History of Bulimia Nervosa
The term bulimia is originally derived from Greek words "bous", meaning head of cattle, and "limos", meaning hunger, therefore suggesting an appetite like that of an ox. Though vomiting after overeating has occurred for thousands of years, bulimia was only first recognized as a disorder in 1980 in the DSM-III. Minor revisions of the diagnosis have been made since, most significantly the addition of two subtypes, purging and non-purging type, in order to highlight the clinical differences between the two populations.
Epidemiology of Bulimia Nervosa
Bulimia nervosa, as defined by strict diagnostic criteria, occurs in approximately 1-3% of the female population. However, it has been reported that as many as 19% of female students may engage in bulimic symptoms (Hoek 2002). Sufferers are predominately female, though 5 to 10% of the clinical population is male. The disease is largely seen in Western countries, however research is ongoing to determine the prevalence rates amongst other ethnic populations.
Cited from: Hoek, H.W. (2002). Distribution of eating disorders. In C.G. Fairburn & K.D. Brownell (Ed.), Eating Disorders and Obesity (pp. 233-237). New York: The Guilford Press.
Risk Factors for Bulimia Nervosa
Bulimia Nervosa is a multi-determined illness. A variety of environmental and genetic factors may play a role in increasing the risk of developing this disorder. Several of these risk factors include:
Gender
Bulimia Nervosa predominately affects womenDieting
Studies have demonstrated that a history of dieting, as well as weight and shape concern increase the risk of developing bulimiaHistory of anorexia nervosa
Some studies indicate that 20-30% of patients with Bulimia Nervosa have at one time met criteria for anorexia nervosa.Family factors
Patients with Bulimia Nervosa often report experiencing negative comments by family on their weight, shape, and eating habits. Additionally, patients with Bulimia Nervosa report greater degrees of parental intrusiveness, jealousy, and competition, particularly in regards to mothers (Polivy & Herman 2002).Certain personality characteristics
These include heightened impulsivity, novelty-seeking, harm-avoidance, stress reactivity, and negative emotionality.Genetics
Twin studies suggest that genetics may be a risk factor in developing bulimia nervosa
Associated Abnormalities of Bulimia Nervosa
Bulimia Nervosa is a serious illness, which affects many aspects of a patient's health and well-being. Some associated abnormalities that have been noted in patients with Bulimia Nervosa include:
Gastrointestinal abnormalities
Several studies indicate that persons with BN often have impairment in feelings of satiety. This may be due to enlarged gastric capacity, delayed gastric emptying, impaired gastric reflex, and hormonal abnormalities. In rare cases, patients with Bulimia Nervosa may develop more serious gastrointestinal complications, such as gastric rupture or esophageal tear.Dental problems
Dental erosion is common in patients with Bulimia Nervosa, resulting from repeat exposure of gastric acid to the teeth.Electrolyte imbalance
Repetitive vomiting and laxative abuse may lead to electrolyte imbalances, which can result in serious consequences such as cardiac disturbance and edema.Menstrual irregularities
Even at a normal weight, individuals with Bulimia Nervosa may experience menstrual irregularities.Psychiatric comorbidities
Patients with Bulimia Nervosa have a higher prevalence of anxiety and mood disorders, in particular depression and dysthymia. Bulimia Nervosas also have increased incidence of substance abuse and self-injurious behaviors.
Assessment of Bulimia Nervosa
A complete assessment for patients with Bulimia Nervosa includes an investigation of developmental, psychiatric, and medical history, as well as current symptomatology, functioning, and social supports. The Bulimia Nervosa patient should specifically be questioned regarding his/her pattern of eating (including binges and other eating episodes), purging, and use of laxatives, diuretics, enemas, excessive exercise, diet pills, and ipecac. A history of the patient's lifetime highest and lowest weights, as well as any significant weight fluctuations should be noted. The patient's current height and weight should be recorded and monitored in order to note any weight changes that occur with changes in symptoms. It may be helpful to speak with the patient's family members or other social supports, as they may be able to provide additionally helpful information regarding the patient's illness. As Bulimia Nervosa has a high rate of comorbidity with other psychiatric disorders, a full psychiatric evaluation should be conducted to determine any other disturbances. Due to the high incidence of medical abnormalities resulting from bulimia nervosa, the patient should be evaluated by a physician. Specifically, any dental erosion should be examined and a serum chemistry panel ought to be drawn to detect any electrolyte imbalances. Additionally, any gastrointestinal distress (including blood in the vomit) and menstrual irregularities should be examined.
