Bulimia nervosa 168536 226004931 2008-07-16T12:10:35Z 58.146.173.7 {{Cleanup|date=April 2007}} {{DiseaseDisorder infobox | Name = Bulimia nervosa | DiseasesDB = 1770 | ICD10 = F50.2 | ICD9 = {{ICD9|307.51}} | | eMedicineSubj = emerg | eMedicineTopic = 810 | eMedicine_mult = {{eMedicine2|med|255}} }} '''Bulimia nervosa''' is an [[eating disorder]] characterised by recurrent [[binge eating]], followed by compensatory behaviors, referred to as "purging".<ref name="dsm">{{cite book|title = [[Diagnostic and Statistical Manual of Mental Disorders]] DSM-IV-TR|year = 1994|edition = 4th|publisher = [[American Psychiatric Association]]|isbn = 0890420629}}</ref> The most common form—practiced more than 75% of people with bulimia nervosa—is [[defensive vomiting|self-induced vomiting]]; [[fasting]], the use of [[laxative]]s, [[enema]]s, [[diuretic]]s, and overexercising are also common.<ref>{{citation|title = Overcoming Binge Eating|first1 = Christopher|last1 = Fairburn|publisher = Guilford|year = 1995|isbn = 0898621798}}</ref> The word ''bulimia'' derives from the Latin (''būlīmia'') from the Greek ''βουλῑμια'' (boulīmia; ravenous hunger), a compound of ''βους'' (bous), ox + ''λῑμος'' (līmos), hunger.<ref>{{cite web|title = Online Etymology Dictionary: bulimia|date = November 2001|accessdate = 2008-04-06|author = Douglas Harper|work = [[Online Etymology Dictionary]]|url = http://www.etymonline.com/index.php?search=bulimia&searchmode=none}}</ref> == Diagnosis == 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. * Self-evaluation is unduly influenced by body shape and weight. * The disturbance does not occur exclusively during episodes of [[anorexia nervosa]].<ref name="durand">{{citation|title = Abnormal Psychology: An Integrative Approach|isbn = 0534633625|first1 = David H|last1 = Barlow|first2 = V Mark|last2 = Durand|date = July 2004|publisher = [[Thomson Corporation|Thomson Wadsworth]]}}</ref> There are two sub-types of bulimia nervosa: purging and non-purging. * '''Purging bulimia''' is the more common of the two and involves self-induced [[vomiting]] (which may include use of [[emetic]]s such as [[syrup of ipecac]]) and self-induced purging (which may include use of laxatives, [[diuretics]], and [[enemas]]) to rapidly remove food from the body before it can be digested. * '''Non-purging bulimia''', which occurs in only approximately 6%-8% of cases, which involves excessive exercise or fasting 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.<ref name="durand" /> The onset of bulimia nervosa is most likely during adolescence (between 13 and 20 years of age), with many sufferers relapsing in adulthood into episodic binging and purging even after initially successful treatment and remission.<ref>{{citation|last1 = Agras |first1 = W S|contribution = Disorders of eating: anorexia nervosa, bulimia nervosa and binge eating disorder|editor-last = Shader|editor-first = R I|title = Manual of psychiatric therapeutics|publisher = [[Lippincott Williams & Wilkins]]|year = 2004|isbn = 0781744598}}</ref> Bulimia nervosa can be difficult to detect, compared to anorexia, because bulimics tend to look healthier and have fewer immediately-visible health complications. Many bulimics may also engage in significantly disordered eating and exercising patterns without meeting the full diagnostic criteria for bulimia nervosa.<ref>{{citation|title = Detection, evaluation, and treatment of eating disorders|last1 = Walsh|first1 = J M E|last2 = Wheat|first2 = M.E|last3 = Freund|first3 = K|journal = Journal of General Internal Medicine|volume = 15|number = 8|pages = 577–590|year = 2000|publisher = Springer|url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1495575|doi = 10.1046/j.1525-1497.2000.02439.x|pmid = 10940151}}</ref> == Prevalence == There is little data on the incidence 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% and 2.1% of males, and between 0.3% and 7.3% of females.