Bulimia
Labels Bulimia
- Definition .
- Description .
- Demographics .
- Causes and Symptoms .
- Diagnosis .
- Treatment .
- Prognosis .
- Prevention .
- The Future .
Showing posts with label Bulimia. Show all posts
Showing posts with label Bulimia. Show all posts
Labels Bulimia
Definition
Bulimia is defined as an eating disorder characterized by recurrent episodes
of binge eating followed by self-induced vomiting, laxative or
diuretic abuse, vigorous exercise, or fasting.
of binge eating followed by self-induced vomiting, laxative or
diuretic abuse, vigorous exercise, or fasting.
Description
The Diagnostic and Statistical Manual of Mental Disorders, fourth edition
(DSM-IV), the reference that doctors use to diagnose mental illness, specifies
that a person must have an eating binge and try to compensate for
it on average twice a week for three months to meet the diagnostic criteria
for bulimia. A binge is an episode in which someone consumes a
larger amount of food within a limited period of time than most people
would eat in similar circumstances. Most bulimics report feelings of loss
of control associated with bingeing. A second criterion of bulimia is
excessive concern with one’s body shape and weight.
There are two subtypes of bulimia, purging and nonpurging,
according to the methods used by the patient to prevent gaining weight
after a binge. People who have the purging subtype use vomiting, laxatives,
enemas, or diuretics to keep from gaining weight; in the nonpurging
subtype, the person fasts or overexercises to prevent weight gain. The
important point is that bulimics do something after a binge to compensate
for their eating. There is another type of eating disorder called
binge eating disorder, in which the person has eating binges but does not
try to vomit, exercise, or do anything else to prevent gaining weight.
Princess Diana and Bulimia
Princess Diana (1961–1997) is sometimes credited with bringing bulimia
out into the open by talking to the press about her own struggles with
the disorder. The princess gave an interview in 1995 in which she described
her bulimia: “I had bulimia for a number of years. And that’s like a
secret disease. You inflict it upon yourself because your self-esteem is at
a low ebb, and you don’t think you’re worthy or valuable. You fill your
stomach up four or five times a day—some do it more—and it gives you
a feeling of comfort. It’s like having a pair of arms around you, but it’s
temporary, temporary. Then you’re disgusted at the bloatedness of
your stomach, and then you bring it all up again. . . . It was a symptom of what
was going on in my marriage.”
When asked by the interviewer whether she had asked for help from
anyone else in the royal family, Diana said, “You have to know that when
you have bulimia you’re very ashamed of yourself and you hate yourself
and people think you’re wasting food—so you don’t discuss it with
people. And the thing about bulimia is your weight always stays the same,
whereas with anorexia you visibly shrink. So you can pretend
the whole way through. There’s no proof.”
(DSM-IV), the reference that doctors use to diagnose mental illness, specifies
that a person must have an eating binge and try to compensate for
it on average twice a week for three months to meet the diagnostic criteria
for bulimia. A binge is an episode in which someone consumes a
larger amount of food within a limited period of time than most people
would eat in similar circumstances. Most bulimics report feelings of loss
of control associated with bingeing. A second criterion of bulimia is
excessive concern with one’s body shape and weight.
There are two subtypes of bulimia, purging and nonpurging,
according to the methods used by the patient to prevent gaining weight
after a binge. People who have the purging subtype use vomiting, laxatives,
enemas, or diuretics to keep from gaining weight; in the nonpurging
subtype, the person fasts or overexercises to prevent weight gain. The
important point is that bulimics do something after a binge to compensate
for their eating. There is another type of eating disorder called
binge eating disorder, in which the person has eating binges but does not
try to vomit, exercise, or do anything else to prevent gaining weight.
Princess Diana and Bulimia
Princess Diana (1961–1997) is sometimes credited with bringing bulimia
out into the open by talking to the press about her own struggles with
the disorder. The princess gave an interview in 1995 in which she described
her bulimia: “I had bulimia for a number of years. And that’s like a
secret disease. You inflict it upon yourself because your self-esteem is at
a low ebb, and you don’t think you’re worthy or valuable. You fill your
stomach up four or five times a day—some do it more—and it gives you
a feeling of comfort. It’s like having a pair of arms around you, but it’s
temporary, temporary. Then you’re disgusted at the bloatedness of
your stomach, and then you bring it all up again. . . . It was a symptom of what
was going on in my marriage.”
When asked by the interviewer whether she had asked for help from
anyone else in the royal family, Diana said, “You have to know that when
you have bulimia you’re very ashamed of yourself and you hate yourself
and people think you’re wasting food—so you don’t discuss it with
people. And the thing about bulimia is your weight always stays the same,
whereas with anorexia you visibly shrink. So you can pretend
the whole way through. There’s no proof.”
