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.
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 should 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 quantity 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. You will find two subtypes of bulimia, purging and nonpurging, according to the techniques used by the patient to stop gaining weight after a binge. Individuals who have the purging subtype use vomiting, laxatives, enemas, or diuretics to maintain from gaining weight; in the nonpurging subtype, the individual fasts or overexercises to stop weight gain.
The essential point is that bulimics do something after a binge to compensate for their eating. There's an additional type of eating disorder called binge eating disorder, in which the person has eating binges but doesn't attempt to vomit, exercise, or do anything else to stop gaining weight.
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. Numerous doctors think, however, that bulimia is underdiagnosed simply because most people with the disorder are of average weight or only slightly overweight.
In addition, there are big numbers of teenagers and young adults who have disordered eating patterns but do not meet the full criteria for bulimia; there might be twice as numerous 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 individuals 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 main risk factor for bulimia. Women whose careers depend on appearance or a certain body develop, 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.
The causes of bulimia aren't recognized for certain, but are thought to be a combination of genetic elements (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 frequently describe their families as conflicted and their parents as either distant and uncaring or hostile and critical.
Bulimia is associated with numerous 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 might develop serious medical problems, including:
Bulimia is usually diagnosed during an office visit to the patient's primary care doctor, although she or he might 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 rapidly answer.
If the doctor thinks that the patient might have bulimia, he or she can search for a few of the physical signs that accompany the disorder, like whether the teeth and salivary glands are regular. In most instances the doctor will order laboratory tests of the patient's blood and urine to make certain that her blood chemistry is regular. Most doctors will also give the patient an electrocardiogram (ECG) to check the patient's heart rhythm. This test is important because some kinds of chemical imbalances in the blood (from vomiting or using diuretics) can lead to irregular heart rhythms.
An additional essential component of evaluating a patient for bulimia is a mental status examination. The physician will need to check the patient for signs of anxiety disorders or depression, simply 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 for bulimia consists of psychotherapy combined with medications. The kind of psychotherapy most frequently 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 might be recommended if the patient's family appears to be a main trigger 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 prognosis of bulimia depends on several elements, including the patient's age at diagnosis, the high 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 a number of 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.
While it is challenging to change an whole 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's essential to convey to kids that they are loved as entire persons with minds and spirits, not just outwardly pleasing faces and bodies.
It is not known with certainty whether bulimia is increasing in the United States, partly simply because it overlaps with other eating disorders in some people and partly simply because doctors are looking more closely at men who might be bulimic but were not diagnosed with the disorder in the past. Even though 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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