Bulimia nervosa Classification and external resources
ICD-10	F50. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings 2
ICD-9	307.51
DiseasesDB	1770
eMedicine	emerg/810  med/255

Bulimia nervosa is an eating disorder characterised by recurrent binge eating, followed by compensatory behaviors, referred to as "purging". The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors An eating disorder is a compulsion to eat or avoid eating that negatively affects both one's physical and mental health Binge eating is a pattern of Disordered eating which consists of episodes of uncontrollable overeating ^[1] The most common form—practised more than 75% of people with bulimia nervosa—is self-induced vomiting; fasting, the use of laxatives, enemas, diuretics, and overexercising are also common. Defensive vomiting is a symptom of Anorexia nervosa and Bulimia nervosa in which a person who has drastically over-eaten (generally in reaction to previous extreme Fasting is primarily the act of willingly abstaining from some or all Food, Drink, or both for a period of time Laxatives (or purgatives) are foods compounds or drugs taken to induce bowel movements or to loosen the stool most often taken to treat Constipation. An enema (plural enemata or enemas) is the procedure of introducing liquids into the Rectum and colon via the Anus. A diuretic is any Drug that elevates the rate of urination ( Diuresis) ^[2]

The word bulimia derives from the Latin (būlīmia) from the Greek βουλῑμια (boulīmia; ravenous hunger), a compound of βους (bous), ox + λῑμος (līmos), hunger. ^[3]

Contents 1 Diagnosis 2 Prevalence 3 Effects 4 Causes 5 Related disorders 6 See also 7 References

Diagnosis

The criteria for diagnosing a patient with bulimia are:

• Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
  • Eating, in a fixed period of time, an amount of food that is definitely larger than most people would eat under similar circumstances.
  • A lack of control over eating during the episode: a feeling that one cannot stop eating or control what or how much one is eating.
• Recurrent inappropriate compensatory behavior to prevent weight gain, such as: self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; excessive exercise. Laxatives (or purgatives) are foods compounds or drugs taken to induce bowel movements or to loosen the stool most often taken to treat Constipation.
• Self-evaluation is unduly influenced by body shape and weight.
• The disturbance does not occur exclusively during episodes of anorexia nervosa. Anorexia Nervosa is a psychiatric Diagnosis that describes an Eating disorder characterized by low Body weight and Body image distortion ^[4]

There are two sub-types of bulimia nervosa: purging and non-purging.

• Purging bulimia is the more common of the two and involves self-induced vomiting (which may include use of emetics such as syrup of ipecac) and self-induced purging (which may include use of laxatives, diuretics, and enemas) to rapidly remove food from the body before it can be digested. Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the Syrup of ipecac commonly referred to as simply Ipecac is derived from the dried Rhizome and Roots of the Ipecacuanha plant and is a well-known A diuretic is any Drug that elevates the rate of urination ( Diuresis) An enema (plural enemata or enemas) is the procedure of introducing liquids into the Rectum and colon via the Anus.
• Non-purging bulimia, which occurs in only approximately 6%-8% of cases, which involves excessive exercise or fasting after a binge to offset the caloric intake after eating. Purging-type bulimics may also exercise or fast, but as a secondary form of weight control. ^[4]

The onset of bulimia nervosa is most likely during adolescence (between 13 and 20 years of age), with many sufferers relapsing in adulthood into episodic binging and purging even after initially successful treatment and remission. ^[5]

Bulimia nervosa can be difficult to detect, compared to anorexia, because bulimics tend to look healthier and have fewer immediately-visible health complications. Many bulimics may also engage in significantly disordered eating and exercising patterns without meeting the full diagnostic criteria for bulimia nervosa. ^[6]

Prevalence

There is little data on the incidence of bulimia nervosa in-the-large, on general populations. Most studies conducted thus far have been on convenience samples from hospital patients, high school or university students. These have yielded a wide range of results: between 0% and 2. 1% of males, and between 0. 3% and 7. 3% of females. ^[7]

Country	Year	Sample size and type	Incidence
USA	1996	1152 college students	0. The United States of America —commonly referred to as the Year 1996 ( MCMXCVI) was a Leap year starting on Monday (link will display full 1996 Gregorian calendar) 2% male	1. 3% female[8]
USA	1992	799 college students	0. The United States of America —commonly referred to as the Year 1992 ( MCMXCII) was a Leap year starting on Wednesday (link will display full 1992 Gregorian calendar) 4% male	5. 1% female[9]
Norway	1995	19067 psychiatric patients	0. Norway ( Norwegian: Norge ( Bokmål) or Noreg ( Nynorsk) officially the Kingdom of Norway, is a Constitutional Year 1995 ( MCMXCV) was a Common year starting on Sunday. Events of 1995 7% male	7. 3% female[10]
Australia	1998	4200 high school students	0. For a topic outline on this subject see List of basic Australia topics. Year 1998 ( MCMXCVIII) was a Common year starting on Thursday (link will display full 1998 Gregorian calendar) 3% combined[11]
Canada	1995	8116 (random sample)	0. Country to "Dominion of Canada" or "Canadian Federation" or anything else please read the Talk Page Year 1995 ( MCMXCV) was a Common year starting on Sunday. Events of 1995 1% male	1. 1% female[12]
Japan	1995	2597 high school students	0. For a topic outline on this subject see List of basic Japan topics. Year 1995 ( MCMXCV) was a Common year starting on Sunday. Events of 1995 7% male	1. 9% female[13]

