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Bulimia nervosa, an increasingly common eating disorder, involves binge eating and subsequent purging behavior. Repeated self-induced vomiting may lead to dental erosion. This article describes the use of resin-bonded ceramic crowns to manage a severely eroded maxillary dentition in such a patient.
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PMID:Use of resin-bonded ceramic crowns in a bulimic patient with severe tooth erosion. 906 23

The nutritional status of 21 patients suffering from bulimia nervosa was evaluated by anthropometric and immunologic indexes in comparison with a control group (n = 15). In addition, the influence of body mass index (BMI; in kg/m2) values and vomiting episodes on the nutritional status of bulimic patients was assessed. Anthropometry showed no signs of malnutrition in either group, except for those patients with low weights (BMI < 19). Bulimic patients had lower lymphocyte counts than did control subjects, except for those without vomiting (NVBN). All T lymphocyte subsets tested as well as CD57 cells were lower (22% and 55%, respectively) in bulimic patients than in control subjects, but the CD19 cell subset remained unmodified. The low-weight bulimic group (LWBN) had lower CD4 cell counts than did the normal-weight (BMI > 19) bulimic group. The NVBN group had lymphocyte subpopulations similar to those in the control group, except for CD57, which was lower. The bulimic patients with vomiting had the lowest cell subset values. These results suggest a depleted nutritional status in all bulimic patients studied, even those with normal weights. The LWBN group had the most depleted nutritional status and the NVBN group was least affected at a subclinical level. CD57 can be considered a good marker of nutritional status in this syndrome because it was the only subpopulation altered in all groups.
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PMID:Evaluation of nutritional status by immunologic assessment in bulimia nervosa: influence of body mass index and vomiting episodes. 925 Jan 37

Bulimia nervosa is a common eating disorder, affecting between 1% to 10% of adolescent girls and college aged women. Because excessive weight loss and amenorrhea are not significant features, as they are in anorexia, bulimia is much harder to diagnose. Orthopaedic surgeons have a unique opportunity to detect one of the few physical signs of the disease, which is skin lesions, consisting of abrasions, small lacerations, and callosities on the dorsum of the hand overlying the metacarpophalangeal and interphalangeal joints. These nondescript dorsal lesions are caused by repeated contact of the incisors to the skin of the hand that occur during self induced vomiting. This finding, known as Russell's sign, may be seen by orthopaedic surgeons during examinations for other reasons. Because eating disorders are recognized as a component of the female athlete triad of osteoporosis, amenorrhea, and eating disorders and because orthopaedic surgeons routinely care for female athletes susceptible to these disorders, recognizing this sign and its implications may have profound influence on the patient's musculoskeletal system and general health.
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PMID:Russell's sign. Subtle hand changes in patients with bulimia nervosa. 934 15

Eating disorders have been widely studied among civilian women and among select groups of men (athletes and wrestlers). Gross disturbances in eating behaviors characterize the conditions of anorexia nervosa (AN), currently seen among 1 to 2% of non-active duty women. Bulimia nervosa (BN) is prevalent among 2% of the female population, and both disorders have a female-to-male ratio of 10:1. Another category of eating disorders known as not otherwise specified (NOS) occurs in between 3 and 35% of the population according to the reported literature. This study examined the prevalence of AN, BN, and NOS among a large sample of active duty Navy men. Multiple military, professional, and behavioral were analyzed to promote an increased understanding and awareness of these disorders among active duty men. This was a descriptive, correlational study among 4,800 Navy men targeted from hospitals, clinics, and ships at sea. Anonymous surveys were returned by 28% of prospective subjects (N = 1,425). The study revealed a prevalence of 2.5% for AN, 6.8% for BN, and 40.8% for NOS among active duty Navy men. AN and BN existed without difference among all active duty men regardless of rank/rate, job assignment, or age. Use of laxatives, diuretics, diet pills, vomiting, and fasting for standards increased during the body measurement and fitness periods, but year-round use of these methods existed at disturbing rates. Multiple logistic regression analysis predicted several factors that might predict the manifestation of eating disorders in this population of active duty members.
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PMID:Prevalence and contributing factors of eating disorder behaviors in active duty Navy men. 935 23

Eating disorders (ED) in the medically ill population have seldom been studied. The objective of this study is to review a series of medical and surgical patients referred for psychiatric evaluation for a presumed ED. Between 1982 and 1990, a series of 65 patients were referred for psychiatric consultation to evaluate for an ED. All patients records were reviewed for demographic, medical, and psychiatric information, including medical course following the consultation. Sixty-three percent of the study population were referred by internal medicine services. The most common presenting symptoms were self-induced vomiting (39.1%), binge eating (34.4%) and weight loss (31.3%). Bulimia nervosa (n = 21), anorexia nervosa (n = 19), and no psychiatric diagnosis (n = 18) were the most frequent diagnoses. Record review suggested significant challenges to accurate eating disorder diagnoses in patients presenting with primary medical complaints.
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PMID:The evaluation of eating and weight symptoms in the general hospital consultation setting. 953 77

