Wilfley DE, Welch RR, Stein RI, ''et al.'' |title=A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder |journal=Archives of General Psychiatry |volume=59 |issue=8 |pages=713–21 |year=2002 |month=August |pmid=12150647 |doi=10.1001/archpsyc.59.8.713 |url=http://courses.csusm.edu/psyc340sr/articles/IBT_vs_CBT_Wilfley.pdf}}</ref>
⚫
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.<ref>{{citation|title = A placebo-controlled, double-blind crossover study of naltrexone hydrochloride in outpatients with normal weight bulimia|first1 = J E|last1 = Mitchell|first2 = G|last2 = Christensen|first3 = J|last3 = Jennings|first4 = M|last4 = Huber|first5 = B|last5 = Thomas|journal = Journal of Clinical Psychopharmacology|volume = 9|number = 2|pages = 94–97|year = 1989}}</ref>


⚫
[[Brain-derived neurotrophic factor]] (BDNF) is also under investigation as a possible cause.<ref>{{cite doi|10.1093/hmg/ddh137}}</ref><ref>{{cite book |title=Annual Review of Eating Disorders - part 2 |year=2008 |pages=14–15|chapter=1 |isbn=978-1-84619-244-9 |url=http://www.radcliffe-oxford.com/books/samplechapter/2447/01_Wonderlich2008_D1-15d05720rdz.pdf}}</ref>
There has also been some research characterizing bulimia nervosa as an addiction disorder, and limited clinical use of [[topiramate]], which blocks cravings for opiates, cocaine, alcohol and food.<ref>{{citation|isbn = 0-387-94002-2|first1 = A James|last1 = Giannini|first2 = Andrew E|last2 = Slaby|year = 1993|publisher = [[Springer-Verlag]]}}</ref> Researchers have also report positive outcomes when bulimics are treated in an addiction-disorders inpatient unit.<ref>{{citation|url = http://courses.csusm.edu/psyc340sr/articles/IBT_vs_CBT_Wilfley.pdf|year = 2002|journal = Archives of General Psychiatry|pages = 713–721|volume = 59|issue = 8|accessdate = 2009-04-09|first1 = Denise E|last1 = Wilfley|first2 = R. Robinson|last2 = Welch|first3 = Richard I|last3 = Stein|first4 = Emily Borman|last4 = Spurrell|first5 = Lisa R|last5 = Cohen|first6 = Brian E|last6 = Saelens|first7 = Jennifer Zoler|last7 = Dounchi|first8 = Mary Ann|last8 = Frank|first9 = Claire V|last9 = Wiseman|first10 = Georg E|last10 = Matt}}</ref>

⚫
[[Brain-derived neurotrophic factor]] (BDNF) is also under investigation as a possible cause.<ref>{{cite doi|10.1093/hmg/ddh137}}</ref><ref>{{cite book|title=Annual Review of Eating Disorders - part 2|date=2008|pages=14–15|chapter=1|isbn=9781846192449|url=http://www.radcliffe-oxford.com/books/samplechapter/2447/01_Wonderlich2008_D1-15d05720rdz.pdf}}</ref>


=== Psychotherapy ===
=== Psychotherapy ===
⚫
There are several empirically-supported psychosocial treatments for bulimia nervosa. [[Cognitive behavioral therapy]] (CBT), which involves teaching clients to challenge automatic thoughts and engage in behavioral experiments (e.g., in session eating of "forbidden foods") has demonstrated efficacy both with and without concurrent antidepressant medication.<ref>{{cite journal |author=Agras WS, Crow SJ, Halmi KA, Mitchell JE, Wilson GT, Kraemer HC |title=Outcome predictors for the cognitive behavior treatment of bulimia nervosa: data from a multisite study |journal=The American Journal of Psychiatry |volume=157 |issue=8 |pages=1302–8 |year=2000 |month=August |pmid=10910795 |url=http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=10910795}}</ref><ref>{{cite journal |author=Wilson GT, Loeb KL, Walsh BT, ''et al.'' |title=Psychological versus pharmacological treatments of bulimia nervosa: predictors and processes of change |journal=Journal of Consulting and Clinical Psychology |volume=67 |issue=4 |pages=451–9 |year=1999 |month=August |pmid=10450615 |url=http://content.apa.org/journals/ccp/67/4/451}}</ref> Researchers have also reported some positive outcomes for interpersonal psychotherapy and [[dialectical behavior therapy]].<ref>{{cite journal |author=Fairburn CG, Agras WS, Walsh BT, Wilson GT, Stice E |title=Prediction of outcome in bulimia nervosa by early change in treatment |journal=The American Journal of Psychiatry |volume=161 |issue=12 |pages=2322–4 |year=2004 |month=December |pmid=15569910 |doi=10.1176/appi.ajp.161.12.2322}}</ref><ref>{{cite journal |author=Safer DL, Telch CF, Agras WS |title=Dialectical behavior therapy for bulimia nervosa |journal=The American Journal of Psychiatry |volume=158 |issue=4 |pages=632–4 |year=2001 |month=April |pmid=11282700 |url=http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=11282700}}</ref>


