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For such a functional writing, this was an critic to be because it sent Here not also due. Self-induced vomiting can lead to gastritis, esophagitis, periodontal disease, and dental caries, the latter caused by the corrosive effect of acidic stomach contentsonthedentalenamel.
Gastricdilitationandgastricoresophagealrupturearerare medical emergencies that may lead to shock. Metabolic alkalosis with the development of clinically significant hypokalemia in patients who vomit is not unusual, and serum electrolytes will reveal typical indices. Electrocardiogram changes in this setting carry significant import, because arrhythmias can lead to cardiac arrest if hypokalemia and related disturbances are not effectively corrected. Use of diuretics can cause similar electrolyte disturbances. Metabolic acidosis can be encountered in those who use large numbers of stimulant-type laxatives.
Dehydration, sometimes requiring intravenous hydration, can accompany each of the aforementioned purging behaviors. More often associated with bulimic behaviors are general physical complaints, such as fatigue and muscle aches. Although becoming less frequently encountered in clinical practice, longterm use of the emetic syrup of ipecac can lead to myopathies, including, most seriously, cardiomyopathy. The latter is not an infrequent cause of death in patients abusing this toxic substance.
This apparent increase in bulimic symptomatology has stimulated research interest that, in turn, has informed treatment strategies. Given the significant psychiatric and medical morbidity encountered in patients with bulimia nervosa, efforts should be made to improve recognition and ensure proper referral. Further exploration into the biological underpinnings of bulimia, continued assessment of treatment outcome, and attempts to identify predictive patient characteristics should lead to more specific tailoring of therapy and enhancement of treatment response.
Stunkard AJ. The current status of treatment of obesity in adults.
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Eating and Its Disorders. Raven, New York, NY, , pp. Russell GFM. Metabolic, endocrine and psychiatric aspects of anorexia nervosa. Sci Basis Med Annu Rev ; — American Psychiatric Association. Am J Psychiatry ; — Johnson CL. Bulimia: A descriptive survey of cases.
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Int J Eat Disord ; — The incidence of bulimia in freshman college students. Binge eating and vomiting: A survey of a high school population. Psychol Schools ; — Eating behaviors amongst young women. Med J Austr ; — Binge-eating and vomiting: a survey of a college population. Psychol Med ; — Strober M. A family study of anorexia nervosa. A controlled family study of anorexia nervosa and bulimia nervosa: psychiatric disorders in first-degree relatives and effects of proband comorbidity.
Arch Gen Psychiatry. Controlled family study of anorexia nervosa and bulimia nervosa: evidence of shared liability and transmission of partial syndromes. Am J Psychiatry. Familial aggregation of eating disorders: results from a controlled family study of bulimia nervosa.
Int J Eat Disord. Primary affective disorder in relatives of patients with anorexia nervosa. Family history study of anorexia nervosa and bulimia. Br J Psychiatry ; — Clinical findings in patients with anorexia nervosa and affective illness in their relatives. Anorexia nervosa and affective disorders: a controlled family history study.
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Affective disturbance in eating disorders. J Nerv Ment Dis ; PsychosomMed; — Major affective disorder in anorexia nervosa and bulimia: a descriptive diagnostic study. Psychiatric comorbidity in patients with eating disorders.
sivasolar.hu/citas-web-medimas.php Other psychiatric disorders among bulimic patients. Compr Psychiatry ; — Wonderlich S, et al. Prevalence of personality disorders among bulimics, non-bulimic binge eaters and normal controls. J Psychopath Behav Ess ; — Personality disorder diagnoses in patients with bulimia nervosa: clinical correlates and changes with treatment.
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J Clin Psychiatry ; — Herzog DB. Are anorexic and bulimic patients depressed. Am J Psych ; — Affective disorder and substance abuse in women with bulimia. Characteristics of patients with bulimia. Bulik C. Drug and alcohol abuse by bulimic women and their families. A summary of these principles and chapter outline is presented in Table 1.
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The purpose is not to make psychiatrists or counselors out of family physicians or other generalists, but rather to improve patient care and to briefly review some basic principles that can be useful in an office setting when working with these patients. Emphasis is placed on a few issues that may significantly increase the likelihood that cases of bulimia nervosa will be detected and that individuals with bulimia nervosa will become engaged in treatment and will take the first steps in the process of recovering from this disorder.
In the case of an individual with bulimia nervosa, this requires a detailed assessment of the various normal and abnormal eating and eating-related behaviors that may be present 1. This assessment see also Chapter 1 will lead the physician logically into treatment planning. Here, we discuss the issues that should be addressed in the assessment. Weight A careful weight history is essential. Also, a family history of obesity is useful information in that there is a high heritability for adult body weight.
As a corollary, it is very useful to evaluate how these patients feel at their current weight in general, and how they feel about specific body parts in particular.
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Many patients with eating disorders are very concerned about body weight, but others worry specifically about certain body parts, particularly their waist, hips, buttocks, and thighs. It is of note that these are the areas with which many young women in the general population are dissatisfied even if they are of normal weight. Meal Pattern It is useful to sketch out the meal pattern, including what the patient is eating and the frequency and timing of meals and snacks. Does the intake appear adequate?