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Bulimia nervosa

Bulimia nervosa

Definition

Bulimia nervosa is an eating disorder characterized by binge eating and engaging in inappropriate ways of counteracting the bingeing (using laxatives, for example) in order to prevent weight gain. The word "bulimia" is the Latin form of the Greek word boulimia, which means "extreme hunger." A binge is consuming a larger amount of food within a limited period of time than most people would eat in similar circumstances. Most people with bulimia report feelings of loss of control associated with bingeing, and some have mildly dissociative experiences in the course of a binge, which means that they feel disconnected from themselves and from reality when they binge.

The handbook for mental health professionals to aid in diagnosis is the Diagnostic and Statistical Manual of Mental Disorders , also known as the DSM-IV-TR. This book categorizes bulimia nervosa as an eating disorder, along with anorexia nervosa .

Description

Bulimia nervosa is classified into two subtypes according to the methods used by the patient to prevent weight gain after a binge. The purging subtype of bulimia is characterized by the use of self-induced vomiting, laxatives, enemas, or diuretics (pills that induce urination); in the nonpurging subtype, fasting or overexercising is used to compensate for binge eating.

The onset of bulimia nervosa is most common in late adolescence or early adult life. Dieting efforts and body dissatisfaction, however, often occur in the teenage years. For these reasons, it is often described as a developmental disorder. Although genetic researchers have identified specific genes linked to susceptibility to eating disorders, the primary factor in the development of bulimia nervosa is environmental stress related to the onset of puberty. Girls who have strongly negative feelings about their bodies in response to puberty are at high risk for developing bulimia.

The binge eating associated with bulimia begins most often after a period of strict dieting. Most people with bulimia develop purging behaviors in response to the bingeing. Vomiting is used by 80%90% of patients diagnosed with bulimia. The personal accounts of recovered bulimics suggest that most "discover" vomiting independently as a way of ridding themselves of the food rather than learning about it from other adolescents. Vomiting is often done to relieve an uncomfortable sensation of fullness in the stomach following a binge as well as to prevent absorption of the calories in the food. Vomiting is frequently induced by touching the gag reflex at the back of the throat with the fingers or a toothbrush, but a minority of patients use syrup of ipecac to induce vomiting. About a third of bulimics use laxatives after binge eating to empty the digestive tract, and a minority use diuretics or enemas. Purging behaviors lead to a series of digestive and metabolic disturbances that then reinforce the behaviors.

A small proportion of bulimics exercise excessively or fast after a binge instead of purging.

Patients with bulimia may come to the attention of a psychiatrist because they develop medical or dental complications of the eating disorder. In some cases, the adolescent's dentist is the "case finder." In many cases, however, the person with bulimia seeks help.

Causes and symptoms

Causes

As of 2002, bulimia nervosa is understood to be a complex disorder with multiple factors contributing to its development. Researchers presently disagree about the degree of influence exerted by genetic factors, psychological patterns in the family of origin, and social trends.

GENETIC. Two recently published reviews (in 1999 and 2000) suggest that there is some heritability for bulimia. In other words, these articles suggest that there is a genetic component to bulimia. Neurotransmitters are chemicals that pass chemical messages along from nerve cell to nerve cell, and people with bulimia have abnormal levels of certain neurotransmitters. Some observers have suggested that these abnormalities in the levels of central nervous system neurotransmitters may also be influenced by genetic factors.

FAMILY OF ORIGIN. A number of recent studies point to the interpersonal relationships in the family of origin (the patient's family while growing up) as a factor in the later development of bulimia. People with bulimia are more likely than people with anorexia to have been sexually abused in childhood; studies have found that abnormalities in blood levels of serotonin (a neurotransmitter associated with mood disorders) and cortisol (the primary stress hormone in humans) in bulimic patients with a history of childhood sexual abuse resemble those in patients with post-traumatic stress disorder . Post-traumatic stress disorder is a mental disorder that can develop after someone has experienced a traumatic event (horrors of war, for example) and is unable to put that event behind him or her the disorder is characterized by very realistic flashbacks of the traumatic event.

A history of eating conflicts and struggles over food in the family of origin is also a risk factor for the development of bulimia nervosa. Personal accounts by recovered bulimics frequently note that one or both parents were preoccupied with food or dieting. Fathers appear to be as influential as mothers in this regard.

An additional risk factor for early-onset bulimia is interest in or preparation for a sport or occupation that requires strict weight control, such as gymnastics, figure skating, ballet, and modeling.

SOCIOCULTURAL CAUSES. Emphasis in the mass media on slenderness in women as the primary criterion of beauty and desirability is commonly noted in studies of bulimia. Historians of fashion have remarked that the standard of female attractiveness has changed over the past half century in the direction of greater slenderness; some have commented that Marilyn Monroe would be considered "fat" by contemporary standards. The ideal female figure is not only unattainable by the vast majority of women, but is lighter than the standards associated with good health by insurance companies. In 1965 the average model weighed 8% less than the average American woman; as of 2001 she weighs 25% less.

Another factor mentioned by intellectual historians is the centuries-old split in Western philosophy between mind and body. Instead of regarding a human person as a unified whole comprised of body, soul, and mind, Western thought since Plato has tended to divide human nature in a dualistic fashion between the life of the mind and the needs of the body. Furthermore, this division was associated with gender symbolism in such a way that the life of the mind was associated with masculinity and the needs of the body with femininity. The notion that the "superior" mind should control the "inferior" physical dimension of human life was correlated with men's physical, legal, and economic domination of women. Although this dualistic pattern of symbolic thought is no longer a conscious part of the Western mindset, it appears to influence Western culture on a subterranean level.

A number of different theories have been put forward to explain the connections between familial and social factors and bulimia. Some of these theories maintain that:

  • Bulimia results from a conflict between mother and daughter about nurturing and dependency. Girls are typically weaned earlier than boys and fed less. The bulimic's bingeing and purging represent a conflict between wanting comfort and believing that she does not deserve it.
  • Bulimia develops when an adolescent displaces larger conflicts about being a woman in a hypersexualized society onto food. Many writers have commented about the contradictory demands placed on women in contemporary society for example, to be sexually appealing yet "untouchable" at the same time. Controlling body size and food intake becomes a simplified solution to a very complex problem of personal identity and moral standards.
  • Bulimia is an obsession with food that the culture encourages in order to protect men from competition from intellectually liberated women. Women who are spending hours each day thinking about food, or bingeing and purging, do not have the emotional and intellectual energy to take their places in the learned professions and the business world.
  • Bulimia expresses a fear of fat rooted in childhood memories of mother's size relative to one's own.
  • Bulimia results from intensified competition among women for professional achievement (getting a desirable job or a promotion, or being accepted into graduate or professional school) as well as personal success (getting a husband), because studies have indicated that businesses and graduate programs discriminate against overweight applicants.
  • Bulimia results from attempts to control emotional chaos in one's interpersonal relationships by imposing rigid controls on food intake.

Nutrition experts have pointed to the easy availability of foods high in processed carbohydrates in developed countries as a social factor that contributes to the incidence of bulimia. One study found that subjects who were given two slices of standard mass-produced white bread with some jelly had their levels of serotonin increased temporarily by 450%. This finding suggests that bulimics who binge on ice cream, bread, cookies, pizza, and fast food items that are high in processed carbohydrates are simply manipulating their neurochemistry in a highly efficient manner. The incidence of bulimia may be lower in developing countries because diets that are high in vegetables and whole-grain products but low in processed carbohydrates do not affect serotonin levels in the brain as rapidly or as effectively.

Symptoms

The DSM-IV-TR specifies that bingeing and the inappropriate attempts to compensate for it must occur twice a week for three months on average to meet the diagnostic criteria for bulimia nervosa.

A second criterion of bulimia nervosa is exaggerated concern with body shape and weight. Bulimia can be distinguished from body dysmorphic disorder (BDD) by the fact that people with BDD usually focus on a specific physical feature most commonly a facial feature rather than overall shape and weight. Bulimics do, however, resemble patients with BDD in that they have distorted body images.

Bulimia is associated with a number of physical symptoms. Binge eating by itself rarely causes serious medical complications, but it is associated with nausea, abdominal distension and cramping, slowed digestion, and weight gain.

Self-induced vomiting, on the other hand, may have serious medical consequences, including:

  • Erosion of tooth enamel, particularly on the molars and maxillary incisors. Loss of tooth enamel is irreversible.
  • Enlargement of the salivary glands.
  • Scars and calloused areas on the knuckles from contact with the teeth.
  • Irritation of the throat and esophagus from contact with stomach acid.
  • Tearing of mucous membranes in the upper gastrointenstinal tract or perforation of the esophagus and stomach wall. Perforation of part of the digestive tract is a rare complication of bulimia but is potentially fatal.
  • Electrolyte imbalances. The loss of fluids from repeated vomiting and laxative abuse can deplete the body's stores of hydrogen chloride, potassium, sodium, and magnesium. Hypokalemia (abnormally low levels of potassium in the blood) is a potential medical emergency that can lead to muscle cramps, seizures , and heart arrhythmias.

Other physical symptoms associated with bulimia include irregular menstrual periods or amenorrhea; petechiae (pinhead-sized bruises from capillaries ruptured by increased pressure due to vomiting) in the skin around the eyes and rectal prolapse (the lowering of the rectum from its usual position).

Demographics

Bulimia nervosa affects between 1% and 3% of women in the developed countries; its prevalence is thought to have increased markedly since 1970. The rates are similar across cultures as otherwise different as the United States, Japan, the United Kingdom, Australia, South Africa, Canada, France, Germany, and Israel. About 90% of patients diagnosed with bulimia are female as of 2002, but some researchers believe that the rate of bulimia among males is rising faster than the rate among females.

The average age at onset of bulimia nervosa appears to be dropping in the developed countries. A study of eating disorders in Rochester, Minnesota over the 50 years between 1935 and 1985 indicated that the incidence rates for women over 20 remained fairly constant, but there was a significant rise for women between 15 and 20 years of age. The average age at onset among women with bulimia was 14 and among men, 18.

In terms of sexual orientation, gay men appear to be as vulnerable to developing bulimia as heterosexual women, while lesbians are less vulnerable.

