INTRODUCTION

Bulimia nervosa is an eating disorder characterized by restraining of food intake for a period of time followed by an over intake or binging period that results in feelings of guilt and low self-esteem. The median age of onset is 18. Sufferers attempt to overcome these feelings in a number of ways.[1] the most common form is defensive vomiting, sometimes called purging; fasting, the use of laxatives, enemas, diuretics, and over exercising are also common.[2] Bulimia nervosa is nine times more likely to occur in women than men (Barker 2003). Antidepressants, especially SSRIs are widely used in the treatment of bulimia nervosa. Bulimia nervosa is an eating disorder worked by consumption in large quantities of food is one setting. Their victims are usually teenage girls and young women. Another disorder, anorexia is characterized by a rapid and substantial weight loss due to self-starvation or extreme dieting. Some individuals may exhibit eating patterns of both bulimia and anorexia. This is referred to or bulimarexia. Since 1980, these disorders have increased at a rate unparalleled in medical history. It is now estimated that one out of five college-going women suffer from bulimia and in every one hundred teenage girls or young women exhibits anorexic habits. Treatment is most successful when medical therapy and psychotherapy are combined. Best education and information dissemination are provided. Psychological counseling is used to treat these disorders. It is important to consult a doctor if an eating disorder is suspected. This medical problem can result nutritional deficiencies and hormonal changes and irregulaties. This behavior appears to stem from a compulsive desire for perfection, pair self image and stressful family relationships. The word bulimia derives from the Latin (blmia), which originally comes from the Greek (boulmia; ravenous hunger), a compound of (bous), ox + (lmos), hunger.[3] Bulimia nervosa was named and first described by the British psychiatrist Gerald Russell in 1979.

UNDERSTANDING BULIMIA NERVOSA

Bulimia Nervosa is a disorder in which a person eats excessive amounts of food often in secret. People with this disease have repeated uncontrollable urges to eat high calorie of foods after over eating, they sometimes try to prevent weight gain by making themselves vomit or by using drugs such as laxatives or diuretics.

SIGNS AND SYMPTONS These cycles often involve rapid and out-of-control eating, which may stop when the bulimic is interrupted by another person or the stomach hurts from overextension, followed by self-induced vomiting or other forms of purging. This cycle may be repeated several times a week or, in more serious cases, several times a day,[1] and may directly cause:

Chronic gastric reflux after eating Dehydration and hypokalemia caused by frequent vomiting

Electrolyte imbalance, which can lead to cardiac arrhythmia, cardiac arrest, and even death

Esophagitis, or inflammation of the esophagus

Oral trauma, in which repetitive insertion of fingers or other objects causes lacerations to the lining of the mouth or throat

Gastroparesis or delayed emptying Constipation, infertility and Peptic ulcers Enlarged glands in the neck, under the jaw line Calluses or scars on back of hands due to repeated trauma from incisors[2][3] Constant weight fluctuations

___________

1.Barker, P (2003) Psychiatric and Mental Health Nursing: The Craft of Caring Arnold, Great Britain. 2.Fairburn, Christopher G. (1995). Overcoming binge eating. New York: Guilford Press. ISBN 0-89862179-8. 3. Douglas Harper (November 2001). "Online Etymology Dictionary: bulimia". Online Etymology Dictionary. Retrieved 2008-04-06.

The frequent contact between teeth and gastric acid, in particular, may cause:

Severe dental erosion Perimolysis, or the erosion of tooth enamel[4] Swollen salivary glands

As with many psychiatric illnesses, delusions can occur with other signs and symptoms leaving the person with a false belief that is not ordinarily accepted by others.[5] The person may also suffer physical complications such as tetany, epileptic seizures, cardiac arrhythmias and muscle weakness. People with bulimia nervosa may also exercise to a point that excludes other activities [6]

Signs and tests A dental exam may show dental cavities or gum infections (such as gingivitis). The enamel of the teeth may be eroded or pitted because of excessive exposure to the acid in vomit. A physical examination may also reveal:

Broken blood vessels in the eyes (from the strain of vomiting) Dry mouth, rashes and pimples

Pouch-like appearance to the corners of the mouth due to swollen salivary glands Small cuts and calluses across the tops of the finger joints due to selfinduced vomiting

_______________

4.Palme^ r R (December 2004). "Bulimia nervosa: 25 years on".The British Journal of Psychiatry : the Journal of Mental Science185: 4478. doi:10.1192/bjp.185.6.447. PMID 15572732. 5.Eating Disorders. Let's Talk About. American Psychiatric Association. 2005. ISBN 0-89042-352-0. 6.Joseph AB, Herr B (May 1985). "Finger calluses in bulimia".The American Journal of Psychiatry 142 (5): 655.PMID 3857013.

