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Encyclopedia > Bulimia nervosa
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Please improve this article if you can. (April 2007)
Bulimia nervosa
Classification and external resources
ICD-10 F50.2
ICD-9 307.51
DiseasesDB 1770
eMedicine emerg/810  med/255

Bulimia nervosa is an eating disorder characterised by recurrent binge eating, followed by compensatory behaviors, referred to as "purging".[1] The most common form—practised more than 75% of people with bulimia nervosa—is self-induced vomiting; fasting, the use of laxatives, enemas, diuretics, and overexercising are also common.[2] The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Binge eating is a pattern of disordered eating which consists of episodes of uncontrollable overeating. ... Defensive vomiting is a symptom of anorexia nervosa and bulimia nervosa in which a person who has drastically over-eaten (generally in reaction to previous extreme dieting) vomits as a reaction to an excess of food which the body is not prepared to handle. ... Fasting is primarily the act of willingly abstaining from some or all food, drink, or both, for a period of time. ... Laxatives (or purgatives) are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool, most often taken to treat constipation. ... This 2qt (about 1. ... This illustration shows where some types of diuretics act, and what they do. ...


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

Contents

Diagnosis

The criteria for diagnosing a patient with bulimia are:

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • Eating, in a fixed period of time, an amount of food that is definitely larger than most people would eat under similar circumstances.
    • A lack of control over eating during the episode: a feeling that one cannot stop eating or control what or how much one is eating.
  • Recurrent inappropriate compensatory behavior to prevent weight gain, such as: self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; excessive exercise.
  • Self-evaluation is unduly influenced by body shape and weight.
  • The disturbance does not occur exclusively during episodes of anorexia nervosa.[4]

There are two sub-types of bulimia nervosa: purging and non-purging. A laxative is a preparation used for the purpose of encouraging defecation, or the elimination of feces. ... For other uses, see Anorexia. ...

  • Purging bulimia is the more common of the two and involves self-induced vomiting (which may include use of emetics such as syrup of ipecac) and self-induced purging (which may include use of laxatives, diuretics, and enemas) to rapidly remove food from the body before it can be ingested.
  • Non-purging bulimia, which occurs in only approximately 6%-8% of cases, which involves excessive exercise or fasting after a binge to offset the caloric intake after eating. Purging-type bulimics may also exercise or fast, but as a secondary form of weight control.[4]

The onset of bulimia nervosa is most likely during adolescence (between 13 and 20 years of age), with many sufferers relapsing in adulthood into episodic binging and purging even after initially successful treatment and remission.[5] Heaving redirects here. ... Vomiting (or emesis) is the forceful expulsion of the contents of ones stomach through the mouth. ... Syrup of Ipecac (derived from the dried rhizome and roots of the Ipecacuanha plant), is an emetic—a substance used to induce vomiting. ... A diuretic is any drug that tends to increase the flow of urine from the body (diuresis). ... This rectal bulb syringe may be used to administer small enemas. ...


Bulimia nervosa can be difficult to detect, compared to anorexia, because bulimics tend to look healthier and have fewer immediately-visible health complications. Many bulimics may also engage in significantly disordered eating and exercising patterns without meeting the full diagnostic criteria for bulimia nervosa.[6]


Prevalence

There is little data on the incidence of bulimia nervosa in-the-large, on general populations. Most studies conducted thus far have been on convenience samples from hospital patients, high school or university students. These have yielded a wide range of results: between 0% and 2.1% of males, and between 0.3% and 7.3% of females.[7]

Country Year Sample size and type Incidence
USA 1996 1152 college students 0.2% male 1.3% female[8]
USA 1992 799 college students 0.4% male 5.1% female[9]
Norway 1995 19067 psychiatric patients 0.7% male 7.3% female[10]
Australia 1998 4200 high school students 0.3% combined[11]
Canada 1995 8116 (random sample) 0.1% male 1.1% female[12]
Japan 1995 2597 high school students 0.7% male 1.9% female[13]

