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Bulimia nervosa, or simply bulimia, is an eating disorder.

People with bulimia consume large amounts of food in a short time (usually less than 2 hours). These food-binges often occur in secret and involve high calorie, high carbohydrate foods that can be eaten quickly, like ice cream, doughnuts, candy, popcorn, and cookies. After these binge episodes, most bulimics (80-90 per cent) 'purge' their bodies of the excess calories by vomiting, abuse of laxatives or diuretics. A smaller number of bulimia sufferers resort to other methods of eliminating these excess calories, like extreme exercise or fasting. A few bulimics use a combination of purging and non-purging methods. Those who resort to extreme fasting-bingeingvomiting may be suffering from both anorexia as well as bulimia. This is a particularly hazardous combination of eating disorders. The use of vomiting by bulimics can easily become addictive. Although in the first instance they may have done it to get rid of excess food calories, it soon becomes a form of security. They are afraid to stop because they fear their eating habits are out of control and without the use of vomiting they fear they will become grossly overweight. Usually, such self-induced vomiting does not lead to the expected weight loss. The body simply adapts. This can lead the bulimic to resort to even more extreme purging measures. Who suffers from bulimia nervosa? Bulimia typically begins between the ages of 12 and 21 years. It occurs in both sexes, but most often in women. Many bulimics maintain fairly normal or high normal body weight, but some experience significant weight fluctuations. The typical bulimic is a white, single, female, high school or college student. A separate category of bulimia sufferers are athletes who are involved in sports/activities with stringent weight-conditions, like gymnastics, ballet, boxing etc The medical consequences of bulimia Bulimia is extremely harmful to the body. The exact medical consequences will depend on the type of purging behavior used and the length of time (and severity) involved. Repeated vomiting causes loss of water (causing dehydration), and loss of minerals like sodium and potassium (causing electrolyte imbalance), as well as trauma. In addition, vomiting can lead to tears in the lining of the throat, esophagus and stomach (ulcers). Also it erodes tooth enamel due to the stomach acid vomited with the food (causing cavities). Over-use/ abuse of laxatives and diuretics causes loss of sodium and potassium (causing increased risk of heart damage) as well as seriously irregular bowel movements and constipation.

Like individuals with anorexia, many people with bulimia suffer from clinical depression, anxiety, obsessive compulsive disorder (OCD), and other psychiatric conditions. These problems, combined with their impulsive tendencies, place them at higher risk of suicide. What is the treatment for bulimia Like anorexia and binge eating, bulimia is a psychological condition with dietary consequences. Therefore, the treatment of bulimia involves sorting out both psychological and dietary needs of the person, in order to restore normal behavior patterns and a healthy approach to diet and weight control. Similar to the treatment for anorexia and binge eating, the treatment of bulimics is usually conducted by a team of medical, nutritional, and mental health professionals, who evaluate the underlying symptoms and provide care. In a nutshell, a bulimic needs to learn other, healthier ways to eat and to control their weight. They must learn that good food and a healthy diet will not make them fat. They also need to understand and manage the triggers/ situations that cause them to binge in the first place. Warning signs of bulimia If you think that your loved one might be in danger from bulimia, here are some warning signs to watch out for. Disappearance of large amounts of food in short periods of time or evidence of wrappers and containers indicating the consumption of large amounts of food. Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics. Excessive, rigid exercise regimen-the feeling to "burn off" calories taken in despite weather, fatigue, illness, or injury. Unusual behavior and/or attitudes indicating that weight loss, dieting, and control of food are becoming overriding concerns. Unusual swelling of the cheeks or jaw area. Discoloration or staining of the teeth. Always remember that most bingeing and purging occurs in secret, or in the company of a very close friend.

How family and friends can help Having spoken with many individuals suffering from bulimia, I advise the following: 1. Bulimia is a serious illness. Do not wait for it to 'go away' or try to treat it yourself. Instead, seek professional medical assistance at the earliest possible opportunity. 2. If you have a loved one whom you suspect of having a binge eating disorder, tell them you are worried about their health and offer to accompany them on a visit to

their doctor. Look for eating disorder clinics in your local phone book. In addition, many college or university campuses have support groups for people with eating disorders. 3. Be supportive and non-judgmental. Remember, like binge-eating, bulimia has nothing to do with personal weakness or greed - it is a psychological issue. It could just as easily happen to you.

Etiology:The etiology of bulimia has been associated with genetic, physiological, psychological, and environmental factors. Several hypotheses exist concerning a physiologic explanation for bulimia, suggesting specific chemical abnormalities in the body. One hypothesis involves abnormalities of serotonergic function. Serotonin is involved in the development of satiety. It is believed to increase postprandial satiety rather than directly decreasing appetite. Disturbances in serotonergic function or low levels of serotonin may be responsible for blunting the sensation of satiety and prolonging periods of food ingestion. Another possible pathophysiology involves the presence of increased levels of peptides, specifically, pancreatic polypeptide PYY, known to increase appetite. Increased levels of PYY have been found in some individuals with bulimia.32 Both obesity and a history of dieting are risk factors for bulimia. Individuals with bulimia have eating binges during or immediately following a diet. Psychological factors and family history of eating disorders also appear to be related to the development of bulimia. Depression, affective disorders, anxiety disorders, substance abuse, and a history of sexual abuse may increase the chances of developing bulimia.21,32 Like individuals with anorexia, athletes and models are thought to be at risk for developing bulimia. These individuals are often placed in front of crowds and judges, which may lead to a preoccupation with weight and body image. Assessment and diagnosis of bulimia may be difficult given that many individuals with this condition appear to be of normal weight and tend to avoid disclosing their bingeing and purging behaviors. Furthermore, there is no specific laboratory study that will diagnose bulimia. A screening tool that is used in the United Kingdom on individuals suspected of having bulimia appears in Table IV. The five items, called the SCOFF (sick, control, one, fat, food) questionnaire, are designed to identify key features of anorexia and bulimia. Morena states that the falsepositive rate is 12.5% and that the sensitivity rate is very high.32 One point is awarded for each yes response. A score greater than two indicates a likely case of anorexia or bulimia. In suspected cases of bulimia, a body chemistry panel may be used to determine if electrolyte imbalances are present. A cardiac assessment is warranted for individuals who use ipecac to purge. Electromyography should be considered if abuse of ipecac is suspected, or the individual has symptoms suggesting hypokalemia or arrhythmias. Gastric motility studies are recommended for individuals with a prolonged history of bulimia, a history of constipation, or other unexplained abdominal pain. DSM:-

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: (1) Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and

under similar circumstances. (2) A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications; fasting, or excessive exercise. C. The binge eating and inappropriate compensatory behaviors occur, on average, at least twice a week for three months. D. Self-evaluation is unduly influenced by body shape and weight. E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa. Eating disorder:Eating disorders refer to a group of conditions characterized by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and emotional health, binge eating disorder, bulimia nervosa, anorexia nervosa being the most common specific forms in the United States.[1] Though primarily thought of as affecting females (an estimated 510 million being affected in the U.S.), eating disorders affect males as well (an estimated 1 million U.S. males being affected).[2][3][4] Although eating disorders are increasing all over the world among both men and women, there is evidence to suggest that it is women in the Western world who are at the highest risk of developing them and the degree of westernization increases the risk. [5]

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