Diagnosis Of Bulimia Research Articles

Levels of intervention and support for newly presenting clients with eating disorders

IntroductionClients with Eating Disorders may be treated as inpatients (IP), day hospital (DH) or community patients (Ambu). The ITAMITED study is following to treatment termination (or end of October 2025) all new clients with EDs presenting between November 2017 and October 2020 to eight centres in Spain.ObjectivesTo describe to what extent initial care levels (IP, DH, Ambu) are associated with gender, age, social relationships, ED diagnosis Body Mass Index (BMI) and baseline medication.MethodsThe study is exploratory/descriptive, practice-based evidence (PBE). Consecutive new clients were approached for participation. Inclusion criteria were a diagnosis of an ED and opting in to treatment.ResultsThe only variables not showing a statistically significant relationship with level were gender (no relationship), diagnosis of bulimia and use of prescribed psychostimulant medication (which was rare). OP care was associated with older age which did not discriminate between DH and IP. Similarly, being in a relationship was associated with OP care but didn’t differentiate between DH and OP. Relationships with ED diagnosis other than AN type I were complex but significant. Relationships with AN type I, BMI and being on antipsychotics, antidepressants, anxiolytics, mood stabilisers and a catch-all category of all other medication all showed an ordered relationship IP > DH > Ambu. The most powerful relationships were with BMI and diagnosis of AN type I.Conclusions Initial level of care is associated with many factors and strongly with many of them. This will complicate the analyses of trajectories of change but reflects the heterogeneity of this client group.Disclosure I am Clinical Director of ITA but analyses are prespecified. Evans, Medina and Paz are not remunerated by ITA nor related to ITA or any of its employees they would counter any pressure on analyses or reporting that might arise from my position.

Family treatment needed for eating disorders of youth

When the American Academy of Pediatrics (AAP) released its clinical report “Identification and Management of Eating Disorders in Children and Adolescents” in the Jan. 2021 issue of Pediatrics, most families were preoccupied, as they still are, with COVID‐19. Providers who treat substance use disorder (SUD) are very familiar with the importance of family treatment, and eating disorders, which often cross over as comorbid, are no exception to the rule: involve the whole family. It's important to note that like SUD, eating disorders affect all races and genders. “For too long, eating disorders were considered a disease that afflicted mostly affluent white teenage girls,” said Laurie L. Hornberger, M.D., M.P.H., F.A.A.P., lead author of the report, written by the AAP Committee on Adolescence. “We know today that girls and boys of all ages, income levels and racial and ethnic groups may be struggling with eating disorders,” she said. “Our hope is to help counter the stigma they may experience and provide an environment for open nonjudgmental conversations.” Anorexia is a life‐threatening condition, and one of its signs is the inability to acknowledge the problem and its seriousness. One of the most promising approaches to treatment is a method that puts parents in charge of refeeding their child, with education, therapy, and support provided by a specially trained team. Some teenagers stuff themselves with food and then force themselves to vomit. Called “bingeing and purging,” the practice, if it continues for 3 months, results in a diagnosis of bulimia. But again, it's not simple. About half of all anorexics have episodes of bulimia at some time. Just like the young person who starves him or herself and wants to be thin, “the bulimic is dissatisfied with [his or her] body and obsessed with slimming down,” according to the AAP. The condition is accompanied by guilt and shame. Some girls take laxatives. They often have binges in secret. Like bulimia nervosa, people who are binge eaters consume enormous quantities of food in a short amount of time, then regret having done so. However, unlike bulimics, they do not purge themselves afterward, or fast, or exercise, or attempt in any way to compensate for the thousands of calories they've just ingested. This is why one in three teens who seek treatment for their weight are compulsive overeaters. Family‐based treatment (FBT) has emerged as the first‐line treatment for pediatric eating disorders, according to the AAP. It's effective and removes the guilt and shame which are so destructive in and of themselves. “Rather than dwelling on possible causes of the eating disorder, FBT is focused on recovery from the disease,” according to the AAP. An adaption of FBT is parent‐focused therapy, in which the clinician meets only with the parents. The patient has brief visits with a nurse for weight and acute mental health assessment but does not see the therapist. For all forms of eating disorders, families should not let shame intrude. Giving the child “agency” while at the same time making sure he or she is nutritionally safe is the parents' role. But even in the absence of a clinical diagnosis, it's a good idea to establish healthy habits rather than to focus on weight and dieting, according to the AAP. In a child who is developing or has an eating disorder, recommendations include more frequent family meals, discouraging weight talk in the home, closely monitoring weight loss in patients who are advised to lose weight, and promoting a healthy body image. This is reminiscent of much treatment for SUDs, in which focusing on the substance itself results in shame and does not reduce consumption or result in recovery. For the AAP report, go to Identification and Management of Eating Disorders in Children and Adolescents.

Quantifying self-quantification: A statistical study on individual characteristics and motivations for digital self-tracking in young- and middle-aged adults in Germany

This study presents a quantitative account of who uses or stops using digital self-tracking (ST). A representative sample of German adults aged 20–50 years ( N = 1022) completed an online survey on their ST practices, personality traits and attitudes toward numbers, on sociodemographic characteristics, mental disorders (particularly bulimia, burnout syndrome, and depression) and somatic disorders. A descriptive statistical analysis was performed on differences between self-trackers and non-trackers. Among others, they differ regarding age, civil status, social class, presence of mental and/or somatic diagnoses, performance-pressure, and strive for competition. A consequent binary logistic regression analysis suggests perfectionism, a somatic diagnosis within the last 5 years, a diagnosis of bulimia in the past, as well as a present mental diagnosis to be significant predictors for ST, though the predictive value of the factors was relatively low.