Recent studies indicate that bulimia in the United States is no longer primarily a disorder of Caucasian women; the rates among African American and Hispanic women have risen faster than the rate of bulimia for the female population as a whole. One report indicates that the chief difference between African American and Caucasian bulimics in the United States is that the African American patients are less likely to eat restricted diets between episodes of binge eating.

Diagnosis

The diagnosis of bulimia nervosa is made on the basis of a physical examination, a psychiatric assessment, the patient's eating history, and the findings of laboratory studies. Patients who do not meet the full criteria for bulimia nervosa may be given the diagnosis of subsyndromal bulimia or of eating disorder not otherwise specified (EDNOS).

Physical examination

Patients suspected of having bulimia nervosa should be given a complete physical examination because the disorder has so many potential medical complications. In addition, most bulimics are close to normal weight or only slightly overweight, and so do not look outwardly different from most people of their sex in their age group. The examination should include not only vital signs and an assessment of the patient's height and weight relative to age, but also checking for such signs of bulimia as general hair loss, abdominal soreness, swelling of the parotid glands, telltale scars on the back of the hand, petechiae, edema, and teeth that look ragged or "moth-eaten."

Psychiatric assessment

Psychiatric assessment of patients with bulimia usually includes four components:

  • A thorough history of body weight, eating patterns, diets, typical daily food intake, methods of purging (if used), and concept of ideal weight.
  • A history of the patient's significant relationships with parents, siblings, and peers, including present or past physical, emotional, or sexual abuse.
  • A history of previous psychiatric treatment (if any) and assessment of comorbid (occurring at the same time as the bulimia) mood, anxiety, substance abuse, or personality disorders .
  • Administration of standardized instruments that measure attitudes toward eating, body size, and weight. Common tests for eating disorders include the Eating Disorder Examination; the Eating Disorder Inventory; the Eating Attitude Test, or EAT; and the Kids Eating Disorder Survey.

Laboratory findings

Laboratory tests ordered for patients suspected of having bulimia usually include a complete blood cell count, blood serum chemistry, thyroid tests, and urinalysis. If necessary, the doctor may also order a chest x ray and an electrocardiogram (EKG). Typical findings in patients with bulimia include low levels of chloride and potassium in the blood, and higher than normal levels of amylase, a digestive enzyme found in saliva.

Treatments

Treatment for bulimia nervosa typically involves several therapy approaches. It is, however, complicated by several factors.

First, patients diagnosed with bulimia nervosa frequently have coexisting psychiatric disorders that typically include major depression, dysthymic disorder , anxiety disorders, substance abuse disorders, or personality disorders. In the case of depression, the mood disorder may either precede or follow the onset of bulimia, and, with bulimia, the prevalence of depression is 40%70%. With regard to substance abuse, about 30% of patients diagnosed with bulimia nervosa abuse either alcohol or stimulants over the course of the eating disorder. The personality disorders most often diagnosed in bulimics are the so-called Cluster B disorders borderline, narcissistic, histrionic, and antisocial. Borderline personality disorder is a disorder characterized by stormy interpersonal relationships, unstable self-image, and impulsive behavior. People with narcissistic personality disorder believe that they are extremely important and are unable to have empathy for others. Individuals with histrionic personality disorder seek attention almost constantly and are very emotional. Antisocial personality disorder is characterized by a behavior pattern of a disregard for others' rights people with this disorder often deceive and mainpulate others. A number of clinicians have noted that patients with bulimia tend to develop impulsive and unstable personality disturbances whereas patients with anorexia tend to be more obsessional and perfectionistic. Estimates of the prevalence of personality disorders among patients with bulimia range between 2% and 50%. The clinician must then decide whether to treat the eating disorder and the comorbid conditions concurrently or sequentially. It is generally agreed, however, that a substance abuse disorder, if present, must be treated before the bulimia can be effectively managed. It is also generally agreed that mood disorders and bulimia can be treated concurrently, often using antidepressant medication along with therapy.

Second, the limitations on treatment imposed by managed care complicate the treatment of bulimia nervosa. When the disorder first received attention in the 1970s, patients with bulimia were often hospitalized until the most significant physical symptoms of the disorder could be treated. As of 2002, however, few patients with bulimia are hospitalized, with the exception of medical emergencies related to electrolyte imbalances and gastrointestinal injuries associated with the eating disorder. Most treatment protocols for bulimia nervosa now reflect cost-containment measures.

Medications

The most common medications given to patients are antidepressants, because bulimia is so closely associated with depression. Short-term medication trials have reported that tricyclic antidepressants desipramine , imipramine , and amitriptyline reduce episodes of binge eating by 47%91% and vomiting by 45%78%. The monoamine oxidase inhibitors are not recommended as initial medications for patients diagnosed with bulimia because of their side effects. The most promising results have been obtained with the selective serotonin reuptake inhibitors, or SSRIs. Fluoxetine (Prozac) was approved in 1998 by the Food and Drug Administration (FDA) for the treatment of bulimia nervosa. Effective dosages of fluoxetine are higher for the treatment of bulimia than they are for the treatment of depression. Although a combination of medication and cognitive-behavioral therapy is more effective in treating most patients with bulimia than medication alone, one team of researchers reported success in treating some bulimics who had not responded to psychotherapy with fluoxetine by itself.

A newer type of medication that shows promise in the treatment of bulimia nervosa is ondansetron, a drug that was originally developed to control nausea from chemotherapy and radiation therapy for cancer. Ondansetron acts to control the transmission of signals in nerves leading to the vagus nerve, which in turn governs feelings of fullness and the vomiting reflex. A British study reported that ondansetron normalized several aspects of eating behaviors in all the patients who received it during the study.

In addition to antidepressant or antinausea medications, such acid-reducing medications as cimetidine and ranitidine, or antacids, may be given to patients with bulimia to relieve discomfort in the digestive tract associated with irritation caused by stomach acid.

Psychotherapy

Cognitive-behavioral therapy (CBT) is regarded as the most successful psychotherapeutic approach to bulimia nervosa. CBT is intended to interrupt the faulty thinking processes associated with bulimia, such as preoccupations with food and weight, black-white thinking ("all or nothing" thinking, or thinking thoughts only at extreme ends of a spectrum) and low self-esteem, as well as such behaviors as the binge-purge cycle. Patients are first helped to regain control over their food intake by keeping food diaries and receiving feedback about their meal plans, symptom triggers, nutritional balance, etc. They are then taught to challenge rigid thought patterns as well as receiving assertiveness training and practice in identifying and expressing their feelings in words rather than through distorted eating patterns. About 50% of bulimic patients treated with CBT are able to stop bingeing and purging. Of the remaining half, some show partial improvement and a small minority do not respond at all.

Family therapy is sometimes recommended as an additional mode of treatment for patients with bulimia who come from severely troubled or food-obsessed families that increase their risk of relapsing.

Other mainstream therapies

Medical nutrition therapy, or MNT, is a recognized component of the treatment of eating disorders. Effective MNT for patients with bulimia involves an understanding of cognitive-behavioral therapy as well as the registered dietitian's usual role of assisting the physician with monitoring the patient's physical symptoms, laboratory values, and vital signs. In the treatment of bulimia, the dietitian's specialized knowledge of nutrition may be quite helpful in dealing with the myths about food and fad diets that many bulimic patients believe. The dietitian's most important task, however, is helping the patient to normalize her or his eating patterns in order to break the deprivation/bingeing cycle that is characteristic of bulimia nervosa. Calorie intake is usually based on retaining the patient's weight in order to prevent hunger, since hunger increases susceptibility to bingeing.

Recent studies in upstate New York have found that bright light therapy , of the type frequently prescribed for seasonal affective disorder (SAD), appears to be effective in reducing binge eating in patients diagnosed with bulimia. It also significantly relieved depressive symptoms, as measured by the patients' scores on the Beck Depression Inventory .

Alternative and complementary treatments

Alternative therapies that have been shown to be helpful for some patients in relieving the anxiety and muscular soreness associated with bulimia nervosa include acupuncture , massage therapy, hydrotherapy, and shiatsu.

Herbal remedies that have been used to calm digestive upsets in bulimic patients include teas made from chamomile or peppermint. Peppermint helps to soothe the intestines by slowing down the rate of smooth muscle contractions (peristalsis). Chamomile has been used to help expel gas from the digestive tract, a common complaint of bulimics. Both herbs have a wide margin of safety.

Some bulimic patients have responded well to yoga because its emphasis on focused breathing and meditation calls attention to and challenges the distorted thought patterns that characterize bulimia. In addition, the stretching and bending movements that are part of a yoga practice help to displace negative thoughts focused on the body's outward appearance with positive appreciation of its strength and agility. Lastly, since yoga is noncompetitive, it allows bulimics to explore the uniqueness of their bodies rather than constantly comparing themselves to other people.

Prognosis

The prognosis of bulimia depends on several factors, including age at onset, types of purging behaviors used (if any), and the presence of other psychiatric conditions or disorders. In many cases, the disorder becomes a chronic (long-term) condition; 20%50% of patients have symptoms for at least five years in spite of treatment. The usual pattern is an alternation between periods of remission and new episodes of bingeing. Patients whose periods of remission last for a year or longer have a better prognosis; patients diagnosed with major depression or a personality disorder have a less favorable prognosis. Overall, however, the prognosis for full recovery from bulimia nervosa is considered relatively poor compared to other eating disorders.

Bulimia nervosa appears to produce changes in the functioning of the serotonin system in the brain. Serotonin is a neurotransmitter. A team of researchers at the University of Pittsburgh who compared brain images taken by positron emission tomography (PET) from bulimic women who had been in remission for a year or longer with brain images from healthy women found that the recovered bulimics did not have a normal age-related decline in serotonin binding. Since serotonin helps to regulate mood, appetite, and impulse control, the study may help to explain why some women may be more susceptible to developing bulimia than others.

Prevention

As of 2002, the genetic factors in bulimia are not well understood. With regard to family influences, an important study published in December 2001 reported that the presence of eating problems in early childhood is a strong predictor of eating disorders in later life. The longitudinal study of 800 children and their mothers was based on psychiatric assessments of the subjects made in 1975, 1983, 1985, and 1992. The researchers found that a diagnosis of bulimia nervosa in early adolescence is associated with a nine-fold increase in risk for late adolescent bulimia and a 20-fold increase in risk for adult bulimia. Late adolescent bulimia nervosa is associated with a 35-fold increase in risk for adult bulimia nervosa. Given these findings, the most important preventive measure that can be taken in regard to bulimia nervosa is the establishment of healthful eating patterns and attitudes toward food in the family of origin.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association, 2000.

