Bulimia

Bulimia, also called bulimia nervosa, is a psychological eating disorder.  People with bulimia nervosa typically feel a lack of control during their eating binges. Their food is usually eaten secretly and gobbled down rapidly with little chewing. A binge is usually ended by abdominal discomfort. When the binge is over, the person with bulimia nervosa feels guilty and purges to rid his or her body of the excess calories.

Excessive shape and weight concerns are also characteristics of bulimia nervosa. A binge is an episode where an individual eats a much larger amount of food than most people would in a similar situation. Binge eating is not a response to intense hunger. It is usually a response to depression, stress, or self esteem issues. During the binge episode, the individual experiences a loss of control. However, the sense of a loss of control is also followed by a short-lived calmness. The calmness is often followed by guilt and self-loathing. The cycle of overeating and purging usually becomes an obsession and is repeated often.

Not all bulimics engage in self-induced vomiting or the misuse of laxatives, diuretics, or enemas during each episode. Some may fast for days following a binge episode. Others may resort to excessive exercise as a method to regain their control and rid their body of the possible weight gained during the binge. Excessive exercise is that which interferes with normal daily activities or when it occurs at inappropriate times or in inappropriate settings, or when it continues despite illness or injury.

Bulimia nervosa is usually less about food and more to do with psychological issues and profound feelings of lack of control. Binge/purge episodes can be severe, sometimes involving rapid and out of control feeding that can stop when the sufferers are interrupted by another person or when their stomach hurts from over-extension. The frequency of bulimic cycles will vary from person to person. Some will suffer from an episode every few months while others who are more severely ill may binge and purge several times a day. Some people may vomit automatically after they have eaten any food. Others will eat socially but may be bulimic in private. Some people do not regard their illness as a problem, while others despise and fear the vicious and uncontrollable cycle they are in.

People with bulimia nervosa can look perfectly normal. Many of them are of normal weight, but many bulimic patients appear thin and emaciated, but some may even be overweight. It is often difficult to determine whether a person is suffering from bulimia nervosa. This occurs because bingeing and purging is often done in secret. Also, individuals suffering from bulimia nervosa often deny their condition. Sufferers consume huge quantities of food. Sometimes up to 20,000 calories at a time. The preferred foods are typically sweet, soft, and high in calories and carbohydrates.

Like anorexia nervosa, bulimia nervosa is a psychological disorder and it is a condition that goes beyond out-of-control dieting. The cycle of overeating and purging can quickly become an obsession or a problem similar to drug addiction or addiction to other substances.

Bulimia nervosa can be very harmful to the body; some of the ways bulimia nervosa can affect health include:

Erosion of tooth enamel because of repeated exposure to acidic gastric contents.
Dental cavities, sensitivity to hot or cold food.
Swelling and soreness in the salivary glands (from repeated vomiting).
Stomach Ulcers.
Ruptures of the stomach and esophagus.
Abnormal buildup of fluid in the intestines.
Disruption in the normal bowel release function.
Electrolyte imbalance.
Dehydration
Irregular heartbeat and in severe cases heart attack
A greater risk for suicidal behavior
Decrease in sexual interest and desire

Causes of bulimia nervosa (adapted from womens-health and 4woman.gov)

Psychological factors: There is currently no definite known cause of bulimia nervosa, but psychosocial factors may contribute to its development. These factors include family disturbance or conflict, sexual abuse, maladaptive learned behavior, struggle for control or self-identity, cultural overemphasis on physical appearance, and parental obesity. Bulimia nervosa is commonly associated with depression. anxiety, phobias, and obsessive-compulsive disorder all of which may interfere with recovery. Depression in a person with bulimia nervosa may lead to suicide attempts or a completed suicide.

Cultural factors: Women in the U.S. are under constant pressure to fit a certain ideal of beauty. Seeing images of flawless, thin females everywhere makes it hard for women to feel good about their bodies. More and more, men are also feeling pressure to have a perfect body.

Family factors:. If you have a mother or sister with bulimia nervosa, you are more likely to also have bulimia nervosa. Parents who think looks are important, diet themselves, or criticize their children's bodies are more likely to have a child with bulimia nervosa.

Life changes or stressful events: Traumatic events like rape and sexual molestation, as well as stressful things like starting a new job, can lead to bulimia nervosa.

Biological factors:  Genes, hormones, and chemicals in the brain may be factors in developing bulimia nervosa.

It is not uncommon that a patient with bulimia nervosa will also have some anxiety or mood disorder as well. Most commonly associated with bulimia is the incidence of anxiety.  One study noted this in 75% of bulimic patients. Also prominent in bulimic patients are mood disorders, most commonly depression as well as substance abuse issues. However recent research suggest that depression is a consequence of the eating disorder itself, rather than the other way around.  Bulimics are also more likely to attempt suicide, and engage in impulsive behaviors.

