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factoids

Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging or fasting, and excessive concern with body shape and weight.JOURNAL, Flett, Gordon L., Newby, Jennifer, Hewitt, Paul L., Persaud, Christina, vanc, Perfectionistic Automatic Thoughts, Trait Perfectionism, and Bulimic Automatic Thoughts in Young Women, Journal of Rational-Emotive & Cognitive-Behavior Therapy, September 2011, 29, 3, 192–206, 10.1007/s10942-011-0135-3, 144731404, This activity aims to expel the body of calories eaten from the binging phase of the process. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives.WEB, Bulimia nervosa fact sheet,weblink Office on Women's Health, July 16, 2012, June 27, 2015, live,weblink" title="web.archive.org/web/20150619030219weblink">weblink June 19, 2015, Other efforts to lose weight may include the use of diuretics, stimulants, water fasting, or excessive exercise.JOURNAL, Hay PJ, Claudino AM, Bulimia nervosa, BMJ Clinical Evidence, 2010, 1009, July 2010, 21418667, 3275326, Most people with bulimia are at normal weight.JOURNAL, Bulik CM, Marcus MD, Zerwas S, Levine MD, La Via M, The changing "weightscape" of bulimia nervosa, The American Journal of Psychiatry, 169, 10, 1031–6, October 2012, 23032383, 4038540, 10.1176/appi.ajp.2012.12010147, The forcing of vomiting may result in thickened skin on the knuckles, breakdown of the teeth, and effects on metabolic rate and caloric intake which cause thyroid dysfunction.biologicalpsychiatryjournal.com/article/0006-3223(93)90168-D/fulltext Bulimia is frequently associated with other mental disorders such as depression, anxiety, borderline personality disorder,JOURNAL, 10.1186/s40479-018-0098-4, Impact of comorbid borderline personality disorder on inpatient treatment for bulimia nervosa: Analysis of routine data, 2019, Hessler, Johannes Baltasar, Heuser, Jörg, Schlegl, Sandra, Bauman, Tabea, Greetfeld, Martin, Voderholzer, Ulrich, Borderline Personality Disorder and Emotion Dysregulation, 6, 1, 30680217, 6335811, free, bipolar disorder,JOURNAL, McElroy SL, Kotwal R, Keck PE, Akiskal HS, Comorbidity of bipolar and eating disorders: distinct or related disorders with shared dysregulations?, J Affect Disord, 86, 2–3, 107–27, June 2005, 15935230, 10.1016/j.jad.2004.11.008, and problems with drugs or alcohol. There is also a higher risk of suicide and self-harm.JOURNAL, Smink FR, van Hoeken D, Hoek HW, August 2012, Epidemiology of eating disorders: incidence, prevalence and mortality rates, Current Psychiatry Reports, 14, 4, 406–14, 10.1007/s11920-012-0282-y, 3409365, 22644309, Bulimia is more common among those who have a close relative with the condition. The percentage risk that is estimated to be due to genetics is between 30% and 80%. Other risk factors for the disease include psychological stress, cultural pressure to attain a certain body type, poor self-esteem, and obesity. Living in a culture that commercializes or glamorizes dieting and having parental figures who fixate on weight are also risks. Diagnosis is based on a person's medical history;BOOK,weblink Diagnostic and Statistical Manual of Mental Disorders, ((American Psychiatric Association)), American Psychiatric Publishing, 2013, 978-0-89042-555-8, Fifth, Arlington, VA, 345–349, however, this is difficult, as people are usually secretive about their binge eating and purging habits. Further, the diagnosis of anorexia nervosa takes precedence over that of bulimia. Other similar disorders include binge eating disorder, Kleine–Levin syndrome, and borderline personality disorder.

Signs and symptoms

(File:Bulimiafaqdia.jpg|thumb|upright=1.6|How bulimia affects the body)(File:Oral Manifestation of Bulimia..jpg|thumb|The erosion on the lower teeth was caused by bulimia. For comparison, the upper teeth were restored with porcelain veneers.Dorfman J, The Center for Special Dentistry {{Webarchive|url=https://web.archive.org/web/20150211120011weblink |date=February 11, 2015 }}.)Bulimia typically involves rapid and out-of-control eating, which may stop when the person is interrupted by another person or the stomach hurts from over-extension, followed by self-induced vomiting or other forms of purging. This cycle may be repeated several times a week or, in more serious cases, several times a dayJOURNAL, 2005, Bulimia Nervosa, Let's Talk Facts, 1,weblink September 13, 2013, March 19, 2015,weblink" title="web.archive.org/web/20150319060513weblink">weblink dead, and may directly cause:

• Chronic gastric reflux after eating, secondary to vomitingJOURNAL, Mehler PS, Clinical practice. Bulimia nervosa, The New England Journal of Medicine, 349, 9, 875–81, August 2003, 12944574, 10.1056/NEJMcp022813,
• Dehydration and hypokalemia due to renal potassium loss in the presence of alkalosis and frequent vomitingJOURNAL, Mehler PS, Crews C, Weiner K, Bulimia: medical complications, Journal of Women's Health, 13, 6, 668–75, 2004, 15333281, 10.1089/jwh.2004.13.668,weblink
• Electrolyte imbalance can lead to abnormal heart rhythms, cardiac arrest, and even death
• Esophagitis, or inflammation of the esophagus
• Mallory-Weiss tears
• Boerhaave syndrome, a rupture in the esophageal wall due to vomiting
• Oral trauma, in which repetitive insertion of fingers or other objects causes lacerations to the lining of the mouth or throat
• Russell's sign: calluses on knuckles and back of hands due to repeated trauma from incisorsJOURNAL, Joseph AB, Herr B, Finger calluses in bulimia, The American Journal of Psychiatry, 142, 5, 655a–655, May 1985, 3857013, 10.1176/ajp.142.5.655a, JOURNAL, Wynn DR, Martin MJ, A physical sign of bulimia, Mayo Clinic Proceedings, 59, 10, 722, October 1984, 6592415, 10.1016/s0025-6196(12)62063-1, free,
• Perimolysis, or severe dental erosion of tooth enamelWEB, American Dental Association,weblink Eating Disorders, Oral Health Topics A–Z,weblink" title="web.archive.org/web/20090203133827weblink">weblink February 3, 2009,
• Swollen salivary glands (for example, in the neck, under the jawline)JOURNAL, Mcgilley BM, Pryor TL, Assessment and treatment of bulimia nervosa, American Family Physician, 57, 11, 2743–50, June 1998, 9636337,weblink
• Gastroparesis, or delayed gastric emptying
• Constipation or diarrhea
• Tachycardia or palpitations
• Hypotension
• Peptic ulcers
• Infertility
• Constant weight fluctuations are common
• Elevated blood sugar, cholesterol, and amylase levels may occur
• Hypoglycemia may occur after vomiting

These are some of the many signs that may indicate whether someone has bulimia nervosa:NEWS, Illawarra Mercury, Symptoms Of Bulimia Nervosa,weblinkweblink" title="web.archive.org/web/20160221214651weblink">weblink dead, February 21, 2016, February 23, 2001,