"Bulimia Nervosa." Section 15, Chapter 196 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 2001.

Chernin, Kim. The Obsession: Reflections on the Tyranny of Slenderness. Revised edition. New York: HarperPerennial Editions, 1994.

Eichenbaum, Luise, and Susie Orbach. Understanding Women: A Feminist Psychoanalytic Approach. New York: Basic Books, Inc., Publishers, 1983.

Hornbacher, Marya. Wasted: A Memoir of Anorexia and Bulimia. New York: HarperPerennial Editions, 1999.

Newmark, Gretchen Rose. "Overcoming Eating Disorders." In Living Yoga: A Comprehensive Guide for Daily Life, edited by Georg Feuerstein and Stephan Bodia. New York: Jeremy P. Tarcher/Perigee, 1993.

Rodin, Judith, PhD. Body Traps: Breaking the Binds That Keep You from Feeling Good About Your Body. New York: William Morrow, 1992.

Roth, Geneen. When Food is Love. New York: Penguin Books, 1992.

Wolf, Naomi. The Beauty Myth: How Images of Beauty Are Used Against Women. New York: Anchor Books, 1992.

PERIODICALS

Bulik, C. M., etal. "Twin Studies of Eating Disorders: A Review." International Journal of Eating Disorders 27 (2000): 1-20.

Eliot, A. W., and C. W. Baker. "Eating Disordered Adolescent Males." Adolescence 36 (Fall 2001): 535-543.

Fairburn, Christopher C. "The Natural Course of Bulimia Nervosa and Binge Eating Disorder in Young Women." Journal of the American Medical Association 284 (October 18, 2000): 1906.

Hay, Phillipa J., and Josue Bacaltchuk. "Bulimia Nervosa: Review of Treatments." British Medical Journal 303 (July 7, 2001): 33-37.

Kaye, Walter H., Guido K. Frank, Carolyn C. Meltzer, and others. "Altered Serotonin 2A Receptor Activity in Women Who Have Recovered From Bulimia Nervosa." American Journal of Psychiatry 158 (July 2001): 1152-1155.

Kotler, Lisa A., Patricia Cohen, Mark Davies, and others. "Longitudinal Relationships Between Childhood, Adolescent, and Adult Eating Disorders." Journal of the American Academy of Child and Adolescent Psychiatry 40 (December 2001): 1434-1440.

"Light Therapy for Bulimia." Family Practice News 10 (February 1, 2000): 32.

Little, J. W. "Eating Disorders: Dental Implications." Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics 93 (February 2002): 138-143.

McGilley, Beth M., and Tamara L. Pryor. "Assessment and Treatment of Bulimia Nervosa." American Family Physician 57 (June 1998): 1339.

Miller, Karl E. "Cognitive Behavior Treatment of Bulimia Nervosa." American Family Physician 63 (February 1, 2001): 536.

"Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Eating Disorders Not Otherwise Specified." Journal of the American Dietetic Association 101 (July 2001): 810-828.

Romano, Steven J., Katherine A. Halmi, Neena P. Sankar, and others. "A Placebo-Controlled Study of Fluoxetine in Continued Treatment of Bulimia Nervosa After Successful Acute Fluoxetine Treatment." American Journal of Psychiatry 159 (January 2002): 96-102.

Steiger, Howard, Lise Gauvin, Mimi Israel, and others. "Association of Serotonin and Cortisol Indices with Childhood Abuse in Bulimia Nervosa." Archives of General Psychiatry 58 (September 2001): 837.

Vink, T., A. Hinney, A. A. van Elburg, and others. "Association Between an Agouti-Related Protein Gene Polymorphism and Anorexia Nervosa." Molecular Psychiatry 6 (May 2001): 325-328.

Walling, Anne D. "Anti-Nausea Drug Promising in Treatment of Bulimia Nervosa." American Family Physician 62 (September 1, 2000): 1156.

ORGANIZATIONS

Academy for Eating Disorders. Montefiore Medical School, Adolescent Medicine, 111 East 210th Street, Bronx, NY 10467. (718) 920-6782.

American Academy of Child and Adolescent Psychiatry. 3615 Wisconsin Avenue, NW, Washington, DC 20016-3007. (202) 966-7300. Fax: (202) 966-2891. <www.aacap.org>.

American Anorexia/Bulimia Association. 165 West 46th Street, Suite 1108, New York, NY 10036. (212) 575-6200.

American Dietetic Association. (800) 877-1600. <www.eatright.org>.

Anorexia Nervosa and Related Eating Disorders, Inc. (ANRED). P.O. Box 5102, Eugene, OR 97405. (541) 344-1144. <www.anred.com>.

Center for the Study of Anorexia and Bulimia. 1 W. 91st St., New York, NY 10024. (212) 595-3449.

Rebecca J. Frey, Ph.D.

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Bulimia Nervosa

Bulimia nervosa

Definition

Bulimia nervosa is a serious and sometimes life-threatening eating disorder affecting mainly young women. People with bulimia, known as bulimics, consume large amounts of food (binge) and then try to rid themselves of the food and calories (purge) by fasting, excessive exercise, vomiting , or using laxatives . The behavior often serves to reduce stress and relieve anxiety . Because bulimia results from an excessive concern with weight control and self-image and is often accompanied by depression, it is also considered to be a psychiatric illness.

Description

Bulimia nervosa is a serious health problem for over 2 million adolescent girls and young women in the United States. The bingeing and purging activity associated with this disorder can cause severe damage, even death, although the risk of death is not as high as for anorexia nervosa , an eating disorder that leads to excessive weight loss.

In rare instances, binge eating may cause the stomach to rupture. In the case of purging, heart failure can result due to loss of vital minerals such as potassium. Vomiting causes other serious problems, including acid-related scarring of the fingers (if used to induce vomiting) and damage to tooth enamel. In addition, the tube that delivers food from the mouth to the stomach (the esophagus) often becomes inflamed, and salivary glands can become swollen. Irregular menstrual periods can also result, and interest in sex may diminish.

Most bulimics find it difficult to stop their behavior without professional help. Many typically recognize that the behavior is not normal, but they feel helpless to control it. Some bulimics struggle with other compulsive, risky behaviors such as drug and alcohol abuse. Many also suffer from other psychiatric illnesses, including clinical depression, anxiety, and obsessive-compulsive disorder (OCD).

Bulimic behavior is often carried out in secrecy, accompanied by feelings of guilt or shame. Outwardly, many people with bulimia appear healthy and successful, while inside they have feelings of helplessness and low self-esteem .

Demographics

Most bulimics are females in their teens to early 20s. Males account for only 5 to 10 percent of all cases. People of all races develop the disorder, but most of those diagnosed are white.

Causes and symptoms

The cause of bulimia is as of 2004 unknown. Researchers believe that it may be caused by a combination of genetic and environmental factors. Bulimia tends to run in families. Research shows that certain brain chemicals, known as neurotransmitters, may function abnormally in acutely ill people with bulimia nervosa. Scientists also believe there may be a link between bulimia and other psychiatric problems, such as depression and OCD. Environmental influences include participation in work or sports that emphasize thinness, such as modeling, dancing, or gymnastics. Family pressures also may play a role. One study found that mothers who are extremely concerned about their daughters' physical attractiveness and weight may in part cause bulimia in them. In addition, girls with eating disorders tend to have fathers and brothers who criticize their weight. Bulimia tends to run in families.

According to the American Anorexia/Bulimia Association Inc., warning signs of bulimia include the following:

  • eating large amounts of food uncontrollably (bingeing)
  • vomiting, abusing laxatives or diuretics, or engaging in fasting, dieting, or vigorous exercise (purging)
  • preoccupation with body weight
  • using the bathroom frequently after meals
  • depression or mood swings
  • irregular menstrual periods
  • onset of dental problems, swollen cheeks or glands, heartburn, or bloating

When to call the doctor

A healthcare professional should be consulted at the first sign of behaviors associated with bulimia.

Diagnosis

Bulimia is treated most successfully when diagnosed early. However, because the bulimic may deny there is a problem, getting medical help is often delayed. A complete physical examination in order to rule out other illnesses is the first step to diagnosis.

According to the American Psychiatric Association, a diagnosis of bulimia requires that a person have all of the following symptoms:

  • recurrent episodes of binge eating (minimum average of two binge-eating episodes a week for at least three months)
  • a feeling of lack of control over eating during the binges
  • regular use of one or more of the following to prevent weight gain: self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise
  • persistent over-concern with body shape and weight

Treatment

Early treatment is important; otherwise, bulimia may become chronic, with serious health consequences. A comprehensive treatment plan is called for in order to address the complex interaction of physical and psychological problems in bulimia. A combination of drug and behavioral therapies is commonly used.

Behavioral approaches include individual psychotherapy, group therapy, and family therapy . Cognitive-behavioral therapy, which teaches people how to change abnormal thoughts and behavior, is also used. Nutrition counseling and self-help groups are often helpful.

Antidepressants commonly used to treat bulimia include desipramine (Norpramin), imipramine (Tofranil), and fluoxetine (Prozac). These medications also may treat any co-existing depression.

In addition to professional treatment, family support plays an important role in helping the bulimic person. Encouragement and emotional support may convince the sick person to get help, stay with treatment, or try again

Bulimia nervosa
Criteria
source: Diagnostic and Statistical Manual of Mental Disorders IV.
1. Recurrent episodes of binge eating, which is characterized by 1) consumption of an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances AND 2) a sense of lack of control over eating during the episode.
2. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or enemas, or other medications; or fasting or excessive exercise.
3. Binge eating and compensatory behaviors both occur an average of twice a week for three months.
4. Self-evaluation is unduly influenced by body shape and weight.
5. The disturbance does not occur exclusively during episodes of anorexia nervosa.
Purging type: Regular episodes of self-induced vomiting or misuse of laxatives, diuretics, or enemas.
Nonpurging type: No regular episodes of self-induced vomiting or misuse of laxatives, diuretics, or enemas. Patient uses fasting or excessive exercise to avoid weight gain.

after a failure. Family members can help locate resources, such as eating disorder clinics in local hospitals or treatment programs in colleges designed for students.