Bulimia nervosa is one of the main types of eating problems as defined by the DSM 1V-TR of the American Psychiatric Association.  In addition to bulimia, the others are obesity and excess weight, anorexia nervosa, and binge-eating. The specific subtypes of bulimia are distinguished by the way the bulimic relieves themself of the binge:

Purging type: The purging type involves self-induced vomiting, laxatives, diuretics, enemas, or ipecac, as a means of rapidly extricating the contents from their body.

Non-Purging Type: This type of bulimia nervosa is rarely found (occurring in only approximately 6%-8% of cases), as it is a less effective means of ridding the body of such a large number of calories. This type of bulimia involves engaging in excessive exercise or fasting following a binge in order to counteract the large amount of calories previously ingested. This is frequently observed in purging-type bulimics as well, however this method is, by definition, not their primary form of weight control following a binge.

It is believed that more than five million individuals experience an eating disorder (bulimia nervosa or anorexia nervosa) in the U.S.  Many people think that eating disorders affect only young, upper-class Caucasian females. It is true that most bulimics are women (90%), but bulimia affects people from all walks of life, including males. It affects approximately nine women for every man. Nearly 2% to 3% of adult women meet the diagnostic criteria for bulimia nervosa compared with the one-half to one percent that is estimated to suffer from anorexia and 5% to 15% have some symptoms of the disorder. Females involved in activities that put an extreme emphasis on thinness and body type (such as gymnastics, dance and cheerleading) are at the greatest risk for the development of eating disorders. Bulimia nervosa usually begins in adolescence or early adulthood and can occur simultaneously with anorexia nervosa. Studies indicate that about 50 percent of those who begin an eating disorder with anorexia nervosa later become bulimic.

Differences between anorexia and bulimia nervosa (adapted from wikipedia):

The main criteria differences involve weight, as an anorexic must technically be classified as underweight. Typically an anorexic is defined by the refusal to maintain a normal weight by self-starvation. Another criteria which must usually be met is amenorrhea, the loss of a female's menstrual cycle not caused by the normal cessation of menstruation during menopause. Generally the anorexic does not engage in regular binging and purging sessions. In the rare instant that this is observed, in that the patient binges and purges as well as fails to maintain a minimum weight they are classified as a purging anorexic, due to the underweight criteria being met.

Characteristically, those with bulimia nervosa feel more shame and out of control with their behaviors, as the anorexic meticulously controls their intake, a symptom that calms their anxiety around food as s/he feels s/he has control of it, naive to the notion that it, in fact, controls him/her. For this reason, the bulimic is more likely to admit to having a problem, as they do not feel they are in control of their behavior. The anorexic is more likely to believe they are in control of their eating and much less likely to admit to needing help, or that a problem even exists in the first place.

Similarly, both anorexics and bulimics have an overpowering sense of self that is determined by their weight and their perceptions of it. They both place all their achievements and successes as the result of their body, and for this reason are often depressed as they feel they are consistently failing to achieve the perfect body. For the bulimic, because s/he cannot achieve the low weight s/he feels physically that s/he is a failure and this outlook infiltrates into all aspects of her/his life. The anorexic cannot see that s/he is truly underweight and is constantly working towards a goal that she will never meet. Because of this misconception s/he will never be thin enough, and therefore will be always working towards this unattainable goal. S/he too allows this failure at achieving the “perfect body” to define her/his self worth. As both the anorexic and bulimic never feel satisfaction in the more important part of their lives, depression often accompanies these disorders.

Treatment is most effective when it is implemented early on in the development of the disorder. The primary goal when treating bulimia nervosa is to cut down on, or even eliminate, the binge eating and purging. Treatment, therefore, involves nutritional counseling, psychological support, and medication management. Patients establish a pattern of eating regular, non-binge meals, and therapy focuses on improvement attitudes related to the eating disorder, encouragement of healthy but not excessive exercise, and resolution of other conditions such as mood or anxiety disorders. Individual psychotherapy, especially cognitive-behavioral therapy or interpersonal psychotherapy and group psychotherapy that uses a cognitive-behavioral approach, and family or marital therapy have been reported to be effective.

Psychotherapy concentrates on interrupting the binge-purge cycle and helping the patient regain control over her eating behavior.  Most people with bulimia nervosa can be treated through individual outpatient therapy because they aren't in danger of starving themselves as are persons with anorexia. However, if the bulimia is out of control, admission to an eating disorders treatment program may help the individual let go of their behaviors so they can concentrate on treatment. Inpatient or outpatient treatment includes behavior modification therapy, which may take place in highly structured settings. Individual psychotherapy and family therapy, which address the eating disorder as a symptom of unresolved conflict, may help the patient understand the basis of her behavior and teach her self-control strategies.

