Bulimia Nervosa F50.2 - ICD10 Description, World Health Organization
Bulimia Nervosa - Diagnostic Criteria, American Psychiatric AssociationIndividuals with bulimia nervosa and anorexia nervosa share many similar features. In both disorders, individuals have an obsession with weight loss, a phobia of weight gain, and marked dissatisfaction with their body size and shape. Both disorders can have self-imposed caloric restriction, food binging and purging (by self-induced vomiting, laxative abuse, or diuretic abuse). Some individuals cycle back and forth between anorexia and bulimia. Anorexic individuals restrict their caloric intake far more than bulimic individuals do; thus anorexics are pathologically thin, whereas many bulimics have a normal weight. Bulimic individuals binge more than anorexic individuals. Bulimia nervosa is most common in women in their 20s and 30s.
Historically, eating disorders were a medical rarity prior to World War I. Then, after fashion magazines were introduced, the incidence of eating disorders shot up. Thus the current epidemic of eating disorders started after World War I in America, spread to Europe, and only after World War II spread to Asia. In Canada's far north, eating disorders were historically unknown in previous generations of aboriginals. The current older aboriginal generation was largely protected from Western influences by a language barrier, but younger aboriginals now speak English. Historically, for the first time, eating disorders are starting to appear in young aboriginals. Thus exposure to Western culture appears to be causal in the development of eating disorders.
It appears that eating disorders start psychologically as an obsession with thinness. The individual diets, then develops a true phobia of getting fat. A point is reached in dieting when genetic and physiological factors kick in, and the disorder becomes physically compulsive and very difficult to stop.
Effective TherapiesRemission rates are 39% for cognitive behavioral therapy (CBT), and only 20% for fluoxetine (the only medication licenced for this disorder). The addition of fluoxetine to CBT does not significantly improve the outcome. Self-help manuals are helpful. Patient and family support groups are also helpful.
Which Behavioral Dimensions Are Involved?The ancient Greek civilization lasted for 1,300 years (8th century BC to 6th century AD). The ancient Greek philosophers taught that the 5 pillars of their civilization were: wisdom, courage, helping others, self-control, and justice. Psychiatry named the opposite of each of these 5 ancient themes as being a major dimension of psychopathology (i.e., irrationality, negative emotion, detachment, disinhibition, and antagonism). (Psychology named these same factors the "Big 5 dimensions of personality": "intellect", "neuroticism", "extraversion", "conscientiousness", and "agreeableness")
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