Motto: (traditional) In God We Trust (official, 1956–present) Anthem: The Star-Spangled Banner Capital Washington, D.C. Largest city New York City Official language(s) None at the federal level; English de facto Government Federal Republic  - President George W. Bush (R)  - Vice President Dick Cheney (R) Independence - Declared - Recognized... Year 1996 (MCMXCVI) was a leap year starting on Monday (link will display full 1996 Gregorian calendar). ... Motto: (traditional) In God We Trust (official, 1956–present) Anthem: The Star-Spangled Banner Capital Washington, D.C. Largest city New York City Official language(s) None at the federal level; English de facto Government Federal Republic  - President George W. Bush (R)  - Vice President Dick Cheney (R) Independence - Declared - Recognized... Year 1992 (MCMXCII) was a leap year starting on Wednesday (link will display full 1992 Gregorian calendar). ... Year 1995 (MCMXCV) was a common year starting on Sunday. ... Year 1998 (MCMXCVIII) was a common year starting on Thursday (link will display full 1998 Gregorian calendar). ... Year 1995 (MCMXCV) was a common year starting on Sunday. ... Year 1995 (MCMXCV) was a common year starting on Sunday. ...

Effects

Bulimics go through cycles of over-eating and purging that can be very destructive to the body. These cycles often involve rapid and out-of-control eating, which may stop when the bulimic is interrupted by another person or the stomach hurts from overextension, followed by self-induced vomiting or other forms of purging. This cycle may be repeated several times a week or, in more serious cases, several times a day[14], and may directly cause:

Gastric acid is, together with several enzymes and the intrinsic factor, one of the main secretions of the stomach. ... Definition A cut is an injury that results in a break or opening in the skin. ... Gastroesophageal Reflux Disease (GERD or GORD using the British Å“sophageal) is defined as chronic symptoms or mucosal damage produced by the abnormal reflux in the esophagus[1]. This is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach. ... Esophagitis (or Oesophagitis) is inflammation of the esophagus. ... The esophagus or oesophagus (see American and British English spelling differences), sometimes known as the gullet, is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. ... Dehydration (hypohydration) is the removal of water (hydro in ancient Greek) from an object. ... Hypokalemia is a potentially fatal condition in which the body fails to retain sufficient potassium to maintain health. ... The salivary glands produce saliva, which keeps the mouth and other parts of the digestive system moist. ...

Causes

Bulimia is related to deep psychological issues and feelings of lack of control. Sufferers often use the destructive eating pattern to feel in control over their lives.[16] They may hide or hoard food and overeat when stressed or upset. They may feel a loss of control during a binge, and consume great quantities of food (over 20,000 calories).[17] After a length of time, the sufferer of bulimia will find that they no longer have control over their binging and purging. The binging becomes an addiction that seems impossible to break. Recovery is very hard and often in the early stages of recovery the patient will gain weight as they are still binging but no longer purging, causing anxiety which will in turn cause the patient to revert back to bulimia.


There are higher rates of eating disorders in groups involved in activities that emphasize thinness and body type, such as gymnastics, dance, cheerleading, acting, and figure skating.[18] Bulimia is more prevalent among Caucasians. In one study, diagnosis of bulimia was correlated with high testosterone and low estrogen levels, and normalizing these levels with combined oral contraceptive pills reduced cravings for fat and sugar.[19] Gymnastics is a sport involving the performance of sequences of movements requiring physical strength, flexibility, balance, endurance, gracefulness, and kinesthetic awareness, and includes such skills as handsprings, handstands, split leaps, aerials and cartwheels. ... Youth Cheerleaders during a football halftime show. ... Figure skating is an ice skating sporting event where individuals, mixed couples, or groups perform spins, jumps, and other moves on the ice, often to music. ... For the peoples actually from the Caucasus, see Peoples of the Caucasus. ... Testosterone is a steroid hormone from the androgen group. ... Estriol. ... The Pill redirects here. ...