<ref name="makino">{{cite journal|title = Prevalence of eating disorders: a comparison of Western and non-Western countries|last1 = Makino|first1 = M|last2 = Tsuboi|first2 = K|last3 = Dennerstein|first3 = L|journal = Medscape General Medicine|volume = 6|number = 3|year = 2004|url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1435625|pages = 49|pmid = 15520673}}</ref> {| class="wikitable" ! Country ! Year ! Sample size and type ! colspan="2" | Incidence |- | [[USA]] || [[1996]] || 1152 college students || 0.2% male || 1.3% female<ref>{{citation|title = Prevalence and Correlates of Bulimia Nervosa and Bulimic Behaviors in a Racially Diverse Sample of Undergraduate Students in Two Universities in Southeast Texas|last1 = Pemberton|first1 = A R|last2 = Vernon|first2 = S W|last3 = Lee|first3 = E S|journal = American Journal of Epidemiology|volume = 144|number = 5|pages = 450–455|year = 2005|publisher = Oxford University Press|url = http://aje.oxfordjournals.org/cgi/content/abstract/144/5/450|pmid = 8781459}}</ref> |- | [[USA]] || [[1992]] || 799 college students || 0.4% male || 5.1% female<ref>{{citation|title = Body weight, dieting, and eating disorder symptoms among college students, 1982 to 1992|last1 = Heatherton|first1 = T F|last2 = Nichols|first2 = P|last3 = Mahamedi|first3 = F|last4 = Keel|first4 = P|journal = American Journal of Psychiatry|volume = 152|number = 11|pages = 1623–9|year = 1995|url = http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=7485625&cmd=showdetailview}}</ref> |- | [[Norway]] || [[1995]] || 19067 psychiatric patients || 0.7% male || 7.3% female<ref>{{citation|title = An epidemiological study of eating disorders in Norwegian psychiatric institutions|last1 = Götestam|first1 = K G|last2 = Eriksen|first2 = L|last3 = Hagen|first3 = H|journal = The International journal of eating disorders|volume = 18|number = 3|pages = 263–268|year = 1995|publisher = Wiley|url = http://cat.inist.fr/?aModele=afficheN&cpsidt=3704897|doi = 10.1002/1098-108X(199511)18:3<263::AID-EAT2260180308>3.0.CO;2-O}}</ref> |- | [[Australia]] || [[1998]] || 4200 high school students || align="center" colspan="2" | 0.3% combined<ref>{{citation|title = The epidemiology of eating disorder behaviors: An Australian community-based survey, last1 = Hay, first1 = P, journal = International Journal of Eating Disorders, volume = 23, number = 4, pages = 371-382, year = 1998|url = http://www3.interscience.wiley.com/cgi-bin/abstract/34755/ABSTRACT}}</ref> |- <!-- | [[Australia]] || [[2008]] || 1943 adolescents (ages 15-17) || 1.4% male || 9.4% female<ref>{{citation|title = Prognosis of adolescent partial syndromes of eating disorder|last1 = Patton|first1 = G C|last2 = Coffey|first2 = C|last3 = Carlin|first3 = J B|last4 = Sanci|first4 = L|last5 = Sawyer|first5 = S|url = http://bjp.rcpsych.org/cgi/content/abstract/192/4/294|journal = The British Journal of Psychiatry|volume = 192|number = 4|pages = 294–299|year = 2008|publisher = [[Royal College of Psychiatrists]]|doi = 10.1192/bjp.bp.106.031112|pmid = 18378993}}</ref> |- --> | [[Canada]] || [[1995]] || 8116 (random sample) || 0.1% male || 1.1% female<ref>{{citation|last1 = Garfinkel|first1 = P E|last2 = Lin|first2 = E|last3 = Goering|first3 = P|last4 = Spegg|first4 = C|last5 = Goldbloom|first5 = D S|last6 = Kennedy|first6 = S|last7 = Kaplan|first7 = A S|last8 = Woodside|first8 = D B|title = Bulimia nervosa in a Canadian community sample: prevalence and comparison of subgroups|journal = Americal Journal of Psychiatry|volume = 152|number = 7|pages = 1052–1058|year = 1995|url = http://ajp.psychiatryonline.org/cgi/content/abstract/152/7/1052|pmid = 7793442}}</ref> |- | [[Japan]] || [[1995]] || 2597 high school students || 0.7% male || 1.9% female<ref>{{citation|title = Coprevalence of bulimia with alcohol abuse and smoking among Japanese male and female high school students|last1 = Suzuki|first1 = K|last2 = Takeda|first2 = A|last3 = Matsushita|first3 = S|journal = Addiction|volume = 90|number = 7|pages = 971--976|year = 1995|publisher = Blackwell Synergy|url = http://www.blackwell-synergy.com/doi/abs/10.1046/j.1360-0443.1995.90797110.x|doi = 10.1046/j.1360-0443.1995.90797110.x}}</ref> |} Although bulimia is overwhelmingly a disease of young women, it can affect others. Former British Deputy Prime Minister [[John Prescott]] says he developed bulimia in his 60s <ref>[http://news.bbc.co.uk/1/hi/uk_politics/7357430.stm by the BBC]</ref>. == Effects == 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<ref>{{citation|title = Let's Talk Facts About: Eating Disorders|isbn = 0-89042-352-0 |year = 1999|publisher = [[American Psychiatric Association]]}} (pamphlet)</ref>, and may directly cause: * [[Perimolysis]], or the erosion of tooth enamel by [[gastric acid]]s. * Oral trauma, where habitual insertion by fingers or other objects cause [[laceration]]s to the lining of the mouth and throat. * Chronic [[gastric reflux]] after eating. * [[Esophagitis]], or irritation of the [[esophagus]] by frequent contact with gastric acids. * [[Dehydration]] and [[hypokalemia]] due to loss of fluids and potassium depletion. * Swollen [[salivary gland]]s.