• A fixation on the number of calories consumed
• A fixation on an extreme consciousness of one's weight
• Low self-esteem and/or self-harming
• Suicidal tendencies
• An irregular menstrual cycle in women
• Regular trips to the bathroom, especially soon after eating
• Depression, anxiety disorders, and sleep disorders
• Frequent occurrences involving the consumption of abnormally large portions of foodWEB, Bulimia Nervosa,weblink Proud2BME, The National Eating Disorders Association, December 5, 2014, live,weblink December 10, 2014,
• The use of laxatives, diuretics, and diet pills
• Compulsive or excessive exercise
• Unhealthy/dry skin, hair, nails, and lips
• Fatigue, or exhaustion

As with many psychiatric illnesses, delusions can occur, in conjunction with other signs and symptoms, leaving the person with a false belief that is not ordinarily accepted by others.BOOK, Barker P, Psychiatric and Mental Health Nursing: The Craft of Caring, Arnold, Great Britain, 2003, 978-0340810262, {{page needed|date=August 2013}}People with bulimia nervosa may also exercise to a point that excludes other activities.

Interoceptive

People with bulimia exhibit several interoceptive deficits, in which one experiences impairment in recognizing and discriminating between internal sensations, feelings, and emotions.JOURNAL, Boswell JF, Anderson LM, Anderson DA, June 2015, Integration of Interoceptive Exposure in Eating Disorder Treatment, Clinical Psychology: Science and Practice, en, 22, 2, 194–210, 10.1111/cpsp.12103, People with bulimia may also react negatively to somatic and affective states.JOURNAL, Badoud D, Tsakiris M, From the body's viscera to the body's image: Is there a link between interoception and body image concerns?, Neuroscience and Biobehavioral Reviews, 77, 237–246, June 2017, 28377099, 10.1016/j.neubiorev.2017.03.017, 768206, Regarding interoceptive sensation, hyposensitive individuals may not detect normal feelings of fullness at the appropriate time while eating, and are prone to eating more calories in a short period of time as a result of this decreased sensitivity.Examining from a neural basis also connects elements of interoception and emotion; notable overlaps occur in the medial prefrontal cortex, anterior and posterior cingulate, and anterior insula cortices, which are linked to both interoception and emotional eating.JOURNAL, Barrett LF, Simmons WK, Interoceptive predictions in the brain, Nature Reviews. Neuroscience, 16, 7, 419–29, July 2015, 26016744, 4731102, 10.1038/nrn3950,

Related disorders

People with bulimia are at a higher risk to have an affective disorder, such as depression or general anxiety disorder. One study found 70% had depression at some time in their lives (as opposed to 26% for adult females in the general population), rising to 88% for all affective disorders combined.JOURNAL, Walsh BT, Roose SP, Glassman AH, Gladis M, Sadik C, Bulimia and depression, Psychosomatic Medicine, 47, 2, 123–31, 1985, 3863157, 10.1097/00006842-198503000-00003, 12748691, Another study in the Journal of Affective Disorders found that of the population of patients that were diagnosed with an eating disorder according to the DSM-V guidelines about 27% also suffered from bipolar disorder. Within this article, the majority of the patients were diagnosed with bulimia nervosa, the second most common condition reported was binge-eating disorder.JOURNAL, McElroy, Susan L., Crow, Scott, Blom, Thomas J., Biernacka, Joanna M., Winham, Stacey J., Geske, Jennifer, Cuellar-Barboza, Alfredo B., Bobo, William V., Prieto, Miguel L., Veldic, Marin, Mori, Nicole, Seymour, Lisa R., Bond, David J., Frye, Mark A., February 2016, Prevalence and correlates of DSM-5 eating disorders in patients with bipolar disorder,weblink Journal of Affective Disorders, en, 191, 216–221, 10.1016/j.jad.2015.11.010, 26682490, Some individuals with anorexia nervosa exhibit episodes of bulimic tendencies through purging (either through self-induced vomiting or laxatives) as a way to quickly remove food in their system.Carlson, N.R., et al. (2007). Psychology: The Science of Behaviour – 4th Canadian ed. Toronto, ON: Pearson Education Canada.{{page needed|date=August 2013}} There may be an increased risk for diabetes mellitus type 2.JOURNAL, Nieto-Martínez R, González-Rivas JP, Medina-Inojosa JR, Florez H, Are Eating Disorders Risk Factors for Type 2 Diabetes? A Systematic Review and Meta-analysis, Current Diabetes Reports, 17, 12, 138, November 2017, 29168047, 10.1007/s11892-017-0949-1, 3688434, Bulimia also has negative effects on a person's teeth due to the acid passed through the mouth from frequent vomiting causing acid erosion, mainly on the posterior dental surface.Research has shown that there is a relationship between bulimia and narcissism.JOURNAL, Maples J, Collins B, Miller JD, Fischer S, Seibert A, Differences between grandiose and vulnerable narcissism and bulimic symptoms in young women, Eat Behav, 12, 1, 83–5, January 2011, 21184981, 10.1016/j.eatbeh.2010.10.001, JOURNAL, Steiger H, Jabalpurwala S, Champagne J, Stotland S, A controlled study of trait narcissism in anorexia and bulimia nervosa, Int J Eat Disord, 22, 2, 173–8, September 1997, 9261656, 10.1002/(sici)1098-108x(199709)22:23.0.co;2-c, JOURNAL, Steinberg BE, Shaw RJ, Bulimia as a disturbance of narcissism: self-esteem and the capacity to self-soothe, Addict Behav, 22, 5, 699–710, 1997, 9347071, 10.1016/s0306-4603(97)00009-9, 25050604, According to a study by the Australian National University, eating disorders are more susceptible among vulnerable narcissists. This can be caused by a childhood in which inner feelings and thoughts were minimized by parents, leading to "a high focus on receiving validation from others to maintain a positive sense of self".JOURNAL, Sivanathan D, Bizumic B, Rieger E, Huxley E, December 2019, Vulnerable narcissism as a mediator of the relationship between perceived parental invalidation and eating disorder pathology, Eat Weight Disord, 24, 6, 1071–1077, 10.1007/s40519-019-00647-2, 30725304, 73416090,

• {{lay source|template=cite news|url=https://health.anu.edu.au/news-events/news/vulnerable-narcissists-more-susceptible-eating-disorders|title=Vulnerable narcissists more susceptible to eating disorders|website=ANU College of Health & Medicine}}

