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Bulimia nervosa

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Bulimia nervosa
SpecialtyPsychiatry Edit this on Wikidata

Bulimia nervosa is an eating disorder characterized by restraining of food intake for a period of time followed by an over intake or binging period that results in feelings of guilt and low self-esteem. The median age of onset is 18. Sufferers attempt to overcome these feelings in a number of ways.[1] The most common form is defensive vomiting, sometimes called purging; fasting, the use of laxatives, enemas, diuretics, and over exercising are also common.[2] Bulimia nervosa is nine times more likely to occur in women than men (Barker 2003). Antidepressants, especially SSRIs are widely used in the treatment of bulimia nervosa. (Newell and Gournay 2000).

The word bulimia derives from the Latin (būlīmia), which originally comes from the Greek βουλιμία (boulīmia; ravenous hunger), a compound of βους (bous), ox + λιμός (līmos), hunger.[3] Bulimia nervosa was named and first described by the British psychiatrist Gerald Russell in 1979.[4][5]

Signs and symptoms

These mother fuckers 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,[6] and may directly cause:

The frequent contact between teeth and gastric acid, in particular, may cause:

As with many psychiatric illnesses, delusions can occur with other signs and symptoms leaving the person with a false belief that is not ordinarily accepted by others.[11]

The person may also suffer physical complications such as tetany, epileptic seizures, cardiac arrhythmias and muscle weakness.(ICD-10)[citation needed].

People with bulimia nervosa may also exercise to a point that excludes other activities [11]

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.[12] Another study by the Royal Children's Hospital in Melbourne on a cohort of 2000 adolescents similarly found that those meeting at least two of the DSM-IV criteria for bulimia nervosa or anorexia nervosa had a sixfold increase in risk of anxiety and a doubling of risk for substance dependency.[13] Bulimia also has negative effects on the sufferer's dental health due to the acid passed through the mouth from frequent vomiting causing acid erosion, mainly on the posterior dental surface. los de la magda son gays y putos cara de pucha

Diagnosis

The onset of bulimia nervosa is often during adolescence, between 13 and 20 years of age, and many cases have previously suffered obesity, with many sufferers relapsing in adulthood into episodic binging and purging even after initially successful treatment and remission.[14]

According to Barker, persons with bulimia are more able to live and interact in everyday chores and tasks such as work and having relationships without the condition overly affecting their abilities.[15]

Bulimia nervosa can be difficult to detect, compared to anorexia nervosa, because bulimics tend to be of average or slightly above or below average weight. Many bulimics may also engage in significantly disordered eating and exercising patterns without meeting the full diagnostic criteria for bulimia nervosa.[16] The diagnostic criteria utilized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR) published by the American Psychiatric Association includes repetitive episodes of binge eating (a discrete episode of overeating during which the individual feels out of control of consumption) compensated for by excessive or inappropriate measures taken to avoid gaining weight.[17] The diagnosis is made only when the behavior is not a part of the symptom complex of anorexia nervosa and when the behavior reflects an overemphasis on physical mass or appearance.

There are two sub-types of bulimia nervosa:

  • Purging type bulimics self-induce vomiting (usually by triggering the gag reflex or ingesting emetics such as syrup of ipecac) to rapidly remove food from the body before it can be digested, or use laxatives, diuretics, or enemas.
  • Non-purging type bulimics (approximately 6%–8% of cases) exercise or fast excessively after a binge to offset the caloric intake after eating. Purging-type bulimics may also exercise or fast, but as a secondary form of weight control.[18]

Pharmacological

Some researchers have hypothesized a relationship to mood disorders and clinical trials have been conducted with tricyclic antidepressants,[19] MAO inhibitors, mianserin, fluoxetine,[20] lithium carbonate, nomifensine, trazodone, and bupropion. Research groups who have seen a relationship to seizure disorders have attempted treatment with phenytoin, carbamazepine, and valproic acid. Opiate antagonists naloxone and naltrexone, which block cravings for gambling, have also been used.[21]

