Bulimia Nervosa Signs and Symptoms, health risks, diagnosis: Bulimia nervosa (BN), also known as bulimia, is an eating disorder characterized by recurrent overeating, accompanied by compensatory behaviors that prevent weight gain and excessive attention to body weight and body shape. Mainly manifested as recurrent, uncontrollable, impulsive overeating, followed by inappropriate compensatory behaviors to prevent weight gain, such as fasting, excessive exercise, induced vomiting, abuse of diuretics, laxatives, appetite suppressants, metabolic acceleration Drugs, etc. are related to their excessive and unobjective evaluation of their body weight and body shape. Bulimia Nervosa Signs and Symptoms, health risks, diagnosis. BN is more common in young women (<30 years old), and more often in adolescence and early adulthood. The age of onset of BN is often later in adolescents than in anorexia nervosa (AN), and the average onset age is usually 16 to 18 years old. In industrialized countries, the prevalence of BN is higher than that of AN. The bulimia nervosa Statics incidence of BN in young women is 3% to 6%, the lifetime prevalence of women is 2% to 4%, men are not more than 1%, and women and men are BN. The ratio is approximately 10:1. BN patients have normal or slightly overweight, 30% to 80% of BN patients have a history of AN, and sometimes have a history of obesity. Bulimia Nervosa Signs and Symptoms, health risks, diagnosis.
Table Of Content:
1: Bulimia Nervosa causes
2: Clinical manifestations of Bulimia Nervosa
3: Bulimia Nervosa Diagnosis
4: Bulimia Nervosa Differential Diagnosis
5: Bulimia Nervosa Treatment
6: Prognosis of Bulimia Nervosa
1: Bulimia Nervosa causes:
BN is a modern disease, its etiology and pathogenesis are still unclear, but most studies believe that the incidence of BN is related to biological, psychological, and sociocultural factors. Family surveys have shown that genetic factors play a role in the pathogenesis of AN. However, there are data indicating that the genetic predisposition of BN is not as obvious as that of AN, and the proportion of heredity in the pathogenesis of BN is still uncertain. The central neurotransmitters 5-HT and NE are thought to be involved in the pathogenesis of BN, and 5-HT deficiency is most closely related to BN.
The onset of BN is related to psychological and personality factors, such as perfectionism, self-concept damage, emotional instability, poor impulse control, poor ability to adapt to development and maturity, including adolescence, marriage, pregnancy, and family members and parents. bulimia nervosa Health risk and Relationship problems, sexual problems encountered, etc., therefore, BN can be a way to deal with the stress events encountered in these processes. BN patients are more communicative, more angry, and more impulsive than patients, lacking super-ego control and self-power comparable to AN patients.
Social and cultural factors play an important role in the pathogenesis of BN. Industrialization has led society to produce enough food and treat it as a quick food. This temptation has contradicted the “slim” aesthetics of women; the development of society has also led to changes in the roles of men and women, and women’s The concern is directly related to the individual’s self-esteem and self-worth; some social views, such as the more slim women, the more attractive, the diet and slimness promote success, making women extremely sensitive to their body shape.
Also Read: Bulimia Nervosa Vs Anorexia Nervosa
2: Clinical manifestations of Bulimia Nervosa:
1: Psychological and behavioral disorders
The behavioral characteristics of BN are mainly eclipse-clearing cycle, which is characterized by impulsive binge eating behavior, lack of satiety, and loss of control. These behaviors are often associated with emptiness, loneliness, frustration, or tempting food. Patients with BN usually discontinue binge eating behavior in the presence of guilt, extreme pain, or physical discomfort such as nausea, bloating, and abdominal pain, followed by compensatory excretion to prevent weight gain. Commonly used clearing behaviors include finger vomiting or spontaneous vomiting, excessive exercise, fasting, abuse of diuretics, laxatives, appetite suppressants, and drugs that accelerate the metabolism of the body such as thyroid hormones. Gluttony-clearing behavior can be repeated. The secrecy of binge eating and compensatory clearance is another feature of BN, and its behavior is often not noticed by family and friends. In addition, impulsive behaviors such as stealing food and alcohol abuse, sexual disorders, self-injury, and suicide attempts are common among BN patients.
