-IBIS-1.5.0-
tx
mental/emotional
bulimia
diagnoses
definition and etiology
definition: An eating disorder characterized by perverted ideas towards food and eating, obsession with thinness and a morbid fear of weight gain. Also characterized by the repetitive, compulsive habit of eating a normal or excessive amount of food only to self-induce vomiting and/or use laxatives in an effort to purge what has been ingested. The patients generally know that their behavior is abnormal, yet have a great fear that they cannot control the binging: when they are finally done eating, they feel markedly depressed and guilty. Low self-esteem may follow: with a negative view of themselves and their bodies: setting into play the next cycle of binging/purging.
etiology: Eating disorders such as bulimia and anorexia nervosa (to which bulimia is closely related) are on the increase in western society: it is estimated that 18-25% of college women have one or both of these problems. The typical patient is white and female (males account for only 5% of patients), and come from a middle or upper class family. Bulimia is rare in lower socioeconomic persons and in Blacks and Orientals.
Binge eating generally occurs daily, with one study showing that in 40 bulimic patients the mean times of binging per week was 12 (with a range from 1 to 46). The eating period usually lasted 1.2 hours, though could go on for as long as 8 hours. Caloric consumption could be extremely high: up to 50,000: though the average amount of calories ingested was 3,500. The five most favorite food items eaten were ice cream, bread, candy, donuts, and soft drinks. Patients are often ashamed and embarrassed about their eating and purging habits and live a life of secrecy, to the extent that friends and family are unaware of the patient's problems.
The cause is unknown. Factors that may be responsible for the condition include a hypothalamic problem, psychiatric disorders such as depression, peer pressure, nutritional deficiencies, and cultural and/or familial attitudes about the body. Binge-purge patients have a higher incidence of dysfunctional families than in the general population, notably families with affective disorders, alcoholism, and recreational drug use.
May be related to hypoglycemia where sympathetic compensation is interfering with gall bladder function. (Easley)
signs and symptoms
signs and symptoms:
Depression: with possible suicidal tendency.
Near normal weight: with a history of fluctuations.
Amenorrhea in about 50% of women.
Wounds or scars on dorsal aspect of hand due to scraping hand against teeth when putting it down throat to initiate vomiting.
Dental caries from stomach acid in vomitus and from high intake of sweet foods.
Constipation based on chronic laxative use (dependency on laxatives for defecation).
Insomnia.
lab findings:
Hypokalemia with metabolic acidosis due to vomiting and laxative use.
May see low zinc status.
(+) psychological testing for depression, or other mental/emotional disorder.
course and prognosis
The prognosis for bulimia is worse than that of anorexia nervosa because the associated mental/emotional problems tend to be more severe. The suicide rate in bulimia is twice that for anorexia nervosa. Other causes of a higher mortality rate include the sequelae of chronic vomiting: aspiration pneumonia, gastric or esophageal rupture, acute gastric dilation, and pancreatitis.
differential diagnosis
other causes of polyphagia
footnotes