There has also been some research characterizing bulimia nervosa as an addiction disorder, and limited clinical use of topiramate, which blocks cravings for opiates, cocaine, alcohol and food.[22] Researchers have also reported positive outcomes when bulimics are treated in an addiction-disorders inpatient unit.[23]

Psychotherapy

There are several empirically-supported psychosocial treatments for bulimia nervosa. Cognitive behavioral therapy (CBT), which involves teaching clients to challenge automatic thoughts and engage in behavioral experiments (for example, in session eating of "forbidden foods") has demonstrated efficacy both with and without concurrent antidepressant medication. By using CBT patients record how much food they eat and periods of vomiting with the purpose of identifying and avoiding emotional fluctuations that bring on episodes of bulimia on a regular basis (Gelder, Mayou and Geddes 2005). Barker (2003) states that research has found 40-60% of patients using cognitive behaviour therapy to become symptom free. He states in order for the therapy to work, all parties must work together to discuss, record and develop coping strategies. Barker (2003) claims by making people aware of their actions they will think of alternatives.[24][25] Researchers have also reported some positive outcomes for interpersonal psychotherapy and dialectical behavior therapy.[26][27]

Maudsley Family Therapy a.k.a. Family Based Treatment (FBT), developed at the Maudsley Hospital in London for the treatment of anorexia nervosa (AN) has been shown to have positive results for the treatment of bulimia nervosa. FBT has been shown through empirical research to be the most efficacious treatment of AN for patients under the age of eighteen and within three years of onset of illness. The studies to date using FBT to treat BN have been promising.[28]

Some researchers have also claimed positive outcomes in hypnotherapy treatment.[29][30][31] [32]

Etiology

Media portrayals of an 'ideal' body shape are widely considered to be a contributing factor to bulimia[1] (Barker 2003). A survey of 15–18 year-old high school girls in Nadroga, Fiji found the self-reported incidence of purging rose from 0% in 1995 (a few weeks after the introduction of television in the province) to 11.3% in 1998.[33]

Brain-derived neurotrophic factor (BDNF) is under investigation as a possible mechanism.[34][35]

Epidemiology

There is little data on the prevalence of bulimia nervosa in-the-large, on general populations. Most studies conducted thus far have been on convenience samples from hospital patients, high school or university students. These have yielded a wide range of results: between 0.1% and 1.4% of males, and between 0.3% and 9.4% of females.[36] Studies on time trends in the prevalence of bulimia nervosa have also yielded inconsistent results.[37] According to Gelder, Mayou and Geddes (2005) bulimia nervosa is prevalent between 1 and 2 per cent of women aged 15–40 years. Bulimia nervosa occurs more frequently in developed countries (Gelder, Mayou and Geddes 2005).

Country Year Sample size and type Incidence
Australia 2008 1,943 adolescents (ages 15–17) 1.0% male 6.4% female[13]
Portugal 2006 2,028 high school students 0.3% female[38]
Brazil 2004 1,807 students (ages 7–19) 0.8% male 1.3% female[39]
Spain 2004 2,509 female adolescents (ages 13–22) 1.4% female[40]
Hungary 2003 580 Budapest residents 0.4% male 3.6% female[41]
Australia 1998 4,200 high school students 0.3% combined[42]
USA 1996 1,152 college students 0.2% male 1.3% female[43]
Norway 1995 19,067 psychiatric patients 0.7% male 7.3% female[44]
Canada 1995 8,116 (random sample) 0.1% male 1.1% female[45]
Japan 1995 2,597 high school students 0.7% male 1.9% female[46]
USA 1992 799 college students 0.4% male 5.1% female[47]

There are higher rates of eating disorders in groups involved in activities which idealize a slim physique, such as dance,[41] gymnastics, modeling, cheerleading, running, acting, rowing and figure skating. Bulimia is more prevalent among Caucasians.[48]