Although bulimia is overwhelmingly a disease of young women, it can affect others. British politician John Prescott says he developed bulimia in his 60s ^[14]. John Leslie Prescott (born 31 May 1938 is a British Labour Party Politician, former Deputy Prime Minister of the United Kingdom, First

Effects

Bulimics go through cycles of over-eating and purging that can be very destructive to the body. These cycles often involve rapid and out-of-control eating, which may stop when the bulimic is interrupted by another person or the stomach hurts from overextension, 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 day^[15], and may directly cause:

• Perimolysis, or the erosion of tooth enamel by gastric acids. Erosion, otherwise known as acid erosion, is the loss of tooth structure due to chemical dissolution by acids not of bacterial origin Gastric acid is one of the main Secretions of the Stomach, together with several Enzymes and Intrinsic factor.
• Oral trauma, where habitual insertion by fingers or other objects cause lacerations to the lining of the mouth and throat. In Medicine, a wound is a type of Injury in which the Skin is torn cut or punctured (an open wound or where blunt force trauma
• Chronic gastric reflux after eating. Gastroesophageal reflux disease ( American English and Canadian English) or Gastro-oesophageal reflux disease ( British English, Hiberno-English
• Esophagitis, or irritation of the esophagus by frequent contact with gastric acids. Esophagitis (or Oesophagitis) is Inflammation of the Esophagus. The esophagus or oesophagus (see American and British English spelling differences) sometimes known as the gullet, is an organ in
• Dehydration and hypokalemia due to loss of fluids and potassium depletion. Dehydration ( hypohydration) is the removal of Water ( hydro in ancient Greek) from an object Hypokalemia refers to the condition in which the concentration of Potassium in the blood is low
• Swollen salivary glands. The salivary glands in mammals are exocrine glands that produce saliva ^[16]

Causes

Bulimia is related to deep psychological issues and feelings of lack of control. Sufferers often use the destructive eating pattern to feel in control over their lives. ^[17] They may hide or hoard food and overeat when stressed or upset. They may feel a loss of control during a binge, and consume great quantities of food (over 20,000 calories). ^[18] After a length of time, the sufferer of bulimia will find that they no longer have control over their binging and purging. The binging becomes an addiction that seems impossible to break. Recovery is very hard and often in the early stages of recovery the patient will gain weight as they are still binging but no longer purging, causing anxiety which will in turn cause the patient to revert back to bulimia.

There are higher rates of eating disorders in groups involved in activities that emphasize thinness and body type, such as gymnastics, modelling, dance, cheerleading, acting, rowing(lightweights/coxwains) and figure skating. Gymnastics is a Sport involving performance of exercises requiring physical strength agility and coordination Cheerleading is a Sport that uses organized routines made from elements of Tumbling, Dance, jumps and stunting to direct spectators of events Figure skating is an athletic Sport in which individuals pairs or groups perform spins, jumps, footwork and other intricate and challenging ^[19] Bulimia is more prevalent among Caucasians. The Caucasian race, sometimes the Caucasoid race, is a term of Racial classification, coined around 1800 by Johann Friedrich Blumenbach for the " In one study, diagnosis of bulimia was correlated with high testosterone and low estrogen levels, and normalizing these levels with combined oral contraceptive pills reduced cravings for fat and sugar. Testosterone is a Steroid hormone from the Androgen group In mammals testosterone is primarily secreted in the testes of males and the Ovaries Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, ^[20]

Related disorders

Bulimics are much more likely than non-bulimics to have an affective disorder, such as depression or general anxiety disorder: a 1985 Columbia University study on female bulimics at New York State Psychiatric Institute found 70% had suffered depression some time in their lives (as opposed to 25. The affective spectrum is a grouping of related psychiatric and medical disorders which may accompany bipolar, unipolar, and Schizoaffective Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression Generalized anxiety disorder ( GAD) is an Anxiety disorder that is characterized by excessive uncontrollable and often irrational worry about everyday things that Year 1985 ( MCMLXXXV) was a Common year starting on Tuesday (link displays 1985 Gregorian calendar) Columbia University is a private University in the United States and a member of the Ivy League. The New York State Psychiatric Institute, established in 1895 and located on Riverside Drive at the foot of Washington Heights, the far upper west side of Manhattan 8% for adult females in a control sample from the general population), rising to 88% for all affective disorders combined. ^[21] Another study by the Royal Children's Hospital in Melbourne on a cohort of 2000 adolescents similarly found that those meeting at least two of the DSM-IV criteria for bulimia nervosa or anorexia nervosa had a sixfold increase in risk of anxiety and a doubling of risk for substance dependency. The Royal Children's Hospital is a Children's hospital in Melbourne, Australia. Melbourne ( is the second most populous city in Australia, with a Metropolitan area population of approximately 3 In Statistics and Demography, a cohort is a group of subjects &mdash most often humans from a given population &mdash defined by experiencing an event (typically The Diagnostic and Statistical Manual of Mental Disorders' ( DSM) is published by the American Psychiatric Association ^[22]

See also

• Anorexia nervosa
• Anorexia mirabilis
• Body dysmorphic disorder
• Body image
• Cachexia
• Calorie restriction
• Defensive vomiting
• Eating disorder not otherwise specified
• Fasting girls for a historical perspective on anorexia nervosa
• Female body shape
• Malnutrition
• Muscle dysmorphia ('reverse' anorexia nervosa)
• Orthorexia nervosa
• Pro-ana
• Purging disorder
• Refeeding syndrome

References

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