Bulimia Counseling

What is Bulimia?

Bulimia nervosa From Wikipedia, the free encyclopedia

Bulimia nervosa

ICD-10 F50.2 ICD-9 307.51

Bulimia nervosa, commonly known as bulimia or "mia", is an eating disorder in which the subject engages in recurrent binge eating followed by feelings of guilt, depression, and self-condemnation. The sufferer will then engage in compensatory behaviors to make up for the excessive eating, which are referred to as "purging". Purging can take the form of vomiting, fasting, the use of laxatives, enemas, diuretics or other medications, or overexercising.

The word bulimia comes from the Latin (būlīmia) from the Greek βουλῑμια (boulīmia), ravenous hunger, compounded from βους (bous), ox + λῑμος (līmos), hunger.[2]

Diagnosis The criteria for diagnosing a patient with bulimia are:[3]

Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

Eating, in a fixed period of time (e.g., within any two-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.

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 to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics or other medications; fasting, or excessive exercise. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for three months.

Self-evaluation is unduly influenced by body shape and weight. The disturbance does not occur exclusively during episodes of anorexia nervosa.

See the Diagnostic and Statistical Manual of Mental Disorders.

If any of these symptoms are noticed, a doctor or psychologist should be contacted. However, these symptoms are often difficult to spot. Unlike anorexia nervosa, the person must be of normal or higher weight and is less likely to drop a significant amount of weight on a continual basis.

Because bulimia carries a great deal of shame, the bulimic desperately tries to hide the symptoms from family and friends. Bulimia is more likely to span over a lifetime unnoticed, causing a great deal of isolation and stress for the suffering individual. Despite the frequent lack of obvious physical symptoms, bulimia has proven to be fatal, as malnutrition takes a serious toll on every bodily organ.

Cyclic patterns

Bulimics go through cycles of over-eating and purging that can be very destructive to the body. These cycles often involve rapid and out-of-control eating, which may stop when the bulimic is interrupted by another person or when his/her stomach hurts from over-extension, followed by self-induced vomiting or other forms of purging. This cycle may be repeated several times a week or, in serious cases, several times a day.

Some bulimics eat secretly; others eat socially but are bulimic in private. They also differ in "how much" they purge. Some can vomit without gagging themselves after eating. Often when the urge hits, they go to great lengths to purge, as if an uncontrollable urge is making them do so. Medical evidence shows that the chemicals released when purging may make a person feel "high".[citation needed] This can also lead to extreme dehydration and electrolyte imbalances.

Some bulimics do not regard their cycles as a problem, while others despise and fear the vicious and uncontrollable cycle.[6] Bulimics may appear underweight, normal weight or overweight.

Types

There are two sub-types of bulimia nervosa: purging and non-purging.

Purging type is the more common type of bulimia, and involves any of self-induced vomiting, laxatives, diuretics, enemas, or Ipecac, to rapidly extricate the contents from their body.

Non-purging type occurs in only approximately 6%-8% of bulimia cases, as it is a less effective means of ridding the body of such a large number of calories. It involves doing excessive exercise or fasting after a binge, to counteract the large amount of calories previously ingested. This often occurs in purging-type bulimics, but is a secondary form of weight control.

Causes

Bulimia is related to deep psychological issues and feelings of lack of control. Sufferers often use the destructive eating pattern to feel in control over their lives.

They may hide or hoard food and overeat when stressed or upset. They may feel a loss of control during a binge, and consume great quantities of food (over 20,000 calories.)

After a length of time, the sufferer of bulimia will find that they no longer have control over their binging and purging.

The binging becomes an addiction that seems impossible to break. Recovery is very hard and often in the early stages of recovery the patient will gain weight as they are still binging but no longer purging, causing anxiety which will in turn cause the patient to revert back to bulimia.

There are higher rates of eating disorders in groups involved in activities that emphasize thinness and body type, such as gymnastics, dance, cheerleading, acting and figure skating.

Bulimia is more prevalent among Caucasians. In one study, diagnosis of bulimia was correlated with high testosterone and low estrogen levels, and normalizing these levels with combined oral contraceptive pills reduced cravings for fat and sugar.[12]

Consequences

Bulimia can cause following health problems:

Malnutrition Dehydration Electrolyte imbalance, which can cause cardiac arrest or brain damage by stroke Hyponatremia Damaging of the voice Vitamin and mineral deficiencies Teeth erosion and cavities, gum disease Salivary gland swelling (sialadenosis) Potential for gastric rupture during periods of binging Esophageal reflux Irritation, inflammation, and possible rupture of the esophagus Laxative dependence Peptic ulcers and pancreatitis Emetic toxicity due to ipecac abuse Swelling of the face and cheeks, especially the lower eyelids, due to the high pressure of blood in the face during vomiting; for the same reason Purpura can occur, a rash caused by burst blood vessels. Callused or bruised fingers Dry or brittle skin, hair, and nails, or hair loss Lanugo Edema Muscle atrophy Decreased or increased bowel activity Digestive problems that may be triggered, including celiac and Crohn's disease Low blood pressure (hypotension) Orthostatic hypotension High blood pressure (hypertension) Iron deficiency Anemia Hormonal imbalances Hyperactivity Depression Insomnia Amenorrhea Infertility High risk pregnancy, miscarriage, still-born babies Diabetes High blood sugar (hyperglycemia) Ketoacidosis Osteoporosis Arthritis Weakness and fatigue Cancer of the throat or cancer of the voice box Liver failure Kidney infection and failure Heart failure, heart arrhythmia, angina Seizure Paralysis Death caused by heart attack or heart failure; lung collapse; internal bleeding, stroke, kidney failure, liver failure; pancreatitis, gastric rupture, perforated ulcer, depression and suicide.

Related psychological disorders

Many bulimics also have anxiety or mood disorders.

One study found anxiety in 75% of bulimic patients.

Prominent mood disorders include depression and substance abuse.

Some experts are finding eating disordered individuals that have been previously misdiagnosed with mood disorders.

After appropriate treatment for an eating disorder, symptoms once thought be the result of bi-polar disorder, depression or anxiety disorder for examples eventually subside along with the eating disorder itself.

Recent research suggests that depression is caused by the eating disorder.

To make patient history, treatment and prognosis even more baffling, many professionals intentionally exaggerate the severity of symptoms, even adding on a mood disorder diagnosis when none is warranted, in order to increase the likelihood of insurance coverage.

Most insurance companies will cover inpatient treatment for severe mood disorders but not for eating disorders alone.

Bulimics are also more likely to attempt suicide and engage in impulsive behaviors. Bulimic females typically have a less favorable opinion of themselves than control groups. They are more pessimistic, more ambivalent towards others, strive for less recognition in areas that are socially significant or require leadership.

Many bulimics, like anorexics, binge eaters and others with eating disorders, at one time were considered over-acheivers, highly intelligent and true rising stars among their peers.

Yet, bulimics eventually become so consumed by food and/or weight that they, like anorexics, binge eaters and other individuals with eating disorders, have little time for the normal ambitions they once had.

They do however express a need to solicit sympathy, affection, and emotional support.

Many bulimics display alexithymia, the inability to consciously experience and express emotions.

Differences from anorexia nervosa

The main criteria differences involve weight: an anorexic must have a body mass index of less than 17.5. Typically an anorexic is defined by the refusal to maintain a normal weight by self-starvation.

Another criterion which must usually be met is amenorrhea, the loss of a female's menstrual cycle not caused by the normal cessation of menstruation during menopause for a period of three months.

Generally the anorexic does not engage in regular binging and purging sessions.

If binging and purging occurs but rarely, and the patient also fails to maintain a minimum weight, they are classified as a purging anorexic, due to the underweight criterion being met and cessation of menstruation.[15]

Characteristically, bulimics feel more shame and out of control with their behaviors, as the anorexic meticulously controls their intake, a symptom that calms their anxiety around food as she/he feels she/he has control of it, na�ve to the notion that it, in fact, controls her/him.

For this reason, the bulimic is more likely to admit to having a problem, as they do not feel they are in control of their behavior.

The anorexic is more likely to believe they are in control of their eating and much less likely to admit that a problem exists.

Anorexics and bulimics have an overpowering sense of self determined by their body and their perceptions of it.

They trace all their achievements and successes to it, and so are often depressed as they feel they are consistently failing to achieve the perfect body. Bulimics feel that they are a failure because she/he cannot achieve a low weight, and this outlook infiltrates into all aspects of their lives.

Anorexics cannot see that they are underweight and constantly work towards a goal that they cannot meet. They too allow this failure to define their self worth. As both the anorexic and bulimic never feel satisfaction in the more important part of their lives, depression often accompanies these disorders.

Treatment

Treatment is most effective early in the development of the disorder, but since bulimia is often easy to hide, diagnosis and treatment often come when the disorder has already become a static part of the patient�s life.

Historically, bulimics were often hospitalized to end the pattern and then released as soon as the symptoms had been relieved. But this is now infrequently used, as this only addresses the surface of the problem, and soon after discharge the symptoms often reappeared as severe, if not worse.

Several residential treatment centers offer long term support, counseling, and symptom interruption. The most popular form of treatment involves therapy, often group psychotherapy or cognitive behavioral therapy.

Anorexics and bulimics typically go through the same types of treatment and are members of these same treatment groups. This is because anorexia and bulimia often go hand in hand, and often patients have at some point suffered from both. Some refer to this as "symptom swapping".

These forms of therapy address both the underlying issues which cause the patient to engage in these behaviors, and the food symptoms.

Sadly, most people with eating disorders will never have the chance to receive treatment from a facility that specializes in eating disorders.

The Hollywood Anorexic type checking in and out of rehab is the minority.

Usually, eating disordered people are professionally, socially and financially devastated by their illness.

