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Bulimia nervosa

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ICD-10	F50.2
ICD-9	307.51
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Bulimia nervosa, more commonly known as bulimia, is an eating disorder. It is a psychological condition in which the subject engages in recurrent binge eating followed by intentionally doing one or more of the following in order to compensate for the intake of the food and prevent weight gain:

• vomiting
• inappropriate use of laxatives, enemas, diuretics or other medication
• excessive exercising

DSM-IV critera

The following six criteria should be met for a patient to be diagnosed with bulimia: [1] [2]

1. The patient feels incapable of controlling the urge to binge, even during the binge itself, and consumes a larger amount of food than a person would normally consume at one sitting.
2. The patient purges him or herself of the recent intake, resorting to vomiting, laxatives, diuretics, exercising, etc.
3. The patient engages in such behavior at least twice per week for three months.
4. The patient is focused upon body image and the desperate desire to appear thin.
5. The patient does not meet the diagnostic criteria for anorexia nervosa. (Some anorectics may demonstrate bulimic behaviours in their illness: binge-eating and purging themselves of food on a regular or infrequent basis at certain times during the course of their disease. Alternatively, some individuals might switch from having anorexia to having bulimia. The mortality rate for anorectics who practice bulimic behaviors is twice that of anorectics who do not. [3])
6. The patient is of normal weight or overweight.

Please note that, in general, diagnostic criteria are considered a guide. A legitimate clinical diagnosis can often be made when not all, but most, of the criteria are met.

Causes

Bulimia is often less about food, and more to do with deep 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 . . . This cycle may be repeated several times a week or, in serious cases, several times a day."[4] Sufferers can often "use the destructive eating pattern to gain control over their lives".[5]

Patterns of bulimic cycles

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. [6]

Consequences of bulimia nervosa

• Electrolyte imbalance, heart arrhythmia, heart failure
• Teeth erosion and cavities
• Sialadenosis (salivary gland swelling)
• Potential for gastric rupture during periods of bingeing
• Acid Reflux
• Irritation, inflammation, and possible rupture of the esophagus
• Laxative dependence
• Peptic ulcers and pancreatitis
• Emetic toxicity due to ipecac abuse
• Potentially death

Mortality risk

Eating disorders have one of the highest death rates of all mental illnesses. The Eating Disorders Association (UK) estimates a 10% mortality rate.[7] An 18% mortality rate has been suggested for Anorexia Nervosa.[8] In addition to the risk of suicide, “death can occur after severe bingeing in bulimia nervosa as well”.[9] For perspective, these death rates are higher than those of some forms of cancer.

At-risk groups

Risk factors for bulimia are similar to those of other eating disorders, such as anorexia nervosa:

• females
• males
• those of age 10 through to 25
• athletes
• Gay Males
• people who are active in dancing, modeling or gymnastics
• students who are under heavy workloads
• those who have suffered traumatic events in their lifetime such as child abuse and sexual abuse
• those positioned in the higher echelons of the socioeconomic scale
• the highly intelligent and/or high-achievers.[10]
• perfectionists

The majority of bulimic patients are young females from 10 to 25 years old, although the disorder can occur in people of all ages and both sexes.

There can be a popular assumption that eating disorders are ‘female diseases’, but the illnesses do not discriminate based on gender, and males can also suffer from them: “even if only 5% of sufferers are male, hundreds of thousands of young men are affected…Studies have been conducted within the homosexual subculture, and have also focused on males who suffer from anorexia and bulimia. These point to a direct connection between gender identity conflict and eating disorder in males but not in females."[11] This does not indicate that only gender-conflicted males suffer from eating disorders, but there is "a tendency for eating disorders in males to go unrecognised or undiagnosed, due to reluctance among males to seek treatment for these stereotypically female conditions." [12]

See also

• Exercise bulimia
• Anorexia nervosa
• Binge eating disorder

External links

• Statistics
• The Something Fishy Website on Eating Disorders
• Bulimia Nervosa - Causes, Symptoms And Treatment
• Eating Disorders Association (EDA)
• BBC-Mental Health
• American Psychiatric Association
• Web4health Eating disorder
• Eating Disorders in Males
• Mental Health Matters: Bulimia Nervosa
• Psych Forums: Bulimia Forum
• Helpguide: Bulimia Signs and Symptoms, Effects and Treatment
• Somerset & Wessex Eating Disorders Association Eating Disorders support and information in Somerset, England
• ECRI: Bulimia Nervosa Resource Guide for Family and Friends

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