Diagnostic criteria for
307.51 Bulimia Nervosa
( cautionary statement )
A person suffering with Bulimia Nervosa consume large amounts of food and then rid their bodies of the excess calories by vomiting, utilising laxatives or diuretics, taking enemas, or excessive exercising. Many sufferers will use a combination of all these forms of purging and "binge and purge" in secret to maintain normal or above normal body weight. In many cases these sufferers may successfully hide their problem from others for years.
Anorexics frequent binges and purges, is common, which can range from once or twice a week to several times a day. Dieting heavily between episodes of binging and purging is also a practice adopted. Eventually, half of those with anorexia will develop bulimia.
As with anorexia, bulimia typically begins during adolescence. The condition occurs most often in women but is also found in men. Many individuals with bulimia, ashamed of their strange habits, do not seek help until they reach their thirties or forties. By this time, their eating behavior is deeply ingrained and more difficult to change.
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 both occur, on average, at least twice a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa .
Specify type:
Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
Associated Features:
Depressed Mood
Somatic or Sexual Dysfunction
Addiction
Dramatic or Erratic or Antisocial Personality
Differential Diagnosis:
Some disorders display similar or sometimes even the same symptom. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which one needs to be ruled out to establish a precise diagnosis.
Anorexia Nervosa.
Binge-Eating/Purging Type.
Kleine-Levin Syndrome.
Major Depressive Disorder, with Atypical Features.
Borderline Personality Disorder.
Cause:
The self esteem of individuals with eating disorders is directly related to their body shape, and weight. This eating disorder often lead to diminished concentration and attention leaving one less able to focus on academic course or professional work. Preoccupation with food and body image result in feelings of anxiety which may also interfere with daily functioning. In severe cases medical problems may arise such as hypotension, dental enamel erosion, malnutrition, impaired renal functioning, electrolyte imbalance, and cardiovascular problems which require medical attention and possible hospitalization.
Treatment:
Counseling and Psychotherapy:
Education about medical complications, supportive and cognitive behavioral therapy and nutritional counseling is extremely important.
Psychotherapeutic interventions may include individual or group therapy. Often simply beginning a course of treatment will result in a feeling of relief at no longer having to keep such an important part of one's life a secret. The focus of psychotherapy is often on improving self-esteem, but may be supplemented with nutrition education, discussions of eating habits, exploration of the role that food and eating play in one's life and underlying family and interpersonal dynamics
Pharmacotherapy:
May include medical stabilization.
Prozac. May lessen the number of binge episodes and associated dysphoria. Treat comorbid depression if present. Hospitalization in a minority of patients (admission criteria similar to those of anorexia nervosa except for weight loss). |