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Bulimia is characterized by recurrent episodes of binge eating and severe self-deprecation, often accompanied by self-induced vomiting and/or laxative abuse. It is most often found among young women in their late teens to mid-30s. Estimates of the disorder's prevalence vary widely, depending on the diagnostic criteria used, but usually range from 5% to 20% of college age women. Binge eating typically begins in late adolescence, frequently after a period of dieting to lose weight. Self-induced vomiting usually follows the onset of binge eating by about a year. To date, theories of the disorder's etiology have included several biological models, a psychosocial model, and a biopsychosocial model. The biological models proposed have viewed bulimia as a form of biological depression, neurological disturbance, or metabolic disturbance. The psychosocial model suggests that society's pressure on young women for extreme thinness leads to excessive dietary restraint, deprivation, and, paradoxically, binge eating. The presence of anxiety or depression exacerbates the process. The biopsychosocial model appears to be the most promising. It proposes that young women with biological predispositions toward overweight, depression, or metabolic disturbance are particularly vulnerable to social pressure for thinness, the binge eating that may result from excessive dieting, and, hence, bulimia. The complex nature of bulimia suggests that a multidisciplinary team approach treatment is appropriate.
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PMID:Bulimia: clinical characteristics, development, and etiology. 351 31

Fifty-five patients with a diagnosis of anorexia nervosa hospitalized between 1970 and 1975 in the Departments of Psychiatry and Internal Medicine of the University of Padua were recalled between 1981 and 1983. Forty patients (73%) participated in this follow-up study. At follow-up, using the criteria of Garfinkel et al., 15 patients (37.5%) had an 'excellent' outcome, 10 (25%) were 'much improved', 7 (17.5%) were 'symptomatic', 6 (15%) had a 'poor' outcome and 2 (5%) were deceased. There was, generally, a more marked improvement in weight and menses than in eating habits and mental state. We also found that percentage weight loss, depressive symptoms, abnormal attitudes towards food and weight, the association vomiting/laxative abuse and sexual relations are all significantly associated with a poor outcome. Results are compared with a review of existing literature.
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PMID:Anorexia nervosa in Italy: clinical features and outcome in a long-term follow-up study. 362 77

The authors present data on 275 patients who met DSM-III criteria for bulimia. The mean age of the patients was 24.8 years, and the average duration of illness was approximately 7 years. These patients reported a variety of abnormal eating-related behaviors: binge eating (100%), self-induced vomiting (88.1%), laxative abuse (60.6%), diuretic abuse (33.1%), and chewing and spitting out food (64.5%). Over one-third reported a history of problems with alcohol or other drugs and most indicated substantial social impairment.
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PMID:Characteristics of 275 patients with bulimia. 385 1

This study examines the daily food intake and eating habits of 30 bulimia nervosa patients of normal weight; 20 vomited daily and 10 purged daily. The aim was to measure and compare food intakes and to examine the belief that laxative abuse is an effective means of controlling body weight. The results indicate that the purgers control their weight by overall dietary restraint, not by the pharmacological action of the laxatives. The purgers' eating patterns were bulimic, but not gross: mean daily energy intake being in a normal range (2210 +/- 210 kcal/day). Binge-eating by the vomiters was of a different order: mean energy intake was very large (6025 kcal/day), nearly three times that recommended and significantly greater (P less than 0.01) than that eaten by the purgers. There was major daily variation (s.d. = 3605) and, on occasions, huge amounts were recorded, up to 30 000 kcal in a day. Despite this, vomiting was highly effective in preventing weight gain, the mean weights of the vomiters being similar (mean = 98 per cent) to their matched population mean weight (MPMW). In contrast, purging was relatively ineffective, for despite smaller energy intakes, all the purgers were above (mean = 114 per cent)--and some markedly above--their MPMW. This difference between the two groups was significant (P less than 0.01). Reasons for persisting with laxative abuse are discussed.
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PMID:Does laxative abuse control body weight? A comparative study of purging and vomiting bulimics. 386 Apr 94

Individuals who are overly conscious of their weight and those with eating disorders may induce vomiting and abuse laxatives and diuretics in order to lose weight. Self-induced vomiting may result in dental erosion, parotid and submandibular gland enlargement, oral and perioral trauma, pharyngeal and esophageal inflammation, aspiration and esophageal-gastric tears. Laxative abuse leads to digestive system complications such as cathartic colon and melanosis coli. All three purging methods lead to dehydration and electrolyte disturbances.
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PMID:Complications of hazardous weight-loss methods. 614 75

