Bulimia nervosa

Bulimia nervosa
Specialty	Psychiatry

Bulimia nervosa, mostly known as bulimia is an eating disorder in which the subject engages in recurrent binge eating followed by feelings of guilt, depression, and self-condemnation. The sufferer will then engage in compensatory behaviors to make up for the excessive eating, which are referred to as "purging". Purging can take the form of vomiting, fasting, the use of laxatives, enemas, diuretics or other medications, or overexercising.

The word bulimia comes from the Latin (būlīmia) from the Greek βουλῑμια (boulīmia), ravenous hunger, compounded from βους (bous), ox + λῑμος (līmos), hunger.

Diagnosis

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

There are two sub-types of bulimia nervosa: purging and non-purging.

• Purging bulimia is the more common of the two and involves self-induced vomiting (which may include use of emetics such as syrup of ipecac) and self-induced purging (which may include use of laxatives, diuretics and enemas) to rapidly remove food from the body before it can be ingested.
• Non-purging bulimia, which occurs in only approximately 6%-8% of cases, which involves 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.

Bulimia nervosa can be difficult to detect, compared to anorexia, because bulimics tend to look healthier and have fewer immediately-visible health complications. 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 incidence 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 prevalence rates: between 0% and 2.1% of males, and between 0.3% and 7.3% of females.

Country	Year	Sample size and type	Incidence
USA	1996	1152 college students	0.2% males	1.3% females
USA	1992	799 college students	0.4% males	5.1% females
Norway	1995	19067 psychiatric patients	0.7% males	7.3% females
Australia	1998	4200 high school students	0.3% combined
Canada	1995	8116 (random sample)	0.1% male	1.1% female
Japan	1995	2597 high school students	0.7% male	1.9% female

Effects

Bulimia can directly cause:

• Perimolysis, or the erosion of tooth enamel by gastric acids.
• Oral trauma, where habitual insertion by fingers or other objects cause lacerations to the lining of the mouth and throat.
• Chronic gastric reflux after eating.
• Esophagitis, or irritation of the esophagus by frequent contact with gastric acids.
• Dehydration and hypokalemia due to loss of fluids and potassium depletion.
• Swollen salivary glands.

Bulimics go through cycles of over-eating and purging that can be very destructive to the body. 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 over-extension, followed by self-induced vomiting or other forms of purging. This cycle may be repeated several times a week or, in serious cases, several times a day.

Causes

Bulimia is related to deep psychological issues and feelings of lack of control. Sufferers often use the destructive eating pattern to feel in control over their lives. They may hide or hoard food and overeat when stressed or upset. They may feel a loss of control during a binge, and consume great quantities of food (over 20,000 calories.) After a length of time, the sufferer of bulimia will find that they no longer have control over their binging and purging. The binging becomes an addiction that seems impossible to break. Recovery is very hard and often in the early stages of recovery the patient will gain weight as they are still binging but no longer purging, causing anxiety which will in turn cause the patient to revert back to bulimia.

There are higher rates of eating disorders in groups involved in activities that emphasize thinness and body type, such as gymnastics, dance, cheerleading, acting and figure skating. Bulimia is more prevalent among Caucasians. In one study, diagnosis of bulimia was correlated with high testosterone and low estrogen levels, and normalizing these levels with combined oral contraceptive pills reduced cravings for fat and sugar.

Related psychological disorders

Many bulimics also have anxiety or mood disorders. One study found anxiety in 75% of bulimic have been previously misdiagnosed with mood disorders. After appropriate treatment for an eating disorder, symptoms once thought be the result of bi-polar disorder, depression or anxiety disorder for examples eventually subside along with the eating disorder itself. Prominent mood disorders include depression and substance abuse. Some experts are finding in some individuals that their depression was caused by the eating disorder itself. To make patient history, treatment and prognosis even more baffling, many professionals intentionally exaggerate the severity of symptoms, even adding on a mood disorder diagnosis when none is warranted, in order to increase the likelihood of insurance coverage. Most insurance companies will cover inpatient treatment for severe mood disorders but not for eating disorders alone.

Bulimics are also more likely to attempt suicide and engage in impulsive behaviors. Bulimic females typically have a less favorable opinion of themselves than control groups. They are more pessimistic, more ambivalent towards others, strive for less recognition in areas that are socially significant or require leadership. Many bulimics, like anorexics, binge eaters and others with eating disorders, at one time were considered over-achievers, highly intelligent and true rising stars among their peers. Yet bulimics eventually become so consumed by food and/or weight that they, like anorexics, binge eaters and other individuals with eating disorders, have little time for the normal ambitions they once had.

Biological Explanations: 1.A Dysfuntion of the Hypothalamus, as it is damaged, could lead to bulimia. This is because the brain cannot control whether an individual is hungry or not, thus leading to them to not eat, and binge eat later. 2.Also neurotransmitters in the brain suppress appetite. Too little of neurotransmitters could lead to bulimia nervosa. Evidence of neurotransmitters is Jimerson et al(1997). 3.Furthermore, bulimia has been argued to be passed on through genetics. Kendler et al(1991), studied the concordance of bulimia in MZ twins and DZ twins.

See also

• Anorexia nervosa
• Body dysmorphic disorder
• Body image
• Binge eating disorder
• Cachexia
• Calorie restriction
• Defensive vomiting
• Eating disorder
• Eating disorder not otherwise specified
• Fasting girls for a historical perspective on anorexia nervosa
• Female body shape
• Malnutrition
• Muscle dysmorphia ('reverse' anorexia nervosa)
• Orthorexia nervosa
• Pro-ana
• Purging disorder
• Refeeding syndrome