Light therapyexposure to bright, artificial lightmay be useful in reducing bulimic episodes, especially during the dark winter months. Some feel that massage may prove helpful, putting people in touch with the reality of their own bodies and correcting misconceptions of body image. Hypnotherapy may help resolve unconscious issues that contribute to bulimic behavior.

Prognosis

Bulimia may become chronic and lead to serious health problems, including seizures, irregular heartbeat, and thin bones. In rare cases, it may be fatal. Timely therapy and medication can effectively manage the disorder and help the bulimic live a normal, productive, and fulfilling life.

Prevention

There is as of 2004 no known method for preventing bulimia. However, parents can promote healthy eating habits in their children and encourage them to embrace realistic, rather than overly thin, body images.

Nutritional concerns

Abnormal food intake and purging may result in abnormal nutrition. Purging may lead to a loss of potassium and other essential metabolic ions. These can become life threatening.

Parental concerns

Parental remarks about body size and shape often trigger bulimia. Parents of bulimics must be supportive and participate in treatment if the condition is to be successfully treated.

KEY TERMS

Binge A pattern of eating marked by episodes of rapid consumption of large amounts of food; usually food that is high in calories.

Diuretics A group of drugs that helps remove excess water from the body by increasing the amount lost by urination.

Neurotransmitters Chemicals in the brain that transmit nerve impulses.

Obsessive-compulsive disorder An anxiety disorder marked by the recurrence of intrusive or disturbing thoughts, impulses, images, or ideas (obsessions) accompanied by repeated attempts to supress these thoughts through the performance of certain irrational and ritualistic behaviors or mental acts (compulsions).

Purge To rid the body of food and calories, commonly by vomiting or using laxatives.

See also Binge eating disorder.

Resources

BOOKS

Bendich, Adrianne, and David J. Goldstein. Management of Eating Disorders and Obesity, 2nd ed. Totawa, NJ: Humana Press, 2004.

Litt, Iris F. "Anorexia Nervosa and Bulimia." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman, et al. Philadelphia: Saunders, 2003, pp. 6523.

Smith, Grainne. Anorexia and Bulimia in the Family: One Parent's Practical Guide to Recovery. New York: Wiley & Sons, 2004.

Walsh, B. Timothy. "Eating Disorders." In Harrison's Principles of Internal Medicine, 15th ed. Edited by Eugene Braunwald, et al. New York: McGraw Hill, 2001, pp. 48690.

West, Delia Smith. "The Eating Disorders." In Cecil Textbook of Medicine, 22nd ed. Edited by Lee Goldman, et al. Philadelphia: Saunders, 2003, pp. 132635.

PERIODICALS

Burns, M., and N. Gavey. "Healthy weight at what cost? Bulimia and a discourse of weight control." Journal of Health Psychology 9, no. 4 (2004): 24965.

Crow, S. J., et al. "Bulimia symptoms and other risk behaviors during pregnancy in women with bulimia nervosa." International Journal of Eating Disorders 36, no. 2 (2004): 2203.

Hinney A., et al. "Genetic risk factors in eating disorders." American Journal of Pharmacogenomics 4, no. 4 (2004): 20923.

Morad, M., I. Kandel, and J. Merrick. "Anorexia and bulimia in the family." International Journal of Adolescent Medicine and Health 16, no. 2 (2004): 8990.

ORGANIZATIONS

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 662112672. Web site: <www.aafp.org/>.

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 600071098. Web site: <www.aap.org/default.htm>.

American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. Web site: <www.psych.org/>.

American Psychological Association. 750 First Street NW, Washington, DC, 200024242. Web site: <www.apa.org/>.

National Eating Disorders Organization (NEDO). 6655 South Yale Ave, Tulsa, OK 74136. Web site: <www.NationalEatingDisorders.org>.

WEB SITES

"Bulimia." National Alliance for the Mentally Ill. Available online at <www.nami.org/Template.cfm?Section=By_Illness&amp;template=/ContentManagement/ContentDisplay.cfm&amp;ContentID=7638> (accessed November 2, 2004).

"Bulimia." National Library of Medicine. Available online at <www.nlm.nih.gov/medlineplus/ency/article/000341.htm> (accessed November 2, 2004).

"Bulimia and Related Disorders." Northern Arizona University. Available online at <http://dana.ucc.nau.edu/~kdk2/bulimia.html> (accessed November 2, 2004).

"Bulimia Nervosa." Internet Mental Health. Available online at <www.mentalhealth.com/dis/p20-et02.html> (accessed November 2, 2004).

L. Fleming Fallon, Jr., MD, DrPH

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Bulimia Nervosa

Bulimia nervosa

Definition

Bulimia nervosa is a serious and sometimes life-threatening eating disorder affecting mainly young women. People with bulimia, known as bulimics, consume large amounts of food (binge) and then try to rid themselves of the food and calories (purge) through fasting , excessive exercise, vomiting , or use of laxatives. Bulimics often feel that the behavior serves to reduce stress and relieve anxiety . Because bulimia results from an excessive concern with weight control and self-image, and is often accompanied by depression , it is also considered a psychiatric illness.

Description

Bulimia nervosa is a serious health problem for more than two million adolescent girls and young women in the United States. The bingeing and purging activity associated with this disorder can cause severe damage, even death, although the risk of death is not as high as for anorexia nervosa , an eating disorder that leads to excessive weight loss.

Binge eating may in rare instances cause the stomach to rupture. In the case of purging, heart failure can result due to loss of vital minerals such as potassium . Vomiting causes other serious problems, including acid-related scarring of the fingers (if used to induce vomiting) and damage to tooth enamel. In addition, the tube that brings food from the mouth to the stomach (the esophagus) often becomes inflamed and salivary glands can become swollen. Irregular menstrual periods can also result, and interest in sex may diminish.

Most bulimics find it difficult to stop their behavior without professional help. Many typically recognize that the behavior is not normal, but feel out of control. Some bulimics struggle with other compulsive, risky behaviors such as drug and alcohol abuse. Many also suffer from other psychiatric illnesses, including clinical depression, anxiety, and obsessive-compulsive disorder (OCD).

Most bulimics are females in their teens or early 20s. Males account for only 5-10% of all cases. People of all races develop the disorder, but most of those diagnosed are white.

Bulimic behavior is often carried out in secrecy, accompanied by feelings of guilt or shame. Outwardly, many people with bulimia appear healthy and successful, while inside they have feelings of helplessness and low self-esteem.

Causes & symptoms

Causes

The cause of bulimia is unknown. Researchers believe that it may be caused by a combination of genetic and environmental factors. Bulimia tends to run in families. Research shows that certain brain chemicals, known as neurotransmitters, may function abnormally in acutely ill bulimia patients. Scientists also believe there may be a link between bulimia and other psychiatric problems, such as depression and OCD. Environmental influences include participation in work or sports that emphasize thinness, such as modeling, dancing, or gymnastics. Family pressures also may play a role. One study found that mothers who are extremely concerned about their daughters' physical attractiveness and weight may help to cause bulimia. In addition, girls with eating disorders tend to have fathers and brothers who criticize their weight.

Symptoms

According to the American Anorexia/Bulimia Association, Inc., warning signs of bulimia include:

  • eating large amounts of food uncontrollably (bingeing)
  • vomiting, abusing laxatives or diuretics, or engaging in fasting, dieting, or vigorous exercise (purging)
  • preoccupation with body weight
  • using the bathroom frequently after meals
  • depression or mood swings
  • irregular menstrual periods
  • onset of dental problems, swollen cheeks or glands, heartburn or bloating

Diagnosis

Bulimia is treated most successfully when diagnosed early. But because the bulimic may deny there is a problem, getting medical help is often delayed. A complete physical examination in order to rule out other illnesses is the first step toward diagnosis.

According to the American Psychiatric Association, a diagnosis of bulimia requires that a person have all of the following symptoms: >

  • recurrent episodes of binge eating (minimum average of two binge-eating episodes a week for at least three months)
  • a feeling of lack of control over eating during the binges
  • regular use of one or more of the following to prevent weight gain: self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise
  • persistent over-concern with body shape and weight

Treatment

Alternative therapies may be used as complementary to conventional treatment program for bulimic patients. They include diet, nutritional therapy, herbal therapy, homeopathy, hydrotherapy, biofeedback training, hypnotherapy, massage therapy and light therapy .

Diet

The following dietary changes may be helpful for bulimic patients:

  • Eat small but nutritious meals at regularly scheduled hours.
  • Avoid sweet, baked goods or any other foods that may cause craving.
  • Avoid allergenic foods.
  • Limit intake of alcohol, caffeine , monosodium glutamate (MSG), and salty foods.

Nutritional therapy

The following supplements may help improve bulimic symptoms and prevent deficiency of essential vitamins and minerals:

  • Multivitamin and mineral supplement to prevent deficiency of essential nutrients.
  • Vitamin B complex with C.
  • Zinc supplement. Bulimic patients may have zinc deficiency, and zinc is an important mineral needed by the body for normal hormonal activity and enzymatic function.

Homeopathy

A homeopathic physician may prescribe patient-specific remedies for the treatment of bulimia.

Light therapy

Light therapy. Exposure to artificial light, available through full spectrum light bulbs or specially designed "light boxes," may be useful in reducing bulimic episodes, especially during the dark winter months.

Hypnotherapy

Hypnotherapy may help resolve unconscious issues that contribute to bulimic behavior.

Exercise

Yoga, qigong, t'ai chi or dance not only make patients physically healthier but also make them feel better about themselves.

Other treatments.

Other potentially beneficial treatments for bulimia include Chinese herbal therapy, hydrotherapy or biofeedback training.

Allopathic treatment

Early treatment of bulimia with a combination of drug and behavioral therapies is necessary to prevent serious health consequences. A comprehensive treatment plan is called for in order to address the complex interaction of physical and psychological problems of bulimia.

Behavioral approaches include individual psychotherapy , group therapy, and family therapy. Cognitive behavioral therapy , which teaches patients how to change abnormal thoughts and behavior, is also used. Nutrition counseling and self-help groups are often helpful.

Antidepressants commonly used to treat bulimia include desipramine (Norpramin), imipramine (Tofranil), and fluoxetine (Prozac). These medications also may treat any co-existing depression.