Causes, incidence, and risk factor

Many more women than men have bulimia, and the disorder is most common in adolescent girls and young women. The affected person is usually aware that her eating pattern is abnormal and may experience fear or guilt with the binge-purge episodes. The exact cause of bulimia is unknown. Genetic, psychological, trauma, family, society, or cultural factors may play a role. Bulimia is likely due to more than one factor.

Treatment People with bulimia rarely need to be hospitalized, except under the following circumstances:

Binge-purge cycles have led to anorexia Drugs are needed for withdrawal from purging Major depression is present

Most often, a stepped approach is taken for patients with bulimia. This treatment approach follows specific stages, depending on the severity of the bulimia, and the person's response to treatments: Support groups may be helpful for patients with mild conditions who do not have any health problems.

Cognitive-behavioral therapy (CBT) and nutritional therapy is the preferred first treatment for bulimia that does not respond to support groups.

Drugs used for bulimia are typically antidepressants known as selective serotonin-reuptake inhibitors (SSRIs). A combination of CBT and SSRIs is very effective if CBT is not effective alone.

Patients may drop out of programs if they have unrealistic expectations of being "cured" by therapy alone. Before a program begins, the following should be made clear: A number of therapies are likely to be tried until the patient succeeds in overcoming this difficult disorder.

It is common for bulimia to return (relapse), and this is no cause for

despair. The process is painful and requires hard work on the part of the patient and the patient's family.

Support Groups Self-help groups like Overeaters Anonymous may help some people with bulimia. The American Anorexia/Bulimia Association is a source of information about this disorder. See: Eating disorders - support group Expectations (prognosis) Bulimia is a chronic illness and many people continue to have some symptoms despite treatment. People with fewer medical complications of bulimia, and who are willing and able to engage in therapy, tend to have a better chance of recovery.

Complications Bulimia can be dangerous and may lead to serious medical complications over time. For example, frequent vomiting puts stomach acid in the esophagus (the tube from the mouth to the stomach), which can permanently damage this area. Possible complications include:

Constipation Dehydration Dental cavities Electrolyte abnormalities Hemorrhoids Inflammation of the throat Pancreatitis Tears of the esophagus from excessive vomiting

Calling your health care provider Call for an appointment with your health care provider if you (or your child) have symptoms of an eating disorder.

Prevention

Less social and cultural emphasis on physical perfection may eventually help reduce the frequency of this disorder.

Related disorders Bulimics are much more likely than non-bulimics to have an affective disorder, such as depression or general anxiety disorder: A 1985 Columbia University study on female bulimics at New found 70% had suffered depression some time in their lives (as opposed to 25.8% for adult females in a control sample from the general population), rising to 88% for all affective disorders combined.[7] Another study by the Royal Children's Hospital in Melbourne on a cohort of 2000 adolescents similarly found that those meeting at least two of the DSM-IV criteria for bulimia nervosa or anorexia nervosa had a sixfold increase in risk of anxiety and a doubling of risk for substance dependency.[8] Bulimia also has negative effects on the sufferer's dental health due to the acid passed through the mouth from frequent vomiting causing acid erosion, mainly on the posterior dental surface.

DIAGNOSIS The onset of bulimia nervosa is often during adolescence, between 13 and 20 years of age, and many cases have previously suffered obesity, with many sufferers relapsing in adulthood into episodic binging and purging even after initially successful treatment and remission.[9] According to Barker, persons with bulimia are more able to live and interact in everyday chores and tasks such as work and having relationships without the condition overly affecting their abilities.[10]

____________
7.

Eating Disorders". Oral Health Topics AZ. American Dental Association.

8. Mcgilley BM, Pryor TL (June 1998). "Assessment and treatment of bulimia nervosa". American Family Physician 57(11): 274350. PMID 9636337. 9. Barker, P (2003) Psychiatric and Mental Health Nursing: The Craft of Caring, Arnold, Great Britain. 10. Walsh BT, Roose SP, Glassman AH, Gladis M, Sadik C (1985). "Bulimia and depression". Psychosomatic Medicine47 (2): 12331. PMID 3863157.

