Bulimia nervosa is an eating disorder characterized by recurrent binge eating, followed by compensatory behaviors. The most common form is self-induced vomiting, sometimes called purging; fasting, the use of laxatives, enemas, diuretics, and over exercising are also common. The word bulimia derives from the Latin (bÅ«lÄ«mia), which originally comes from the Greek Î²Î¿Ï…Î»Î¹Î¼Î¯Î± (boulÄ«mia; ravenous hunger), a compound of Î²Î¿Ï…Ï‚ (bous), ox + Î»Î¹Î¼ÏŒÏ‚ (lÄ«mos), hunger.
Bulimia nervosa was named and first described by the British psychiatrist Gerald Russell in 1979.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR) published by the American Psychiatric Association, 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.
- Triggers include periods of stress, traumatic events, and self-evaluation of body shape and weight.
- These symptoms may occur after every meal on a daily basis or once every few months.
- The disturbance does not occur exclusively during episodes of anorexia nervosa.
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.
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.
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.
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. Studies on time trends in the prevalence of bulimia nervosa have also yielded inconsistent results.
|Country||Year||Sample size and type||Incidence|
|Australia||2008||1943 adolescents (ages 15â€“17)||1.4% male||9.4% female|
|Portugal||2006||2028 high school students||0.3% female|
|Brazil||2004||1807 students (ages 7â€“19)||0.8% male||1.3% female|
|Spain||2004||2509 female adolescents (ages 13â€“22)||1.4% female|
|Hungary||2003||580 Budapest residents||0.4% male||3.6% female|
|Australia||1998||4200 high school students||0.3% combined|
|USA||1996||1152 college students||0.2% male||1.3% female|
|Norway||1995||19067 psychiatric patients||0.7% male||7.3% female|
|Canada||1995||8116 (random sample)||0.1% male||1.1% female|
|Japan||1995||2597 high school students||0.7% male||1.9% female|
|USA||1992||799 college students||0.4% male||5.1% female|
There are higher rates of eating disorders in groups involved in activities which idealize a slim physique, such as dance, gymnastics, modeling, cheerleading, running, acting, rowing and figure skating. Bulimia is more prevalent among Caucasians.
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, and may directly cause:
- Chronic gastric reflux after eating
- Dehydration and hypokalemia caused by frequent vomiting
- Electrolyte imbalance, which can lead to cardiac arrhythmia, cardiac arrest, and even death
- Esophagitis, or inflammation of the esophagus
- Oral trauma, in which repetitive insertion of fingers or other objects causes lacerations to the lining of the mouth or throat
- Gastroparesis or delayed emptying
- Enlarged glands in the neck, under the jaw line
- Calluses or scars on back of hands due to repeated trauma from incisors
The frequent contact between teeth and gastric acid, in particular, may cause:
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. 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. Bulimia also has negative effects on the sufferer's dental health due to the acid passed through the mouth from frequent vomitting causing acid erosion, mainly on the posterior dental surface.
There has been no single, consistently-effective therapy for bulimia nervosa.
Some researchers have hypothesized a relationship to mood disorders and clinical trials have been conducted with tricyclic antidepressants, MAO inhibitors, mianserin, fluoxetine, 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.
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. Researchers have also report positive outcomes when bulimics are treated in an addiction-disorders inpatient unit,
Brain-derived neurotrophic factor (BDNF) is also under investigation as a possible cause.
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 (e.g., in session eating of "forbidden foods") has demonstrated efficacy both with and without concurrent antidepressant medication.. Researchers have also reported some positive outcomes for interpersonal psychotherapy and dialectical behavior therapy.
Some researchers have also claimed positive outcomes in hypnotherapy treatment.
Famous people with bulimia
In April 2008, former British Deputy Prime Minister John Prescott revealed he became bulimic during the stress of his first years as deputy prime minister.
Princess Diana admitted to suffering for years with bulimia.
