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BULIMIA NERVOSA
 


Prediction: Variable (Few Months To Many Years)

      Occupational-Economic: N/A
      Wisdom vs Irrationality: N/A
      Courage vs Negative Emotion:
  • Normal weight, yet obsessed with weight loss, phobic of weight gain, and markedly dissatisfied with own body size and shape
  • Food binging and purging (by self-induced vomiting, laxative abuse, or diuretic abuse); caloric restriction
  • May cycle between having anorexia nervosa (caloric restriction), and having bulimia nervosa (food binging)
  • When severe, develop depression and anxiety
      Helping Others vs Detachment: N/A
      Self-Control vs Disinhibition:
  • 30% develop Substance Abuse or Dependence (especially alcohol or stimulants)
  • Many develop Borderline Personality Disorder or some other PD
      Justice vs Antagonism: N/A
      Medical:
  • Illness denial is common; excessive exercise; menstrual irregularity; gastrointestinal symptoms; rectal prolapse; purging can cause: dental enamel erosion, fluid & electrolyte disturbances, esophageal tears, gastric rupture, and cardiac arrhythmias


SYNOPSIS

Bulimia Nervosa F50.2 - ICD10 Description, World Health Organization

A syndrome characterized by repeated bouts of overeating and an excessive preoccupation with the control of body weight, leading to a pattern of overeating followed by vomiting or use of purgatives. This disorder shares many psychological features with anorexia nervosa, including an overconcern with body shape and weight. Repeated vomiting is likely to give rise to disturbances of body electrolytes and physical complications. There is often, but not always, a history of an earlier episode of anorexia nervosa, the interval ranging from a few months to several years.
Bulimia Nervosa - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with bulimia nervosa needs to meet all of the following criteria:

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

    • Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.

    • A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating.

  • Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.

  • The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.

  • Self-evaluation is unduly influenced by body shape and weight.

  • The disturbance does not occur exclusively during episodes of anorexia nervosa.
Individuals 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 Therapies

Remission 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")

    Bulimia Nervosa: Negative Emotion
            Wisdom vs Irrationality: N/A
            Courage vs Negative Emotion:
      • Normal weight, yet obsessed with weight loss, phobic of weight gain, and markedly dissatisfied with own body size and shape
      • Food binging and purging (by self-induced vomiting, laxative abuse, or diuretic abuse); caloric restriction
      • When severe, develop depression and anxiety
            Helping Others vs Detachment: N/A
            Self-Control vs Disinhibition:Disinhibition:
      • 30% develop Substance Abuse or Dependence (especially alcohol or stimulants)
            Justice vs Antagonism: N/A

Description


Stories

Free Diagnosis Of This Disorder

Rating Scales

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Research

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