⚫
[[Maudsley Family Therapy]] or "Family Based Treatment" (FBT), developed at the Maudsley Hospital in London for the treatment of anorexia nervosa (AN) has been shown to have positive results for the treatment of bulimia nervosa. FBT has been shown through [[empirical]] research to be the most efficacious treatment of AN for patients under the age of eighteen and within three years of onset of illness. The studies to date using FBT to treat BN have been promising.<ref>{{cite journal |author=Lock J, le Grange D |title=Family-based treatment of eating disorders |journal=The International Journal of Eating Disorders |volume=37 Suppl |issue= |pages=S64–7; discussion S87–9 |year=2005 |pmid=15852323 |doi=10.1002/eat.20122}}</ref>
⚫
There are several empirically-supported psychosocial treatments for bulimia nervosa. [[Cognitive behavioral therapy]] (CBT), which involves teaching clients to challenge automatic thoughts and engage in behavioral experiments (e.g., in session eating of "forbidden foods") has demonstrated efficacy both with and without concurrent antidepressant medication.<ref>Agras, W., Crow, S.J., Halmi, K.A., Mitchell, J.E., Wilson, G., & Kraemer, H.C. (2000). Outcome predictors for the cognitive behavior treatment of bulimia nervosa: Data from a multisite study. American Journal of Psychiatry, 157, 1302-1308.</ref><ref>Wilson, G.T., Loeb, K.L., Walsh, B.T., Labouvie, E., Pekova, E., Liu, X., et al. (1999). Psychological versus pharmacological treatments of bulimia nervosa: Predictors and precesses of change. Journal of Consulting and Clinical Psychology, 67, 451-459.</ref>. Researchers have also reported some positive outcomes for interpersonal psychotherapy and [[dialectical behavior therapy]].<ref>{{citation|url = http://ajp.psychiatryonline.org/cgi/content/full/161/12/2322|year = 2004|journal = American Journal of Psychiatry|pages = 2322–2324|volume = 161|issue = 12|first1 = Christopher G|last1 = Fairburn|first2 = W Stewart|last2 = Agras|first3 = B Timothy|last3 = Walsh|first4 = G Terence|last4 = Wilson|first5 = Eric|last6 = Stice}}</ref><ref>{{citation|url = http://ajp.psychiatryonline.org/cgi/content/full/158/4/632|year = 2001|journal = American Journal of Psychiatry|pages = 632–634|volume = 158|issue = 4|accessdate = 2009-04-09|first1 = Debra L|last1 = Safer|first2 = Christy F|last2 = Telch|first3 = W Stewart|last3 = Agras}}</ref>


⚫
Some researchers have also claimed positive outcomes in hypnotherapy treatment.<ref>{{cite journal |author=Barabasz M |title=Treatment of bulimia with hypnosis involving awareness and control in clients with high dissociative capacity |journal=International Journal of Psychosomatics |volume=37 |issue=1-4 |pages=53–6 |year=1990 |pmid=2246105}}</ref><ref>{{cite journal |author=Barabasz M |title=Efficacy of hypnotherapy in the treatment of eating disorders |journal=The International Journal of Clinical and Experimental Hypnosis |volume=55 |issue=3 |pages=318–35 |year=2007 |month=July |pmid=17558721 |doi=10.1080/00207140701338688}}</ref><ref>{{cite journal |author=Griffiths RA |year=1995 |title=Two-Year Follow-Up Findings of Hypnobehavioural Treatment for Bulimia Nervosa |journal=Australian Journal of Clinical and Experimental Hypnosis |volume=23 |issue=2 |pages=135-44}}</ref>
⚫
[[Maudsley Family Therapy]] or "Family Based Treatment" (FBT), developed at the Maudsley Hospital in London for the treatment of anorexia nervosa (AN) has been shown to have positive results for the treatment of bulimia nervosa. FBT has been shown through [[empirical]] research to be the most efficacious treatment of AN for patients under the age of eighteen and within three years of onset of illness. The studies to date using FBT to treat BN have been promising.<ref>Lock J, le Grange D. Family-based treatment of eating disorders. Int J Eat Disord. 2005;37 Suppl:S64-7; discussion S87-9.PMID 15852323</ref>