BN is closely related to other mental disorders. It can be combined with mood disorders, anxiety disorders, substance abuse, especially alcohol and stimulant abuse. The comorbidity rate of personality disorder in BN patients is higher, mainly marginal, antisocial, performance and Narcissistic personality disorder.
2: Physical disorders
BN’s physical disorders can manifest as mild or transient symptoms such as fatigue, bloating, and constipation, and develop into chronic, even life-threatening disorders such as hypokalemia, kidney function, and heart damage. Gluttony can lead to a range of gastrointestinal symptoms, with nausea, abdominal pain, bloating, indigestion and weight gain being more common, and severe complications of acute gastric rupture are less common. The most commonly used compensatory clearance behavior in BN patients is self-induced vomiting, which can cause a series of severe physical discomfort or physical illnesses: acid reflux or ulceration, esophageal and pharyngeal damage; repeated vomiting can cause swelling of the parotid glands and salivary glands, Mumps; self-induced vomiting, finger or tooth and oral mucosa friction or stimulation can cause mouth or hand injury; frequent vomiting causes excessive loss of K +, Cl-, H +, bulimia nervosa DSM 5 criteria causing low potassium, low chloride alkalosis, There are even arrhythmias or kidney damage; in addition, secondary metabolic disorders can also be manifested as fatigue, convulsions, and seizures. Common somatic complications of BN include laxative dependence and chronic pancreatitis.
3: Bulimia Nervosa Diagnosis:
1: There is a persistent and uncontrollable concept of eating and craving food, and the patient succumbs to a bulimia episode of a large amount of food in a short period of time.
2: At least one of the following methods to counteract the obesity of food: 1 self-induced vomiting; 2 abuse of laxatives; 3 intermittent fasting; 4 use of anorexia, thyroxine preparations or diuretics. If you are diabetic, you may give up insulin therapy.
3: Often pathologically afraid of fat.
4: There is often a history of anorexia nervosa, which varies from months to years.
5: Paroxysmal binge eating at least 2 times a week for 3 months.
6: The excluded nervous system is the quality of STDovereating and change caused by epilepsy, schizophrenia, mental disorders secondary to overeating.
Sometimes the disease can be secondary to depression, leading to a diagnosis or a side-by-side diagnosis if necessary.
4: Bulimia Nervosa Differential Diagnosis:
1: Anorexia nervosa
If binge eating and clearing behavior occur only during the episode of anorexia nervosa, the diagnosis of bulimia nervosa cannot be made. In this case, an anorexia nervosa, binge eating-clearing type was diagnosed.
2: Nervous system diseases
Some neurological diseases or syndromes, such as epileptic seizures, central nervous system tumors, Klüver-Bucy syndrome, Kleine-Levin syndrome, etc., also have episodes of binge eating, which can be performed by neurological examination and corresponding examination. Identification. The syndrome is now less and less and is unlikely to cause a differential diagnosis. Neurogenic bulimia usually begins in adolescents, with more women than men, and more men than women. ‘Bulimia Nervosa Signs and Symptoms, health risks, diagnosis’
3: Major depression
Patients may have an excessive diet, but there is no compensation for inappropriate weight loss, such as vomiting, catharsis, etc., so it is different from neuropathic nervosa.
Patients with this disease can be followed by binge eating behavior, the patient sees this as a silent, without any weight control behavior, and has other symptoms of schizophrenia.
5: Bulimia Nervosa Treatment
Good treatment of BN patients requires close collaboration between multidisciplinary professionals, and the individualization of treatment plans is important. In addition, a complete treatment plan should consider combined mental disorders such as depression, personality disorder, and drug abuse. This goal of treatment is to relieve symptoms and prevent recurrence and cure it. Depending on the condition of the BN patient, outpatient treatment or hospitalization can be selected. When a patient’s psychiatric or physical condition threatens life and the patient refuses to be hospitalized, mandatory treatment must first be considered, such as suicidal ideation and suicidal behavior, electrolyte imbalance, and arrhythmia. BN physical complications are less than AN, and most can be treated in the outpatient department. The main treatments are medication, psychotherapy, and comprehensive treatment.