Uri Geller struggled with bulimia for much of his adult life
- Hungry: A Mother and Daughter Fight Anorexia (book)
- ↑ (1994) Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, 4th, American Psychiatric Association. ISBN 0890420629.
- ↑ Fairburn, Christopher (1995), Overcoming Binge Eating, Guilford, ISBN 0898621798
- ↑ Douglas Harper (November 2001). Online Etymology Dictionary: bulimia. Retrieved on 2008-04-06.
- ↑ Russell, Gerald (August 1979). "Bulimia nervosa: an ominous variant of anorexia nervosa" 9: 429â€“48.. Psychological Medicine.
- ↑ Palmer, Robert (2004). "Bulimia nervosa: 25 years on" 185: 447â€“448. British Journal of Psychiatry.
- ↑ 6.0 6.1 Barlow, David H & Durand, V Mark (July 2004), Abnormal Psychology: An Integrative Approach, Thomson Wadsworth, ISBN 0534633625
- ↑ Agras, W S (2004), "Disorders of eating: anorexia nervosa, bulimia nervosa and binge eating disorder", in Shader, R I, Manual of psychiatric therapeutics, Lippincott Williams & Wilkins, ISBN 0781744598
- ↑ Walsh, J M E; Wheat, M.E & Freund, K (2000), "Detection, evaluation, and treatment of eating disorders", Journal of General Internal Medicine (Springer) 15 (8): 577â€“590, PMID 10940151, doi:10.1046/j.1525-1497.2000.02439.x, <http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1495575>
- ↑ (January 13, 2004) "Prevalence of eating disorders: a comparison of Western and non-Western countries". Medscape General Medicine 6 (3): 49. PMID 15520673.
- ↑ Hay, Phillipa J; Mond, Jonathan & Buttner, Petra et al. (2008), "Eating Disorder Behaviors Are Increasing: Findings from Two Sequential Community Surveys in South Australia", PLoS ONE (Public Library of Science) 3 (2), PMID 18253489, doi:10.1371/journal.pone.0001541, <http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2212110&blobtype=pdf>
- ↑ 11.0 11.1 Patton, G C; Coffey, C & Carlin, J B et al. (2008), "Prognosis of adolescent partial syndromes of eating disorder", The British Journal of Psychiatry (Royal College of Psychiatrists) 192 (4): 294â€“299, PMID 18378993, doi:10.1192/bjp.bp.106.031112, <http://bjp.rcpsych.org/cgi/content/abstract/192/4/294>
- ↑ Machado, Paulo; Machado, Barbara & GonÃ§alves, SÃ³nia et al. (2007), "The prevalence of Eating Disorders Not Otherwise Specified", International journal of eating disorders (Wiley) 40 (3): 212-217, doi:10.1002/eat.20358, <http://repositorium.sdum.uminho.pt/bitstream/1822/5722/1/EDNOS%20IJED%20accepted.pdf>
- ↑ Vilela, JoÃ£o E M; LamounierII, Joel A & Filho, Marcos A Dellaretti et al. (2004), "Eating disorders in school children", Jornal de Pediatria (Scielo) 80 (2): 49-54, ISSN 0021-7557, doi:10.1590/S0021-75572004000100010, <http://www.scielo.br/scielo.php?pid=S0021-75572004000100010&script=sci_arttext&tlng=en>
- ↑ Lahortiga-Ramos, Francisca; De Irala-EstÃ©vez, Jokin & Cano-Prous, AdriÃ¡n et al. (2005), "Incidence of eating disorders in Navarra", European Psychiatry (Elsevier) 20 (2): 179-185, doi:doi:10.1016/j.eurpsy.2004.07.008, <http://www.cun.es/fileadmin/Departamentos/Psiquiatria%20y%20Psicologia%20Medica/PDF/IncidenceoEatingDisorderinNavarra.pdf>
- ↑ 15.0 15.1 TÃ¶lgyes, T & Nemessury, J (2004), "Epidemiological studies on adverse dieting behaviours and eating disorders among young people in Hungary", Social Psychiatry and Psychiatric Epidemiology (Springer) 39 (8): 647-654, DOI 10.1007/s00127-004-0783-z