The medical journal Borderline Personality Disorder and Emotion Dysregulation notes that a "substantial rate of patients with bulimia nervosa" also have Borderline personality disorder.A study by the Psychopharmacology Research Program of the University of Cincinnati College of Medicine "leaves little doubt that bipolar and eating disorders—particularly bulimia nervosa and bipolar II disorder—are related." The research shows that most clinical studies indicate that patients with bipolar disorder have higher rates of eating disorders, and vice versa. There is overlap in phenomenology, course, comorbidity, family history, and pharmacologic treatment response of these disorders. This is especially true of "eating dysregulation, mood dysregulation, impulsivity and compulsivity, craving for activity and/or exercise."Studies have shown a relationship between bulimia's effect on metabolic rate and caloric intake with thyroid dysfunction.JOURNAL, Altemus M, Hetherington M, Kennedy B, Licinio J, Gold PW, Thyroid function in bulimia nervosa, Psychoneuroendocrinology, 21, 3, 249–61, April 1996, 8817724, 10.1016/0306-4530(96)00002-9, 24919021,

Causes

Biological

As with anorexia nervosa, there is evidence of genetic predispositions contributing to the onset of this eating disorder.WEB, Biological Causes of Anorexia Nervosa and Bulimia Nervosa,weblink July 4, 2016,weblink" title="web.archive.org/web/20160502145058weblink">weblink May 2, 2016, dead, Abnormal levels of many hormones, notably serotonin, have been shown to be responsible for some disordered eating behaviors. Brain-derived neurotrophic factor (BDNF) is under investigation as a possible mechanism.JOURNAL, Ribasés M, Gratacòs M, Fernández-Aranda F, Bellodi L, Boni C, Anderluh M, Cavallini MC, Cellini E, Di Bella D, Erzegovesi S, Foulon C, Gabrovsek M, Gorwood P, Hebebrand J, Hinney A, Holliday J, Hu X, Karwautz A, Kipman A, Komel R, Nacmias B, Remschmidt H, Ricca V, Sorbi S, Wagner G, Treasure J, Collier DA, Estivill X, 6, Association of BDNF with anorexia, bulimia and age of onset of weight loss in six European populations, Human Molecular Genetics, 13, 12, 1205–12, June 2004, 15115760, 10.1093/hmg/ddh137, free, BOOK, Annual Review of Eating Disorders â€“ part 2, 2018, Wonderlich S, Mitchell JE, de Zwaan M, Steiger H, Radcliffe Publishing, 14–15, Psychobiology of eating disorders,weblink 978-1-84619-244-9, There is evidence that sex hormones may influence appetite and eating in women and the onset of bulimia nervosa. Studies have shown that women with hyperandrogenism and polycystic ovary syndrome have a dysregulation of appetite, along with carbohydrates and fats. This dysregulation of appetite is also seen in women with bulimia nervosa. In addition, gene knockout studies in mice have shown that mice that have the gene encoding estrogen receptors have decreased fertility due to ovarian dysfunction and dysregulation of androgen receptors. In humans, there is evidence that there is an association between polymorphisms in the ERβ (estrogen receptor β) and bulimia, suggesting there is a correlation between sex hormones and bulimia nervosa.JOURNAL, Hirschberg AL, Sex hormones, appetite and eating behaviour in women, Maturitas, 71, 3, 248–56, March 2012, 22281161, 10.1016/j.maturitas.2011.12.016, Bulimia has been compared to drug addiction, though the empirical support for this characterization is limited.JOURNAL, Broft A, Shingleton R, Kaufman J, Liu F, Kumar D, Slifstein M, Abi-Dargham A, Schebendach J, Van Heertum R, Attia E, Martinez D, Walsh BT, 6, Striatal dopamine in bulimia nervosa: a PET imaging study, The International Journal of Eating Disorders, 45, 5, 648–56, July 2012, 22331810, 3640453, 10.1002/eat.20984, However, people with bulimia nervosa may share dopamine D2 receptor-related vulnerabilities with those with substance use disorders.JOURNAL, Kaye WH, Wierenga CE, Bailer UF, Simmons AN, Wagner A, Bischoff-Grethe A, Does a shared neurobiology for foods and drugs of abuse contribute to extremes of food ingestion in anorexia and bulimia nervosa?, Biological Psychiatry, 73, 9, 836–42, May 2013, 23380716, 3755487, 10.1016/j.biopsych.2013.01.002, Dieting, a common behaviour in bulimics, is associated with lower plasma tryptophan levels.JOURNAL, Strasser B, Fuchs D, Diet Versus Exercise in Weight Loss and Maintenance: Focus on Tryptophan, International Journal of Tryptophan Research, 9, 9–16, 2016, 27199566, 4864009, 10.4137/IJTR.S33385, Decreased tryptophan levels in the brain, and thus the synthesis of serotonin, such as via acute tryptophan depletion, increases bulimic urges in currently and formerly bulimic individuals within hours.JOURNAL, Smith KA, Fairburn CG, Cowen PJ, Symptomatic relapse in bulimia nervosa following acute tryptophan depletion, Archives of General Psychiatry, 56, 2, 171–6, February 1999, 10025442, 10.1001/archpsyc.56.2.171, free, JOURNAL, Weltzin TE, Fernstrom MH, Fernstrom JD, Neuberger SK, Kaye WH, Acute tryptophan depletion and increased food intake and irritability in bulimia nervosa, The American Journal of Psychiatry, 152, 11, 1668–71, November 1995, 7485633, 10.1176/ajp.152.11.1668, Abnormal blood levels of peptides important for the regulation of appetite and energy balance are observed in individuals with bulimia nervosa, but it remains unknown if this is a state or trait.JOURNAL, Tortorella A, Brambilla F, Fabrazzo M, Volpe U, Monteleone AM, Mastromo D, Monteleone P, Central and peripheral peptides regulating eating behaviour and energy homeostasis in anorexia nervosa and bulimia nervosa: a literature review, European Eating Disorders Review, 22, 5, 307–20, September 2014, 24942507, 10.1002/erv.2303, In recent years, evolutionary psychiatry as an emerging scientific discipline has been studying mental disorders from an evolutionary perspective. If eating disorders, Bulimia nervosa in particular, have evolutionary functions or if they are new modern "lifestyle" problems is still debated.JOURNAL, Abed RT, The sexual competition hypothesis for eating disorders, Br J Med Psychol, 71 ( Pt 4), 4, 525–47, December 1998, 9875960, 10.1111/j.2044-8341.1998.tb01007.x, JOURNAL, Nettersheim J, Gerlach G, Herpertz S, Abed R, Figueredo AJ, Brüne M, Evolutionary Psychology of Eating Disorders: An Explorative Study in Patients With Anorexia Nervosa and Bulimia Nervosa, Front Psychol, 9, 2122, 2018, 30429818, 6220092, 10.3389/fpsyg.2018.02122, free, BOOK, Nesse RM, Good reasons for bad feelings: insights from the frontier of evolutionary psychiatry, 2020, Penguin Books, Limited, 978-0-14-198491-9, 1100591660, {{page needed|date=July 2021}}