<ref name="mcgilley">{{citation|url = http://www.aafp.org/afp/980600ap/mcgilley.html|title = Assessment and Treatment of Bulimia Nervosa|first1 = Beth M|last1 = McGilley|first2 = Tamara L|last2 = Pryor|date = June 1998|journal = [[American Academy of Family Physicians]]}}</ref> == Causes == Bulimia is related to deep psychological issues and feelings of lack of control. Sufferers often use the destructive eating pattern to feel in control over their lives.<ref>[http://www.bbc.co.uk/health/conditions/mental_health/disorders_eating.shtml BBC - Health - Conditions - Eating disorders<!-- Bot generated title -->]</ref> They may hide or hoard food and overeat when stressed or upset. They may feel a loss of control during a binge, and consume great quantities of food (over 20,000 calories).<ref>[http://www.at-risk.org/bulimia.html Bulimia<!-- Bot generated title -->]</ref> After a length of time, the sufferer of bulimia will find that they no longer have control over their binging and purging. The binging becomes an addiction that seems impossible to break. Recovery is very hard and often in the early stages of recovery the patient will gain weight as they are still binging but no longer purging, causing anxiety which will in turn cause the patient to revert back to bulimia. There are higher rates of eating disorders in groups involved in activities that emphasize thinness and body type, such as [[gymnastics]], modelling, dance, [[cheerleading]], running, acting, rowing(lightweights/coxwains) and [[figure skating]].<ref>[http://www.healthsystem.virginia.edu/uvahealth/adult_mentalhealth/edbulim.cfm Bulimia Nervosa<!-- Bot generated title -->]</ref> Bulimia is more prevalent among [[Caucasian race|Caucasian]]s. In one study, diagnosis of bulimia was correlated with high [[testosterone]] and low [[estrogen]] levels, and normalizing these levels with [[combined oral contraceptive pill]]s reduced cravings for fat and sugar.<ref>[http://ki.se/ki/jsp/polopoly.jsp?d=130&a=22684&l=en&newsdep=130 Bulimia May Result from Hormonal Imbalance - Startpage - ki.se<!-- Bot generated title -->]</ref> == Related disorders == Bulimics are much more likely than non-bulimics to have an [[affective spectrum|affective disorder]], such as [[clinical depression|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.<ref>{{citation|last1 = Walsh|first1 = B T|last2 = Roose|first2 = S P|last3 = Glassman|first3 = A H|last4 = Gladis|first4 = M|last5 = Sadik|first5 = C|title = Bulimia and depression|journal = Psychosomatic Medicine|volume = 47|number = 2|pages = 123–131|year = 1985|url = http://www.psychosomaticmedicine.org/cgi/reprint/47/2/123.pdf}}</ref> Another study by the [[Royal Children's Hospital]] in [[Melbourne]] on a [[cohort (statistics)|cohort]] of 2000 adolescents similarly found that those meeting at least two of the [[Diagnostic and Statistical Manual of Mental Disorders|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.<ref>{{citation|title = Anorexia a pointer to later depression|url = theage.com.au/news/national/anorexia-a-pointer-to-later-depression/2008/04/27/1209234656201.html|publisher = [[The Age]]|date = 2008-04-28|accessdate = 2004-04-28|first = Jill|last = Stark}}</ref> [http://recoverhealth.blogspot.com/] == See also == * [[Anorexia nervosa]] * [[Anorexia mirabilis]] * [[Body dysmorphic disorder]] * [[Body image]] * [[Cachexia]] * [[Calorie restriction]] * [[Defensive vomiting]] * [[Eating disorder not otherwise specified]] * [[Fasting girls]] for a historical perspective on anorexia nervosa * [[Female body shape]] * [[Malnutrition]] * [[Muscle dysmorphia]] ('reverse' anorexia nervosa) * [[National Association of Anorexia Nervosa and Associated Disorders]] * [[Orthorexia nervosa]] * [[Pro-ana]] * [[Purging disorder]] * [[Refeeding syndrome]] == References == {{Reflist|2}} {{Mental and behavioural disorders}} [[Category:Eating disorders]] [[Category:Culture-specific syndromes]] [[ca:Bulímia]] [[cs:Bulimie]] [[de:Bulimie]] [[et:Buliimia]] [[es:Bulimia]] [[eo:Bulimio]] [[eu:Bulimia]] [[fr:Boulimie]] [[ko:폭식증]] [[hr:Bulimija]] [[is:Lotugræðgi]] [[it:Bulimia]] [[he:בולימיה]] [[ka:ბულიმია]] [[lt:Bulimija]] [[lmo:Bülimía]] [[nl:Boulimie]] [[ja:神経性大食症]] [[pl:Bulimia]] [[pt:Bulimia nervosa]] [[ru:Булимия]] [[simple:Bulimia nervosa]] [[sl:Bulimija]] [[sr:Булимија]] [[fi:Bulimia]] [[sv:Bulimia nervosa]] [[zh:神經性暴食症]]