Global InformationBulimia nervosa information
 | This article needs to be updated. (September 2022) |
| Bulimia nervosa | |
|---|---|
| Other names | Bulimia |
 | |
| Loss of enamel (acid erosion) from the inside of the upper front teeth as a result of bulimia | |
| Specialty | Psychiatry, clinical psychology |
| Symptoms | Eating a large amount of food in a short amount of time followed by vomiting or the use of laxatives, often normal weight[1][2] |
| Complications | Breakdown of the teeth, depression, anxiety, substance use disorders, suicide[2][3] |
| Causes | Genetic and environmental factors[2][4] |
| Diagnostic method | Based on person's medical history[5] |
| Differential diagnosis | Anorexia, binge eating disorder, Kleine-Levin syndrome, borderline personality disorder[5] |
| Treatment | Cognitive behavioral therapy[2][6] |
| Medication | Selective serotonin reuptake inhibitors, tricyclic antidepressant[4][7] |
| Prognosis | Half recover over 10 years with treatment[4] |
| Frequency | 3.6 million (2015)[8] |
Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging or fasting, and excessive concern with body shape and weight.[9][2] This activity aims to expel the body of calories eaten from the binging phase of the process.[9] Binge eating refers to eating a large amount of food in a short amount of time.[2] Purging refers to the attempts to get rid of the food consumed.[2] This may be done by vomiting or taking laxatives.[2]
Other efforts to lose weight may include the use of diuretics, stimulants, water fasting, or excessive exercise.[2][4] Most people with bulimia are at normal weight.[1] The forcing of vomiting may result in thickened skin on the knuckles, breakdown of the teeth, and effects on metabolic rate and caloric intake which cause thyroid dysfunction.[2][10] Bulimia is frequently associated with other mental disorders such as depression, anxiety, borderline personality disorder,[11] bipolar disorder,[12] and problems with drugs or alcohol.[2] There is also a higher risk of suicide and self-harm.[3]
Bulimia is more common among those who have a close relative with the condition.[2] The percentage risk that is estimated to be due to genetics is between 30% and 80%.[4] Other risk factors for the disease include psychological stress, cultural pressure to attain a certain body type, poor self-esteem, and obesity.[2][4] Living in a culture that commercializes or glamorizes dieting and having parental figures who fixate on weight are also risks.[4]
Diagnosis is based on a person's medical history;[5] however, this is difficult, as people are usually secretive about their binge eating and purging habits.[4] Further, the diagnosis of anorexia nervosa takes precedence over that of bulimia.[4] Other similar disorders include binge eating disorder, Kleine–Levin syndrome, and borderline personality disorder.[5]
Signs and symptoms
Bulimia typically involves rapid and out-of-control eating, which may stop when the person is interrupted by another person or the stomach hurts from over-extension, followed by self-induced vomiting or other forms of purging. This cycle may be repeated several times a week or, in more serious cases, several times a day[14] and may directly cause:
- Chronic gastric reflux after eating, secondary to vomiting[15]
- Dehydration and hypokalemia due to renal potassium loss in the presence of alkalosis and frequent vomiting[16]
- Electrolyte imbalance can lead to abnormal heart rhythms, cardiac arrest, and even death
- Esophagitis, or inflammation of the esophagus
- Mallory-Weiss tears
- Boerhaave syndrome, a rupture in the esophageal wall due to vomiting
- Oral trauma, in which repetitive insertion of fingers or other objects causes lacerations to the lining of the mouth or throat
- Russell's sign: calluses on knuckles and back of hands due to repeated trauma from incisors[17][18]
- Perimolysis, or severe dental erosion of tooth enamel[19]
- Swollen salivary glands (for example, in the neck, under the jawline)[19][20]
- Gastroparesis, or delayed gastric emptying
- Constipation or diarrhea
- Tachycardia or palpitations
- Hypotension
- Peptic ulcers
- Infertility
- Constant weight fluctuations are common
- Elevated blood sugar, cholesterol, and amylase levels may occur
- Hypoglycemia may occur after vomiting
These are some of the many signs that may indicate whether someone has bulimia nervosa:[21]
- A fixation on the number of calories consumed
- A fixation on an extreme consciousness of one's weight
- Low self-esteem and/or self-harming
- Suicidal tendencies
- An irregular menstrual cycle in women
- Regular trips to the bathroom, especially soon after eating
- Depression, anxiety disorders, and sleep disorders
- Frequent occurrences involving the consumption of abnormally large portions of food[22]
- The use of laxatives, diuretics, and diet pills
- Compulsive or excessive exercise
- Unhealthy/dry skin, hair, nails, and lips
- Fatigue, or exhaustion
As with many psychiatric illnesses, delusions can occur, in conjunction with other signs and symptoms, leaving the person with a false belief that is not ordinarily accepted by others.[23]
People with bulimia nervosa may also exercise to a point that excludes other activities.[23]
- ^ a b Bulik CM, Marcus MD, Zerwas S, Levine MD, La Via M (October 2012). "The changing "weightscape" of bulimia nervosa". The American Journal of Psychiatry. 169 (10): 1031–6. doi:10.1176/appi.ajp.2012.12010147. PMC 4038540. PMID 23032383.