Social

Media portrayals of an 'ideal' body shape are widely considered to be a contributing factor to bulimia. In a 1991 study by Weltzin, Hsu, Pollicle, and Kaye, it was stated that 19% of bulimics undereat, 37% of bulimics eat an average or normal amount of food, and 44% of bulimics overeat.BOOK, Psychology: the science of behaviour, 4th Canadian, Neil R., Carlson, William, Buskist, C. Donald, Heth, Rod, Schmaltz, vanc, 2010, Pearson Education Canada, Toronto, 978-0-205-70286-2, 415, A survey of 15- to 18-year-old high school girls in Nadroga, Fiji, found the self-reported incidence of purging rose from 0% in 1995 (a few weeks after the introduction of television in the province) to 11.3% in 1998.JOURNAL, Becker AE, Burwell RA, Gilman SE, Herzog DB, Hamburg P, Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls, The British Journal of Psychiatry, 180, 6, 509–14, June 2002, 12042229, 10.1192/bjp.180.6.509, free, In addition, the suicide rate among people with bulimia nervosa is 7.5 times higher than in the general population.Nolen-Hoeksema, Susan (2014). "Bulimia Nervosa" Abnormal Psychology. 6e. pg 344.When attempting to decipher the origin of bulimia nervosa in a cognitive context, Christopher Fairburn et al.{{'}}s cognitive-behavioral model is often considered the golden standard.JOURNAL, Cooper Z, Fairburn CG, The Evolution of "Enhanced" Cognitive Behavior Therapy for Eating Disorders: Learning From Treatment Nonresponse, Cognitive and Behavioral Practice, 2013, 18, 3, 394–402, 10.1016/j.cbpra.2010.07.007, 23814455, 3695554, Fairburn et al.'s model discusses the process in which an individual falls into the binge-purge cycle and thus develops bulimia. Fairburn et al. argue that extreme concern with weight and shape coupled with low self-esteem will result in strict, rigid, and inflexible dietary rules. Accordingly, this would lead to unrealistically restricted eating, which may consequently induce an eventual "slip" where the individual commits a minor infraction of the strict and inflexible dietary rules. Moreover, the cognitive distortion due to dichotomous thinking leads the individual to binge. The binge subsequently should trigger a perceived loss of control, promoting the individual to purge in hope of counteracting the binge. However, Fairburn et al. assert the cycle repeats itself, and thus consider the binge-purge cycle to be self-perpetuating.JOURNAL, Fairburn CG, Beglin SJ, Studies of the epidemiology of bulimia nervosa, The American Journal of Psychiatry, 147, 4, 401–8, April 1990, 2180327, 10.1176/ajp.147.4.401, In contrast, Byrne and Mclean's findings differed slightly from Fairburn et al.{{'}}s cognitive-behavioral model of bulimia nervosa in that the drive for thinness was the major cause of purging as a way of controlling weight. In turn, Byrne and Mclean argued that this makes the individual vulnerable to binging, indicating that it is not a binge-purge cycle but rather a purge-binge cycle in that purging comes before bingeing. Similarly, Fairburn et al.{{'}}s cognitive-behavioral model of bulimia nervosa is not necessarily applicable to every individual and is certainly reductionist. Every one differs from another, and taking such a complex behavior like bulimia and applying the same one theory to everyone would certainly be invalid. In addition, the cognitive-behavioral model of bulimia nervosa is very culturally bound in that it may not be necessarily applicable to cultures outside of Western society. To evaluate, Fairburn et al..'s model and more generally the cognitive explanation of bulimia nervosa is more descriptive than explanatory, as it does not necessarily explain how bulimia arises. Furthermore, it is difficult to ascertain cause and effect, because it may be that distorted eating leads to distorted cognition rather than vice versa.BOOK, Trull, Thimothy, vanc, Abnormal Psychology and Life: A Dimensional Approach, Wadsworth, Cengage Learning, Belmont CA, 978-1-111-34376-7, 236–8,weblink 2010-10-08, live,weblink 2016-02-07, JOURNAL, Byrne SM, McLean NJ, The cognitive-behavioral model of bulimia nervosa: a direct evaluation, The International Journal of Eating Disorders, 31, 1, 17–31, January 2002, 11835294, 10.1002/eat.10002, A considerable amount of literature has identified a correlation between sexual abuse and the development of bulimia nervosa. The reported incident rate of unwanted sexual contact is higher among those with bulimia nervosa than anorexia nervosa.JOURNAL, Waller G, Sexual abuse and the severity of bulimic symptoms, The British Journal of Psychiatry, 161, 90–3, July 1992, 1638336, 10.1192/bjp.161.1.90, 39739310, When exploring the etiology of bulimia through a socio-cultural perspective, the "thin ideal internalization" is significantly responsible. The thin-ideal internalization is the extent to which individuals adapt to the societal ideals of attractiveness. Studies have shown that young women that read fashion magazines tend to have more bulimic symptoms than those women who do not. This further demonstrates the impact of media on the likelihood of developing the disorder.BOOK, Nolen-Hoeksema, Susan, vanc, (Ab)normal Psychology, 2013, McGraw Hill, 978-0078035388, 338, Individuals first accept and "buy into" the ideals, and then attempt to transform themselves in order to reflect the societal ideals of attractiveness. J. Kevin Thompson and Eric Stice claim that family, peers, and most evidently media reinforce the thin ideal, which may lead to an individual accepting and "buying into" the thin ideal. In turn, Thompson and Stice assert that if the thin ideal is accepted, one could begin to feel uncomfortable with their body shape or size since it may not necessarily reflect the thin ideal set out by society. Thus, people feeling uncomfortable with their bodies may result in body dissatisfaction and may develop a certain drive for thinness. Consequently, body dissatisfaction coupled with a drive for thinness is thought to promote dieting and negative effects, which could eventually lead to bulimic symptoms such as purging or bingeing. Binges lead to self-disgust which causes purging to prevent weight gain.WEB, Zieve, David, vanc, Bulimia,weblink PubMed Health, April 18, 2011, live,weblink" title="web.archive.org/web/20110211185310weblink">weblink February 11, 2011, A study dedicated to investigating the thin ideal internalization as a factor of bulimia nervosa is Thompson's and Stice's research. Their study aimed to investigate how and to what degree media affects the thin ideal internalization. Thompson and Stice used randomized experiments (more specifically programs) dedicated to teaching young women how to be more critical when it comes to media, to reduce thin-ideal internalization. The results showed that by creating more awareness of the media's control of the societal ideal of attractiveness, the thin ideal internalization significantly dropped. In other words, less thin ideal images portrayed by the media resulted in less thin-ideal internalization. Therefore, Thompson and Stice concluded that media greatly affected the thin ideal internalization.JOURNAL, 10.1111/1467-8721.00144, Thin-Ideal Internalization: Mounting Evidence for a New Risk Factor for Body-Image Disturbance and Eating Pathology, 2001, Thompson, J. Kevin, Stice, Eric, vanc, Current Directions in Psychological Science, 10, 5, 181–3, 20182734, 20401750, Papies showed that it is not the thin ideal itself, but rather the self-association with other persons of a certain weight that decide how someone with bulimia nervosa feels. People that associate themselves with thin models get in a positive attitude when they see thin models and people that associate with overweight get in a negative attitude when they see thin models. Moreover, it can be taught to associate with thinner people.JOURNAL, Papies EK, Nicolaije KA, Inspiration or deflation? Feeling similar or dissimilar to slim and plus-size models affects self-evaluation of restrained eaters, Body Image, 9, 1, 76–85, January 2012, 21962524, 10.1016/j.bodyim.2011.08.004,