Bulimia nervosa can be difficult to detect, compared to anorexia nervosa, because bulimics tend to be of average or slightly above or below average weight. Many bulimics may also engage in significantly disordered eating and exercising patterns without meeting the full diagnostic criteria for bulimia nervosa.[11] The diagnostic criteria utilized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR) published by the American Psychiatric Association includes repetitive episodes of binge eating (a discrete episode of overeating during which the individual feels out of control of consumption) compensated for by excessive or inappropriate measures taken to avoid gaining weight.[12] The diagnosis is made only when the behavior is not a part of the symptom complex of anorexia nervosa and when the behavior reflects an overemphasis on physical mass or appearance. There are two sub-types of bulimia nervosa: Purging type bulimics self-induce vomiting (usually by triggering the gag reflex or ingesting emetics such as syrup of ipecac) to rapidly remove food from the body before it can be digested, or use laxatives, diuretics, or enemas.

Non-purging type bulimics (approximately 6%8% of cases) exercise or fast excessively after a binge to offset the caloric intake after eating. Purging-type bulimics may also exercise or fast, but as a secondary form of weight control.[13]

Pharmacological Some researchers have hypothesized a relationship to mood disorders and clinical trials have been conducted with tricyclic antidepressants,[14] MAO inhibitors, mianserin, fluoxetine,lithium carbonate, nomifensine, trazodone, and bupropion.

__________
11.

Patton GC, Coffey C, Carlin JB, Sanci L, Sawyer S (April 2008). "Prognosis of adolescent partial

syndromes of eating disorder". The British Journal of Psychiatry 192 (4): 294doi: 10.1192/bjp.bp.106.031112. PMID 18378993. 13. Shader, Richard I. (2004). Manual of Psychiatric Therapeutics. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-4459-8

14. Barker, 2003, p. 323

Research groups who have seen a relationship to seizure disorders have attempted treatment with phenytoin, carbamazepine, and valproic acid. Opiate antagonists naloxone and naltrexone, which block cravings for gambling, have also been used.[15] There has also been some research characterizing bulimia nervosa as an addiction disorder, and limited clinical use of topiramate, which blocks cravings for opiates, cocaine, alcohol and food.[16] Researchers have also reported positive outcomes when bulimics are treated in an addiction-disorders inpatient unit.

Psychotherapy There are several empirically-supported psychosocial treatments for bulimia nervosa. Cognitive behavioral therapy (CBT), which involves teaching clients to challenge automatic thoughts and engage in behavioral experiments (for example, in session eating of "forbidden foods") has demonstrated efficacy both with and without concurrent antidepressant medication. By using CBT patients record how much food they eat and periods of vomiting with the purpose of identifying and avoiding emotional fluctuations that bring on episodes of bulimia on a regular basis (Gelder, Mayou and Geddes 2005). Barker (2003) states that research has found 40-60% of patients using cognitive behaviour therapy to become symptom free. He states in order for the therapy to work, all parties must work together to discuss, record and develop coping strategies. Barker (2003) claims by making people aware of their actions they will think of alternatives. Researchers have also reported some positive outcomes for interpersonal psychotherapy and dialectical behavior therapy.[17]

___________
15. Walsh JM, Wheat ME, Freund K (August 2000). "Detection, evaluation, and treatment of eating disorders the role of the primary care physician". Journal of General Internal Medicine 15(8): 577 90. doi:10.1046/j.1525-1497.2000.02439.x.PMID 10940151. 16 American Psychiatric Association (2000). "Diagnostic criteria for 307.51 Bulimia Nervosa". Diagnostic and Statistical Manual of Mental Disorders (4th, text revision (DSM-IV-TR) ed.).ISBN 0-89042-025-4. Retrieved 2010-03-14.

17 Barlow, David H.; Durand, Vincent Mark (2002). Abnormal psychology: an integrative approach. Belmont, CA: Wadsworth/Thomson Learning. ISBN 0-534-63362-5.

Maudsley Family Therapy a.k.a. Family Based Treatment (FBT), developed at the Maudsley Hospital in London for the treatment of anorexia nervosa (AN) has been shown to have positive results for the treatment of bulimia nervosa. FBT has been shown through empirical research to be the most efficacious treatment of AN for patients under the age of eighteen and within three years of onset of illness. The studies to date using FBT to treat BN have been promising. Some researchers have also claimed positive outcomes in hypnotherapy treatment.