Most insurance companies will only cover brief inpatient stays in general hospital psych wards. This ultimately leaves the eating disordered person more confused, more desperate and sicker than before.

Specialized treatment is necessary for recovery. Few can afford it and few receive it. Consequently, many continue to die from these mental illnesses.

In combination with therapy, many psychiatrists prescribe anti-depressants or anti-psychotics.

Anti-depressants come in different forms, and the most promising one has been Prozac.

In a study of 382 bulimics, those who took 20 to 60 mg of Prozac reduced their symptoms from 45% to 67%, respectively. It is possible that several other drugs could be more effective, but often insurance companies will not pay for other drugs until the patient has tried Prozac, because it has some positive outcome results.

Anti-psychotics are used in smaller doses than for treating schizophrenia. With an eating disorder, the patient perceives reality differently and has difficulty grasping what it is like to eat normally.

Unfortunately, since this disorder has only recently been recognized by the DSM, long-term outcomes of people with the disorder are unknown. Current research indicates that up to 30% of patients rapidly relapse, while 40% are chronically symptomatic.

The rate in which the patient receives treatment is the most important factor affecting prognosis. Those who receive treatment early on for the disorder have the highest and most permanent recovery rates.

Dr Sabine Naess�n from the Karolinska Institute discovered that some female patients suffer from a hormonal imbalance of over-production of the male hormone testosterone, that can be countered by a contraceptive pill containing estrogen, resulting in a reduction of the symptoms of bulimia.[17] Further studies are required to determine the efficacy of such a treatment.

Mortality

Eating disorders have one of the highest death rates of all mental illnesses. Relatively little is known about the long-term outcome of bulimia. Research to date suggests that the prognosis is varied. The illness may pursue a long-term, fluctuating course over many years or may be more episodic and may be precipitated by life events and crises. In the shorter term, some reports suggest a 50% improvement in binge eating and purging behavior among patients who are able to engage in treatment. Consistent predictors of outcome have not yet been identified. However, the severity of the purging sequelae may be an important indicator of prognosis; electrolyte imbalances, esophagitis, and hyperamylasemia reflect more severe purging and may predict a poorer outcome. [1] Death can occur after severe binging, or from suicide.[18]

High mortality rates might be directly related to Western society's routine grave denial of the seriousness and widespread effect of eating disorders.

In a culture where diet and weight loss industries ever grow along side obesity rates, and where thinness is glamourized in every magazine on every stand, it is no wonder that those with eating disorders aren't treated as seriously as say individuals with schizophrenia.

Mental illnesses such as schizophrenia offer huge profits for pharmaceutical companies and inpatient treatment centers. In simple economic terms, a recovering schizophrenic means profit. A recovered bulimic does not.

Bulimics that lose weight are often congratulated by others for their weight loss and "control".

Losing weight is usually associated with success rather than illness in Western culture. And further, the general misconception of eating disorders being just a temporary adolescent trend remains. In some cultural circles, it isn't just thinness that is glamourized, but the eating disorder itself, as seen on pro-ana/mia and thinspiration websites.

Unfortunately, all of these attitudes, misconceptions and market forces only perpetuate the growing epidemic of eating disorders and the likelihood of death for those afflicted.

At-risk groups

Risk factors for bulimia are similar to those of other eating disorders, such as anorexia.

The groups listed below are considered to be at the highest risk:

those of age 10 through to 30 (though typically bulimia tends to start in late teens or early 20s) athletes[19] those with/without a history of anorexia[20] students who are under heavy workloads those who have suffered traumatic events in their lifetime such as child abuse and sexual abuse people raised in dysfunctional families those positioned higher on the socioeconomic scale the highly intelligent and/or high-achievers[21] perfectionists However, the disorder can occur in people of all ages and both sexes. There is a new rise of cases in men. In older patients, symptoms may have continued untreated for several years or decades, making the behaviors increasingly ingrained and difficult to confront. A popular assumption is that eating disorders are female diseases, but 2-8% of patients are male.[22] Unfortunately, many men do not get the help they need for fear being thought of as homosexual or having a "women's disease"[citation needed]

Prevention

There is no known way to prevent the onset of bulimia. Less social and cultural emphasis on physical perfection may help, but it is difficult to make sweeping societal changes. The best way to stop the progression of bulimia is early intervention by contacting a medical health professional and receiving psychotherapy. Adults have an immeasurable impact on their children. Teaching children to adopt a healthy diet as a way of life and incorporating fun activities into their day allows this to become second nature to them. Children should be taught an emphasis on their internal characteristics and qualities rather than the external focus so much of society and the media tend to focus on. Action is the best way of teaching, and the adults' self-criticism and behavior reflects substantially on their children�s impressions of themselves.[23]

History

Bulimia was first described in 1976 by Boskind-Lodahl and Gerald Russell, who worked at the Royal Free Hospital, London. It has been recognized as an autonomous eating disorder by the American Psychiatric Association since 1980.[24]

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Bulimia Counseling

What is Bulimia?

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