Bulimia Nervosa

Bulimia nervosa is an eating disorder whereby a person eats large amounts of food and then free their bodies of the excess calories by acts like vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively.^[1]

Epidemiology

In the United States, the prevalence of bulimia nervosa is 1%. Lifetime prevalence is 0.5% for males and 1.5% for females. Females are more affected than males with female-to-male ratio of 10:1. The mean age of onset is 19.7.^[2]

Diagnostic Criteria

 In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), the diagnostic criteria for bulimia nervosa is as follows^[2]:

• 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-h 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)

• 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.
• The binge eating and inappropriate compensatory behaviours both occur, on average, at least twice a week for 3 months.
• Self-evaluation is unduly influenced by body shape and weight.
• The disturbance does not occur exclusively during episodes of anorexia nervosa.

Causes

Exact cause is unclear. Genes, cultural pressures and psychological factors like having low self esteem may be contributory. A history of sexual abuse is reported in some cases.

Symptoms

Binge eating signs and symptoms include lack of control over eating, secrecy surrounding eating unusually large amounts of food, disappearance of food as signified by numerous empty wrappers and alternating between overeating and fasting. Purging signs and symptoms include going to bathroom after meals, smell of vomitus, use of laxatives, diuretics or enemas and excessive exercising. Physical signs and symptoms include calluses or scars on the knuckles or hands, puffy chipmunk cheeks, stained teeth, being normal weight or slightly overweight and frequent fluctuations in weight.^[4]

Diagnosis

Patient's medical history is obtained.  Physical examination may reveal signs of the illness such as dry mouth and calluses. Blood tests may show electrolyte imbalance like hypokalemia.^[5]

Treatment

Patients are rarely hospitalized. Cognitive-behavioural therapy (CBT) and nutritional therapy are necessary. Antidepressants are often used. Social support is extremely important.^[5]

References:

1. http://psychcentral.com/disorders/sx3.htm
2. http://emedicine.medscape.com/article/286485-overview
3. http://www.umm.edu/altmed/articles/bulimia-nervosa-000020.htm
4. http://www.helpguide.org/mental/bulimia_signs_symptoms_causes_treatment.htm
5. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001381/

Alternative Treatment Efficacy According to GRADE* Ranking:

Creative Art Therapy (Expressive Therapy)

Recomendation: Weakly in favor (Studies have shown the benefits of Expressive Therapy on eating disorders like Bulimia Nervosa)

Grade of Evidence: very low quality of evidence

* www.gradeworkinggroup.org