Related disorders

Bulimics are much more likely than non-bulimics to have an affective disorder, such as depression or general anxiety disorder: a 1985 Columbia University study on female bulimics at New York State Psychiatric Institute found 70% had suffered depression some time in their lives (as opposed to 25.8% for adult females in a control sample from the general population), rising to 88% for all affective disorders combined.[20] Another study by the Royal Children's Hospital in Melbourne on a cohort of 2000 adolescents similarly found that those meeting least two of the DSM-IV criteria for bulimia nervosa or anorexia nervosa had a sixfold increase in risk of anxiety and a doubling of risk for substance dependency.[21] The affective spectrum is a grouping of related psychiatric and medical disorders which may accompany bipolar, unipolar, and schizoaffective disorders at statistically higher rates than would normally be expected. ... On the Threshold of Eternity. ... General anxiety disorder or generalized anxiety disorder (GAD) is an anxiety disorder that is characterized by excessive and uncontrollable worry about everyday things. ... This article is about the year. ... Alma Mater Columbia University is a private university in the United States and a member of the Ivy League. ... The New York State Psychiatric Institute, established in 1895, was one of the first institutions in the United States to integrate teaching, research and therapeutic approaches to the care of patients with mental illnesses. ... The Royal Childrens Hospital in Melbourne, Australia is the major specialist paediatric hospital for Victoria offering a full range of clinical services, tertiary care and health promotion and prevention programs for children and adolescents. ... This article is about the Australian city; the name may also refer to City of Melbourne or Melbourne city centre (also known as The CBD). ... For other meanings see cohort In statistics and demography, a cohort is a group of subjects — most often humans from a given population — defined by a condition on their date of birth. ... The Diagnostic and Statistical Manual published by the American Psychiatric Association The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a handbook for mental health professionals that lists different categories of mental disorder and the criteria for diagnosing them, according to the publishing organization the American Psychiatric Association. ...


See also

For other uses, see Anorexia. ... Body dysmorphic disorder (BDD) is a mental disorder that involves a distorted body image. ... Body image is a term which may refer to our perceptions of our own physical appearance, or our internal sense of having a body which is constructed by the brain. ... See also Negative calorie diet, very low calorie diet CRON redirects here. ... Defensive vomiting is a symptom of anorexia nervosa and bulimia nervosa in which a person who has drastically over-eaten (generally in reaction to previous extreme dieting) vomits as a reaction to an excess of food which the body is not prepared to handle. ... Eating disorder not otherwise specified (EDNOS) is a diagnostic category of sub-clinical mental disorders that involve disordered eating patterns. ... Fasting girls were young females, usually preadolescent, who, it was claimed, were capable of surviving over indefinitely long periods of time without consuming any food or other nourishment. ... This article or section is in need of attention from an expert on the subject. ... Percentage of population affected by malnutrition by country, according to United Nations statistics. ... Muscle dysmorphia is a disorder in which an individual becomes obsessed that they are not muscular enough. ... Orthorexia, or orthorexia nervosa is a term coined by Dr. Steven Bratman, a Colorado MD, to denote an eating disorder characterized by a fixation on eating what the sufferer considers to be healthful food, which can ultimately lead to early death. ... It has been suggested that Pro-mia be merged into this article or section. ... Purging disorder is an eating disorder characterized by recurrent purging (self-induced vomiting, misuse of laxatives, diuretics, or enemas) to control weight or shape in the absence of binge eating episodes that occurs in people with normal or near-normal weight. ... Refeeding syndrome is a syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved or severely malnourished. ...