- ^ a b c d e f g h i j k l m "Bulimia nervosa fact sheet". Office on Women's Health. July 16, 2012. Archived from the original on June 19, 2015. Retrieved June 27, 2015.
- ^ a b Smink FR, van Hoeken D, Hoek HW (August 2012). "Epidemiology of eating disorders: incidence, prevalence and mortality rates". Current Psychiatry Reports. 14 (4): 406–14. doi:10.1007/s11920-012-0282-y. PMC 3409365. PMID 22644309.
- ^ a b c d e f g h i Hay PJ, Claudino AM (July 2010). "Bulimia nervosa". BMJ Clinical Evidence. 2010: 1009. PMC 3275326. PMID 21418667.
- ^ a b c d American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 345–349. ISBN 978-0-89042-555-8.
- ^ Cite error: The named reference
Hay2013was invoked but never defined (see the help page). - ^ Cite error: The named reference
Mc2012was invoked but never defined (see the help page). - ^ Cite error: The named reference
GBD2015Prewas invoked but never defined (see the help page). - ^ a b Flett GL, Newby J, Hewitt PL, Persaud C (September 2011). "Perfectionistic Automatic Thoughts, Trait Perfectionism, and Bulimic Automatic Thoughts in Young Women". Journal of Rational-Emotive & Cognitive-Behavior Therapy. 29 (3): 192–206. doi:10.1007/s10942-011-0135-3. S2CID 144731404.
- ^ biologicalpsychiatryjournal.com/article/0006-3223(93)90168-D/fulltext
- ^ Hessler, Johannes Baltasar; Heuser, Jörg; Schlegl, Sandra; Bauman, Tabea; Greetfeld, Martin; Voderholzer, Ulrich (2019). "Impact of comorbid borderline personality disorder on inpatient treatment for bulimia nervosa: Analysis of routine data". Borderline Personality Disorder and Emotion Dysregulation. 6: 1. doi:10.1186/s40479-018-0098-4. PMC 6335811. PMID 30680217.
- ^ McElroy SL, Kotwal R, Keck PE, Akiskal HS (June 2005). "Comorbidity of bipolar and eating disorders: distinct or related disorders with shared dysregulations?". J Affect Disord. 86 (2–3): 107–27. doi:10.1016/j.jad.2004.11.008. PMID 15935230.
- ^ Dorfman J, The Center for Special Dentistry Archived February 11, 2015, at the Wayback Machine.
- ^ "Bulimia Nervosa" (PDF). Let's Talk Facts: 1. 2005. Archived from the original (PDF) on March 19, 2015. Retrieved September 13, 2013.
- ^ Mehler PS (August 2003). "Clinical practice. Bulimia nervosa". The New England Journal of Medicine. 349 (9): 875–81. doi:10.1056/NEJMcp022813. PMID 12944574.
- ^ Mehler PS, Crews C, Weiner K (2004). "Bulimia: medical complications". Journal of Women's Health. 13 (6): 668–75. doi:10.1089/jwh.2004.13.668. PMID 15333281.
- ^ Joseph AB, Herr B (May 1985). "Finger calluses in bulimia". The American Journal of Psychiatry. 142 (5): 655a–655. doi:10.1176/ajp.142.5.655a. PMID 3857013.
- ^ Wynn DR, Martin MJ (October 1984). "A physical sign of bulimia". Mayo Clinic Proceedings. 59 (10): 722. doi:10.1016/s0025-6196(12)62063-1. PMID 6592415.
- ^ a b "Eating Disorders". Oral Health Topics A–Z. American Dental Association. Archived from the original on February 3, 2009.
- ^ Mcgilley BM, Pryor TL (June 1998). "Assessment and treatment of bulimia nervosa". American Family Physician. 57 (11): 2743–50. PMID 9636337.
- ^ "Symptoms Of Bulimia Nervosa". Illawarra Mercury. February 23, 2001. Archived from the original on February 21, 2016.
- ^ "Bulimia Nervosa". Proud2BME. The National Eating Disorders Association. Archived from the original on December 10, 2014. Retrieved December 5, 2014.
- ^ a b Barker P (2003). Psychiatric and Mental Health Nursing: The Craft of Caring. Great Britain: Arnold. ISBN 978-0340810262.[page needed]