This study examined the relative efficacy of a brief-psychoeducational treatment approaches for bulimia nervosa. Our sample comprised 26 women who sought consecutively treatment at the Eating Disorders Outpatient Unit. All subjects met DSM-IV criteria for Bulimia nervosa. For the assessment were used commonly applied questionnaires in the fiel of eating disorders such as: Eating Attitudes Test (EAT-40), Eating Disorders Inventory (EDI) and the Beck Depression Inventory (BDI). Outcome measures included also change in vomiting and binge-eating episodes per week. Each patient was assessed before and after a 6 weeks brief psychoeducational group therapy. At posttreatment, 30% of the patients were abstinent from binge eating-purging and 62% reduced their weekly frequency in binge eating and 56% reduced their weekly frequency in vomiting. Good-outcome (EAT scores < 30) was observed in more than 35% of our patients. The authors sought to identify factors that differentiate bulimic patients who improve while receiving treatment from those who do not.
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PMID:[Psychoeducative ambulatory group in bulimia nervosa. Evaluation of a short-term approach]. 954 33

Bulimia nervosa and bulimic behavior are among the most common eating disorders, affecting up to 13% of female college students. Most health professionals are aware of the compulsive overeating, self-induced vomiting, and laxative abuse associated with this disease; yet, only a small proportion of affected patients are ever diagnosed, generally only after years of abuse. Since the dental changes observed in most bulimics are recognizable and usually undeniable, the clinician should be aware of the oral and maxillofacial changes of this disease in order to arrive at an early diagnosis. Without successful treatment, an estimated 1 in 300 bulimic cases will have a fatal outcome. Even with treatment, one-third of affected individuals suffer early relapse and half of them do not consider themselves cured after 5 years of psychologic therapy. The learning objective of this article is to discuss the dental and psychologic features of this disorder, with focus on the differential diagnosis and treatment of the oral manifestations.
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PMID:Bulimia nervosa: dental perspectives. 957 37

The reproductive and sexual histories of women who had recovered or were recovering from bulimia nervosa were examined. Of 48 consecutive female patients, 43 were studied 10-15 years after first presenting for treatment. At follow-up, 74% were considered recovered and 26% still had an eating disorder. Only 2 women fulfilled the criteria for bulimia nervosa. A history of amenorrhea was common (81% of women), 63% of women being without their menstrual periods for more than 12 months. Menstruation was present in women at a body mass index of 19 or more who were no longer using the weight loss practices of self-induced vomiting, laxative abuse, and starvation. Bulimia nervosa women are more likely to be investigated for infertility when their eating disorder is active. Bulimia sufferers are sexually active, but have times of withdrawing from their partners and ceasing sexual behavior. They associate their sexual feeling with body weight, pregnancy, breastfeeding, and status of their relationships. Marital breakdown is also more common but only if the eating disorder was active at the time of marriage. Forty-five percent left their relationship had a negative effect on their eating disorder. Short-term episodes of bulimic-free behavior are associated with pregnancy and breastfeeding in some pregnancies. Termination of pregnancy occurs more often. The prevalence of miscarriage, hyperemesis gravidarum, and postnatal depression was greater among women who had not recovered from their eating disorder at the time of their pregnancy. Recovery from eating disorder behavior before attempting conception reduces the prevalence of the gynecologic, obstetric, and psychiatric problems associated with eating disorder behavior.
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PMID:Sexuality and reproduction in bulimia nervosa patients over 10 years. 958 91

Bulimia nervosa is characterized by binge eating and inappropriate compensatory behaviors, such as vomiting, fasting, excessive exercise and the misuse of diuretics, laxatives or enemas. Although the etiology of this disorder is unknown, genetic and neurochemical factors have been implicated. Bulimia nervosa is 10 times more common in females than in males and affects up to 3 percent of young women. The condition usually becomes symptomatic between the ages of 13 and 20 years, and it has a chronic, sometimes episodic course. The long-term outcome has not been clarified. Other psychiatric conditions, including substance abuse, are frequently associated with bulimia nervosa and may compromise its diagnosis and treatment. Serious medical complications of bulimia nervosa are uncommon, but patients may suffer from dental erosion, swollen salivary glands, oral and hand trauma, gastrointestinal irritation and electrolyte imbalances (especially of potassium, calcium, sodium and hydrogen chloride). Treatment strategies are based on medication, psychotherapy or a combination of these modalities.
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PMID:Assessment and treatment of bulimia nervosa. 963 37

The 3 eating disorders--anorexia nervosa, bulimia nervosa, and binge eating--occur at a frequency far greater than usually realized. Anorexia has been found to be present in up to 1% of teenage and young adult women, whereas estimates of bulimia have ranged up to 5%. The prevalence of binge-eating disorder is not known, but may be higher than bulimia. Anorexia nervosa is characterized by weight loss, body image disturbance, and a morbid fear of weight gain. Bulimia nervosa is characterized by binge eating and compensatory purging by vomiting; use of laxatives, diuretics, or diet pills; exercise; or fasting. Binge-eating disorder is characterized by binge behavior and loss of control of food intake, with an absence of purging. Eating disorders create significant mortality and morbidity. Medical complications associated with anorexia are those related to malnutrition and semistarvation. Medical complications associated with bulimia are those related to electrolyte imbalance and the physical effects of vomiting. The mortality rate of eating disorders may be as high as 15%, including deaths from arrhythmia, gastric hemorrhaging, and suicide. The core struggle within women with anorexia is the "2 Ps": feeling powerless and striving towards perfectionism. The core conflict within a bulimic person appears to be the "2 Ds": deprivation and dependency. The treatment of eating disorders includes psychotherapy, and, frequently, psychopharmacologic intervention. The psychotherapy primarily addresses issues of chaotic eating, hunger, inadequate caloric intake, conditioned response, and profound fear of expressing impulses and feelings, especially those of anger and sadness. Antidepressants, especially serotonergic agents, have been found to be useful, particularly in the treatment of bulimia.
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PMID:What's New in the Treatment of Anorexia Nervosa and Bulimia? 974 43


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