References

  1. ^ (1994) Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, 4th, American Psychiatric Association. ISBN 0890420629. 
  2. ^ Fairburn, Christopher (1995), Overcoming Binge Eating, Guilford, ISBN 0898621798 
  3. ^ Douglas Harper (November 2001). Online Etymology Dictionary: bulimia. Online Etymology Dictionary. Retrieved on 2008-04-06.
  4. ^ a b Barlow, David H & Durand, V Mark (July 2004), Abnormal Psychology: An Integrative Approach, Thomson Wadsworth, ISBN 0534633625 
  5. ^ Agras, W S (2004), "Disorders of eating: anorexia nervosa, bulimia nervosa and binge eating disorder", in Shader, R I, Manual of psychiatric therapeutics, Lippincott Williams & Wilkins, ISBN 0781744598 
  6. ^ Walsh, J M E; Wheat, M.E & Freund, K (2000), "Detection, evaluation, and treatment of eating disorders", Journal of General Internal Medicine (Springer) 15 (8): 577-590, <http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1495575> 
  7. ^ "Prevalence of eating disorders: a comparison of Western and non-Western countries" (2004). Medscape General Medicine 6. 
  8. ^ Pemberton, A R; Vernon, S W & Lee, E S (2005), "Prevalence and Correlates of Bulimia Nervosa and Bulimic Behaviors in a Racially Diverse Sample of Undergraduate Students in Two Universities in Southeast Texas", American Journal of Epidemiology (Oxford University Press) 144 (5): 450-455, <http://aje.oxfordjournals.org/cgi/content/abstract/144/5/450> 
  9. ^ Heatherton, T F; Nichols, P; Mahamedi, F & Keel, P (1995), "Body weight, dieting, and eating disorder symptoms among college students, 1982 to 1992", American Journal of Psychiatry 152 (11): 1623-9, <http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=7485625&cmd=showdetailview> 
  10. ^ Götestam, K G; Eriksen, L & Hagen, H (1995), "An epidemiological study of eating disorders in Norwegian psychiatric institutions", The International journal of eating disorders (Wiley) 18 (3): 263-268, <http://cat.inist.fr/?aModele=afficheN&cpsidt=3704897> 
  11. ^ The epidemiology of eating disorder behaviors: An Australian community-based survey, last1 = Hay, first1 = P, journal = International Journal of Eating Disorders, volume = 23, number = 4, pages = 371-382, year = 1998, <http://www3.interscience.wiley.com/cgi-bin/abstract/34755/ABSTRACT> 
  12. ^ Garfinkel, P E; Lin, E; Goering, P; Spegg, C; Goldbloom, D S; Kennedy, S; Kaplan, A S & Woodside, D B (1995), "Bulimia nervosa in a Canadian community sample: prevalence and comparison of subgroups", Americal Journal of Psychiatry 152 (7): 1052-1058, <http://ajp.psychiatryonline.org/cgi/content/abstract/152/7/1052> 
  13. ^ Suzuki, K; Takeda, A & Matsushita, S (1995), "Coprevalence of bulimia with alcohol abuse and smoking among Japanese male and female high school students", Addiction (Blackwell Synergy) 90 (7): 971--976, <http://www.blackwell-synergy.com/doi/abs/10.1046/j.1360-0443.1995.90797110.x> 
  14. ^ Let's Talk Facts About: Eating Disorders, American Psychiatric Association, 1999, ISBN 0-89042-352-0  (pamphlet)
  15. ^ McGilley, Beth M & Pryor, Tamara L (June 1998), "Assessment and Treatment of Bulimia Nervosa", American Academy of Family Physicians, <http://www.aafp.org/afp/980600ap/mcgilley.html> 
  16. ^ BBC - Health - Conditions - Eating disorders
  17. ^ Bulimia
  18. ^ Bulimia Nervosa
  19. ^ Bulimia May Result from Hormonal Imbalance - Startpage - ki.se
  20. ^ Walsh, B T; Roose, S P; Glassman, A H; Gladis, M & Sadik, C (1985), "Bulimia and depression", Psychosomatic Medicine 47 (2): 123-131, <http://www.psychosomaticmedicine.org/cgi/reprint/47/2/123.pdf> 
  21. ^ Stark, Jill (2008-04-28), [theage.com.au/news/national/anorexia-a-pointer-to-later-depression/2008/04/27/1209234656201.html Anorexia a pointer to later depression], The Age, <theage.com.au/news/national/anorexia-a-pointer-to-later-depression/2008/04/27/1209234656201.html>. Retrieved on 28 April 2004 
The Diagnostic and Statistical Manual published by the American Psychiatric Association The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a handbook for mental health professionals that lists different categories of mental disorder and the criteria for diagnosing them, according to the publishing organization the American Psychiatric Association. ... Due to the epidemic of medical errors, readers are cautioned to be aware that the American Psychiatric Association isnt immune to this. ... An editor has expressed a concern that the subject of the article does not satisfy the notability guideline for Web content. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 96th day of the year (97th in leap years) in the Gregorian calendar. ... 