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07-SEPTEMBER-2008 03:17:44 - Bulimia nervosa This article may require cleanup to meet 's quality standards. Please improve this article if you can. April 2007 Bulimia nervosa Classification and external resources ICD-10 F50.2 ICD-9 307.51 DiseasesDB 1770 eMedicine emerg/810 med/255 Bulimia nervosa is an eating disorder characterised by recurrent binge eating, followed by compensatory behaviors, referred to as purging.1 The most common form-practiced more than 75% of people with bulimia nervosa-is self-induced vomiting; fasting, the use of laxatives, enemas, diuretics, and overexercising are also common.2 The word bulimia derives from the Latin bÅ«lÄ«mia from the Greek βουλῑμια boulÄ«mia; ravenous hunger, a compound of βους bous, ox + λῑμος lÄ«mos, hunger.3 Contents 1 Diagnosis 2 Prevalence 3 Effects 4 Causes 5 Related disorders 6 See also 7 Informational links 8 References 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.4 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 digested. 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.4 The onset of bulimia nervosa is most likely 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.5 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.6 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 results: between 0% and 2.1% of males, and between 0.3% and 7.3% of females.7 Country Year Sample size and type Incidence USA 1996 1152 college students 0.2% male 1.3% female8 USA 1992 799 college students 0.4% male 5.1% female9 Norway 1995 19067 psychiatric patients 0.7% male 7.3% female10 Australia 1998 4200 high school students 0.3% combined11 Canada 1995 8116 random sample 0.1% male 1.1% female12 Japan 1995 2597 high school students 0.7% male 1.9% female13 Although bulimia is overwhelmingly a disease of young women, it can affect others. Former British Deputy Prime Minister John Prescott says he developed bulimia in his 60s 14. 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 day15, and may directly cause: Perimolysis, or the erosion of tooth enamel by gastric acids. Oral trauma, in which repetitive insertion of fingers or other objects causes lacerations to the lining of the mouth or 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.16 Electrolyte imbalance. 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.17 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.18 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, modelling, dance, cheerleading, running, acting, rowinglightweights/coxwains and figure skating.19 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.20 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.21 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.22 See also Anorexia nervosa Anorexia mirabilis Body dysmorphic disorder Body image Cachexia Calorie restriction Defensive vomiting Eating disorder not otherwise specified Fasting girls for a historical perspective on anorexia nervosa Female body shape Malnutrition Muscle dysmorphia 'reverse' anorexia nervosa National Association of Anorexia Nervosa and Associated Disorders Orthorexia nervosa Pro-ana Purging disorder Refeeding syndrome Informational links UCLA Eating Disorders Program References ^ 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, 4th, American Psychiatric Association. ISBN 0890420629. ^ Fairburn, Christopher 1995, Overcoming Binge Eating, Guilford, ISBN 0898621798 ^ Douglas Harper November 2001. Online Etymology Dictionary: bulimia. Online Etymology Dictionary. Retrieved on 2008-04-06. ^ a b Barlow, David H Durand, V Mark July 2004, Abnormal Psychology: An Integrative Approach, Thomson Wadsworth, ISBN 0534633625 ^ Agras, W S 2004, Disorders of eating: anorexia nervosa, bulimia nervosa and binge eating disorder, in Shader, R I, Manual of psychiatric therapeutics, Lippincott Williams Wilkins, ISBN 0781744598 ^ Walsh, J M E; Wheat, M.E Freund, K 2000, Detection, evaluation, and treatment of eating disorders, Journal of General Internal Medicine Springer 158: 577-590, doi:10.1046/j.1525-1497.2000.02439.x, PMID 10940151, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1495575 ^ Prevalence of eating disorders: a comparison of Western and non-Western countries 2004. Medscape General Medicine 6: 49. PMID 15520673. ^ Pemberton, A R; Vernon, S W Lee, E S 2005, Prevalence and Correlates of Bulimia Nervosa and Bulimic Behaviors in a Racially Diverse Sample of Undergraduate Students in Two Universities in Southeast Texas, American Journal of Epidemiology Oxford University Press 1445: 450-455, PMID 8781459, http://aje.oxfordjournals.org/cgi/content/abstract/144/5/450 ^ Heatherton, T F; Nichols, P; Mahamedi, F Keel, P 1995, Body weight, dieting, and eating disorder symptoms among college students, 1982 to 1992, American Journal of Psychiatry 15211: 1623-9, http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmeduid=7485625cmd=showdetailview ^ Götestam, K G; Eriksen, L Hagen, H 1995, An epidemiological study of eating disorders in Norwegian psychiatric institutions, The