Diagnosis

The onset of bulimia nervosa is often during adolescence, between 13 and 20 years of age, and many cases have previously experienced obesity, with many relapsing in adulthood into episodic bingeing and purging even after initially successful treatment and remission.BOOK, Shader, Richard I., vanc, Manual of Psychiatric Therapeutics, Lippincott Williams & Wilkins, Hagerstwon, MD, 2004, 978-0-7817-4459-1, {{Page needed|date=September 2010}} A lifetime prevalence of 0.5 percent and 0.9 percent for adults and adolescents, respectively, is estimated among the United States population.[Nolen-Hoeksema, S. (2013)."(Ab)normal Psychology"(6th edition). McGraw-Hill. p.344] Bulimia nervosa may affect up to 1% of young women and, after 10 years of diagnosis, half will recover fully, a third will recover partially, and 10–20% will still have symptoms.Adolescents with bulimia nervosa are more likely to have self-imposed perfectionism and compulsivity issues in eating compared to their peers. This means that the high expectations and unrealistic goals that these individuals set for themselves are internally motivated rather than by social views or expectations.JOURNAL, Castro-Fornieles J, Gual P, Lahortiga F, Gila A, Casulà V, Fuhrmann C, Imirizaldu M, Saura B, Martínez E, Toro J, 6, Self-oriented perfectionism in eating disorders, The International Journal of Eating Disorders, 40, 6, 562–8, September 2007, 17510925, 10.1002/eat.20393,

Criteria

Bulimia nervosa can be difficult to detect, compared to anorexia nervosa, because bulimics tend to be of average or slightly above average weight. Many bulimics may also engage in significantly disordered eating and exercise patterns without meeting the full diagnostic criteria for bulimia nervosa.JOURNAL, Walsh JM, Wheat ME, Freund K, Detection, evaluation, and treatment of eating disorders the role of the primary care physician, Journal of General Internal Medicine, 15, 8, 577–90, August 2000, 10940151, 1495575, 10.1046/j.1525-1497.2000.02439.x, Recently, the Diagnostic and Statistical Manual of Mental Disorders was revised, which resulted in the loosening of criteria regarding the diagnoses of bulimia nervosa and anorexia nervosa.[Nolen-Hoeksema, S. (2013)."(Ab)normal Psychology"(6th edition). McGraw-Hill. p.343] The diagnostic criteria utilized by the DSM-5 includes repetitive episodes of binge eating (a discrete episode of overeating during which the individual feels out of control of consumption) compensated for by excessive or inappropriate measures taken to avoid gaining weight.BOOK, Diagnostic and Statistical Manual of Mental Disorders, 4th, text revision (DSM-IV-TR), American Psychiatric Association, 2000, 978-0-89042-025-6, Diagnostic criteria for 307.51 Bulimia Nervosa,weblink 2010-03-14, 2021-08-28,weblink dead, The diagnosis also requires the episodes of compensatory behaviors and binge eating to happen a minimum of once a week for a consistent time period of 3 months.[Nolen-Hoeksema, S. (2013)."(Ab)normal Psychology" (6th edition). McGraw-Hill. p.343] The diagnosis is made only when the behavior is not a part of the symptom complex of anorexia nervosa and when the behavior reflects an overemphasis on physical mass or appearance. Purging often is a common characteristic of a more severe case of bulimia nervosa.Nolan-Hoeksema, Susan (2014). Abnormal Psychology (6 ed.). McGraw-Hill Education. p. 345. {{ISBN|978-0-07-803538-8}}.

Treatment

There are two main types of treatment given to those with bulimia nervosa; psychopharmacological and psychosocial treatments.JOURNAL, Hoste RR, Labuschagne Z, Le Grange D, Adolescent bulimia nervosa, Current Psychiatry Reports, 14, 4, 391–7, August 2012, 22614677, 10.1007/s11920-012-0280-0, 36665983,

Psychotherapy

Cognitive behavioral therapy is the primary treatment for bulimia.JOURNAL, Hay P, July 2013, A systematic review of evidence for psychological treatments in eating disorders: 2005-2012, The International Journal of Eating Disorders, 46, 5, 462–9, 10.1002/eat.22103, 23658093, Antidepressants of the selective serotonin reuptake inhibitor (SSRI) or tricyclic antidepressant classes may have a modest benefit.JOURNAL, McElroy SL, Guerdjikova AI, Mori N, O'Melia AM, October 2012, Current pharmacotherapy options for bulimia nervosa and binge eating disorder, Expert Opinion on Pharmacotherapy, 13, 14, 2015–26, 10.1517/14656566.2012.721781, 22946772, 1747393, While outcomes with bulimia are typically better than in those with anorexia, the risk of death among those affected is higher than that of the general population. At 10 years after receiving treatment about 50% of people are fully recovered.Cognitive behavioral therapy (CBT), which involves teaching a person to challenge automatic thoughts and engage in behavioral experiments (for example, in session eating of "forbidden foods") has a small amount of evidence supporting its use.JOURNAL, Hay PP, Bacaltchuk J, Stefano S, Kashyap P, Psychological treatments for bulimia nervosa and binging, The Cochrane Database of Systematic Reviews, 4, CD000562, October 2009, 2009, 19821271, 7034415, 10.1002/14651858.CD000562.pub3, By using CBT people record how much food they eat and periods of vomiting with the purpose of identifying and avoiding emotional fluctuations that bring on episodes of bulimia on a regular basis. Barker (2003) states that research has found 40–60% of people using cognitive behaviour therapy to become symptom free. He states in order for the therapy to work, all parties must work together to discuss, record and develop coping strategies. Barker (2003) claims by making people aware of their actions they will think of alternatives.JOURNAL, Agras WS, Crow SJ, Halmi KA, Mitchell JE, Wilson GT, Kraemer HC, Outcome predictors for the cognitive behavior treatment of bulimia nervosa: data from a multisite study, The American Journal of Psychiatry, 157, 8, 1302–8, August 2000, 10910795, 10.1176/appi.ajp.157.8.1302, JOURNAL, Wilson GT, Loeb KL, Walsh BT, Labouvie E, Eva Petkova, Petkova E, Liu X, Waternaux C, Psychological versus pharmacological treatments of bulimia nervosa: predictors and processes of change, Journal of Consulting and Clinical Psychology, 67, 4, 451–9, August 1999, 10450615, 10.1037/0022-006X.67.4.451, 10.1.1.583.7568, People undergoing CBT who exhibit early behavioral changes are most likely to achieve the best treatment outcomes in the long run.JOURNAL, Trunko ME, Rockwell RE, Curry E, Runfola C, Kaye WH, Management of bulimia nervosa, Women's Health, 3, 2, 255–65, March 2007, 19803857, 10.2217/17455057.3.2.255, free, Researchers have also reported some positive outcomes for interpersonal psychotherapy and dialectical behavior therapy.JOURNAL, Fairburn CG, Agras WS, Walsh BT, Wilson GT, Stice E, Prediction of outcome in bulimia nervosa by early change in treatment, The American Journal of Psychiatry, 161, 12, 2322–4, December 2004, 15569910, 10.1176/appi.ajp.161.12.2322, JOURNAL, Safer DL, Telch CF, Agras WS, Dialectical behavior therapy for bulimia nervosa, The American Journal of Psychiatry, 158, 4, 632–4, April 2001, 11282700, 10.1176/appi.ajp.158.4.632, Maudsley family therapy, developed at the Maudsley Hospital in London for the treatment of anorexia, has been shown promising results in bulimia.JOURNAL, Lock J, le Grange D, Family-based treatment of eating disorders, The International Journal of Eating Disorders, 37 Suppl, S64–7; discussion S87–9, 2005, 15852323, 10.1002/eat.20122, 25752094, free, The use of CBT has been shown to be quite effective for treating bulimia nervosa (BN) in adults, but little research has been done on effective treatments of BN for adolescents.JOURNAL, Keel PK, Haedt A, Evidence-based psychosocial treatments for eating problems and eating disorders, Journal of Clinical Child and Adolescent Psychology, 37, 1, 39–61, January 2008, 18444053, 10.1080/15374410701817832, 16098576, 10.1.1.822.6191, Although CBT is seen as more cost-efficient and helps individuals with BN in self-guided care, Family Based Treatment (FBT) might be more helpful to younger adolescents who need more support and guidance from their families.JOURNAL, Nadeau PO, Leichner P, Treating Bulimia in Adolescents: A Family-Based Approach, Journal of the Canadian Academy of Child and Adolescent Psychiatry, February 2009, 18, 1, 67–68, 2651218, Adolescents are at the stage where their brains are still quite malleable and developing gradually.JOURNAL, Le Grange D, Lock J, Dymek M, Family-based therapy for adolescents with bulimia nervosa, American Journal of Psychotherapy, 57, 2, 237–51, 2003, 12817553, 10.1176/appi.psychotherapy.2003.57.2.237, free, Therefore, young adolescents with BN are less likely to realize the detrimental consequences of becoming bulimic and have less motivation to change,JOURNAL, Castro-Fornieles J, Bigorra A, Martinez-Mallen E, Gonzalez L, Moreno E, Font E, Toro J, Motivation to change in adolescents with bulimia nervosa mediates clinical change after treatment, European Eating Disorders Review, 19, 1, 46–54, 2011, 20872926, 10.1002/erv.1045, which is why FBT would be useful to have families intervene and support the teens. Working with BN patients and their families in FBT can empower the families by having them involved in their adolescent's food choices and behaviors, taking more control of the situation in the beginning and gradually letting the adolescent become more autonomous when they have learned healthier eating habits.

