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

A reanalysis of treatment response and relapse was performed using survival analysis in a 12-week clinical trial of cognitive behavioral group psychotherapy for the treatment of bulimia nervosa. One hundred forty-three (143) bulimic women with high incidence of binge eating, self-induced vomiting, and/or laxative abuse were randomly assigned to one of four possible treatment conditions that consisted of a combination of two factors: (1) emphasis on abstinence (high and low), and (2) treatment intensity (high and low). "Initial" and "maintained" response to treatment based on "total" and "near" abstinence criteria were determined using self-reported binge eating, vomiting, and laxative use data. Results suggest that an emphasis on abstinence appears important in achieving initial abstinence, whereas intensity of treatment may be important in maintaining abstinence.
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PMID:Survival analysis of response to group psychotherapy in bulimia nervosa. 849 Jun 38

Numerous studies have estimated the frequency of bulimia nervosa among high school girls and college women, but population-based trends in incidence in a community have not been reported. In this study we determined the incidence of bulimia nervosa by identifying persons residing in the community of Rochester, Minnesota, who had the disorder initially diagnosed during the 11-year period from 1980 to 1990. Using our comprehensive population-based data resource (the Rochester Epidemiology Project), we identified cases by screening 777 medical records with diagnoses of bulimia; feeding disturbance; rumination syndrome; adverse effects of cathartics, emetics, or diuretics; polyphagia; sialosis; or vomiting. We identified 103 Rochester residents (100 female and 3 male) who fulfilled DSM-III-R diagnostic criteria for bulimia nervosa during the 11-year study period. Mean +/- S.D. age for females at the time of diagnosis was 23.0 +/- 6.1 years (range, 14.4 to 40.2 years). Yearly incidence in females rose sharply from 7.4 per 100000 population in 1980 to 49.7 in 1983, and then remained relatively constant around 30 per 100000 population. The annual age-adjusted incidence rates were 26.5 per 100000 population for females and 0.8 per 100000 population for males. The overall age- and sex-adjusted annual incidence was 13.5 per 100000 population. Bulimia nervosa is a common disorder in adolescent girls and young women from 15 to 24 years of age. Histories of alcohol or drug abuse, depression, or anorexia nervosa were higher than expected in the general population.
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PMID:Bulimia nervosa in Rochester, Minnesota from 1980 to 1990. 858 3

Recent cases in our Eating Disorders Clinic suggest that patients diagnosed with bulimia nervosa seeking surgical fat removal may be exhibiting a variant of the purging behavior seen in bulimic patients. These same patients exhibit historical or concurrent abuse of laxatives and/or diuretics or self-induced vomiting in a pathologic attempt to obtain or maintain an idealized body image. This paper presents two case studies that illustrate the bulimic patient's compulsive quest for lipectomy with unrealistic expectations that surgical alteration of the body will be an emotional and physical panacea. Plastic surgeons must be cautioned regarding this potential manifestation of bulimia nervosa and the dangers inherent in colluding with the patient in a pathologic request for surgery. It is important for plastic surgeons to recognize appropriate use of lipectomy as an alternative to traditional purging behavior in the bulimic patient.
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PMID:Lipoplasty in the bulimic patient. 876 15

Dental erosion due to intrinsic factors is caused by gastric acid reaching the oral cavity and the teeth as a result of vomiting or gastroesophageal reflux. Since clinical manifestation of dental erosion does not occur until gastric acid has acted on the dental hard tissues regularly over a period of several years, dental erosion caused by intrinsic factors has been observed only in those diseases which are associated with chronic vomiting or persistent gastroesophageal reflux over a long period. Examples of such conditions include disorders of the upper alimentary tract, specific metabolic and endocrine disorders, cases of medication side-effects and drug abuse, and certain psychosomatic disorders, e.g. stress-induced psychosomatic vomiting, anorexia and bulimia nervosa or rumination. Based on a review of the medical and dental literature, the main symptoms of all disorders which must be taken into account as possible intrinsic etiological factors of dental erosion are thoroughly discussed with respect to the clinical picture, prevalence and risk of erosion.
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PMID:Etiology of dental erosion--intrinsic factors. 880 85

There is controversy over how best to classify eating disorders in which there is recurrent binge eating. Many patients with recurrent binge eating do not meet diagnostic criteria for other of the two established eating disorders, anorexia nervosa or bulimia nervosa. The present study was designed to derive an empirically based, and clinically meaningful, diagnostic scheme by identifying subgroups from among those with recurrent binge eating, testing the validity of these subgroups and comparing their predictive validity with that of the DSM-IV scheme. A general population sample of 250 young women with recurrent binge eating was recruited using a two-stage design. Four subgroups among the sample were identified using a Ward's cluster analysis. The first subgroup had either objective or subjective bulimic episodes and vomiting or laxative misuse; the second had objective bulimic episodes and low levels of vomiting or laxative misuse; the third had subjective bulimic episodes and low levels of vomiting or laxative misuse; and the fourth was heterogeneous in character. This cluster solution was robust to replication. It had good descriptive and predictive validity and partial construct validity. The results support the concept of bulimia nervosa and its division into purging and non-purging subtypes. They also suggest a possible new binge eating syndrome. Binge eating disorder, listed as an example of Eating Disorder Not Otherwise Specified within DSM-IV, did not emerge from the cluster analysis.
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PMID:The classification of bulimic eating disorders: a community-based cluster analysis study. 881 15