Antidepressants, particularly selective serotonin re uptake inhibitors (SSRIs), have been found helpful for people with bulimia nervosa, especially those who have depression or anxiety, or who don't respond to therapy alone.

The patient may also benefit from participation in self-help groups such as Overeaters Anonymous or a drug rehabilitation program if she has a concurrent substance abuse problem.

The more you understand about bulimia nervosa, binge eating, and other eating disorders, the better you can cope with their effects. Reaching out for information and assistance can help you live a healthier and more fulfilling life. People who suffer from bulimia nervosa and other eating problems can get help from a mental health professional such as a psychologist, psychiatrist, or clinical social worker. For more information about bulimia nervosa, binge eating, eating problems, and weight control issues, please visit the websites listed below and the glossary that follows.

Bulimia Nervosa Glossary of Terms (adapted from medicinenet) is provided below.  You can also see a weight control glossary adapted from the U.S. government"s National Institutes of Health website on pages binge eating or excess weight and weight control.

Anorexia Nervosa: An eating disorder characterized by markedly reduced appetite or total aversion to food. Anorexia is a serious psychological disorder. It is a condition that goes well beyond out-of-control dieting. The person with anorexia, most often a girl or young woman, initially begins dieting to lose weight. Over time, the weight loss becomes a sign of mastery and control. The drive to become thinner is thought to be secondary to concerns about control and fears relating to one's body. The individual continues the endless cycle of restrictive eating, often to a point close to starvation. This becomes an obsession and is similar to an addiction to a drug. Anorexia can be life-threatening. Also called anorexia nervosa.

Antagonist: In biochemistry, an antagonist acts against and blocks an action. For example, insulin lowers the level of glucose (sugar) in the blood, whereas another hormone called glucagon raises it; therefore, insulin and glucagon are antagonists.

Antidepressant: Anything, and especially a drug, used to prevent or treat depression.

Bowel: Another name for the intestine . The small bowel and the large bowel are the small intestine and large intestine, respectively.

Cavities: Holes in the two outer layers of a tooth called the enamel and the dentin. The enamel is the outermost white hard surface and the dentin is the yellow layer just beneath enamel. Both layers serve to protect the inner living tooth tissue called the pulp, where blood vessels and nerves reside. Small cavities may not cause pain, and may be unnoticed by the patient. Larger cavities can collect food, and the inner pulp of the affected tooth can become irritated by bacterial toxins, foods that are cold, hot, sour, or sweet - causing toothache. Also referred to as caries.

Colon: The part of the large intestine that runs from the cecum to the rectum as a long hollow tube that serves to remove water from digested food and let the remaining material, solid waste called stool , move through it to the rectum and leave the body through the anus.

Diagnosis: 1 The nature of a disease ; the identification of an illness. 2 A conclusion or decision reached by diagnosis. The diagnosis is rabies . 3 The identification of any problem. The diagnosis was a plugged IV.

DSM-IV: The 4th edition of "Diagnostic and Statistical Manual of Mental Disorders" (DSM) a comprehensive classification of officially recognized psychiatric disorders. DSM-IV was issued in 1993.

Edema: The swelling of soft tissues as a result of excess water accumulation.

Electrolyte: An electrolyte is a substance that will dissociate into ions in solution and acquire the capacity to conduct electricity. The electrolytes include sodium, potassium, chloride, calcium and phosphate. Informally, called lytes. (The clue to the word electrolyte is in the lyte which comes from the Greek lytos meaning that may be dissolved.)

Esophagus: The tube that connects the pharynx (throat) with the stomach. The esophagus lies between the trachea (windpipe) and the spine. It passes down the neck, pierces the diaphragm just to the left of the midline, and joins the cardiac (upper) end of the stomach. In an adult, the esophagus is about 25 centimeters (10 inches) long. When a person swallows, the muscular walls of the esophagus contract to push food down into the stomach. Glands in the lining of the esophagus produce mucus, which keeps the passageway moist and facilitates swallowing. Also known as the gullet or swallowing tube. From the Greek oisophagos, from oisein meaning to bear or carry + phagein, to eat.

Essential: 1. Something that cannot be done without.
2. Required in the diet, because the body cannot make it. As in an essential amino acid or an essential fatty acid.
3. Idiopathic. As in essential hypertension. "Essential" is a hallowed term meaning "We don't know the cause."

Euphoria: Elevated mood. Euphoria is a desirable and natural occurrence when it results from happy or exciting events. An excessive degree of euphoria that is not linked to events is characteristic of hypomania or mania, abnormal mood states associated with bipolar disorders.

Gastric: Having to do with the stomach.