Demographics
There is some disagreement about the demographics of bulimia, partly
because the rules for diagnosing it have changed over time. The usual
figure given for bulimia in the United States is 1–3 percent of high
school- and college-age women. Many doctors think, however, that
bulimia is underdiagnosed because most people with the disorder are of
average weight or only slightly overweight. In addition, there are large
numbers of teenagers and young adults who have disordered eating patterns
but do not meet the full criteria for bulimia; there may be twice as
many young people in this second group as those who meet the full
DSM-IV definition.
The gender ratio is usually given as ten females to every one male
affected, but some people think that as many as 15 percent of bulimics
are male. Gay men appear to be at greater risk of developing bulimia than
heterosexual men.
At one time bulimia was thought to affect mostly Caucasian women,
but the rates among African American and Hispanic women have risen
faster than the rate of bulimia for the female population as a whole, at least
in the United States. Occupation appears to be a major risk factor for bulimia.
Women whose careers depend on appearance or a certain body build, such as
ballet dancers, models, and professional athletes, are reported to be four times
as likely to develop bulimia as women in the general population.
because the rules for diagnosing it have changed over time. The usual
figure given for bulimia in the United States is 1–3 percent of high
school- and college-age women. Many doctors think, however, that
bulimia is underdiagnosed because most people with the disorder are of
average weight or only slightly overweight. In addition, there are large
numbers of teenagers and young adults who have disordered eating patterns
but do not meet the full criteria for bulimia; there may be twice as
many young people in this second group as those who meet the full
DSM-IV definition.
The gender ratio is usually given as ten females to every one male
affected, but some people think that as many as 15 percent of bulimics
are male. Gay men appear to be at greater risk of developing bulimia than
heterosexual men.
At one time bulimia was thought to affect mostly Caucasian women,
but the rates among African American and Hispanic women have risen
faster than the rate of bulimia for the female population as a whole, at least
in the United States. Occupation appears to be a major risk factor for bulimia.
Women whose careers depend on appearance or a certain body build, such as
ballet dancers, models, and professional athletes, are reported to be four times
as likely to develop bulimia as women in the general population.
Causes and Symptoms
The causes of bulimia are not known for certain, but are thought to be a
combination of genetic factors (possibly unusual sensitivity to foods high in
carbohydrates); the emotional climate in the patient’s family; and pressures
in the wider society to live up to a standardized image of beauty. In terms
of family patterns, people with bulimia often describe their families as conflicted
and their parents as either distant and uncaring or hostile and critical.
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 bloating and cramping, slowed digestion,
and weight gain.
Bulimics who force themselves to vomit after a binge may develop
serious medical problems, including:
combination of genetic factors (possibly unusual sensitivity to foods high in
carbohydrates); the emotional climate in the patient’s family; and pressures
in the wider society to live up to a standardized image of beauty. In terms
of family patterns, people with bulimia often describe their families as conflicted
and their parents as either distant and uncaring or hostile and critical.
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 bloating and cramping, slowed digestion,
and weight gain.
Bulimics who force themselves to vomit after a binge may develop
serious medical problems, including:
- Erosion of the enamel on the teeth, caused by stomach acid in the
vomited material. - Enlargement of the salivary glands.
- Scars and calloused areas on the knuckles from contact with the
teeth. - Irritation of the throat and esophagus.
- Low blood pressure and slowed heart rate.
- Electrolyte imbalances. The loss of fluids from repeated vomiting
can deplete the body’s stores of hydrogen chloride, potassium,
sodium, and magnesium. The loss of these chemicals in turn can
sometimes affect heart rhythm.
Diagnosis
Bulimia is usually diagnosed during an office visit to the patient’s primary
care doctor, although she or he may be sent to a psychiatrist for
an additional evaluation. Primary care doctors are now encouraged to
give a screening test to an adolescent or young adult who seems unusually
concerned about their weight or asks the doctor a lot of questions
about weight loss. These screeners are short sets of five questions about
eating habits that the patient can quickly answer. If the doctor thinks
that the patient may have bulimia, he or she can look for some of the
physical signs that accompany the disorder, such as whether the teeth
and salivary glands are normal. In most cases the doctor will order laboratory
tests of the patient’s blood and urine to make sure that her blood
chemistry is normal. Most doctors will also give the patient an electrocardiogram
(ECG) to check the patient’s heart rhythm. This test is important
because some types of chemical imbalances in the blood (from
vomiting or using diuretics) can lead to irregular heart rhythms.