In addition to professional treatment, family support plays an important role in helping the bulimic person. Encouragement and caring can provide the support needed to convince the sick person to get help, stay with treatment, or try again after a failure. Family members can help locate resources, such as eating disorder clinics in local hospitals or treatment programs in colleges designed for students.

Expected results

Bulimia may become chronic and lead to serious health problems, including seizures, irregular heartbeat, and thin bones. In rare cases, it can be fatal.

Timely therapy and medication can effectively manage the disorder and help the bulimic look forward to a normal, productive, and fulfilling life.

Prevention

There is no known method to prevent bulimia.

Resources

BOOKS

The Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Fife, WA: Future Medicine Publishing, 1995.

Cassell, Dana K. The Encyclopedia of Obesity and Eating Disorders. New York, NY: Facts on File, Inc., 1994.

Jablow, Martha M. A Parent's Guide to Eating Disorders and Obesity. New York, NY: Dell Publishing, 1992.

Kubersky, Rachel. Everything You Need to Know about Eating Disorders. New York, NY: The Rosen Publishing Group, Inc., 1992.

The Medical Advisor: The Complete Guide to Alternative & Conventional Treatments. Richmond, VA: TimeLife Education, 1997.

PERIODICALS

Berg, Frances M. "Eating Disorders Affect Both the Mind and Body." Healthy Weight Journal. 9/2 (1995): 27-31.

Cismoski, Janet, et al. "Teen Nutrition." Whose Kids?..Our Kids! 6 (1995).

Levine, Michael P. "10 Things Men Can Do and Be to Help Prevent Eating Disorders." Healthy Weight Journal. 9/1 (1995): 15.

ORGANIZATIONS

American Anorexia/Bulimia Association, Inc. 293 Central Park West, Suite IR, New York, NY 10024. (212) 501-8351.

Anorexia Nervosa and Related Eating Disorders, Inc. PO Box 5102, Eugene, OR 97405. (541) 344-1144.

Center for the Study of Anorexia and Bulimia, 1 W. 91st St., New York, NY 10024. (212) 595-3449.

Eating Disorder Awareness & Prevention, Inc. 603 Stewart St., Suite 803, Seattle, WA 98101. (206) 382-3587.

National Association of Anorexia Nervosa and Associated Disorders. Box 7, Highland Park, IL 60035. (708) 831-3438.

National Eating Disorders Organization. 6655 South Yale Ave, Tulsa, OK 74136. (918) 481-4044.

Mai Tran

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Bulimia Nervosa

Bulimia Nervosa

Definition

Bulimia nervosa is a serious and sometimes life-threatening eating disorder affecting mainly young women. People with bulimia, known as bulimics, consume large amounts of food (binge) and then try to rid themselves of the food and calories (purge) by fasting, excessive exercise, vomiting, or using laxatives. The behavior often serves to reduce stress and relieve anxiety. Because bulimia results from an excessive concern with weight control and self-image, and is often accompanied by depression, it is also considered a psychiatric illness.

Description

Bulimia nervosa is a serious health problem for over two million adolescent girls and young women in the United States. The bingeing and purging activity associated with this disorder can cause severe damage, even death, although the risk of death is not as high as for anorexia nervosa, an eating disorder that leads to excessive weight loss.

Binge eating may in rare instances cause the stomach to rupture. In the case of purging, heart failure can result due to loss of vital minerals such as potassium. Vomiting causes other serious problems, including acid-related scarring of the fingers (if used to induce vomiting) and damage to tooth enamel. In addition, the tube that brings food from the mouth to the stomach (the esophagus) often becomes inflamed and salivary glands can become swollen. Irregular menstrual periods can also result, and interest in sex may diminish.

KEY TERMS

Binge To consume large amounts of food uncontrollably within a short time period.

Diuretic A drug that promotes the formation and excretion of urine.

Neurotransmitters Certain brain chemicals that may function abnormally in acutely ill bulimic patients.

Obsessive-compulsive disorder (OCD) A disorder that may accompany bulimia, characterized by the tendency to perform repetitive acts or rituals in order to relieve anxiety.

Purge To rid the body of food and calories, commonly by vomiting or using laxatives.

Most bulimics find it difficult to stop their behavior without professional help. Many typically recognize that the behavior is not normal, but feel out of control. Some bulimics struggle with other compulsive, risky behaviors such as drug and alcohol abuse. Many also suffer from other psychiatric illnesses, including clinical depression, anxiety, and obsessive-compulsive disorder (OCD).

Most bulimics are females in their teens or early 20s. Males account for only 5-10% of all cases. People of all races develop the disorder, but most of those diagnosed are white.

Bulimic behavior is often carried out in secrecy, accompanied by feelings of guilt or shame. Outwardly, many people with bulimia appear healthy and successful, while inside they have feelings of helplessness and low self-esteem.

Causes and symptoms

Causes

The cause of bulimia is unknown. Researchers believe that it may be caused by a combination of genetic and environmental factors. Bulimia tends to run in families. Research shows that certain brain chemicals, known as neurotransmitters, may function abnormally in acutely ill bulimia patients. Scientists also believe there may be a link between bulimia and other psychiatric problems, such as depression and OCD. Environmental influences include participation in work or sports that emphasize thinness, such as modeling, dancing, or gymnastics. Family pressures also may play a role. One study found that mothers who are extremely concerned about their daughters' physical attractiveness and weight may help to cause bulimia. In addition, girls with eating disorders tend to have fathers and brothers who criticize their weight.

Symptoms

According to the American Anorexia/Bulimia Association, Inc., warning signs of bulimia include:

  • eating large amounts of food uncontrollably (bingeing)
  • vomiting, abusing laxatives or diuretics, or engaging in fasting, dieting, or vigorous exercise (purging)
  • preoccupation with body weight
  • using the bathroom frequently after meals
  • depression or mood swings
  • irregular menstrual periods
  • onset of dental problems, swollen cheeks or glands, heartburn or bloating

Diagnosis

Bulimia is treated most successfully when diagnosed early. But because the bulimic may deny there is a problem, getting medical help is often delayed. A complete physical examination in order to rule out other illnesses is the first step to diagnosis.

According to the American Psychiatric Association, a diagnosis of bulimia requires that a person have all of the following symptoms:

  • recurrent episodes of binge eating (minimum average of two binge-eating episodes a week for at least three months)
  • a feeling of lack of control over eating during the binges
  • regular use of one or more of the following to prevent weight gain: self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise
  • persistent over-concern with body shape and weight

Treatment

Early treatment is important otherwise bulimia may become chronic, with serious health consequences. A comprehensive treatment plan is called for in order to address the complex interaction of physical and psychological problems in bulimia. A combination of drug and behavioral therapies is commonly used.

Behavioral approaches include individual psychotherapy, group therapy, and family therapy. Cognitive-behavioral therapy, which teaches patients how to change abnormal thoughts and behavior, is also used. Nutrition counseling and self-help groups are often helpful.

Antidepressants commonly used to treat bulimia include desipramine (Norpramin), imipramine (Tofranil), and fluoxetine (Prozac). These medications also may treat any co-existing depression.

In addition to professional treatment, family support plays an important role in helping the bulimic person. Encouragement and caring can provide the support needed to convince the sick person to get help, stay with treatment, or try again after a failure. Family members can help locate resources, such as eating disorder clinics in local hospitals or treatment programs in colleges designed for students.

Alternative treatment

Light therapyexposure to bright, artificial lightmay be useful in reducing bulimic episodes, especially during the dark winter months. Some feel that massage may prove helpful, putting people in touch with the reality of their own bodies and correcting misconceptions of body image. Hypnotherapy may help resolve unconscious issues that contribute to bulimic behavior.

Prognosis

Bulimia may become chronic and lead to serious health problems, including seizures, irregular heartbeat, and thin bones. In rare cases, it may be fatal.

Timely therapy and medication can effectively manage the disorder and help the bulimic look forward to a normal, productive, and fulfilling life.

Prevention

There is no known method to prevent bulimia.

Resources

ORGANIZATIONS

American Anorexia/Bulimia Association, Inc. 293 Central Park West, Suite IR, New York, NY 10024. (212) 501-8351.

Anorexia Nervosa and Related Eating Disorders, Inc. P.O. Box 5102, Eugene, OR 97405. (541) 344-1144.

Center for the Study of Anorexia and Bulimia. 1 W. 91st St., New York, NY 10024. (212) 595-3449.

Eating Disorder Awareness. & Prevention, Inc., 603 Stewart St., Suite 803, Seattle, WA 98101. (206) 382-3587.

National Association of Anorexia Nervosa and Associated Disorders. Box 7, Highland Park, IL 60035. (708) 831-3438.

National Eating Disorders Organization (NEDO). 6655 South Yale Ave, Tulsa, OK 74136. (918) 481-4044.

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Bulimia

BULIMIA

Bulimia (from the Greek boulima : hunger [limos ] of an ox [bous ]), a medical term that has entered common usage, refers to an eating disorder characterized by episodes.

A bulimic episode (a binge) is defined as a fit of frenzied overeating in which an excessive amount of food is consumed in a short time; this episode involves a sense of loss of control. It can occur several times in one day and can completely overwhelm the subject. Bulimia always entails a major and overwhelming event that is convulsive or ritualized, and violent. There is usually an awareness of the pathological nature of this behavior, combined with fear of an inability to avoid it, pleasure, shame, and self-denigration. In addition to bulimia relating to food, there is a form of bulimia that relates to various consumer items (medicines, pathological buying) and to sex.

There are descriptions of bulimic episodes dating from antiquity. Medical dictionaries, particularly in the English language, refer to this disorder from the beginning of the eighteenth century (Blankaart, 1708). Historically, bulimia was predominantly a male disorder and was akin to hyperphagia and gluttony. It was long considered a manifestation of the same order as neurotic symptoms (Janet, 1903); Sigmund Freud referred to it as one of the symptoms of anxiety neurosis and also recorded it as an eating compulsion motivated by a fear of starvation.

As a manifestation of orality in the broad sense, bulimia is generally a form of pathological behavior, a passage to the act that is often impulsive and bypasses any mentalization or psychic material. It then has a defensive function in warding off psychotic disorganization or depressive affects. Karl Abraham mentioned it in his work on melancholia and, in Fear of Breakdown (1974), Donald Winnicott described it as a form of defense against the frightening nature of the void.