Medication

Antidepressants of the selective serotonin reuptake inhibitors (SSRI) class may have a modest benefit. This includes fluoxetine, also known as prozac, which is FDA approved, for the treatment of bulimia, other antidepressants such as sertraline may also be effective against bulimia. Topiramate may also be useful but has greater side effects. Compared to placebo, the use of a single antidepressant has been shown to be effective.JOURNAL, Bacaltchuk J, Hay P, Antidepressants versus placebo for people with bulimia nervosa, Cochrane Database Syst Rev, 4, CD003391, 2003, 14583971, 10.1002/14651858.CD003391, 6991155, Combining medication with counseling can improve outcomes in some circumstances.JOURNAL, Bacaltchuk J, Hay P, Trefiglio R, Antidepressants versus psychological treatments and their combination for bulimia nervosa, The Cochrane Database of Systematic Reviews, 4, CD003385, 2001, 2001, 11687197, 6999807, 10.1002/14651858.CD003385, Some positive outcomes of treatments can include: abstinence from binge eating, a decrease in obsessive behaviors to lose weight and in shape preoccupation, less severe psychiatric symptoms, a desire to counter the effects of binge eating, as well as an improvement in social functioning and reduced relapse rates.

Alternative medicine

Some researchers have also claimed positive outcomes in hypnotherapy.JOURNAL, Barabasz M, Efficacy of hypnotherapy in the treatment of eating disorders, The International Journal of Clinical and Experimental Hypnosis, 55, 3, 318–35, July 2007, 17558721, 10.1080/00207140701338688, 9684032, The first use of hypnotherapy in Bulimic patients was in 1981. When it comes to hypnotherapy, Bulimic patients are easier to hypnotize than Anorexia Nervosa patients. In Bulimic patients, hypnotherapy focuses on learning self-control when it comes to binging and vomiting, strengthening stimulus control techniques, enhancing ones ego, improving weight control, and helping overweight patients see their body differently (have a different image). JOURNAL, Vanderlinden, Johan, Vandereycken, Walter, September 1988, The use of hypnotherapy in the treatment of eating disorders,weblink International Journal of Eating Disorders, 7, 5, 673–679, 10.1002/1098-108x(198809)7:53.0.co;2-r, 0276-3478,

Risk factors

Being female and having bulimia nervosa takes a toll on mental health. Women frequently reported an onset of anxiety at the same time of the onset of bulimia nervosa.JOURNAL, Bulik, Cynthia M, Sullivan, Patrick F, Carter, Frances A, Joyce, Peter R, September 1996, Lifetime anxiety disorders in women with bulimia nervosa,weblink Comprehensive Psychiatry, 37, 5, 368–374, 10.1016/s0010-440x(96)90019-x, 8879912, 0010-440X, The approximate female-to-male ratio of diagnosis is 10:1. In addition to cognitive, genetic, and environmental factors, childhood gastrointestinal problems and early pubertal maturation also increase the likelihood of developing bulimia nervosa.JOURNAL, Jacobi, Corinna, Hayward, Chris, de Zwaan, Martina, Kraemer, Helena C., Agras, W. Stewart, 2004, Coming to Terms With Risk Factors for Eating Disorders: Application of Risk Terminology and Suggestions for a General Taxonomy.,weblink Psychological Bulletin, en, 130, 1, 19–65, 10.1037/0033-2909.130.1.19, 14717649, 1939-1455, Another concern with eating disorders is developing a coexisting substance use disorder.JOURNAL, Carbaugh, Rebecca, Sias, Shari, 2010-04-01, Comorbidity of Bulimia Nervosa and Substance Abuse: Etiologies, Treatment Issues, and Treatment Approaches,weblink Journal of Mental Health Counseling, 32, 2, 125–138, 10.17744/mehc.32.2.j72865m4159p1420, 1040-2861,