International journal of eating disorders Wiley 183: 263-268, doi:10.1002/1098-108X19951118:3263::AID-EAT22601803083.0.CO;2-O, http://cat.inist.fr/?aModele=afficheNcpsidt=3704897 ^ 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, http://www3.interscience.wiley.com/cgi-bin/abstract/34755/ABSTRACT ^ Garfinkel, P E; Lin, E; Goering, P; Spegg, C; Goldbloom, D S; Kennedy, S; Kaplan, A S Woodside, D B 1995, Bulimia nervosa in a Canadian community sample: prevalence and comparison of subgroups, Americal Journal of Psychiatry 1527: 1052-1058, PMID 7793442, http://ajp.psychiatryonline.org/cgi/content/abstract/152/7/1052 ^ Suzuki, K; Takeda, A Matsushita, S 1995, Coprevalence of bulimia with alcohol abuse and smoking among Japanese male and female high school students, Addiction Blackwell Synergy 907: 971--976, doi:10.1046/j.1360-0443.1995.90797110.x, http://www.blackwell-synergy.com/doi/abs/10.1046/j.1360-0443.1995.90797110.x ^ by the BBC ^ Let's Talk Facts About: Eating Disorders, American Psychiatric Association, 1999, ISBN 0-89042-352-0 pamphlet ^ McGilley, Beth M Pryor, Tamara L June 1998, Assessment and Treatment of Bulimia Nervosa, American Academy of Family Physicians, http://www.aafp.org/afp/980600ap/mcgilley.html ^ BBC - Health - Conditions - Eating disorders ^ Bulimia ^ Bulimia Nervosa ^ Bulimia May Result from Hormonal Imbalance - Startpage - ki.se ^ Walsh, B T; Roose, S P; Glassman, A H; Gladis, M Sadik, C 1985, Bulimia and depression, Psychosomatic Medicine 472: 123-131, http://www.psychosomaticmedicine.org/cgi/reprint/47/2/123.pdf ^ Stark, Jill 2008-04-28, theage.com.au/news/national/anorexia-a-pointer-to-later-depression/2008/04/27/1209234656201.html Anorexia a pointer to later depression, The Age, theage.com.au/news/national/anorexia-a-pointer-to-later-depression/2008/04/27/1209234656201.html. Retrieved on 28 April 2004 v d e WHO ICD-10 mental and behavioral disorders F · 290-319 Neurological/symptomatic Dementia Alzheimer's disease, multi-infarct dementia, Pick's disease, Creutzfeldt-Jakob disease, Huntington's disease, Parkinson's disease, AIDS dementia complex, Frontotemporal dementia, Elopement, Sundowning, Wandering · Delirium · Post-concussion syndrome · Organic brain syndrome Psychoactive substance alcohol drunkenness, alcohol dependence, alcoholic hallucinosis, Alcohol withdrawal, delirium tremens, Korsakoff's syndrome, alcohol abuse · opioids opioid dependency · sedative/hypnotic benzodiazepine withdrawal · cocaine cocaine dependence · general Intoxication, Drug abuse, Physical dependence, Withdrawal Psychotic disorder Schizophrenia disorganized schizophrenia · Schizophreniform disorder · Schizotypal personality disorder · Delusional disorder · Folie à deux · Schizoaffective disorder Mood affective Mania · Bipolar disorder · Clinical depression · Cyclothymia · Dysthymia Neurotic, stress-related and somatoform Anxiety disorder Agoraphobia, Panic disorder, Panic attack, Generalized anxiety disorder, Social anxiety, Social phobia · OCD · Acute stress reaction · PTSD · Adjustment disorder · Conversion disorder Ganser syndrome · Somatoform disorder Somatization disorder, Body dysmorphic disorder, Hypochondriasis, Nosophobia, Da Costa's syndrome, Psychalgia · Neurasthenia Physiological/physical behavioral Eating disorder: Anorexia nervosa · Bulimia nervosa Sleep disorder: Dyssomnia Hypersomnia, Insomnia · Parasomnia REM behavior disorder, Night terror · Nightmare Sexual dysfunction: Erectile dysfunction · Premature ejaculation · Vaginismus · Dyspareunia · Hypersexuality · Female sexual arousal disorder Postpartum depression · Postnatal psychosis Adult personality and behavior Personality disorder · Passive-aggressive behavior · Kleptomania · Trichotillomania · Voyeurism · Factitious disorder · Munchausen syndrome · Ego-dystonic sexual orientation · Fetishism Mental retardation Mental retardation Psychological development developmental disorder Specific: speech and language expressive language disorder, aphasia, expressive aphasia, receptive aphasia, Landau-Kleffner syndrome, lisp · Scholastic skills dyslexia, dysgraphia, Gerstmann syndrome · Motor function developmental dyspraxia Pervasive: Autism · Rett syndrome · Asperger syndrome Behavioral and emotional, childhood and adolescence onset ADHD · Conduct disorder · Oppositional defiant disorder · Separation anxiety disorder · Selective mutism · Reactive attachment disorder · Tic disorder · Tourette syndrome · Speech stuttering · cluttering Retrieved from http://en..org/wiki/Bulimia_nervosa Categories: Eating disorders | Culture-specific syndromesHidden categories: Cleanup from April 2007 | All pages needing cleanup Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Català Česky Deutsch Eesti Español Esperanto Euskara Français í•œêµì–´ Hrvatski Ã?slenska Italiano עברית ქáƒ?რთული Lietuvių Lumbaart Nederlands 日本語 Polski Português РуÑ?Ñ?кий Simple English SlovenÅ¡Ä?ina СрпÑ?ки / Srpski Suomi Svenska ä¸æ–‡ This page was last modified on 27 August 2008, at 05:27
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