Etiology Media portrayals of an 'ideal' body shape are widely considered to be a contributing factor to bulimia (Barker 2003). A survey of 1518 year-old high school girls in Nadroga, Fiji found the self-reported incidence of purging rose from 0% in 1995 (a few weeks after the introduction of television in the province) to 11.3% in 1998. Brain-derived neurotrophic factor (BDNF) is under investigation as a possible mechanism.

EPIDEMIOLOGY

There is little data on the prevalence of bulimia nervosa in-the-large, on general populations. Most studies conducted thus far have been on convenience samples from hospital patients, high school or university students. These have yielded a wide range of results: between 0.1% and 1.4% of males, and between 0.3% and 9.4% of females. Studies on time trends in the prevalence of bulimia nervosa have also yielded inconsistent results. According to Gelder, Mayou and Geddes (2005) bulimia nervosa is prevalent between 1 and 2 per cent of women aged 1540 years. Bulimia nervosa occurs more frequently in developed countries (Gelder, Mayou and Geddes 2005).There are higher rates of eating disorders in groups involved in activities which idealize a slim physique, such as dance, gymnastics, modeling, cheerleading, running, acting, rowing and figure skating. Bulimia is more prevalent among Caucasians.

CONCLUSION

Through this study, the researchers learned of about the complex nature of Bulimia Nervosa that the victims are usually teenage girls and young women from the middle and socio economic groups. The severe medical problem can result from bulimia nervosa, such as nutritional deficiencies and hormonal changes leading to menstrual irregularities. Such behaviors appear to stem from a compulsive desire for perfection, poor self: image, stressful family relationships and depression. In its extreme form, affected individuals may die from damage of vital organs, heart failure, rapture of the esophagus, or other causes. The mortality rate of these disorders is, perhaps, the highest of any conditions classified as a psychiatric disorder. Even diagnosis of these disorders is a problem. It is important to consult a doctor if an eating disorder is suspected. Treatment is most successful when medical therapy and psychotherapy is combined. In addition, the sufferer may require hospitalization and therapeutic interventions such as behavior modifications and individual or group therapy. For some information about this disorder we can do our part to help patients conquer this lifelong illness and improve their living life. Prevention is better than cure; the best saying of a practitioner. The best remedy for this disorder is the good lifestyles. We must follow the best advice of a physician. A good routinary habit. Eat fruits and vegetables a plentiful water and excessive exercises. In this theoretical kind of disorder, the author and other medical specialist connected on these, recommends further research on the said matter. First-hand interviews with patients and others affected family members have such knowledge about of this disease are looking for deeper insights that help readers avoid unto these conditions. There are following steps that may help every individual to prevent this disease. Asking for more information about this disorder, professional doctors are there to guide and help to overcome such illness like this.

BIBLIOGRAPHY 1. American Psychiatric Association. Treatment of patients with eating disorders, 3rd ed. American Psychiatric Association. Am J Psychiatry. 2006 Jul;163(7 Suppl):4-54. [PubMed] 2. Hall MN, Friedman RJ 2nd, Leach L. Treatment of bulimia nervosa. Am Fam Physician. 2008 Jun 1;77(11):1588, 1592. [PubMed] 3. Schmidt U, Lee S, Beecham J, et al. A randomized controlled trial of family therapy and cognitive behavior therapy guided self-care for adolescents with bulimia nervosa and related disorders. Am J Psychiatry. 2007 Apr;164(4):591-8. [PubMed] Review Date: 2/1/2010. Reviewed by: Paul Ballas, DO, Department of Psychiatry, Thomas Jefferson University Hospital, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. -http://www.eatingdisordersonline.com/explain/bulimia.php Date: March 1, 2011 11:04 pm 4. French Barbara, coping with bulimia (1987); Mitchel James, bulimia Nervosa (1989); Pirke, K.M. et. Al., eds., Psychobiology of Bulimia Nervosa (1988).

UNDERSTANDING BULIMIA NERVOSA

A report Presented to The Department of English CATANDUANES NATIONAL HIGH SCHOOL

In partial fulfillment Of the requirements In English IV

By Beverly A. Dela Torre

March 2011