The frequencies of various forms of eating-related behaviour (such as vomiting and laxative abuse) are reported for a series of non-anorectic bulimia patients seen for evaluation in an eating disorders clinic. The results of serum electrolyte, glucose and other screening tests in these patients are presented. Electrolyte abnormalities were found in 82 of the 168 patients (48.8%) who were diagnosed as having either bulimia or atypical eating disorder. The most common abnormality was metabolic alkalosis (27.4%); hypochloremia (23.8%) and hypokalemia (13.7%) were also commonly seen. No significant blood sugar abnormalities were encountered. An elevated serum amylase level was found to be associated with frequent binge-eating and vomiting behaviour. The pathophysiology of electrolyte abnormalities in this patient group is briefly reviewed.
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PMID:Electrolyte and other physiological abnormalities in patients with bulimia. 619 59

Over a period of 10 years 25 patients, 24 of them females, with anorexia nervosa were observed. The disease is characterized by marked loss of weight, amenorrhoea, low blood pressure and early-onset behavioural disorders towards members of the family and friends. Anaemia, peripheral oedema and pronounced muscular weakness due to electrolyte imbalance may be observed in advanced cases. The disease commences in puberty by more or less obvious loss of weight following reduced food intake, rarely it is caused by vomiting and laxative abuse. Patients tend to deny connections between reduced food intake and loss of weight. There is no standardized treatment. Therapy should be initiated by the psychiatrist. In severe cases parenteral nutrition and intensive care may be required. This is particularly true in complicated cases such as occurrence of infection, serious electrolyte disorders or coagulation defects. The earlier a diagnosis is made the better the prognosis. Manifest disease of more than 5 years' duration decreases the chances for cure considerably.
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PMID:[Anorexia nervosa. A catamnestic analysis]. 642 21

This study reports the results of a biochemical investigation of 80 eating disorder patients and results of an endocrinological investigation of 20 subjects. Of the 80 subjects studied, 22 suffered from anorexia nervosa and 51 were diagnosed as having bulimia. These patient's results were compared to those of 30 control subjects. The eating disorder patients had significantly higher levels of total CO2 calcium, alanine aminotransferase and cholesterol, and significantly lower levels of potassium, chloride and phosphate in the plasma. Hypokalaemia was strongly associated with self-induced vomiting and laxative abuse. Hypercholesterolaemia occurred most commonly in anorexia nervosa patients. Preliminary endocrinological results suggest decreased gonadotrophin levels are associated with binge eating and self-induced vomiting and laxative abuse, as well as with low weight. We feel eating disorder patients should be interviewed and examined by a physician with an interest in this area. Appropriate investigations should be ordered. The physician should also undertake counseling about the short- and long-term sequelae of disordered eating.
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PMID:Hormonal and biochemical abnormalities in women suffering from eating disorders. 644 82

Bulimia is an eating disorder characterized by the ingestion of large amounts of food, usually followed by self-induced vomiting or laxative abuse. Although sometimes a symptom of obesity or anorexia nervosa, bulimia is often associated with borderline weight and nutritional status and thus may be difficult to detect. Since secrecy and shame accompany this syndrome, patients are reluctant to seek treatment. We present ten diagnostic clues for identifying bulimic patients: (1) preoccupation with weight, (2) gastrointestinal complaints, (3) dental and oropharyngeal changes, (4) salivary gland enlargement, (5) edema and bloating, (6) amenorrhea, (7) dermatologic complaints, (8) substance abuse, (9) laboratory changes, and (10) serious consequences. A case study illustrates the major features of the disorder and its treatment.
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PMID:Bulimia: diagnostic clues. 657 18

Bulimia (bulimia nervosa; binge eating) is characterized by episodic eating of large amounts of food, followed by self-induced vomiting or laxative abuse. Psychotherapy has been the mainstay of treatment and often has been unsuccessful. The similarity of bulimia to major depression has led to evaluation of antidepressant drugs for treatment of the disease. Imipramine has proven effective in reducing binging episodes, and further evaluation of antidepressants seems warranted. Phenytoin also has been effective in some cases, suggesting that bulimia may be a neurologic disorder analogous to epilepsy. Optimal treatment may be antidepressants combined with a nutrition/psychotherapy program.
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PMID:Treatment of bulimia. 658 Jan 31


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