Bulimia nervosa a syndrome of 'binge eating

Bulimia nervosa a syndrome of 'binge eating

Bulimia nervosa is a syndrome of 'binge eating' (bulimia:to stuff oneself with food) and self-induced vomiting in thepresence of normal weight. There is an overlap here withanorexia nervosa, where binge-vomit cycles can also occur,but in anorexia the patient is always abnormally thin andalso amenorrhoeic. The usual age of presentation inbulimia also tends to be older, with patients (usuallywomen) in the 20-30 age range, rather than the teens.The bulimic is frightened of becoming fat, but can accepther normal weight. She is terrified by her greed and triesto avoid its consequences by making herself sick. She normallyfeels deeply ashamed about this. She lives in a stateof dietary chaos, in which she is determined to fast, succeedsfor a while, then succumbs to hunger and startseating. She binges, then feels guilty, makes herself sick andthen starves; and so the cycle starts again.The physical consequences of bingeing and vomitinginclude erosion of dental enamel from exposure to gastricacid, Mallory-Weiss oesophageal tears, and even oesophagealrupture. Repeated vomiting causes hypokalaemia,which may in turn produce tetany, paraesthesiae, ileus,cardiac arrhythmias and epileptic fits.Bulimia is more common than anorexia: the prevalencerate in Europe and North America is 1-2%, compared to0.5-1% for anorexia; 20% of women attending a familyplanning clinic admitted to bingeing, and 2% had thefull syndrome. Like anorexia, bulimia may exist either onits own, or as part of a general disturbance of personality,and be associated with alcoholism, deliberate self-harmor shop lifting, all of which make the prognosis less good.Treatment of bulimia nervosa is usually successful andinvolves helping the woman to re-establish a regular eating pattern, and to feel less guilty. The bulimic often feels agreat relief when dietary control is re-established, unlikethe anorexic, who feels threatened at the idea of giving upher own control. In addition to a cognitive-behavioural approach, exploration of the conflicts underlying the bulimia (such as marital difficulties or feelings of anger which the patient is unable to express) is also necessary.A proportion of bulimics have experienced sexual abuse in childhood, and this too needs psychotherapeutic exploration.

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