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Day # 146: Bulimia Nervosa Part 1

Today we will continue our current theme of eating disorders. Today's topic is bulimia nervosa. In part 1 we will cover an introduction, definitions, diagnostic criteria, epidemiology, and pathogenesis. In part 2 we will cover clinical pearls, physical complications, and treatment.

Today's Content Level: Beginner and Intermediate

Introduction 1

  • Bulimia nervosa (BN) is an eating disorder characterized by recurrent binge eating combined with behaviors intended to counteract the weight gain.

  • Binge eating = Eating a larger-than-normal amount of food in a discrete time period (2 hours). This is accompanied by feeling out of control during the eating episode such as feeling like they cannot stop eating.

  • Compensatory behaviors = Behaviors intended to prevent weight gain such as self-induced vomiting, misuse of medications (laxatives, diuretics, other medications), fasting, or excessive exercise.

  • The term, bulimia nervosa, comes from the Greek term for "ravenous hunger" and a Latin word implying "nervous origin".

  • Individuals are excessively concerned with body weight. However, unlike patients with anorexia nervosa, they usually maintain a normal body weight (and may even be overweight).

Diagnostic Criteria 2

  • Recurrent episodes of binge eating.

  • Recurrent inappropriate compensatory behaviors.

  • Binge eating and compensatory behaviors occur, on average, ≥ once a week for 3 months.

  • Undue influence of body weight/shape on self evaluation.

  • Does not occur exclusively during an episode of anorexia nervosa.

  • Severity is specified based on frequency of inappropriate compensatory behaviors per week. Mild = 1-3. Moderate = 4-7. Severe = 8-13. Extreme = ≥14. The level of severity may be increased to reflect other clinical symptoms or degree of functional disability.

Epidemiology/Pathogenesis 3, 4, 5, 6 , 7 , 8

  • Lifetime prevalence of BN is ~1.5% in females (studies vary: 0.5-2.5%) and <0.5% in men (studies vary: (0.1-1.3%).

  • Studies reflect approximately a 10:1 female to male ratio.

  • Most common age of onset is in adolescence or young adulthood. Onset before puberty is uncommon.

  • Tends to be a chronic and relapsing illness, however the course is variable. Has a better prognosis than anorexia nervosa. Symptoms tend to diminish in studies with long-term follow up.

  • High mortality rate (~2% per decade). This is lower than anorexia nervosa (~5-6% per decade).

  • As with most psychiatric disorders, the dominant theory suggests BN develops from a combination of genetic, biological, environmental, and psychosocial factors.

  • Risk factors are similar to anorexia nervosa and include family history of eating disorders (strong genetic concordance), female gender, age (adolescents and young adults have a higher risk), neglect/abuse/trauma, living in industrialized countries (food is abundant and high social pressure to be thin), poor body image / low self-esteem / dissatisfaction with weight, childhood obesity, early pubertal maturation, and participation in sports or activities with an emphasis on weight/size or involve subjective judging and weight classes (gymnastics, ballet, modeling, running, cheerleading, figure skating, wrestling, etc.).

  • There is also an association between mood disorders, impulsivity, personality disorders (most commonly borderline PD), and anxiety disorders.

  • Certain psychodynamic theories and personality traits have also been associated: obsessive-compulsive personality traits, difficulty differentiating emotional from visceral sensations, and exaggerated values of control / achievement / perfectionism.


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