- ↑ Hay, P (1998), "The epidemiology of eating disorder behaviors: An Australian community-based survey", International Journal of Eating Disorders 23 (4): 371-382, DOI 10.1002/(SICI)1098-108X(199805)23:4<371::AID-EAT4>3.0.CO;2-F
- ↑ Pemberton, A R; Vernon, S W & Lee, E S (September 1, 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): 450â€“455, PMID 8781459, <http://aje.oxfordjournals.org/cgi/content/abstract/144/5/450>
- ↑ GÃ¶testam, 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): 263â€“268, doi:10.1002/1098-108X(199511)18:3<263::AID-EAT2260180308>3.0.CO;2-O, <http://cat.inist.fr/?aModele=afficheN&cpsidt=3704897>
- ↑ Garfinkel, P E; Lin, E & Goering, P et al. (July 1, 1995), "Bulimia nervosa in a Canadian community sample: prevalence and comparison of subgroups", Americal Journal of Psychiatry 152 (7): 1052â€“1058, PMID 7793442, <http://ajp.psychiatryonline.org/cgi/content/abstract/152/7/1052>
- ↑ Suzuki, K; Takeda, A & Matsushita, S (1995), "Coprevalence of bulimia with alcohol abuse and smoking among Japanese male and female high school students", Addiction (Blackwell Synergy) 90 (7): 971--976, doi:10.1046/j.1360-0443.1995.90797110.x, <http://www.blackwell-synergy.com/doi/abs/10.1046/j.1360-0443.1995.90797110.x>
- ↑ Heatherton, T F; Nichols, P & Mahamedi, F et al. (1995), "Body weight, dieting, and eating disorder symptoms among college students, 1982 to 1992", American Journal of Psychiatry 152 (11): 1623â€“9, <http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=7485625&cmd=showdetailview>
- ↑ Franko, Debra L; Becker, Anne E & Thomas, Jennifer J et al. (2007), "Cross-ethnic differences in eating disorder symptoms and related distress", International Journal of Eating Disorders (Wiley) 40 (2), DOI 10.1002/eat.20341
- ↑ Let's Talk Facts About: Eating Disorders, American Psychiatric Association, 1999, ISBN 0-89042-352-0 (pamphlet)
- ↑ Joseph, A B & Herr, B (1985), "Finger calluses in bulimia", American Journal of Psychiatry (American Psychiatric Association) 142 (5): 655, <http://ajp.psychiatryonline.org/cgi/reprint/142/5/655a.pdf>
- ↑ Wynn, D R & Martin, M J (1984), "A physical sign of bulimia", Mayo Clinic proceedings (Mayo Clinic) 59 (10): 722
- ↑ 26.0 26.1 Oral Health Topics: Eating Disorders, American Dental Association, <http://www.ada.org/public/topics/eating_disorders.asp>
- ↑ 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>
- ↑ Walsh, B T; Roose, S P & Glassman, A H et al. (1985), "Bulimia and depression", Psychosomatic Medicine 47 (2): 123â€“131, <http://www.psychosomaticmedicine.org/cgi/reprint/47/2/123.pdf>
- ↑ Mitchell, J E; Raymond, N & Specker, S (1993), "A review of the controlled trials of pharmacotherapy and psychotherapy in the treatment of bulimia nervosa", International Journal of Eating Disorders (Wiley}) 14 (3), DOI 10.1002/1098-108X(199311)14:3<229::AID-EAT2260140302>3.0.CO;2-X
- ↑ Walsh, B T (1995), Pharmacotherapy of eating disorders, New York: Guilford, pp. 329-340
- ↑ Mitchell, J E; Christensen, 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): 94-97
- ↑ Giannini, A James & Slaby, Andrew E (1993), ISBN 0-387-94002-2
- ↑ Wilfley, Denise E; Welch, R. Robinson & Stein, Richard I et al. (2002), Archives of General Psychiatry 59 (8): 713â€“721, <http://courses.csusm.edu/psyc340sr/articles/IBT_vs_CBT_Wilfley.pdf>. Retrieved on 2009-04-09
- ↑ doi:10.1093/hmg/ddh137
This citation will be automatically completed in the next few minutes. You can jump the queue or expand by hand
- ↑ (2008) "1", Annual Review of Eating Disorders - part 2, 14-15. ISBN 9781846192449.