1: Drug therapy
The drug treatment research of BN is faster than that of AN. The commonly used drugs are antidepressants and anticonvulsants, and the former are the main ones. A commonly used safe antidepressant is a selective 5-HT reuptake inhibitor, and the anticonvulsant phenytoin and carbamazepine have a slight anti-feeding effect.
Most psychotherapy studies have found that psychological intervention is effective for BN, which can reduce the number of binge eating episodes and improve the symptoms of a clearing.
(1) Cognitive Behavioral Therapy (CBT) The goal of CBT treatment is to break the binge eating-clearing cycle, control BN symptoms, and prevent recurrence. The CBT method considers that regular eating is very important, and uses behavioral techniques to reduce gluttony behavior, including avoiding various situations that are prone to overeating, changing the way of thinking about problems, teaching patients to prevent recurrence, etc., while using self-monitoring methods to record in detail. Your own diet.
(2) Interpersonal relationship psychotherapy (IPT) is different from CBT method. IPT does not directly focus on the symptoms of BN, but focuses on and corrects “problematic interpersonal relationships.” By changing the interpersonal relationship of BN patients, the purpose of controlling and relieving symptoms is achieved, so IPT is slow and takes a long time. A series of comparative studies found that CBT was effective, while IPT was slow, and CBT was better than IPT at the beginning of treatment. Then the symptoms of BN patients with IPT continued to improve; although the onset time of CBT and IPT was different, the two treatments were equally effective.
(3) Behavioral Therapy (BT) There are many treatments for BT. It is reported that exposure and response prevention (ERP) treatment is effective for BN, and ERP treatment is derived from the mode of relieving anxiety in the treatment of obsessive-compulsive disorder. BN patients received ERP treatment, and most of the symptoms improved even significantly. Long-term follow-up studies found that CBT and IPT were superior to BT, and BT patients were prone to recurrence compared with the first two methods.
(4) Psychodynamic psychotherapy Although CBT has become the preferred psychotherapeutic treatment for BN, psychodynamic psychotherapy (psychotherapy based on psychoanalytic theory) still plays a role, especially when limited time psychological education and When CBT is ineffective for BN, it is suitable for psychodynamic psychotherapy. In a well-designed controlled study of CBT and kinetic therapy, initial results were better in the cognitive-behavioral treatment group, but in the longer follow-up period, the two treatments were almost identical in efficacy.
(5) Family therapy In the treatment of BN, family intervention in the form of support, education and possible family therapy is also needed. Since BN is often part of a family balance, family therapy or family interventions that combine individual treatments are often necessary.
(6) group psychotherapy to psychoanalysis-oriented group psychotherapy is an effective adjuvant therapy.
3: Comprehensive treatment
In the clinical work, in order to obtain the best effect, more comprehensive treatment measures including psychotherapy combined with drug therapy are adopted. The therapeutic effects of CBT alone or in combination with drugs are superior to those of drugs alone. In addition, some patients also need physical support treatment, stipulate the patient’s eating time and food intake, minimize or stop vomiting behavior, disable catharsis drugs; symptomatic treatment of water and electrolyte metabolism disorders.
6: Prognosis of Bulimia Nervosa:
BN is a chronic disease with a fluctuating course. Overall, the prognosis of BN is better than AN. “Bulimia Nervosa Signs and Symptoms, health risks, diagnosis” In the short-term, more than 50% of binge eating and excretion behaviors in BN patients who can participate in treatment are improved; however, during the improvement period, patients are not asymptomatic, and some patients with milder conditions can achieve long-term remission. Some patients need to be admitted to hospital; less than one-third of patients at three-year follow-up is in good condition, more than one-third have improved symptoms, and about one-third have worse outcomes and chronic symptoms. In some untreated BN patients, natural remission occurs after 1 to 2 years. Prognosis depends on the severity of the excretion, whether the patient has an electrolyte imbalance, and the degree of complications such as esophagitis, amylase, salivary gland hyperplasia, and tooth ulcers caused by frequent vomiting. There are marginal, narcissistic, performance and antisocial personality disorder, impulsive quality, and low self-esteem. BN has a low mortality rate and is chronically developed. The most common causes of death are traffic accidents and suicide.