Bulimia is also associated with the addictions (Radó, 1926). In 1945, Otto Fenichel classified it as a "drugless addiction." Marie-Claire Célérier regards it as a symptom on the boundary between a psychosomatic loss of meaning and a hysterical signifier (1977), while Joyce McDougall describes it in terms of a symptomatic act that substitutes for the undreamt dream.

Bulimia is a widespread phenomenon in Western societies that is both on the increase and more out in the open. It has gradually become a syndrome in its own rightbulimia nervosawith a separate status from anorexia nervosa and obesity. Wermuth and Russell first established the diagnostic criteria for the bulimic syndrome. In addition to bulimic episodes, these include various strategies for controlling weight and a psychiatric co-morbidity that can be severe (thymic disorders and addictions). These criteria reflect the notions of loss of control, chaotic functioning, inadequate mentalization and relationships of dependency (Jeammet, 1991) that are observed in these patients.

Contemporary discussions of bulimia refer to a complex, multi-faceted disorder that combines eating binges with a range of strategies for maintaining a normal weight, distortions in cognitive functioning and body-image perception, and emotional disturbances (Vindreau, 1991). In the majority of cases, the origins of the disorder are traced back to adolescence and its physiological and psychodynamic transformations. As of 2004, ninety percent of bulimics are women but the bulimia rate is rising among men. Whereas the incidence of the syndrome is three percent in the general population, it rises to seven percent in some adolescent, student, and high-school groups.

The conception of bulimia has developed from a simple compulsive substitution for a repressed sexual drive, into the widely-recognized, contemporary bulimia nervosa. Throughout this development, its definition has closely reflected both sociological and cultural changes and the psychopathological theories that prevailed over time. Above all, both the recourse of acting out through eating behavior, and the perceived need for particular bodily sensations in order to produce a psychic effect (Brusset, 1991), pose questions relating to self-esteem, difficulty in controlling behavior and emotions, narcissistic difficulties, and the quest for identity.

Christine Vindreau

See also: Anorexia nervosa; Self representation.

Bibliography

Abraham, Karl. (1924). A short study of the development of the libido, viewed in the light of mental disorders. Selected papers on Psycho-Analysis (pp. 418-501). London: Hogarth Press.

Brusset, Bernard. (1991). Psychopathologie de l 'anorexie mentale. Paris: Dunod.

Célérier, Marie-Claire. (1977). La boulimie compulsionnelle. Topique, 18, 95-116.

Fenichel, Otto. (1945). The psychoanalytic theory of neurosis. New York: W. W. Norton.

Freud, Sigmund. (1926d). Inhibitions, symptoms and anxiety. SE, 20: 75-172.

Igoin, Laurence. (1979). La boulimie et son infortune. Paris: Presses Universitaires de France.

Janet, Pierre. (1903). Les Obsessions et la psychasthénie. Paris: Alcan.

Jeammet, Phillipe. (1991). Dysrégulations narcissiques et objectales dans la boulimie. In Bernard Brusset and Catherine Couvreur (Eds.), La boulimie (pp. 89-104). Paris: Presses Universitaires de France.

McDougall, Joyce. (1974). The psyche-soma and the psychoanalytic process. International Journal of Psycho-Analysis, 1, 437-460.

Radó, Sándor. (1926). The psychic effects of intoxicants: an attempt to evolve a psycho-analytical theory of morbid cravings. International Journal of Psycho-Analysis, 7, 396-413.

Vindreau, Christine. (1991). La boulimie dans la clinique psychiatrique. In Bernard Brusset and Catherine Couvreur (Eds.), La boulimie (pp. 63-79). Paris: Presses Universitaires de France.

Winnicott, Donald W. (1974). Fear of breakdown. International Journal of Psycho-Analysis, 1, 103-107.

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Bulimia

Bulimia

An eating disorder in which a person indulges in recurrent episodes of binge eating, followed by purging through self-induced vomiting or by the use of laxatives and/or diuretics in order to prevent weight gain.

The symptoms of bulimia, or bulimia nervosa, include eating uncontrollably (binging) and then purging by dieting, fasting, exercising, vomiting, or abusing laxatives or diuretics. A binge involves a large amount of food, for example, several boxes of cookies, a loaf of bread, a half gallon of ice cream, and a bucket of fried chicken, eaten in a short and well-defined time period. Specific behaviors associated with bulimia include: 1) eating high-calorie "junk food" (candy bars, cookies, ice cream, etc.); 2) eating surreptitiously; 3) eating until stopped by a stomach ache, drowsiness, or external interruption; 4) a tendency to go on "crash diets"; and 5) weight that varies over a 10-pound (4.5 kg) range. Although all of these behaviors are not present in all bulimics, the presence of at least three makes it likely that an individual is suffering from the disorder. In general, binging episodes occur at least twice a week, and may take place two or more times a day.

Unlike anorexics, bulimics may be close to normal weight or overweight (within 15 percent of normal standards) and do not suffer from amenorrhea or lose interest in sex. Bulimics feel out of control, realize that their eating patterns are abnormal, and experience intense feelings of guilt and shame over their binging. Their preoccupation with body weight and secretive eating behaviors may combine with depression or mood swings. Possible warning signals of bulimia may include irregular periods, dental problems, swollen cheeks, heartburn, bloating, and alcohol or drug abuse.

The American Anorexia/Bulimia Association estimates that up to 5 percent of college-age women are bulimic and more than 90 percent of all bulimics are women. The onset of the disorder commonly occurs in the late teens or early twenties and can begin after a period of dieting or weight loss. Risk factors for the disorder involve a pattern of excessive dieting in an attempt to weigh less, a history of depression or alcoholism, low self-esteem , obese parents or siblings, and a history of anorexia nervosa. It has also been suggested that bulimia may have physiological causes, including a defective satiety mechanism.

In order to reduce the risks of developing an eating disorder, cultural attitudes associating thinness and beauty with personal worth and happiness must change to reflect a greater emphasis on developing healthier attitudes and eating behaviors in early childhood . Individuals must learn to value themselves and others for intrinsic rather than extrinsic qualities such as appearance.

Although bulimia is seldom life-threatening, it is a serious illness with severe medical consequences, including abdominal pain , vomiting blood, electrolyte imbalance possibly leading to weakness or cardiac arrest, muscle weakness, and intestinal damage. Bulimics and anorexics rarely cure themselves and the longer the behavior continues, the more difficult it is to help the individual change. The most effective treatment involves a team approach consisting of medical evaluation, individual and/or group psychotherapy , nutritional counseling, anti-depressant medication, and possible hospitalization. Psychotherapy generally consists of investigating the patient's unconscious motivations for binging in combination with behavior modification techniques to help cope with the disease. Commonly recommended medications include diphenylhydantoin (Dilantin), an anticonvulsant, and tricyclic antidepressants . Even with treatment, only about one-third of bulimics appear to recover while another third show some improvement in their eating behavior. The remaining third do not respond to treatment and 10 to 20 percent of these people eventually die of the disease.

See also Anorexia; Body image

Further Information

American Anorexia/Bulimia Association (AABA). 418 E. 76th St., New York, New York 10021, (212) 7341114.

American Dietetic Association (ADA) NCND-Eating Disorders. 216 W. Jackson Blvd., Chicago, Illinois 60606,(800) 3661655.

National Anorexic Aid Society. 445 E. Dublin-Granville Rd., Worthington, Ohio 43229, (614) 4361112.

National Association of Anorexia Nervosa and Associated Disorders (ANAD). Box 7, Highland Park, Illinois 60035,(708) 8313438.

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Bulimia Nervosa

Bulimia Nervosa

Bulimia nervosa is an eating disorder characterized by frequent episodes of binge eating, which are followed by purging to prevent weight gain. During these incidents, unusually large portions of food are consumed in secret, followed by compensatory behaviors such as self-induced vomiting or diuretic and laxative abuse. Although the types of food chosen may vary, sweets and high-calorie foods are commonly favored. Bulimic episodes are typically accompanied by a sense of a loss of self-control and feelings of shame.

A clinical diagnosis of bulimia nervosa requires that the behavior occur at least two times a week for a minimum of three months.

see also Addiction, Food; Anorexia Nervosa; Binge Eating; Body Image; Eating Disorders; Eating Disturbances.

Karen Ansel

Bibliography

American Dietetic Association (1998). Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Eating Disorder Not Otherwise Specified (EDNOS). Chicago: Author.

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Washington, DC: Author.

Escott-Stump, Sylvia, and Mahan, L. Kathleen (1996). Krause's Food, Nutrition, & Diet Therapy, 9th edition. Philadelphia: W. B. Saunders.

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Bulimia Nervosa

BULIMIA NERVOSA

DEFINITION


Bulimia (pronounced bu-LIM-ee-uh) nervosa is a serious and sometimes life-threatening eating disorder that affects primarily young women. Bulimics (people who have bulimia) go through cycles of binging and purging. Binging is the consumption of abnormally large amounts of food in a very short period of time, and purging is the elimination of food by some unusual activity. Bulimics use fasting (not eating), excessive exercise, vomiting, or laxatives to purge themselves of food. Bulimia is partly caused by excessive concern about weight control and self-image. It is considered to be a psychiatric (mental) disorder.

DESCRIPTION


Bulimia nervosa is a serious health problem for over two million adolescent girls and young women in the United States. In the most extreme cases, bulimia can cause severe bodily damage or even death. For example, in rare cases, binging can cause the stomach to break open. Purging can be dangerous because the body loses nutrients it needs to function properly. The loss of potassium, for example, can cause heart failure.

Vomiting is a common source of problems. When a person vomits, he or she brings up partially digested food and stomach acid. The acid is very strong and can burn the digestive tract, the mouth, and the lips. It can also damage the teeth. Binging and purging also disrupts the menstrual cycle.

Most bulimics know that their eating patterns are not normal, but they feel unable to change their behavior. Their binging and purging is done in secrecy so that family and friends often do not even know about their disorder. Some bulimics may turn to other ways of solving their problems, such as drugs and alcohol. Many develop other mental disorders, such as depression (see depressive disorders) and anxiety. In many cases, a physician or mental health professional must be consulted.

Most bulimics are females in their teens or early twenties; males of the same age range make up about 5 to 10 percent of bulimics. People of all races develop the disorder. The majority of bulimics who receive treatment, however, are white.