See also

Notes

  1. ^ a b Barker, P (2003) Psychiatric and Mental Health Nursing: The Craft of Caring Arnold, Great Britain.
  2. ^ Fairburn, Christopher G. (1995). Overcoming binge eating. New York: Guilford Press. ISBN 0-89862-179-8.[page needed]
  3. ^ Douglas Harper (2001). "Online Etymology Dictionary: bulimia". Online Etymology Dictionary. Retrieved 2008-04-06. {{cite web}}: Unknown parameter |month= ignored (help)
  4. ^ Russell G (1979). "Bulimia nervosa: an ominous variant of anorexia nervosa". Psychological Medicine. 9 (3): 429–48. doi:10.1017/S0033291700031974. PMID 482466. {{cite journal}}: Unknown parameter |month= ignored (help)
  5. ^ Palmer R (2004). "Bulimia nervosa: 25 years on". The British Journal of Psychiatry : the Journal of Mental Science. 185: 447–8. doi:10.1192/bjp.185.6.447. PMID 15572732. {{cite journal}}: Unknown parameter |month= ignored (help)
  6. ^ Eating Disorders. Let's Talk About. American Psychiatric Association. 2005. ISBN 0-89042-352-0.
  7. ^ Joseph AB, Herr B (1985). "Finger calluses in bulimia". The American Journal of Psychiatry. 142 (5): 655. PMID 3857013. {{cite journal}}: Unknown parameter |month= ignored (help)
  8. ^ Wynn DR, Martin MJ (1984). "A physical sign of bulimia". Mayo Clinic Proceedings. Mayo Clinic. 59 (10): 722. PMID 6592415. {{cite journal}}: Unknown parameter |month= ignored (help)
  9. ^ a b "Eating Disorders". Oral Health Topics A–Z. American Dental Association.
  10. ^ Mcgilley BM, Pryor TL (1998). "Assessment and treatment of bulimia nervosa". American Family Physician. 57 (11): 2743–50. PMID 9636337. {{cite journal}}: Unknown parameter |month= ignored (help)
  11. ^ a b Barker, P (2003) Psychiatric and Mental Health Nursing: The Craft of Caring, Arnold, Great Britain.
  12. ^ Walsh BT, Roose SP, Glassman AH, Gladis M, Sadik C (1985). "Bulimia and depression". Psychosomatic Medicine. 47 (2): 123–31. PMID 3863157.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. ^ a b Patton GC, Coffey C, Carlin JB, Sanci L, Sawyer S (2008). "Prognosis of adolescent partial syndromes of eating disorder". The British Journal of Psychiatry. 192 (4): 294–9. doi:10.1192/bjp.bp.106.031112. PMID 18378993. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  14. ^ Shader, Richard I. (2004). Manual of Psychiatric Therapeutics. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-4459-8.[page needed]
  15. ^ Barker, 2003, p. 323
  16. ^ Walsh JM, Wheat ME, Freund K (2000). "Detection, evaluation, and treatment of [[eating disorder]]s the role of the primary care physician". Journal of General Internal Medicine. 15 (8): 577–90. doi:10.1046/j.1525-1497.2000.02439.x. PMC 1495575. PMID 10940151. {{cite journal}}: URL–wikilink conflict (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  17. ^ American Psychiatric Association (2000). "Diagnostic criteria for 307.51 Bulimia Nervosa". Diagnostic and Statistical Manual of Mental Disorders (4th, text revision (DSM-IV-TR) ed.). ISBN 0-89042-025-4. {{cite book}}: |access-date= requires |url= (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)
  18. ^ Barlow, David H.; Durand, Vincent Mark (2002). Abnormal psychology: an integrative approach. Belmont, CA: Wadsworth/Thomson Learning. ISBN 0-534-63362-5.[page needed]
  19. ^ Mitchell JE, Raymond N, Specker S (1993). "A review of the controlled trials of pharmacotherapy and psychotherapy in the treatment of bulimia nervosa". The International Journal of Eating Disorders. 14 (3): 229–47. doi:10.1002/1098-108X(199311)14:3<229::AID-EAT2260140302>3.0.CO;2-X. PMID 8275060. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  20. ^ Walsh, B T (1995). "Pharmacotherapy of eating disorders". In Brownell, K D; Fairburn (eds.). Eating Disorders and Obesity: A Comprehensive Handbook. New York: Guilford. pp. 329–40. ISBN 978-0-89862-850-0. {{cite book}}: |editor-first2= missing |editor-last2= (help)