Epidemiology

(File:Eating disorders world map-Deaths per million persons-WHO2012.svg|thumb|upright=1.3|Deaths due to eating disorders per million persons in 2012 {{Div col|small=yes|colwidth=10em}}{{legend|#ffff20|0-0}}{{legend|#ff9a20|1-1}}{{legend|#e06815|2-2}}{{legend|#d85010|3-3}}{{legend|#d02010|4–25}}{{div col end}})There is little data on the percentage of people with bulimia in general populations. Most studies conducted thus far have been on convenience samples from hospital patients, high school or university students; research on bulimia nervosa among ethnic minorities has also been limited.JOURNAL, Ruchkin, Vladislav, Isaksson, Johan, Schwab-Stone, Mary, Stickley, Andrew, 2021-10-21, Prevalence and early risk factors for bulimia nervosa symptoms in inner-city youth: gender and ethnicity perspectives, Journal of Eating Disorders, en, 9, 1, 136, 10.1186/s40337-021-00479-5, free, 2050-2974, 8529812, 34674763, Existing studies have yielded a wide range of results: between 0.1% and 1.4% of males, and between 0.3% and 9.4% of females.JOURNAL, Makino M, Tsuboi K, Dennerstein L, Prevalence of eating disorders: a comparison of Western and non-Western countries, MedGenMed, 6, 3, 49, September 2004, 15520673, 1435625, Studies on time trends in the prevalence of bulimia nervosa have also yielded inconsistent results.JOURNAL, Hay PJ, Mond J, Buttner P, Darby A, Eating disorder behaviors are increasing: findings from two sequential community surveys in South Australia, PLOS ONE, 3, 2, e1541, February 2008, 18253489, 2212110, 10.1371/journal.pone.0001541, Murthy RS, 2008PLoSO...3.1541H, free, According to Gelder, Mayou and Geddes (2005) bulimia nervosa is prevalent between 1 and 2 percent of women aged 15–40 years. Bulimia nervosa occurs more frequently in developed countriesBOOK, Michael Graham, Gelder, Richard, Mayou, John, Geddes, vanc, 2005, Psychiatry, Oxford University Press, 978-0-19-852863-0, registration,weblink {{page needed|date=August 2013}} and in cities, with one study finding that bulimia is five times more prevalent in cities than in rural areas.JOURNAL, van Son GE, van Hoeken D, Bartelds AI, van Furth EF, Hoek HW, Urbanisation and the incidence of eating disorders, The British Journal of Psychiatry, 189, 6, 562–3, December 2006, 17139044, 10.1192/bjp.bp.106.021378, free, There is a perception that bulimia is most prevalent amongst girls from middle-class families;WEB, Bulimia,weblinkweblink" title="archive.today/20120709083530weblink">weblink dead, 2012-07-09, finddoctorsonline.com, however, in a 2009 study girls from families in the lowest income bracket studied were 153 percent more likely to be bulimic than girls from the highest income bracket.NEWS, Grohol J, Black Girls At Risk for Bulimia,weblink March 19, 2009, live,weblink" title="web.archive.org/web/20120524041711weblink">weblink May 24, 2012, According to a study conducted in 2022 by Silen et al., which conglomerated statistics using various methods such as SCID, MRFS, EDE, SSAGA, and EDDI, the US, Finland, Australia, and the Netherlands had an estimated 2.1%, 2.4%, 1.0%, and 0.8% prevalence of bulimia nervosa among females under 30 years of age.JOURNAL, 10.1097/YCO.0000000000000818, Worldwide prevalence of DSM-5 eating disorders among young people, 2022, Silén, Yasmina, Keski-Rahkonen, Anna, Current Opinion in Psychiatry, 35, 6, 362–371, 36125216, This demonstrates the prevalence of bulimia nervosa in developed, Western, first-world countries, indicating an urgency in treating adolescent women. Additionally, these statistics may be misrepresentative of the true population affected with bulimia nervosa due to potential underreporting bias.There are higher rates of eating disorders in groups involved in activities which idealize a slim physique, such as dance, gymnastics, modeling, cheerleading, running, acting, swimming, diving, rowing and figure skating. Bulimia is thought to be more prevalent among whites;JOURNAL, Franko DL, Becker AE, Thomas JJ, Herzog DB, Cross-ethnic differences in eating disorder symptoms and related distress, The International Journal of Eating Disorders, 40, 2, 156–64, March 2007, 17080449, 10.1002/eat.20341, however, a more recent study showed that African-American teenage girls were 50 percent more likely than white girls to exhibit bulimic behavior, including both binging and purging.WEB, McBride, Hugh, vanc, Study Reveals Stunning Prevalence of Bulimia Among African-American Girls,weblinkweblink" title="web.archive.org/web/20120210165357weblink">weblink February 10, 2012, {| class="wikitable" style="margin-left: auto; margin-right: auto; border: none;"! Country! Year! Sample size and type! colspan="2" | % affectedPortugal > JOURNAL = THE INTERNATIONAL JOURNAL OF EATING DISORDERS ISSUE = 3 DATE = APRIL 2007 DOI = 10.1002/EAT.20358 HDL = 1822/5722, Brazil > LANGUAGE = PT VOLUME = 80 PAGES = 49–54 PMID = 14978549 TRANS-TITLE = EATING DISORDERS IN SCHOOL CHILDREN, free, JOURNAL = EUROPEAN PSYCHIATRY ISSUE = 2 DATE = MARCH 2005 DOI = 10.1016/J.EURPSY.2004.07.008, 20615315, Budapest residents > JOURNAL = SOCIAL PSYCHIATRY AND PSYCHIATRIC EPIDEMIOLOGY ISSUE = 8 DATE = AUGUST 2004 DOI = 10.1007/S00127-004-0783-Z, 23275345, 0.3% combinedHAY P > TITLE = THE EPIDEMIOLOGY OF EATING DISORDER BEHAVIORS: AN AUSTRALIAN COMMUNITY-BASED SURVEY VOLUME = 23 PAGES = 371–82 PMID = 9561427, 10.1002/(SICI)1098-108X(199805)23:43.0.CO;2-F, JOURNAL = AMERICAN JOURNAL OF EPIDEMIOLOGY ISSUE = 5 DATE = SEPTEMBER 1996 DOI = 10.1093/OXFORDJOURNALS.AJE.A008950, free, JOURNAL = THE INTERNATIONAL JOURNAL OF EATING DISORDERS ISSUE = 3 DATE = NOVEMBER 1995 DOI = 10.1002/1098-108X(199511)18:33.0.CO;2-O, TITLE = BULIMIA NERVOSA IN A CANADIAN COMMUNITY SAMPLE: PREVALENCE AND COMPARISON OF SUBGROUPS VOLUME = 152 PAGES = 1052–8 PMID = 7793442, 10.1176/ajp.152.7.1052, JOURNAL = ADDICTION ISSUE = 7 DATE = JULY 1995 DOI = 10.1046/J.1360-0443.1995.90797110.X, JOURNAL = THE AMERICAN JOURNAL OF PSYCHIATRY ISSUE = 11 DATE = NOVEMBER 1995 DOI = 10.1176/AJP.152.11.1623,

History

Etymology

The term bulimia comes from Greek boulīmia, "ravenous hunger", a compound of βοῦς bous, "ox" and λιμός, līmos, "hunger".WEB, Online Etymology Dictionary: bulimia, November 2001, 2008-04-06, Douglas Harper, Online Etymology Dictionary,weblink live,weblink" title="web.archive.org/web/20080617205424weblink">weblink 2008-06-17, Literally, the scientific name of the disorder, bulimia nervosa, translates to "nervous ravenous hunger".