CAUSES


The cause of bulimia nervosa is unknown. Both genetic and social factors are probably responsible. Bulimia does appear to run in families, so a child is at risk for bulimia if another family member already has the disorder.

An important factor contributing to bulimia is the social pressure for women to be thin. Advertisements, television programs, and motion pictures are full of images depicting beautiful, successful women who are very thin. Young women often feel that they, too, need to be slender in order to be attractive and ultimately accepted in society. For young women with these feelings, bulimia may be the only way to achieve such standards.

Bulimia Nervosa: Words to Know

Binge:
To consume large amounts of food without control in a short period of time.
Purge:
To rid the body of food by vomiting, the use of laxatives, or some other method.

For some young women, the social pressure to maintain thinness may come from family, friends, or the social activities in which they participate. For instance, modeling, dancing, and gymnastics tend to emphasize an importance on body size and shape.

SYMPTOMS


The following are typical symptoms of bulimia nervosa:

  • Eating large amounts of food uncontrollably (binging)
  • Vomiting, using laxatives, or using other methods to eliminate food (purging)
  • Excessive concern about body weight
  • Depression or changes in mood
  • Irregular menstrual periods
  • Unusual dental problems, swollen cheeks or glands, heartburn, or bloating (swelling of the stomach)

IS IT BARBIE'S FAULT?

The causes of bulimia are many and complex. Could the Barbie doll be one of those causes? Some researchers think so. They point out that Barbie dolls have been one of the most popular toys ever developed and that an untold number of young girls have grown up playing with Barbie. So, in some ways, Barbie may have become a role model for young girls.

But how realistic is Barbie? For years critics have complained that Barbie's measurements are exaggerated. They argue that Barbie's waist was so small and breasts so large that a woman with the same measurements would not be able to stand. The fear is that young girls may begin to think that they should look like Barbie. And if their idea of beauty is being molded by a doll who was incredibly thin and unnaturally shaped, the message may lead to dangerous behavior such as anorexia or bulimia.

Scientists are also wondering if toys can affect the way boys view their bodies. For example, GI Joe has long been a very popular action figure among young boys. Unlike Barbie, GI Joe had a relatively realistic design. For example, the size of the doll's biceps (upper arm) was equivalent to 11 and one-half inch biceps on an adult male. This size falls within normal range for the average adult male.

In 1997, however, a new version of GI Joe was introduced called GI Joe Extreme. The new toy's dimensions increased so that the adult equivalent of his biceps would now measure 26 inches around, which is unnaturally exaggerated. It is interesting to note that also in 1997, Mattel, the toy company that produces both Barbie and GI Joe, announced that it was changing the shape of Barbie. In efforts to create a more realistic Barbie, the new and improved doll has smaller breasts and a wider waist.

DIAGNOSIS


Bulimia is often difficult to diagnose because patients often try to hide their condition and may deny they have a problem. Early diagnosis, however, is important. The sooner the condition is diagnosed, the better the chance it can be treated. One step in diagnosis is a physical examination. Because the symptoms of bulimia are similar to those of other diseases, a doctor needs to make sure that a patient is not suffering from some other physical problem.

According to the American Psychiatric Association, there are four signs that indicate bulimia. They are:

  • Repeated episodes of binge eating
  • Repeated use of purging devices, such as vomiting
  • A feeling of lack of control over binge eating
  • An ongoing concern over body shape and weight

TREATMENT


Bulimia nervosa is usually treated with a combination of drugs and counseling. Drugs are used to help the patient deal with his or her mental concerns. For example, anti-depressants may be used to help a person feel better about himself or herself.

Many types of counseling may be needed in the treatment of bulimia. Individual and group therapy can help patients understand the cause of their disorder, which may help patients learn to deal with their problems in ways other than binging and purging. Family counseling is also valuable.

Alternative Treatment

Light therapy may prove helpful in treating bulimia. Some people become depressed when there is an absence of light. The winter months can be especially difficult. Light therapy involves the use of artificial light to improve a patient's mood. Massage and hydrotherapy (water therapy) are also recommended for the treatment of bulimia. These techniques may help a person feel better about the shape and appearance of his or her own body.

PROGNOSIS


Bulimia may become chronic. That is, it can turn into an ongoing problem that lasts for many years. In such cases, it can cause a number of health problems, including seizures, irregular heartbeat, and thin bones. On rare occasions, bulimia can be fatal. Early treatment is the key to a promising prognosis. People who learn to deal with their problems of self-image can often be cured of the condition and can go on to lead normal, productive lives.

PREVENTION


Because bulimia is a psychiatric disorder with many possible causes, it is difficult to identify methods of prevention. Many suggest that the reason for eating disorders comes from society at large and that until the images of women in the media are changed to become more realistic, eating disorders such as bulimia, will continue to exist.

FOR MORE INFORMATION


Books

Cassell, Dana K. The Encyclopedia of Obesity and Eating Disorders. New York: Facts on File, 1994.

Jablow, Martha M. A Parent's Guide to Eating Disorders and Obesity. New York: Dell Publishing, 1992.

Kubersky, Rachel. Everything You Need to Know about Eating Disorders. New York: The Rosen Publishing Group, 1992.

Organizations

American Anorexia/Bulimia Association. 165 West 46th Street, Suite 1108 New York, NY 10036. (212) 5756200.

Anorexia Nervosa and Related Eating Disorders. PO Box 5102, Eugene, OR 97405. (541) 3441144.

Center for the Study of Anorexia and Bulimia. 1 W. 91st Street, New York, NY 10024. (212) 5953449.

Eating Disorder Awareness & Prevention. 603 Steward St., Suite 803, Seattle, WA 98101. (206) 3823587.

National Association of Anorexia Nervosa and Associated Disorders. Box 7, Highland Park, IL 60035. (708) 8313438.

National Eating Disorders Organization. 6655 South Yale Avenue, Tulsa, OK 74136. (918) 4814044.

Web sites

Anorexia Nervosa and Related Eating Disorders, Inc. [Online] http://www.anred.com (accessed on June 15, 1999).

"A Teen Guide to Eating Disorders." [Online] http://kidshealth.org. (accessed on October 5, 1999).

"Understanding Eating Disorders." [Online] http://www.ndmda.org. (accessed on June 15, 1999).

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bulimia

bu·lim·i·a / boŏˈlimēə; ˈlē-/ • n. insatiable overeating as a medical condition, in particular: ∎  (also bu·lim·i·a ner·vo·sa / nərˈvōsə/ ) an emotional disorder involving distortion of body image and an obsessive desire to lose weight, in which bouts of extreme overeating are followed by depression and self-induced vomiting, purging, or fasting. Also called binge-purge syndrome. DERIVATIVES: bu·lim·ic / -ˈlimik; ˈlē-/ adj. & n.

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Bulimia

Bulimia

Marlenes Perfect Figure

What Is Bulimia?

What Causes Bulimia?

What Are the Signs and Symptoms of Bulimia?

How Is Bulimia Diagnosed?

How Is Bulimia Treated?

Resources

Bulimia (bull-EE-me-a), sometimes referred to as the binge-purge disorder, involves repeated episodes of excessive eating (bingeing) followed by attempting to rid the body of the food by vomiting, using laxatives or enemas (purging), or exercising excessively.

KEYWORDS

for searching the Internet and other reference sources

Anorexia

Binge eating disorder

Binge and purge

Compulsive overeating

Eating disorders

Marlenes Perfect Figure

To her friends and family, Marlene had a perfectly fine figure, and she seemed confident and self-assured. But privately, Marlene suffered from bulimia and could not seem to stop bingeing and purging. Several times a week, she would eat whole batches of cookies, packages of candies, and as much bread and muffins as she could find. Her guilt and fear of overweight always led her to make herself vomit. Marlene stayed at a healthy weight for her size, but she was obsessed with her weight and body shape.

What Is Bulimia?

Eating disorders are habits or patterns of eating that are out of balance and may involve major health and emotional problems. Bulimia is a type of eating disorder in which a person binges, or consumes large quantities of food, and then purges, or attempts to rid the body of the food. When bingeing, people with bulimia often feel like they have little control over their behavior. After a binge, they feel guilty and fearful of becoming fat, so they try to rid the body of the food by vomiting or using laxatives or enemas. They may use diet pills or take drugs to reduce the volume of fluids in the body. Some people with bulimia also exercise excessively in order to burn up some of the calories eaten during binges. People with bulimia have a distorted body image*; even though many people with bulimia stay at a fairly healthy weight, they are fixated on body shape and weight and feel like they are fat.

* body image
is a persons impressions, thoughts, feelings, and opinions about his or her body.

Most people who develop bulimia are girls and young women of European ancestry, although males and people of all ethnic groups can have it. Bulimia affects at least 1 to 3 percent of middle and high school girls and up to 5 percent of college-age women in the United States.

What Causes Bulimia?

Bulimia often starts out with dieting after a binge, but once the purging begins, the situation worsens. A person eats too much, feels guilty about it, and purges. The purging provides some immediate relief but is followed by shame and guilt. People with bulimia begin to believe that the only way to control their weight is to purge. They often feel intense social and cultural pressure to be thin. Family problems and conflict are also often present in the lives of people with bulimia. Poor self-esteem can also play a role. People with bulimia overemphasize the importance of body shape and size in their overall self-image.

What Are the Signs and Symptoms of Bulimia?

A person with bulimia can often hide it very well. A girl with bulimia is usually near a healthy weight but is preoccupied with eating and dieting. Bulimia and other eating disorders share many symptoms, such as fatigue, low blood pressure, dehydration, preoccupation with food, and secretiveness about eating. However, because of the purging, bulimia can be associated with additional, serious symptoms that include:

  • tooth and other dental problems caused by stomach acids damaging tooth enamel
  • rips or tears in the esophagus (the tube that runs from the throat to the stomach) from frequent vomiting
  • other gastrointestinal problems
  • imbalances in electrolytes (essential body chemicals and minerals) that can lead to heart and other health problems
  • feelings of loss of control, shame, depression, irritability, withdrawal, and secretiveness

How Is Bulimia Diagnosed?

Like Marlene, people often keep their bulimia hidden from family, friends, and health care professionals. The shame and embarrassment about purging can be profound. Sometimes a dentist will notice damage to the tooth enamel. A health care professional might ask about a persons weight, diet, nutrition, and body image, and the responses may reveal an eating disorder. If concerned, a physician might order lab tests to study nutritional and medical status. A mental health professional may uncover bulimia when a person is treated for a different symptom, such as anxiety* or depression*.

