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University of Regina

Bulimia Nervosa  Ms Bs beh is BN. Bulimia from a Greek word means ox hunger.  This disorder involves episodes of rapid consumption of a large amount of food, followed by compensatory beh such as vomiting, fasting or excessive exercise to prevent weight gain  The DSM defines a binge as eating an excessive amount of food within less than two hours. BN is not diagnosed if the binging and purging occur only in the context of AN and its extreme weight loss; the diagnosis in such as case is AN binge eating purging subtype  Binges typically occur in secret may be triggered by stress and the negative emotions it arouses and continue until the person is uncomfortably full.  Stressors that involve negative social interactions may be particularly potent elicitors of binges.  Bulimics have high levels of interpersonal sensitivity, as reflected in large increases in self- criticism following negative social interactions.  Further binge episodes tend to be preceded by poorer than average social experiences, self concepts and moods  Also reported that the binge episodes are followed by deterioration in self concept, mood state and social perception  The person who is engaged in a binge often feels a loss of control over the amount of food being consumed. Foods that can be rapidly consumed, esp sweets such as ice cream or cake are usually part of a binge. Although research suggests that patients with BN sometimes ingest an enormous quantity of food during a binge.  Binges are not always as large as the DSM implies and there may be wide variation in the caloric content consumed by individuals with BN during binges. Patients are usually ashamed of their binges and try to conceal them. They report that they lose control during a binge even to the point of experiencing something akin to a dissociative state perhaps losing awareness of what they are doing of feeling that it is not really they who are binging  After the binge is over disgust, feelings of discomfort and fear of weight gain lead to the 2 step of BN—[urging to undo the caloric effects of the binge. As seen with Ms. B purging can involve induced vomiting and excessive exercise. The use of laxatives and diuretics is common even though this odes not actually result in weight loss  The DSM diagnoses of BN requires that the episodes of binging and purging occur at least twice a week for three months  Suggesting that there is a continuum of severity rather than a sharp distinction  Like patients with AN patients with BN are afraid of gaining weight and their self esteem depends heavily on maintaining normal weight.  Observed that a morbid fear of fat is an essential diagnostic criterion for BN cuz 1) it covers what clinicians and researchers view as the core psychopathology of BN 2) it makes the diagnosis more restrictive and 3) it makes the syndrome more closely resemble the related disorder or AN  as with anorexia two subtypes of BN are distinguished: a purging type and a non purging type in which the compensatory beh are fasting or excessive exercise. And recent evidence does not strongly support the validity of this distinction  BN typically begins in late adolescence or early adulthood. About 90% of cases are women and prevalence among women is thought to be about 1 to 2% of the population.  Find tat lifetime rates for females are approx 1.1% of the population for BN and 0.5% of the population for AN  Suggests that bulimia is more common than anorexia among adolescents  One study found that by age 18 80% of young women in BC with normal height and weight indicate that they would like to weight less.  Another study of more than 1,800 females from Ottawa, Hamilton, and T,O between the ages of 12 and 18 found that 27% has disordered eating attitudes and beh and approx 1 in 7 participants engaged in binge eating with associated loss of control  Comparisons across time suggest that the frequency of BN may be increasing.  Cohort effect- with rates being higher among ppl born after 1960 who alsp tend to have younger ages of onset  BN patients are somewhat overweight before the onset of the disorder and that the binge eating often starts during an episode of dieting.  Long term follow up of BN patients reveal that about 70% recover although about 10% remain fully symptomatic  BN is associated with numerous other diagnoses, notably depression, personality disorders ( esp borderline person disorder) anxiety dis, substance abuse and conduct disorder  Suicide rates are much higher among ppl with BN than in the general population. A twin study had found that bulimia and depression are genetically related  Somewhat curiously BN has been associated with stealing. Patients with bulimia who steal tend also to be illicit drug users and promiscuous. This combination of beh may reflect impulsivity or lack of self control, characteristics that may be relevant to the beh of binge eating  Like anorexia bulimia is associated with several psychical side effects. Frequent purging can cause potassium depletion. Heavy use of laxatives includes diarrhoea which can also lead to changes in electrolytes and cause irregularities in the heart beat. Recurrent vomiting may lead to dental enamel as stomach acids eat away at the teeth, making them ragged. The salivary glands may become swollen. However mortality appears to be much less common in BN than in AN Binge Eating Disorder  DSM-IV-TR includes binge eating disorder (BED) as a diagnosis in need of further study rather than a formal diagnosis. This disorder includes recurrent binges (2 x per week for at least 6 months), lack of control during the binging episode, and distress about
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