  21. ^ Mitchell JE, Christenson G, Jennings J; et al. (1989). "A placebo-controlled, double-blind crossover study of naltrexone hydrochloride in outpatients with normal weight bulimia". Journal of Clinical Psychopharmacology. 9 (2): 94–7. doi:10.1097/00004714-198904000-00004. PMID 2656781. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  22. ^ Slaby, Andrew Edmund (1993). The eating disorders. Berlin: Springer-Verlag. ISBN 0-387-94002-2.[page needed]
  23. ^ Wilfley DE, Welch RR, Stein RI; et al. (2002). "A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder" (PDF). Archives of General Psychiatry. 59 (8): 713–21. doi:10.1001/archpsyc.59.8.713. PMID 12150647. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  24. ^ Agras WS, Crow SJ, Halmi KA, Mitchell JE, Wilson GT, Kraemer HC (2000). "Outcome predictors for the cognitive behavior treatment of bulimia nervosa: data from a multisite study". The American Journal of Psychiatry. 157 (8): 1302–8. doi:10.1176/appi.ajp.157.8.1302. PMID 10910795. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  25. ^ Wilson GT, Loeb KL, Walsh BT; et al. (1999). "Psychological versus pharmacological treatments of bulimia nervosa: predictors and processes of change". Journal of Consulting and Clinical Psychology. 67 (4): 451–9. doi:10.1037/0022-006X.67.4.451. PMID 10450615. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  26. ^ Fairburn CG, Agras WS, Walsh BT, Wilson GT, Stice E (2004). "Prediction of outcome in bulimia nervosa by early change in treatment". The American Journal of Psychiatry. 161 (12): 2322–4. doi:10.1176/appi.ajp.161.12.2322. PMID 15569910. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  27. ^ Safer DL, Telch CF, Agras WS (2001). "Dialectical behavior therapy for bulimia nervosa". The American Journal of Psychiatry. 158 (4): 632–4. doi:10.1176/appi.ajp.158.4.632. PMID 11282700. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  28. ^ Lock J, le Grange D (2005). "Family-based treatment of eating disorders". The International Journal of Eating Disorders. 37 Suppl: S64–7, discussion S87–9. doi:10.1002/eat.20122. PMID 15852323.
  29. ^ Barabasz M (1990). "Treatment of bulimia with hypnosis involving awareness and control in clients with high dissociative capacity". International Journal of Psychosomatics. 37 (1–4): 53–6. PMID 2246105.
  30. ^ Barabasz M (2007). "Efficacy of hypnotherapy in the treatment of eating disorders". The International Journal of Clinical and Experimental Hypnosis. 55 (3): 318–35. doi:10.1080/00207140701338688. PMID 17558721. {{cite journal}}: Unknown parameter |month= ignored (help)
  31. ^ Griffiths RA (1995). "Two-Year Follow-Up Findings of Hypnobehavioural Treatment for Bulimia Nervosa". Australian Journal of Clinical and Experimental Hypnosis. 23 (2): 135–44.
  32. ^ Kraft T, Kraft D (2009). The Place of Hypnosis in Psychiatry, Part 3: the Application to the Treatment of Eating Disorders' Australian Journal of Clinical and Experimental Hypnosis, 37, (1): 1-20.
  33. ^ Becker AE, Burwell RA, Gilman SE, Herzog DB, Hamburg P (2002). "Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls". The British Journal of Psychiatry. 180: 509–14. doi:10.1192/bjp.180.6.509. PMID 12042229. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  34. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1093/hmg/ddh137, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1093/hmg/ddh137 instead.
  35. ^ "1". Annual Review of Eating Disorders – part 2 (PDF). 2008. pp. 14–15. ISBN 978-1-84619-244-9.
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