oakwood_house Three types of people in the world: those who make things happen, those who watch what happens and those who say "what happened?"
12 days ago via web
oakwood_house "Independence? That's middle class blasphemy. We are all dependent on one another, every soul of us on earth." George Bernard Shaw
14 days ago via web
oakwood_house "Kindness is more important than wisdom, and the recognition of this is the beginning of wisdom." T.J. Rubin
16 days ago via web
Bulimia
What is it?The effects of bulimia
What causes bulimia?
Treatment of bulimia
References
What is it?
Bulimia Nervosa, usually called bulimia, is more common than anorexia. Studies show bulimia may affect in 1 in 100 of the British population and that 90% of those diagnosed are female (Hay, Bacaltchuk and Stefano, 2004). Bulimia generally effects adolescents and young adults, but also occurs in children and adults. People with bulimia experience regular episodes of overeating, typically in far larger quantities than would be considered normal. These episodes are called "binges" or "binge eating," and are generally experienced as being out of the individual's control. Diagnostic criteria for bulimia state that episodes of binge eating should occur at least twice a week (APA, DSM-IV, 1994) but some individuals with bulimia-like symptoms experience binge eating at irregular or less frequent intervals.
Bulimia is also characterised by the regular occurrence of inappropriate weight control behaviours such as self-induced vomiting; misuse of laxatives, diuretics, enemas or emetics; misuse of diet pills, amphetamines, insulin or thyroxine; fasting or misuse of ketosis-inducing meal replacement products; and/or excessive exercise. These weight control measures are commonly used to compensate for binges in an attempt to prevent weight gain, but may also occur at other times other than after an episode of binge eating. In diagnostic terms, bulimia has been divided into two subtypes: purging and non-purging (APA, DSM-IV, 1994). This division separates weight control/compensatory behaviours into those that involve elimination (vomiting, laxative abuse and the like) from those that do not (such as excessive dieting or exercise). This division can be confusing and is not commonly used (van Hoeken, et.al., 2009).
People with bulimia generally place excessive importance on their efforts to control their weight or shape. As a result they may fear gaining weight, may experience a perpetual drive to lose weight, or be chronically dissatisfied or preoccupied with their body image.
People with bulimia are usually of a healthy weight (BMI 19-25), despite their distorted eating patterns. While the symptom of their eating disorder are generally valued by people with anorexia, people with bulimia generally feel guilt and shame about binge eating and purging. They often go to lengths to hide the symptoms of the illness from others, even while being highly preoccupied with thoughts about food and eating, and spending a great deal of time planning and carrying out episodes of binge eating or purging. Other people with bulimia will leave signs of binge eating or purging behaviour for others to find (NCCMH, 2004).
Back to topThe effects of bulimia
The medical consequences of bulimia are numerous and can be severe. Frequent purging by vomiting or laxative abuse can lead to electrolyte imbalance. Electrolytes are essential minerals, including potassium, sodium, chloride and magnesium. A fine balance of electrolytes in the body is necessary for normal nerve and muscle function and proper fluid regulation. Electrolyte imbalance can lead to cardiac irregularities, neurological problems, generalised weakness, confusion and memory impairment, mood swings, and ultimately, cardiac arrest or kidney failure. Purging by vomiting can cause esophageal damage, fluid retention and edema, swollen salivary glands, erosion of tooth enamel and ultimately extensive dental damage. Purging by laxative abuse can lead to severe constipation, laxative dependence and intestinal problems, as well as cardiac and electrolyte disturbances, and anemia. Laxatives containing phenolphthalein suppress bone marrow and damage blood cell production. Binge eating can lead to gastric dilation and in extreme cases, gastric rupture. People with bulimia develop pancreatitis and peptic ulcers at higher than expected frequency (Zerbe, 1995). People with bulimia have a higher than average risk of also developing drug or alcohol over-use or dependence (Wilson, 1993).
Psychologically, bulimia can cause lowered self-esteem, mood swings, social withdrawal, family problems and other interpersonal difficulties. People with bulimia may experience problems in employment. For some people with bulimia, carrying out the cycles of binge eating and compensatory behaviours can take up most of their time and energy. Binge eating tends to be accompanied by feelings of emotional numbness or complete loss of control, and purging behaviour tends to be accompanied by a feeling of relief or release of tension.
What causes bulimia?