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Landau-Kleffner syndrome (LKS), also called progressive epileptic aphasia, is a rare, childhood neurological syndrome characterized by the sudden or gradual development of aphasia (the inability to understand or express language) and an abnormal electroencephalogram (EEG). ... For the programming language, see Lisp (programming language). ... This article is about developmental dyslexia. ... Dysgraphia (or agraphia) is a deficiency in the ability to write, regardless of the ability to read, not due to intellectual impairment. ... Gerstmann syndrome is a neurological disorder. ... Developmental Dyspraxia is one or all of a heterogeneous range of psychological development disorders affecting the initiation, organization and performance of action[1]. It entails the partial loss of the ability to coordinate and perform certain purposeful movements and gestures in the absence of motor or sensory impairments. ... The diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD), refers to a group of disorders characterized by delays in the development of multiple basic functions including socialization and communication. ... Autism is a brain development disorder characterized by impairments in social interaction and communication, and restricted and repetitive behavior, all exhibited before a child is three years old. ... Rett syndrome/ disorder is a neurodevelopmental disorder that is classified as a pervasive developmental disorder by the DSM-IV. Many[1] argue that this is a misclassification just as it would be to include such disorders as fragile X syndrome, tuberous sclerosis, or Down syndrome where one can see autistic... Asperger syndrome (also Aspergers syndrome, Aspergers disorder, Aspergers, or AS) is one of several autism spectrum disorders (ASD) characterized by difficulties in social interaction and by restricted and stereotyped interests and activities. ... Attention-Deficit Hyperactivity Disorder (ADHD), is a neurobehavioural developmental disorder[1] [2] [3] affecting about 3-5% of the worlds population under the age of 19[4]. It typically presents itself during childhood, and is characterized by a persistent pattern of inattention and/or hyperactivity, as well as forgetfulness... Conduct disorder is a psychiatric category to describe a pattern of repetitive behavior where the rights of others or the social norms are violated. ... Oppositional defiant disorder is a controversial psychiatric category listed in the Diagnostic and Statistical Manual of Mental Disorders where it is described as an ongoing pattern of disobedient, hostile, and defiant behavior toward authority figures that goes beyond the bounds of normal childhood behavior. ... Separation Anxiety redirects here. ... Selective mutism is a social anxiety disorder in which a person who is normally capable of speech is unable to speak in given situations. ... Reactive attachment disorder (RAD) is the diagnostic term for severe and relatively uncommon disorders of attachment that can affect children. ... A tic is a repeated, impulsive action, almost reflexive in nature, which the actor feels powerless to control or avoid. ... “Tourette” redirects here. ... Speech disorders or speech impediments, as they are also called, are a type of communication disorders where normal speech is disrupted. ... “Stutter” redirects here. ... Cluttering (also called tachyphemia) is a communicative disorder characterized by speech that is difficult for listeners to understand due to rapid speaking rate, erratic rhythm, poor syntax or grammar, and words or groups of words unrelated to the sentence. ...

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Bulimia Nervosa: Eating Disorders: Merck Manual Home Edition (599 words)
Bulimia nervosa is characterized by the repeated rapid consumption of large quantities of food (bingeing), followed by attempts to rid the body of the excess food consumed (purging).
As in anorexia nervosa, bulimia nervosa is influenced by hereditary and social factors.
Also as in anorexia nervosa, most people who have bulimia nervosa are young women, are deeply concerned about body shape and weight, and belong to the middle or upper socioeconomic classes.
bulimia nervosa (4777 words)
Overall, the balance of aetiological factors is in favour of psychological and social causes, given that bulimia nervosa is a relatively new condition and has arisen at a time of profound social and cultural change, with little concurrent change in human biology.
The perspective on the perpetuation of bulimia nervosa is a cognitive one.
Bulimia nervosa is extremely rare in girls aged under 14 and the majority of cases are recognized between the ages of 18 and 25.
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