Before the 20th century

Although diagnostic criteria for bulimia nervosa did not appear until 1979, evidence suggests that binging and purging were popular in certain ancient cultures. The first documented account of behavior resembling bulimia nervosa was recorded in Xenophon's Anabasis around 370 B.C, in which Greek soldiers purged themselves in the mountains of Asia Minor. It is unclear whether this purging was preceded by binging.Giannini, A. J. (1993). "A history of bulimia". In The Eating disorders (pp. 18–21). Springer New York. In ancient Egypt, physicians recommended purging once a month for three days to preserve health.Russell, G. (1997). The history of bulimia nervosa. D. Garner & P. Garfinkel (Eds.), Handbook of Treatment for Eating Disorders (2nd ed., pp. 11–24). New York, NY: The Guilford Press. This practice stemmed from the belief that human diseases were caused by the food itself. In ancient Rome, elite society members would vomit to "make room" in their stomachs for more food at all-day banquets. Emperors Claudius and Vitellius both were gluttonous and obese, and they often resorted to habitual purging.Historical records also suggest that some saints who developed anorexia (as a result of a life of asceticism) may also have displayed bulimic behaviors. Saint Mary Magdalen de Pazzi (1566–1607) and Saint Veronica Giuliani (1660–1727) were both observed binge eating—giving in, as they believed, to the temptations of the devil. Saint Catherine of Siena (1347–1380) is known to have supplemented her strict abstinence from food by purging as reparation for her sins. Catherine died from starvation at age thirty-three.While the psychological disorder "bulimia nervosa" is relatively new, the word "bulimia", signifying overeating, has been present for centuries. The Babylon Talmud referenced practices of "bulimia", yet scholars believe that this simply referred to overeating without the purging or the psychological implications bulimia nervosa. In fact, a search for evidence of bulimia nervosa from the 17th to late 19th century revealed that only a quarter of the overeating cases they examined actually vomited after the binges. There was no evidence of deliberate vomiting or an attempt to control weight.

20th century

Globally, bulimia was estimated to affect 3.6 million people in 2015.JOURNAL, Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, etal, October 2016, Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015, Lancet, 388, 10053, 1545–1602, 10.1016/S0140-6736(16)31678-6, 5055577, 27733282, GBD 2015 Disease and Injury Incidence and Prevalence Collaborators, About 1% of young women have bulimia at a given point in time and about 2% to 3% of women have the condition at some point in their lives. The condition is less common in the developing world. Bulimia is about nine times more likely to occur in women than men. Among women, rates are highest in young adults. Bulimia was named and first described by the British psychiatrist Gerald Russell in 1979.JOURNAL, Russell G, August 1979, Bulimia nervosa: an ominous variant of anorexia nervosa, Psychological Medicine, 9, 3, 429–48, 10.1017/S0033291700031974, 482466, 23973384, JOURNAL, Palmer R, December 2004, Bulimia nervosa: 25 years on, The British Journal of Psychiatry, 185, 6, 447–8, 10.1192/bjp.185.6.447, 15572732, free, At the turn of the century, bulimia (overeating) was described as a clinical symptom, but rarely in the context of weight control.JOURNAL, Casper, Regina C., vanc, On the emergence of bulimia nervosa as a syndrome a historical view, International Journal of Eating Disorders, 2, 3, 3–16, 1983, 10.1002/1098-108X(198321)2:33.0.CO;2-D, Purging, however, was seen in anorexic patients and attributed to gastric pain rather than another method of weight control.In 1930, admissions of anorexia nervosa patients to the Mayo Clinic from 1917 to 1929 were compiled. Fifty-five to sixty-five percent of these patients were reported to be voluntarily vomiting to relieve weight anxiety. Records show that purging for weight control continued throughout the mid-1900s. Several case studies from this era reveal patients with the modern description of bulimia nervosa. In 1939, Rahman and Richardson reported that out of their six anorexic patients, one had periods of overeating, and another practiced self-induced vomiting. Wulff, in 1932, treated "Patient D", who would have periods of intense cravings for food and overeat for weeks, which often resulted in frequent vomiting. Patient D, who grew up with a tyrannical father, was repulsed by her weight and would fast for a few days, rapidly losing weight. Ellen West, a patient described by Ludwig Binswanger in 1958, was teased by friends for being fat and excessively took thyroid pills to lose weight, later using laxatives and vomiting. She reportedly consumed dozens of oranges and several pounds of tomatoes each day, yet would skip meals. After being admitted to a psychiatric facility for depression, Ellen ate ravenously yet lost weight, presumably due to self-induced vomiting. However, while these patients may have met modern criteria for bulimia nervosa, they cannot technically be diagnosed with the disorder, as it had not yet appeared in the Diagnostic and Statistical Manual of Mental Disorders at the time of their treatment.An explanation for the increased instances of bulimic symptoms may be due to the 20th century's new ideals of thinness. The shame of being fat emerged in the 1940s when teasing remarks about weight became more common. The 1950s, however, truly introduced the trend of aspiration for thinness.In 1979, Gerald Russell first published a description of bulimia nervosa, in which he studied patients with a "morbid fear of becoming fat" who overate and purged afterward. He specified treatment options and indicated the seriousness of the disease, which can be accompanied by depression and suicide. In 1980, bulimia nervosa first appeared in the DSM-III.After its appearance in the DSM-III, there was a sudden rise in the documented incidents of bulimia nervosa. In the early 1980s, incidents of the disorder rose to about 40 in every 100,000 people. This decreased to about 27 in every 100,000 people at the end of the 1980s/early 1990s. However, bulimia nervosa's prevalence was still much higher than anorexia nervosa's, which at the time occurred in about 14 people per 100,000.In 1991, Kendler et al. documented the cumulative risk for bulimia nervosa for those born before 1950, from 1950 to 1959, and after 1959.JOURNAL, Kendler KS, MacLean C, Neale M, Kessler R, Heath A, Eaves L, The genetic epidemiology of bulimia nervosa, The American Journal of Psychiatry, 148, 12, 1627–37, December 1991, 1842216, 10.1176/ajp.148.12.1627, The risk for those born after 1959 is much higher than those in either of the other cohorts.

See also

• Anorectic Behavior Observation Scale
• Eating recovery
• Evolutionary psychiatry
• Binge eating disorder
• List of people with bulimia nervosa

References

{{Reflist}}

External links

{{Commons category|Bulimia nervosa}}{{Medical resources| DiseasesDB = 1770F250}}307.51}}| MedlinePlus = 000341| OMIM = 607499| eMedicineSubj = emerg| eMedicineTopic = 810med|255}}| MeshID = D052018}}{{Mental and behavioural disorders|selected = physical}}{{Authority control}}