⚫
Some researchers have also claimed positive outcomes in hypnotherapy treatment.<ref>{{citation|pmid = 2246105|title = Treatment of bulimia with hypnosis involving awareness and control in clients with high dissociative|year = 1990|author = Barabasz, M.|journal = International journal of psychosomatics: official publication of the International Psychosomatics Institute|pages = 53|volume = 37|issue = 1-4|accessdate = 2009-04-09}}</ref><ref>Barga, J & Barabasz, M (in press). Effects of Hypnosis as an adjunct to Cognitive-Behavior therapy in the treatment of Bulimia. International Journal of Clinical and Experimental Hypnosis. In Barabasz, M (2007) Efficacy of hypnotherapy in the treatment of Eating Disorders. International Journal of Clinical and Experimental Hypnosis, 55(3):318-335</ref><ref>Griffifths, RA. (1995) Two-year follow-up findings of hypnobehavioral treatment for bulimia nervosa. Australian Journal of Clinical and Experimental Hypnosis, 23 (2), 135-144</ref>


== References ==
== References ==

{{reflist|2}}
{{reflist|2}}


Revision as of 10:05, 18 March 2010

Bulimia nervosa
SpecialtyPsychiatry Edit this on Wikidata

Bulimia nervosa is an eating disorder characterized by recurrent binge eating, followed by compensatory behaviors.[1] The most common form is defensive vomiting, sometimes called purging; fasting, the use of laxatives, enemas, diuretics, and over exercising are also common.[2]

The word bulimia derives from the Latin (būlīmia), which originally comes from the Greek βουλιμία (boulīmia; ravenous hunger), a compound of βους (bous), ox + λιμός (līmos), hunger.[3]

Bulimia nervosa was named and first described by the British psychiatrist Gerald Russell in 1979.[4][5]

Diagnosis

The onset of bulimia nervosa is often during adolescence (between 13 and 20 years of age) and many cases have previously suffered obesity, with many sufferers relapsing in adulthood into episodic binging and purging even after initially successful treatment and remission.[6]

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.[7] The diagnostic criteria utilized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR) published by the American Psychiatric Association includes repetitive episodes of binge eating (a discrete episode of overeating during which the individual feels out of control of consumption) compensated for by excessive or inappropriate measures taken to avoid gaining weight.[8] The diagnosis is made only when the behavior is not a part of the symptom complex of Anorexia Nervosa and when the behavior reflects an overemphasis on physical mass or appearance.

There are two sub-types of bulimia nervosa:

  • Purging type bulimics self-induce vomiting (usually by triggering the gag reflex or ingesting emetics such as syrup of ipecac) to rapidly remove food from the body before it can be digested, or use laxatives, diuretics, or enemas.
  • Non-purging type bulimics (approximately 6%-8% of cases) exercise or fast excessively 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.[9]

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 0.1% and 1.4% of males, and between 0.3% and 9.4% of females.[10] Studies on time trends in the prevalence of bulimia nervosa have also yielded inconsistent results.[11]

Country Year Sample size and type Incidence
Australia 2008 1,943 adolescents (ages 15–17) 1.4% male 9.4% female[12]
Portugal 2006 2,028 high school students 0.3% female[13]
Brazil 2004 1,807 students (ages 7–19) 0.8% male 1.3% female[14]
Spain 2004 2,509 female adolescents (ages 13–22) 1.4% female[15]
Hungary 2003 580 Budapest residents 0.4% male 3.6% female[16]
Australia 1998 4,200 high school students 0.3% combined[17]
USA 1996 1,152 college students 0.2% male 1.3% female[18]
Norway 1995 19,067 psychiatric patients 0.7% male 7.3% female[19]
Canada 1995 8,116 (random sample) 0.1% male 1.1% female[20]
Japan 1995 2,597 high school students 0.7% male 1.9% female[21]
USA 1992 799 college students 0.4% male 5.1% female[22]

There are higher rates of eating disorders in groups involved in activities which idealize a slim physique, such as dance,[16] gymnastics, modeling, cheerleading, running, acting, rowing and figure skating. Bulimia is more prevalent among Caucasians.[23] Exposure to mass media also appears to have an effect: a survey of 15-18 year-old high schoolgirls in Nadroga, Fiji found the self-reported incidence of purging rose from 0% in 1995 (a few weeks after the introduction of television in the province) to 11.3% in 1998.[24]

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,[25] 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.[30] 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 sixfold increase in risk of anxiety and a doubling of risk for substance dependency.[12] Bulimia also has negative effects on the sufferer's dental health due to the acid passed through the mouth from frequent vomiting causing acid erosion, mainly on the posterior dental surface.

