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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a clinical series of 40 bulimic women, a reported history of unwanted sexual experience was associated with more frequent bingeing and (to a lesser extent) vomiting. These symptoms were more marked when the abuse was intrafamilial, involved force, or occurred before the victim was 14 years old. Further research is required to establish the causal links between the phenomena of sexual abuse and bulimic symptoms.
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PMID:Sexual abuse and the severity of bulimic symptoms. 163 36

Major depression disease is uncommon in children; it occurs mostly in children with a depressed parent or in children under major psychosocial stress such as physical or sexual abuse. Most depression in children is masked, i.e., the child presents with signs or symptoms such as headaches, abdominal pain, muscle weakness, vomiting, dizziness, hyperactivity, or school avoidance. Careful evaluation of the history is required to assist in the diagnosis. Some basic laboratory tests should be done to rule out organic disease. Psychiatric referral should be carried out after an appropriate evaluation.
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PMID:Depression and chronic fatigue in children. A masquerade ball. 187 11

In this replication study of adolescents in a nonclinical setting, the prevalence of reported problem behaviors, emotions, and abuse is evaluated, and the impact of abuse on multivariate emotional and behavioral risk is assessed. A total of 3998 students (69%) in a rural midwestern community in grades 7 to 12 participated in the study. Almost 20% of the students reported some form of physical and/or sexual abuse, with more girls than boys reporting sexual abuse (chi 2 = 48.5, P less than .001). Some problem behaviors (alcohol use) and emotions (trouble sleeping, difficulty with anger) were common among all adolescents and some were strongly associated with a history of abuse (especially, considering or attempting suicide, running away, laxative use, and vomiting to lose weight). Higher emotional and behavioral risk scores among abused students were confirmed. The effects of physical and sexual abuse on risk scores were independent and additive; no interaction was observed. An interaction of gender and sexual abuse on problem behavior was observed, with problem behavior being significantly greater among sexually abused boys. The results confirm increased risk of problem behaviors and negative feelings among abused adolescents when compared with nonabused peers, and better define influences of gender and abuse type on emotional and behavioral risks.
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PMID:Behavioral risk, emotional risk, and child abuse among adolescents in a nonclinical setting. 225 Oct 27

We hypothesized that high school students who experienced prior maltreatment would be more likely than their peers to report health risk behaviors and suicide attempts. Before the establishment of a high school-based clinic, an anonymous needs assessment survey was completed by 600 adolescents (grades 9 to 12). Sociodemographic information was obtained and questions were asked about physical and sexual abuse, health-related behaviors and habits, and suicide attempts. Thirteen percent of the adolescents had been maltreated: 5.2% reported prior physical abuse, 5.4% sexual abuse, and 2.7% both physical and sexual abuse. Multivariate statistical techniques were used to clarify how previous abuse was related to adolescent risk-taking behaviors and suicide. Students with a history of physical abuse were three times more likely than non-abused peers to drink alcohol and smoke cigarettes, almost twice as likely to use illicit drugs, six times more likely to self-induce vomiting, and five times more likely to attempt suicide. A student with a history of prior sexual abuse had a three and one-half times greater chance of being sexually active and was more than three times more likely to attempt suicide. These data on a nonclinical, nondeviant population of adolescents indicate that physical or sexual abuse in childhood may have a significant impact on adolescent health risk behaviors and suicide attempts.
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PMID:Health risk behaviors and attempted suicide in adolescents who report prior maltreatment. 232 31

Evidence of a link between reported sexual abuse and specific eating behaviours was considered in 100 anorexic women. The women were assessed as part of case series from two separate clinics. There was a strong association between reported unwanted sexual experiences and purging behaviours (vomiting and/or abusing laxatives). Anorexics who did not purge had lower reported rates of abuse. The pattern and prevalence rate of reported abuse were similar in the two clinics, suggesting that the association was not a product of a specific method of eliciting disclosure. Implications for treatment and possible causal mechanisms behind this relationship are discussed.
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PMID:Sexual abuse as a factor in anorexia nervosa: evidence from two separate case series. 830 27

Reported sexual abuse is associated with bulimic symptomatology. It has been suggested that this association might be due to impaired self-esteem. However, from the evidence to date, it appears that general self-esteem may be too "blunt" a construct, and that more specific psychological mediators need to be considered. This study compares the values of a measure of general self-esteem and a measure of specific self-denigratory beliefs consequent upon sexual abuse in predicting levels of eating psychopathology in eating-disordered women. Self-esteem was associated with the level of general eating attitudes, whereas specific self-denigratory beliefs were associated with the frequency of vomiting. Neither variable adequately predicted the frequency of binging.
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PMID:Self-denigratory beliefs following sexual abuse: association with the symptomatology of bulimic disorders. 849 Jun 42

Recent reports have postulated the existence of two different types of self-injurious behavior: impulsive and compulsive. The aim of the present study is to analyze the dimensionality of self-injurious behavior and to study the link between self-injurious behavior and clinical features in anorexia nervosa. The study involved 236 consecutive patients with anorexia nervosa, diagnosed by DSM-IV criteria. Subjects were evaluated by means of a semistructured interview and self-reported questionnaires, such as the Eating Disorders Inventory and Hopkins Symptom Checklist. A principal component analysis was used to study the dimensionality of different types of self-injurious behavior, including purging. Our findings confirm the distinction between impulsive and compulsive self-injurious behavior. The dimensions appear to be represented as a continuum in both the anorexia nervosa diagnostic subgroups. A third distinct dimension emerged that included self-induced vomiting and laxative/diuretics abuse. Childhood sexual abuse and anxiety significantly predict the presence of impulsive self-injury, whereas obsessionality and age predict compulsive self-injury. The coexistence of a positive score on both dimensions of self-injurious behavior was the strongest predictor of treatment dropout. The present study highlights the importance of self-injurious behavior; it should be given due consideration in future outcome studies on anorexia nervosa
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PMID:Self-injurious behavior in anorexia nervosa. 1097 74

