Bulimia nervosa (BN) is an eating disorder that is characterized with repeated incidents of uncontrollable ingesting of large amounts of food, actions aimed at compensating food consumption in order to prevent gaining weight, such as self-induced vomiting, excessive physical exercises, and substance abuse, and obsessive behavior regarding weight and body shape. Eating disorders are more common in Western countries, in industrial and capitalist societies and have low occurrence in the rest of the world. Bulimia is closely related to anorexia nervosa (AN) and was initially used to refer to specific symptoms in patients diagnosed with chronic anorexia. Bulimia nervosa was recognized as a distinct psychiatric disorder in the late 1940s and can also be referred to as the gorging-purging syndrome, bulimarexia, and dietary chaos syndrome.
Bulimia nervosa is a condition of unknown etiology that most often progress in female population during adolescence and most often is a chronic disease. According to the cognitivebehavioral theory of eating disorders, concerns about weight and body shape are located at the center of BNs etiology. Bulimia nervosa usually appears after a patient have experienced food restriction of some sort. The patient engages in binge eating of large amounts of food, which is followed by either self-induced vomiting, or by some other ways to shed weight. Even though abnormally low weight is an exclusion for the bulimia diagnosis, about 25 to 30 percent of patients have been earlier diagnosed with anorexia nervosa.
Due to the prevalence of bulimia nervosa in women during their adolescence, the disorder is theorized to be affected by cultural influences of perceived body image. The contributing aspect is that diets and the self-obsession of thin body are common in Western countries. However, bulimia nervosa affects about 1.5 to 2.5 percent of female general population, which is significantly lower than the estimated prevalence of pressures for thinness. This fact together with evidence of anorexia nervosa and bulimia nervosa occurring at least few centuries ago and high heritability emphasizes the significant probability of biological factors that may contribute to the risk of BN. Among other risk factors, it has been hypothesized that BN is cross transmitted in families. Twin studies of bulimia nervosa suggest there is about 50 to 80 percent of liability for contribution by genetic factors. Such rates are similar to those discovered in other psychiatric conditions, such as schizophrenia. This fact suggest bulimia is as influenced by genetic factors as other biological disorders.
Bulimia nervosa majorly affects eating patterns and body image distortions. Although the pathogenesis of the disorder lacks understanding, due to unusual and prominent nature of its symptoms, it is relatively easy to detect. Bulimia nervosa is not characterized by a pathological increase in appetite but is rather associated with a seemingly strong urge to restrain their consumption of food, an great anxiety regarding weight gain, and commonly with a distorted perception of ones actual body image. Patients with bulimia tend to lose control with overeating, which happens irregularly and usually only after a period of the onset of a diet. Such symptoms of restrains in eating patterns and problems with perception of body weight and shape is common for most types individuals diagnosed with eating disorders. Bulimia patients usually have a range of other puzzling symptoms, such as extreme physical exercises and motor restlessness. Individuals with bulimia often show signs of resistance to treatment. This resistance is partially caused by the patients denial to accept the seriousness of the disease.
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Diagnosis and Treatment
According to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), The diagnostic criteria for bulimia nervosa are as follows:
- Recurrent cases of binge eating, which include both of the following characteristics:
food consumption in a discrete period, for example within any two hours; an amount of food that is significantly bigger than normal for other people under similar circumstances;
a feeling of lack of control over food consumption, for example when a person cannot stop eating or control the amount of food consumed.
- Recurrent inadequate compensatory actions aimed at preventing oneself from gaining weight.
- The incidence of both binge eating and compensatory actions more than twice a week within a three-month period.
- Excessive obsession over body shape and weight.
- No disturbance during anorexia nervosa occurrences.
Additionally, bulimia nervosa is differentiated between the two specific types:
- Purging Type, which is characterized by regular self-induced vomiting or laxatives, diuretics, or enemas abuse.
- Nonpurging Type, in which the person engages in other compensatory behaviors.
Prevention methods against bulimia nervosa mainly interventions during adolescence, which as stage of development in which individuals can engage in unhealthy dietary patterns. Therefore, identification and prevention of BN is very effective if performed by middle and high school staff and parents. Education is believed to be one of the most successful approaches to prevention of the disorder. Different programs and initiatives can be used in a range of institutions, such as schools, homes, healthcare centers, churches and others. The effectiveness is increased in multifarious efforts in schools, families, and communities.
A treatment of bulimia nervosa was complex after it was first identified in the 1940s. Since then, multiple therapies have been introduced, two of which are have the highest efficacy. The first one is cognitive-behavioral therapy, which has proven to be more effective than other forms of psychological treatment. Another type of treatment involves using antidepressant medications. However, many studies showed antidepressants to be effective but questioned their capability to treat the disorder using only medications. The major limitation of antidepressants include relatively frequent side effects of some constituents of those medications. In addition, many researchers question their long-term outcomes.
Cultural Impact of the Illness
Culture is inseparably related to eating behaviors in general.
The impact of culture on the prevalence of eating disorders has been clearly identified. The fact that bulimia nervosa is more common in Western countries and more likely to affect women than men signals the importance of cross-cultural differences in the role of perception of thinness for women. Another trend, which shows that bulimia has become more widespread among younger women during the second half of the 20th century, correlates with a tendency of American beauty standard shifting towards appreciation of more and more thinner women. These patterns indict current cultural beauty ideals in the etiology and maintenance of eating disorders.
However, there are cultural impacts of the disorder on society, one of which is related to its etiology and history. Although the vast majority of BN patient constitute young females in Western countries, there are other social groups that are affected by the disorder. The cultural impact of the disorder has led to a misconception that still influences common population as well as academics. There is a gap in research on eating disorders, and bulimia nervosa specifically, in men, ethnic minorities and non-Western countries due to a historical bias that bulimia effects only white women. Another significant outcome of this effect is that men or members of minorities are less likely to admit that they have a disorder and seek medical attention.