- ↑ Agras, W., Crow, S.J., Halmi, K.A., Mitchell, J.E., Wilson, G., & Kraemer, H.C. (2000). Outcome predictors for the cognitive behavior treatment of bulimia nervosa: Data from a multisite study. American Journal of Psychiatry, 157, 1302-1308.
- ↑ Wilson, G.T., Loeb, K.L., Walsh, B.T., Labouvie, E., Pekova, E., Liu, X., et al. (1999). Psychological versus pharmacological treatments of bulimia nervosa: Predictors and precesses of change. Journal of Consulting and Clinical Psychology, 67, 451-459.
- ↑ Fairburn, Christopher G; Agras, W Stewart & Walsh, B Timothy et al. (2004), American Journal of Psychiatry 161 (12): 2322â€“2324, <http://ajp.psychiatryonline.org/cgi/content/full/161/12/2322>
- ↑ Safer, Debra L; Telch, Christy F & Agras, W Stewart (2001), American Journal of Psychiatry 158 (4): 632â€“634, <http://ajp.psychiatryonline.org/cgi/content/full/158/4/632>. Retrieved on 2009-04-09
- ↑ Barabasz, M. (1990), "Treatment of bulimia with hypnosis involving awareness and control in clients with high dissociative", International journal of psychosomatics: official publication of the International Psychosomatics Institute 37 (1-4): 53, PMID 2246105
- ↑ Barga, J & Barabasz, M (in press). Effects of Hypnosis as an adjunct to Cognitive-Behavior therapy in the treatment of Bulimia. International Journal of Clinical and Experimental Hypnosis. In Barabasz, M (2007) Efficacy of hypnotherapy in the treatment of Eating Disorders. International Journal of Clinical and Experimental Hypnosis, 55(3):318-335
- ↑ Griffifths, RA. (1995) Two-year follow-up findings of hypnobehavioral treatment for bulimia nervosa. Australian Journal of Clinical and Experimental Hypnosis, 23 (2), 135-144
- ↑ Hawkins, Ross (2008-04-20), Prescott's shocking confession, BBC Online, <http://news.bbc.co.uk/1/hi/uk_politics/7357430.stm>. Retrieved on 2009-02-28
- ↑ Diana: The BBC interview, BBC Online, 1995-11-24, <http://scoop.evansville.net/diana.html>. Retrieved on 2009-04-25
- ↑ Uri Geller: Bingeing is an addictive drug, Telegraph, 2008-04-21, <http://www.telegraph.co.uk/news/uknews/1896230/Uri-Geller-Bingeing-is-an-addictive-drug.html>
- Readers may use this email link to report errors and/or omissions they have discovered, or to add additional material or comments regarding this article "Bulimia nervosa"
- Wiki Staff should discuss this article in the Wiki Staff Forum
- Susan's Place Transgender Resources Forums
- Susan's Place Transgender Chat
Browse: Gender | Cross-dressing | Intersexuality | Transgender topics | Transsexualism | Hormone Therapy | Surgery | Standards of Care | Legal Information | Psychology | Transitioning | Family & Friends | People | Books | Abbreviations | Browse All TopicsRead the FAQ | Return to the Main Page
Want to help us? Write New Articles and/or Expand Current Articles
*Some information provided in whole or in part by http://en.wikipedia.org/