A 13-year-old otherwise healthy premenarchal girl presented with acute onset of painful vulvar ulcerations. One day before developing vulvar ulcerations, she experienced flu-like symptoms, including a low-grade fever, cough, sore throat, and myalgia. Results of a throat swab were positive for influenza A infection (polymerase chain reaction [PCR] assay), and the patient was treated with oseltamivir. The patient's constitutional symptoms improved slightly, but within 2 days after her initial presentation, she returned to her primary care provider and described 24 hours of dysuria and vulvar swelling. She had a history of herpes labialis (cold sores) and rare episodes of minor oral aphthae (canker sores) that occurred less than twice a year. The patient denied a history of sexual activity, sexual abuse, or physical trauma. Physical examination showed ulceration and swelling of the labia minora, and the patient received an empiric dose of acyclovir (200 mg 4 times daily) for presumed autoinoculated herpes simplex virus (HSV) infection. An ulcer swab was performed, and urinalysis revealed no evidence of infection. Two days later, the patient presented to the emergency department with increasing vulvar pain and vaginal discharge. The previous ulcer swab findings were negative for HSV (PCR assay), and consequently, acyclovir was discontinued after 1 day of therapy. She received topical viscous lidocaine and an empiric dose of oral fluconazole. The lidocaine provided temporary symptomatic relief. Results of DNA amplification studies were negative for Chlamydia trachomatis and Neisseria gonorrhoeae. A potassium hydroxide preparation was negative for fungi, and an ulcer swab for bacterial culture revealed usual flora. Of note, the PCR assay for Epstein-Barr virus was not performed on ulcer cells. The patient was referred to the department of dermatology, and results of a physical examination showed copious white mucoid discharge and a 2-cm ulceration of the left labia minora (Figure, panel A). Two smaller pinpoint ulcerations and swelling of the left labia minora were also noted. The lesions were clinically indistinguishable from the genital aphthous ulcers of patients with complex aphthosis (recurrent, severe aphthous ulcers on oral or genital mucosa). A diagnosis of ulcus vulvae acutum was made, and treatment was started with clobetasol 0.05% ointment (4 times daily) and lidocaine gel as needed. Four days later, the patient reported marked symptomatic improvement. Physical examination showed near resolution of the large vulvar ulceration (Figure, panel B). The patient tapered use of clobetasol ointment over the next several days until the ulcerations healed completely. Two months after her initial episode, the patient again had 3 small vulvar erosions after symptoms that included low-grade fever, malaise, and vomiting. She did not receive oseltamivir for this illness; clobetasol ointment was applied 4 times daily, and the vulvar erosions ameliorated within a few days. Her constitutional symptoms resolved without treatment. The patient has not experienced any further episodes of vulvar ulcerations in the 18 months after the most recent treatment.
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PMID:Ulcus vulvae acutum in a 13-year-old girl after influenza A infection. 1832 8

This is the first study determining correlates of suicide behavior in children with eating disorders using multiple sleep, psychological, and demographic variables. Mothers rated suicide ideation and attempts in 90 children ages 7-18 with bulimia nervosa or anorexia nervosa. Suicide ideation was more prevalent in children with bulimia nervosa (43%) than children with anorexia nervosa (20%). All children with bulimia nervosa who experienced ideation attempted suicide, whereas only 3% of children with anorexia nervosa attempted suicide. Correlates of ideation were externalizing behavior problems and sleep disturbances. Correlates of attempts were bulimia nervosa, self-induced vomiting, nightmares, and physical or sexual abuse. These problems should be assessed and targeted for intervention because of their association with suicide behavior.
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PMID:Correlates of suicide ideation and attempts in children and adolescents with eating disorders. 2484 6

Recurrent abdominal pain (RAP) in children is defined as at least three episodes of pain that occur over at least three months and affect the child's ability to perform normal activities. RAP is most often considered functional (nonorganic) abdominal pain, but an organic cause is found in 5% to 10% of cases. Further workup is warranted in children who have RAP and fever, vomiting, blood in the stool, more than three alarm symptoms, or a history of urinary tract infections. Physical examination findings that should prompt further workup include weight loss or failure to grow; jaundice; costovertebral tenderness or back pain with lower extremity neurologic symptoms; liver, spleen, or kidney enlargement; an abdominal mass; or localized tenderness on abdominal examination. Workup may include complete blood count, erythrocyte sedimentation rate, C-reactive protein level, fecal guaiac testing, fecal ova and parasite testing, or urinalysis. Pregnancy testing and screening for sexually transmitted infections should be considered in adolescents or if there are concerns about sexual abuse. Abdominal radiography can be helpful for diagnosing obstruction or constipation. Abdominal ultrasonography identifies an abnormality in up to 10% of children with RAP who meet criteria for further workup, compared with 1% of those who do not meet these criteria. Functional abdominal pain is a clinical diagnosis and no workup is needed. Management of functional abdominal pain focuses on improving quality of life, reducing parent and child concerns about the seriousness of the condition, and reducing the disability associated with pain rather than complete resolution of pain. Although evidence is lacking for most pharmacologic treatments of functional abdominal pain, psychological therapies such as cognitive behavior therapy and hypnotherapy have been shown to be beneficial.
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PMID:Recurrent Abdominal Pain in Children. 3021 16


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