Incidence: The frequency with which something, such as a disease, appears in a particular population or area. In disease epidemiology, the incidence is the number of newly diagnosed cases during a specific time period. The incidence is distinct from the prevalence which refers to the number of cases alive on a certain date.
See the entire definition of Incidence

Injury: Harm or hurt. The term "injury" may be applied in medicine to damage inflicted upon oneself as in a hamstring injury or by an external agent on as in a cold injury. The injury may be accidental or deliberate, as with a needlestick injury. The term "injury" may be synonymous (depending on the context) with a wound or with trauma.

Intervention: The act of intervening, interfering or interceding with the intent of modifying the outcome. In medicine, an intervention is usually undertaken to help treat or cure a condition. For example, early intervention may help children with autism to speak. "Acupuncture as a therapeutic intervention is widely practiced in the United States," according to the National Institutes of Health. From the Latin intervenire, to come between.

Menstrual: Pertaining to menstruation (the menses), as in last menstrual period, menstrual cramps, menstrual cycle, and premenstrual syndrome. From the Latin menstrualis, from mensis meaning month.

Metabolic: Relating to metabolism, the whole range of biochemical processes that occur within us (or any living organism). Metabolism consists of anabolism (the buildup of substances) and catabolism (the breakdown of substances).

Neuroendocrine: Having to do with neuroendocrinology: the interactions between the nervous system and the endocrine system.

Neurological: Having to do with the nerves or the nervous system.

Neurotransmitter: A chemical that is released from a nerve cell which thereby transmits an impulse from a nerve cell to another nerve, muscle, organ, or other tissue. A neurotransmitter is a messenger of neurologic information from one cell to another.

Outpatient: A patient who is not an inpatient (not hospitalized) but instead is cared for elsewhere -- as in a doctor's office, clinic, or day surgery center. The term outpatient dates back at least to 1715. Outpatient care today is also called ambulatory care.

Prevalence: The proportion of individuals in a population having a disease. Prevalence is a statistical concept referring to the number of cases of a disease that are present in a particular population at a given time.

Primary: First or foremost in time or development. The primary teeth (the baby teeth) are those that come first. Primary may also refer to symptoms or a disease to which others are secondary.

Prognosis: 1. The expected course of a disease .
2. The patient's chance of recovery.
The prognosis predicts the outcome of a disease and therefore the future for the patient . His prognosis is grim, for example, while hers is good.

Psychiatric: Pertaining to or within the purview of psychiatry , the medical specialty concerned with the prevention, diagnosis , and treatment of mental illness.

Recurrent: Back again. A recurrent fever is a fever that has returned after an intermission: a recrudescent fever.

Reflux: The term used when liquid backs up into the esophagus from the stomach.

Reuptake: The reabsorption of a secreted substance by the cell that originally produced and secreted it. The process of reuptake, for example, affects serotonin.

Selective serotonin reuptake inhibitor: A selective serotonin reuptake inhibitor (SSRI) is one of the commonly prescribed drugs for treating depression.

Sensitivity: 1. In psychology, the quality of being sensitive. As, for example, sensitivity training, training in small groups to develop a sensitive awareness and understanding of oneself and of ones relationships with others. 2. In disease epidemiology, the ability of a system to detect epidemics and other changes in disease occurrence. 3. In screening for a disease, the proportion of persons with the disease who are correctly identified by a screening test. 4. In the definition of a disease, the proportion of persons with the disease who are correctly identified by defined criteria.

Serotonin: A hormone , also called 5-hydroxytryptamine , in the pineal gland , blood platelets, the digestive tract, and the brain. Serotonin acts both as a chemical messenger that transmits nerve signals between nerve cells and that causes blood vessels to narrow.

Side effects: Problems that occur when treatment goes beyond the desired effect. Or problems that occur in addition to the desired therapeutic effect.

SSRI: Abbreviation for selective serotonin reuptake inhibitors, commonly prescribed drugs for treating depression . SSRIs affect the chemicals that nerves in the brain use to send messages to one another. These chemical messengers, called neurotransmitters, are released by one nerve and taken up by other nerves. Neurotransmitters that are not taken up by other nerves are taken up by the same nerves that released them. This process is termed "reuptake." SSRIs work by inhibiting the reuptake of serotonin, an action which allows more serotonin to be available to be taken up by other nerves.

Stomach: 1. The sac-shaped digestive organ that is located in the upper abdomen, under the ribs. The upper part of the stomach connects to the esophagus, and the lower part leads into the small intestine.

Systemic: Affecting the entire body. A systemic disease such as diabetes can affect the whole body. Systemic chemotherapy employs drugs that travel through the bloodstream and reach and affect cells all over the body.

Vital: Necessary to maintain life. Breathing is a vital function.

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