* anxiety
can be experienced as a troubled feeling, a sense of dread, fear of the future, or distress over a possible threat to a persons physical or mental well-being.
* depression
(de-PRESH-un) is a mental state characterized by feelings of sadness, despair, and discouragement.

How Is Bulimia Treated?

Bulimia, like other eating disorders, is treated most effectively with a combination of therapies. The main treatment for bulimia is psychotherapy*. The focus of treatment is on changing eating behaviors and thinking patterns. To help a person overcome bulimia, a therapist will also address the persons distorted body image and fear of fat. Sometimes a physician will prescribe an antidepressant medication to relieve anxiety or depressive symptoms. Nutritional counseling, support groups, and family counseling can also be helpful.

* psychotherapy
(sy-ko-THER-apee), or mental health counseling, involves talking about feelings with a trained professional. The counselor can help the person change thoughts, actions, or relationships that play a part in the illness.

See also

Anorexia

Binge Eating Disorder

Body Dysmorphic Disorder

Body Image

Eating Disorders

Peer Pressure

Self-Esteem

Resources

Organizations

American Anorexia Bulimia Association, Inc., 165 West 46th Street, Suite 1108, New York, NY 10036. Telephone 212-575-6200 http://aabainc.org

Eating Disorders Awareness and Prevention, Inc. (EDAP), 603 Stewart Street, Suite 803, Seattle, WA 98101. Telephone: (800) 931-2237 for toll-free information and referral hotline http://www.edap.org

National Association of Anorexia Nervosa and Associated Disorders (ANAD), P.O. Box 7, Highland Park, IL 60035. Telephone 807-831-3438 http://anad.org

U.S. Food and Drug Administration (FDA) posts the fact sheet On the Teen Scene: Eating Disorders Require Medical Attention at its website. http://www.fda.gov/opacom/catalog/eatdis.html

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Bulimia Nervosa

BULIMIA NERVOSA

Since 1980, bulimia nervosa has been recognized by the American Psychiatric Association as an autonomous eating disorder. The term bulimia means "an extreme hunger," but the word is most commonly understood to refer to Bulimia Nervosa. It is characterized by recurrent episodes of binge eating followed by such regular activities as self-induced vomiting, excessive use of laxatives and/or diuretics, fasting or dieting, and vigorous exerciseall of which are directed at weight control. A characteristic feature in the bulimic patient is a persistent concern with weight and body shape. Other psychiatric disorders can accompany bulimia, particularly major depression. The full syndrome affects 1 to 3 percent of the adolescent and young adult female population, but many more experience subclinical variants of the disorder. Bulimia nervosa does occur in males, but such incidence is rare.

This disturbance in eating affects mostly young womenusually women of normal weightand is often preceded by Anorexia nervosa (restricted eating). The bulimic symptoms may continue for many years with exacerbations and remissions. From the mid-1970s to the mid-1990s, the prevalence of eating disorders appeared to be increasing in industrialized countries. The etiology of bulimia is unknown, although psychological, sociocultural, and biological theories have been proposed. Many consider Western societies' increasing emphasis on thinness, especially among women, to be a contributing influence.

Parallels between bulimia nervosa and substance abuse have been drawn based on an Addic-Tion model, a self-psychology model, and a psychobiological model. According to the addiction model, food is the "substance" that is abused in bulimia nervosa. Although there are superficial similarities in phenomenology between binge eating and substance abuse, these similarities are selective and rely on a loose definition of addiction. The self-psychology perspective is that both bulimia nervosa and substance abuse arise from a common deficit in psychological functioning. Difficulties regulating affect and tension generate a need for the external distraction provided by food or psychoactive substances, respectively. This model may have some heuristic value but it has not, as of the mid-1990s, received empirical validation. The psychobiological view regards eating and drinking as consummatory behaviors with the potential for dysregulation. One possibility is a shared disturbance in the brain neurochemical functioning that regulates drives of appetite. There is some evidence that brain Serotonin function may be disrupted in both bulimia nervosa and Alcohol abuse; however, research in this area has just begun and the validity of this model is unknown as of the mid-1990s.

Among women receiving treatment for substance abuse, estimates of the prevalence of bulimia nervosa range from 8 to 17 percent, and estimates of the prevalence of some eating disorder range from 26 to 47 percent. Similarly, estimates of alcohol abuse among women seeking treatment for bulimia nervosa range from 27 to 49 percent. Thus, substance abuse and bulimia nervosa occur together in young women much more frequently than would be expected for independent disorders. One potential source of this comorbidity lies in genetic risk. Several studies have indicated an overrepresentation of alcohol abuse in the families of women with eating disorders. Another possibility is that certain psychological factors place certain women at risk for the development of either bulimia nervosa or substance abuse. There is some limited evidence for an underlying Addictive Personality in both disorders. As well, women with both disorders seem to have more difficulties, generally, with impulsive behaviors.

The treatment of bulimia nervosa depends on its severity. Many cases of the eating disturbance resolve on their own. Specific interventions that may be tried include psychodynamic (individual, family, group) therapies as well as cognitive and behaviorally oriented therapies and pharmacological treatments. Modest improvements have been reported with the use of Antidepressant medication. Studies conducted in the late 1990s have shown that ondansetron (a drug commonly used for patients with vomiting associated with chemotheraphy) could be an effective treatment for those with bulimia; this drug was not shown to treat the psychological aspects of the disorder though (Kiss, 2000).

BIBLIOGRAPHY

Fairburn, Christopher G., et al. (2000). The natural course of bulimia nervosa and binge eating disorders in young women. Archives of General Psychiatry, 57, 659.

Goldbloom, D. S. (1993). Alcohol abuse and eating disorders: Aspects of an association. Alcohol and Alcoholism.

Kiss, Alexander (2000). Treatment of chronic bulimic symptoms: new answers, more questions. The Lancet, 355, 769.

Mitchell, J. E. (1990). Bulimia nervosa. Minneapolis: University of Minnesota Press.

Peveler, R., & Fairburn, C. (1990). Eating disorders in women who abuse alcohol. British Journal of Addiction, 85, 1633-1638.

Vandereycken, W. (1990). The addiction model in eating disorders: some critical remarks and a selected bibliography. International Journal of Eating Disorders, 9, 95-101.

Wilson, G. T. (1991). The addiction model of eating disorders: a critical analysis. Advances in Behaviour Research and Therapy, 12, 27-72.

Marion Olmsted

David Goldbloom

Miroslava Romach

Karen Parker

Revised by Rebecca Marlow-Ferguson

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OLMSTED, MARION; GOLDBLOOM, DAVID; ROMACH, MIROSLAVA; PARKER, KAREN; MARLOW-FERGUSON, REBECCA. "Bulimia Nervosa." Encyclopedia of Drugs, Alcohol, and Addictive Behavior. 2001. Encyclopedia.com. (September 25, 2016). http://www.encyclopedia.com/doc/1G2-3403100093.html

OLMSTED, MARION; GOLDBLOOM, DAVID; ROMACH, MIROSLAVA; PARKER, KAREN; MARLOW-FERGUSON, REBECCA. "Bulimia Nervosa." Encyclopedia of Drugs, Alcohol, and Addictive Behavior. 2001. Retrieved September 25, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3403100093.html

bulimia nervosa

bulimia nervosa Eating disorder that takes the form of compulsive eating, then purging by induced vomiting or the use of a laxative or diuretic. Confined mainly to girls and women, the disorder most often results from an underlying psychological problem. An obsession with body image may be reinforced by Western media stereotypes of slim as beautiful.

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bulimia

bulimia (bew-lim-iă) n. insatiable overeating. This symptom may be psychogenic, as in anorexia nervosa (b. nervosa or the binge–purge syndrome); or it may be due to neurological causes, such as a lesion of the hypothalamus.

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bulimia nervosa

bulimia nervosa An eating disorder, characterized by powerful and intractable urges to overeat, followed by self‐induced vomiting and the excessive use of purgatives; mainly a problem of young women. See also anorexia nervosa.

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DAVID A. BENDER. "bulimia nervosa." A Dictionary of Food and Nutrition. 2005. Retrieved September 25, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O39-bulimianervosa.html

bulimia

bulimia: see eating disorders.

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"bulimia." The Columbia Encyclopedia, 6th ed.. 2016. Encyclopedia.com. 25 Sep. 2016 <http://www.encyclopedia.com>.

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Bulimia Nervosa

Bulimia Nervosa

SeeEating Disorders

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"Bulimia Nervosa." International Encyclopedia of Marriage and Family. 2003. Encyclopedia.com. 25 Sep. 2016 <http://www.encyclopedia.com>.

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bulimia

bulimia •Grasmere • cashmere •Emyr, premier •macadamia, Mesopotamia •academia, anaemia (US anemia), Bohemia, Euphemia, hypoglycaemia, leukaemia (US leukemia), septicaemia (US septicemia), uraemia •bulimia, Ymir •arrhythmia • Vladimir • encomia •costumier • Windermere •Hermia, hyperthermia, hypothermia

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"bulimia." Oxford Dictionary of Rhymes. 2007. Encyclopedia.com. 25 Sep. 2016 <http://www.encyclopedia.com>.

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"bulimia." Oxford Dictionary of Rhymes. 2007. Retrieved September 25, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O233-bulimia.html

bulimia nervosa

bulimia nervosaanorexia nervosa, bulimia nervosa, curiosa, Formosa, grocer, samosa, Via Dolorosa •coaxer, hoaxer •greengrocer •rejoicer, voicer •Abu Musa, Appaloosa, babirusa, inducer, introducer, juicer, producer, reducer, rusa, seducer, sprucer, traducer •discusser, fusser, trusser •propulsor, Tulsa, ulcer •oncer • conveyancer • piercer •influencer • Odense • balancer •silencer • grimacer • trespasser •harasser • remembrancer •licenser, licensor •traverser • canvasser • sequencer •bursar, converser, curser, cursor, disburser, mercer, purser, rehearser, reverser, vice versa

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"bulimia nervosa." Oxford Dictionary of Rhymes. 2007. Retrieved September 25, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O233-bulimianervosa.html

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