Another important part of evaluating a patient for bulimia is a
mental status examination. The doctor will need to check the patient for
signs of anxiety disorders or depression, because a high proportion of
bulimics have a mood disorder. In addition, people with bulimia are
more likely to be treated successfully for their eating disorder when their
anxiety or depression is also being treated.
care doctor, although she or he may be sent to a psychiatrist for
an additional evaluation. Primary care doctors are now encouraged to
give a screening test to an adolescent or young adult who seems unusually
concerned about their weight or asks the doctor a lot of questions
about weight loss. These screeners are short sets of five questions about
eating habits that the patient can quickly answer. If the doctor thinks
that the patient may have bulimia, he or she can look for some of the
physical signs that accompany the disorder, such as whether the teeth
and salivary glands are normal. In most cases the doctor will order laboratory
tests of the patient’s blood and urine to make sure that her blood
chemistry is normal. Most doctors will also give the patient an electrocardiogram
(ECG) to check the patient’s heart rhythm. This test is important
because some types of chemical imbalances in the blood (from
vomiting or using diuretics) can lead to irregular heart rhythms.
Another important part of evaluating a patient for bulimia is a
mental status examination. The doctor will need to check the patient for
signs of anxiety disorders or depression, because a high proportion of
bulimics have a mood disorder. In addition, people with bulimia are
more likely to be treated successfully for their eating disorder when their
anxiety or depression is also being treated.
Treatment
Treatment for bulimia consists of psychotherapy combined with medications.
The type of psychotherapy most often recommended for bulimics
is cognitive-behavioral therapy (CBT), along with interpersonal therapy.
In CBT, the patient is helped to recognize the distortions in their mental
image of their body and to correct irrational beliefs about food and
eating. Family therapy may be recommended if the patient’s family
appears to be a major cause of his or her emotional distress; as of late
2007, there was some evidence that family therapy is more helpful for
some patients with bulimia than individual therapy. Some bulimics also
benefit from group therapy or support group meetings.
The medications most often prescribed for bulimics are antidepressants,
in particular such drugs as fluoxetine (Prozac) and sertraline
(Zoloft). Scientists do not fully understand how these drugs help in
treating bulimia, but some think that they help to regulate chemical
imbalances in the patient’s central nervous system.
The type of psychotherapy most often recommended for bulimics
is cognitive-behavioral therapy (CBT), along with interpersonal therapy.
In CBT, the patient is helped to recognize the distortions in their mental
image of their body and to correct irrational beliefs about food and
eating. Family therapy may be recommended if the patient’s family
appears to be a major cause of his or her emotional distress; as of late
2007, there was some evidence that family therapy is more helpful for
some patients with bulimia than individual therapy. Some bulimics also
benefit from group therapy or support group meetings.
The medications most often prescribed for bulimics are antidepressants,
in particular such drugs as fluoxetine (Prozac) and sertraline
(Zoloft). Scientists do not fully understand how these drugs help in
treating bulimia, but some think that they help to regulate chemical
imbalances in the patient’s central nervous system.
Prognosis
The prognosis of bulimia depends on several factors, including the
patient’s age at diagnosis, the quality of family life, and the number of
close friendships that she or he has. Patients who are diagnosed early,
have good relationships with their parents, and have several close friends
are more likely to recover. About half of bulimics have good outcomes
after treatment, 18 percent have intermediate outcomes, and 20 percent
have poor outcomes.
patient’s age at diagnosis, the quality of family life, and the number of
close friendships that she or he has. Patients who are diagnosed early,
have good relationships with their parents, and have several close friends
are more likely to recover. About half of bulimics have good outcomes
after treatment, 18 percent have intermediate outcomes, and 20 percent
have poor outcomes.
Prevention
While it is difficult to change an entire society and its overly high valuation
of physical attractiveness, parents can certainly lower a child’s risk of
bulimia in later life by creating a warm and loving home. It is important
to convey to children that they are loved as whole persons with minds
and spirits, not just outwardly pleasing faces and bodies.
of physical attractiveness, parents can certainly lower a child’s risk of
bulimia in later life by creating a warm and loving home. It is important
to convey to children that they are loved as whole persons with minds
and spirits, not just outwardly pleasing faces and bodies.
The Future
It is not known with certainty whether bulimia is increasing in the
United States, partly because it overlaps with other eating disorders in
some people and partly because doctors are looking more closely at men
who may be bulimic but were not diagnosed with the disorder in the
past. Although doctors are looking for better treatments of bulimia,
including new medications, further research in the chemistry of the brain
is needed.
United States, partly because it overlaps with other eating disorders in
some people and partly because doctors are looking more closely at men
who may be bulimic but were not diagnosed with the disorder in the
past. Although doctors are looking for better treatments of bulimia,
including new medications, further research in the chemistry of the brain
is needed.
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