Basal thyroid-stimulating hormone (TSH) and thyroid hormone levels were evaluated in 18 women with bulimia nervosa during a period of active binging and vomiting and again after 7 weeks of abstinence from these behaviors and compared to measures in 27 control women. In 10 of the patients and 11 of the controls, the TSH nocturnal surge was calculated from hourly TSH measurements obtained in the afternoon from 1500 to 1900 h and in the night from 2300 to 0400 h. During the binging phase of the illness patients had lower total triiodothyronine (T3) values than controls (p < .001). After 7 weeks without binge eating or purging, patients had lower T3, total thyroxine (T4), free triiodothyronine, free thyroxine (FT4), reverse triiodothyronine and thyroid-binding globulin (TBG) values compared to controls (p < .01) and significant reductions in T3, T4, FT4 and TBG compared to themselves in the active phase of the illness (p < .02). The reduction in thyroid hormone levels was not due to a reduction in the nocturnal thyrotropin surge, since surge values did not differ between normals and patients at either phase of the illness. Bulimics in the binging phase of the illness showed a positive correlation between caloric intake and TSH values (p < .01), suggesting that food binging may stimulate thyroid activity. In sum, these results show a substantial reduction in thyroid hormone levels after 7 weeks of abstinence from binging and vomiting behaviors.
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PMID:Thyroid function in bulimia nervosa. 881 24

Eighty two patients with bulimia nervosa were managed by providing them with supervision in the use of a highly structured cognitive behavioral self-help manual. Their progress was assessed in an open clinical trial. The 67 patients who completed the course of self-help experienced considerable benefit; the frequency of bulimic episodes and self-induced vomiting decreasing by 80% and 79%, respectively. Compared to those who benefited, those who had a poor outcome or dropped out of treatment were more than twice as likely to have had anorexia nervosa in the past and were somewhat more likely to have a personality disorder. Three-quarters of those who persisted with the programme of supervised self-help were followed up a year after commencing treatment. Clinical gains were well maintained: almost two thirds were abstinent with respect to both bulimic episodes and self-induced vomiting. It would seem appropriate that, as part of a stepped care approach to the management of bulimia nervosa, supervised cognitive behavioral self-help should routinely be the first line treatment.
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PMID:An evaluation of the efficacy of supervised cognitive behavioral self-help bulimia nervosa. 886 Nov 24

The characteristics of anorexia nervosa and bulimia nervosa were studied in ballet dancers in full-time training and compared with other young women at school. Dancers had higher scores on the Eating Attitudes Test. Dancers were more likely to have an eating disorder when strict modified DSM-3-R criteria were applied. Currently 1 dancer (1.6%) and no student had anorexia nervosa, 1 dancer (1.6%) and 3 students (1.3%) had bulimia nervosa and 5 dancers (8.3%) and 9 students (4.2%) had an unclassified eating disorder. Another dancer had been treated for anorexia nervosa in the past. One dancer was treated for bulimia nervosa and 6 for weight loss. Dancers were more likely to have been told to increase their body weight. Dancers were not more likely to be afraid of losing control of their weight and becoming obese if they attempted weight gain, to ignore the advice to gain weight or resist gaining weight. Regular self-induced vomiting was reported by 4% of women. Dancers are at risk for the development of eating disorders. Ballet dancers are under pressure to maintain low body weight. The low body weight and menstrual disturbance found among young dancers during training are two of the characteristics of anorexia nervosa Ballet dancers use behaviours aimed at weight control and weight loss. In dancers and professional groups under intense pressure to diet, low body weight and amenorrhoea are not sufficient criteria to diagnose anorexia nervosa. These behaviours can result in binge eating and multiple behaviours aimed at preventing binge eating. Whether the characteristics of bulimia among dancers are sufficient for a diagnosis of bulimia nervosa to be made is unknown. The aim of this paper is to study the characteristics of the eating disorders anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified among young ballet dancers in full-time ballet training and to provide information about the risk of development of eating disorders among young women required to maintain below average body weight while continuing above average exercise.
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PMID:Characteristics of eating disorders among young ballet dancers. 886 53

The increased occurrence of dental erosion from self-induced vomiting in bulimia nervosa is not linearly associated with the frequency or the duration of vomiting. Possible changes in the buffering and lubricating role of saliva in bulimia nervosa and their relationship to erosion have not been previously investigated. Chewing-gum-stimulated salivary flow rate, pH, bicarbonate concentration and viscosity were compared between two groups of vomiting bulimics and with 10 healthy controls. One bulimic group (n = 9) had pathological tooth wear present according to the criteria of the Tooth Wear Index and the other bulimic group (n = 10) did not. The influence of salivary pellicle on enamel acid dissolution by perchloric acid was also assessed by an enamel biopsy method. Bicarbonate was measured in a Natelson microgasometer. Both the bulimic groups had mean initial 3-min flow rates and overall 9-min flow rates significantly lower (p < 0.01) than the healthy subjects. The mean pH values were not significantly different between the two bulimic groups or the control group. However, the mean bicarbonate concentration in both bulimic groups was significantly less (p < 0.01) than in the control group. The mean salivary viscosity of 7.4 centipoise (cP), measured by a DV1 Brookfield viscometer, was significantly greater (p < 0.05) in the pathological tooth-wear-present group than in the tooth-wear-absent group (4.5 cP) and the control group (4.1 cP). Slightly more calcium was released from the pellicle-free surface in both groups but this was not statistically significant, whilst the dissolved calcium in enamel biopsies was significantly lower (p < 0.05) in the tooth-wear-present group.
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PMID:Salivary factors in vomiting bulimics with and without pathological tooth wear. 887 90

A 25-year-old female patient with a 9-year history of bulimia nervosa gave a 2-year history of regularly ingesting up to 24 x 300 mg aspirin tablets to facilitate vomiting after a binge. Awareness of this dangerous practice is important when asking for an eating disorder history. Assessing for the possible physical sequelae of aspirin misuse and educating the patient about the risks would be an important part of the overall treatment.
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PMID:Use of aspirin to facilitate vomiting in a young woman with bulimia nervosa: a case report. 906 45


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