Treatment

Pharmacological

Some researchers have hypothesized a relationship to mood disorders and clinical trials have been conducted with tricyclic antidepressants,[31] MAO inhibitors, mianserin, fluoxetine,[32] 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.[33]

There has also been some research characterizing bulimia nervosa as an addiction disorder, and limited clinical use of topiramate, which blocks cravings for opiates, cocaine, alcohol and food.[34] Researchers have also report positive outcomes when bulimics are treated in an addiction-disorders inpatient unit.[35]

Brain-derived neurotrophic factor (BDNF) is also under investigation as a possible cause.[36][37]

Psychotherapy

There are several empirically-supported psychosocial treatments for bulimia nervosa. Cognitive behavioral therapy (CBT), which involves teaching clients to challenge automatic thoughts and engage in behavioral experiments (e.g., in session eating of "forbidden foods") has demonstrated efficacy both with and without concurrent antidepressant medication.[38][39] Researchers have also reported some positive outcomes for interpersonal psychotherapy and dialectical behavior therapy.[40][41]

Maudsley Family Therapy or "Family Based Treatment" (FBT), developed at the Maudsley Hospital in London for the treatment of anorexia nervosa (AN) has been shown to have positive results for the treatment of bulimia nervosa. FBT has been shown through empirical research to be the most efficacious treatment of AN for patients under the age of eighteen and within three years of onset of illness. The studies to date using FBT to treat BN have been promising.[42]

Some researchers have also claimed positive outcomes in hypnotherapy treatment.[43][44][45]

References

  1. ^ Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Association. 1994. ISBN 0-89042-062-9.[page needed]
  2. ^ Fairburn, Christopher G. (1995). Overcoming binge eating. New York: Guilford Press. ISBN 0-89862-179-8.[page needed]
  3. ^ Douglas Harper (2001). "Online Etymology Dictionary: bulimia". Online Etymology Dictionary. Retrieved 2008-04-06. {{cite web}}: Unknown parameter |month= ignored (help)
  4. ^ Russell G (1979). "Bulimia nervosa: an ominous variant of anorexia nervosa". Psychological Medicine. 9 (3): 429–48. PMID 482466. {{cite journal}}: Unknown parameter |month= ignored (help)
  5. ^ Palmer R (2004). "Bulimia nervosa: 25 years on". The British Journal of Psychiatry : the Journal of Mental Science. 185: 447–8. doi:10.1192/bjp.185.6.447. PMID 15572732. {{cite journal}}: Unknown parameter |month= ignored (help)
  6. ^ Shader, Richard I. (2004). Manual of Psychiatric Therapeutics. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-4459-8.[page needed]
  7. ^ Walsh JM, Wheat ME, Freund K (2000). "Detection, evaluation, and treatment of eating disorders the role of the primary care physician". Journal of General Internal Medicine. 15 (8): 577–90. PMC 1495575. PMID 10940151. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  8. ^ American Psychiatric Association (2000). "Diagnostic criteria for 307.51 Bulimia Nervosa". Diagnostic and Statistical Manual of Mental Disorders (4th, text revision (DSM-IV-TR) ed.). ISBN 0-89042-025-4. {{cite book}}: |access-date= requires |url= (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)
  9. ^ Barlow, David H.; Durand, Vincent Mark (2002). Abnormal psychology: an integrative approach. Belmont, CA: Wadsworth/Thomson Learning. ISBN 0-534-63362-5.[page needed]
  10. ^ Makino M, Tsuboi K, Dennerstein L (2004). "Prevalence of eating disorders: a comparison of Western and non-Western countries". MedGenMed. 6 (3): 49. PMC 1435625. PMID 15520673.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  11. ^ Hay PJ, Mond J, Buttner P, Darby A (2008). "Eating disorder behaviors are increasing: findings from two sequential community surveys in South Australia". Plos One. 3 (2): e1541. doi:10.1371/journal.pone.0001541. PMC 2212110. PMID 18253489.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
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