The causes of bulimia are similar to the causes of anorexia. Research indicates there may be genetic or hereditary influences on eating disorders (Klump, et.al., 2009). Some people develop bulimia after experiencing symptoms of anorexia. Others may develop bulimia during a period of excessive dieting. Some people develop bulimia because a parent has an active eating disorder. Psychological vulnerabilities may include a personal history of depression, anxiety, low self-esteem, obsessive or compulsive traits; or a family history of psychological illness, body-image preoccupation and dieting, or drug or alcohol abuse. People with bulimia may tend to have a dichotomous, "all or nothing" thinking style which leads to a dichotomous eating style. Social vulnerabilities include being female, being bullied about weight or being overweight as a child, the demands of life-stage transitions (such as starting university or leaving home), experience of loss (such as parental separation or the death of a loved one), or experience of abuse or trauma.
Back to topTreatment of bulimia
Current NICE Guidelines for the treatment of bulimia (NCCMH, 2004) recommends a form of cognitive behaviour therapy specifically devised for the treatment of bulimia and binge eating, CBT-BN (Fairburn, Marcus and Wilson, 2003). This form of CBT can also be used in a self-help format (Fairburn, 1995). A review of recent studies of the effectiveness of psychotherapy for bulimia and binge eating (Hay, Bacaltchuk and Stefano, 2004) concluded that CBT self-help conducted with guidance from professionals had better results than self-help undertaken without any form of assistance. This review also concluded that interpersonal psychotherapy (e.g. Weissman, Markowitz and Klerman, 2000) was also an effective treatment, although it possibly takes longer than CBT to produce similar results. NICE Guidance suggests that a simplified form of dialectical behavior therapy (DBT) may also be as effective as CBT in reducing episodes of binge eating or purging. On the other hand there is little or no evidence that "focal supportive psychotherapy," (bespoke therapy without a standard format) has any impact on remission rates (NCCMH, 2004, p. 122).
The manual for an updated, transdiagnostic form of CBT-BN, called Enhanced CBT for Eating Disorders (CBT-E) has recently been published (Fairburn, 2008) and early studies using this form of CBT with people who have binge eating and purging symptoms are promising (Fairburn et.al., 2009).
A particular type of antidepressant medication called fluoxetine has been shown to have beneficial effects in reducing the urge to binge for some people with binge eating disorders (NCCMH, 2004), and is the only medication licensed specifically for the symptoms of bulimia.
References
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association.
Fairburn, C.G. (1995). Overcoming Binge Eating. London: Guilford.
Fairburn, C.G. (2008). Cognitive Behavior Therapy and Eating Disorders. London: Guilford.
Fairburn, C.G., Marcus, M.D. ∠ Wilson, G.T. (2003). Cognitive behavioral therapy for binge eating and bulimia nervosa: A comprehensive treatment manual. In Fairburn, C.G. and Wilson, G.T. (Eds), Binge Eating: Nature, Assessment and Treatment. New York: Guilford.
Hay, P.J., Bacaltchuk, J. and Stefano, S. (2004). Psychotherapy for bulimia nervosa and binging. Cochrane Database of Systematic Reviews, Issue 3, Art No.: CD000562. DOI: 10.1002/14651858.CD000562.pub.2.
Klump, K.L., Suisman, J.L., Burt, S.A., McGue, M. and Iacono, W.G. (2009). Genetic and environmental influences on disordered eating: An adoption study. Journal of Abnormal Psychology, 118, No. 4, 797-805.
National Collaborating Centre for Mental Health (NICE) (2004). Eating Disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. National Clinical Guideline No. CG9. BPS and Gaskell.
Weissman, M.M., Markowitz, J.C. and Klerman, G.L. (2000). Comprehensive Guide to Interpersonal Psychotherapy. New York: Basic Books.
van Hoeken, D., Veling, W., Sinke, S., Mitchell, J.E. and Hoek, H.W. (2009). The Validity and Utility of Subtyping Bulimia Nervosa. International Journal of Eating Disorders, 42, 595-602.
Wilson, G.T. (1993). Binge eating and addictive disorders. In Fairburn, C.G. and Wilson, G.T. (Eds), Binge Eating: Nature, Assessment and Treatment. New York: Guilford.
Zerbe, K.J. (1995). The Body Betrayed: Women, Eating Disorders, and Treatment. Carlsbad, CA, USA: Gurze Books.