Bulimia Nervosa: A Psychological Eating Disorder

Eating disorders are multifaceted mental health problems which require medical treatments and counseling from a psychological expert.In extreme condition,these eating disorders can cause serious health problems and may be lethal if these are not diagnosed and treated timely.Eating Disorder Hope organization has conducted a survey which revealed thatalmost 40% of teen age girls were suffering from at least one kind of eating disorder while91% of young females do dieting to reduce their weight. It has been estimated that about one million males and ten million females suffer from various types of eating disorders. 
 Bulimia nervosa is one of the eating disorders. It oftens develops in teenage or early adulthood.It is common in women than men. In bulimia nervosa, a person usually eats a lot in a short period of time. It seems that the personcannot control himself fromeating food. It happens until they are painfully full and then they will purge to end their discomfort and to compensate their calories. They will purge by forced vomitinglaxatives,diuretics or excessive exercise.Frequent self-induced vomiting can contribute to inflammation of parotidgland and can result in hand calluses. It is more common in families appearing in generations.There are many risk factors for this disease like being overweight/obesity, socio-cultural pressures to have a well tonned body, psychological impacts resulting in stress and poor self-esteem. Dieting has become a part of our culture. There are manysymptoms of bulimia. For example, patients live in a fear of gaining weight, they go through the repeated episodes of abnormal eating large amounts of food in single sitting. There is a feeling which develops in patients that they cannot control what they eat and what type of food they eat, and after bingering they are forcing themselves to vomit and do more exercise to stop weight gain.
 If we leave bulimia untreated it will cause kidney problems, irregular heart rhythms, digestive issues and dental problems etc. In time treatment and diagnosis of bulimia helps the person to recover well and quick and the person can get rid of this disorder completely otherwise it can be life threatening. A person experiences bulimia to manage the emotional pain he is undergoing but it only worsens the condition and the response may be to ramp up obsessive thoughts and compulsive behaviors. Nearly half of bulimia patients have a co-occuring mood disorder and more than half of bulimia patients have co-occuring anxiety disorders. Self-harm is a common condition affecting 34% of those with bulimia. Recent studies on bulimia show that in 10-15% of male members of our society who are living with this disorder, risk of suicide has increased. Statistics show that relapse of this disorder isvery common.Relapse is occurring in about30-50% of the cases, and it isleading to common cause of death in suicide.For treatment of bulimia nervosa, you may need to go for several types. Bulimia can be reduced by taking anti-depressants or psychotherapy, but using both in combination is more fruitful to overcome this disorder. Psychotherapy is very important for patients, in which the person goes to the psychiatrist to discuss the issues related to bulimia. Educating the patient on nutrition also helps in this regard. Anutritionist can prescribe the food by which a person will feel the cravings for food to a lesser extent. In severe conditions,the patient can be admitted to a hospital because sometimes there is a need fortreatment in a hospital. In many cases it is not possible to eradicate it completely.But before the situation goes wrong, we can guide a person to lead a healthier life with the help of professionally used treatments. Since we are living in an era where everyone is busy, it is important to guide and educate the children about a healthy lifestyle. There is a need to give them confidence about their physical appearance, no matter what their weight, size and shape is. Enjoyable family meals should be arranged on daily basis or regularly. Talks on physical appearances, body weight and dieting should be discouraged at home. Exercise, walk, activities like sports and swimming can help young generation to adopt a healthy lifestyle and streamline their daily life. If you observe that someone in your friends or relatives is having issues related to food which is indicating thathe or she can possibly has an eating disorder, you should talk to the person supportively and discuss the issue and help them in any way you can before the situation gets worse.

Demographic and psychiatric correlates of compulsive sexual behaviors in gambling disorder.

Background and aimsGambling disorder (GD) and compulsive sexual behavior (CSB) may commonly co-occur. Yet, the psychiatric correlates of these co-occurring disorders are an untapped area of empirical scrutiny, limiting our understanding of appropriate treatment modalities for this dual-diagnosed population. This study examined the demographic and clinical correlates of CSB in a sample of treatment-seeking individuals with GD (N = 368) in São Paulo, Brazil.MethodsPsychiatrists and psychologists conducted semi-structured clinical interviews to identify rates of CSB and other comorbid psychiatric disorders. The Shorter PROMIS Questionnaire was administered to assess additional addictive behaviors. The TCI and BIS-11 were used to assess facets of personality. Demographic and gambling variables were also assessed.ResultsOf the total sample, 24 (6.5%) met diagnostic criteria for comorbid CSB (GD + CSB). Compared to those without compulsive sexual behaviors (GD − CSB), individuals with GD + CSB were more likely to be younger and male. No differences in gambling involvement emerged. Individuals with GD + CSB tended to have higher rates of psychiatric disorders (depression, post-traumatic stress disorder, and bulimia nervosa) and engage in more addictive behaviors (problematic alcohol use, drug use, and exercise) compared to GD − CSB. Those with GD + CSB evidenced less self-directedness, cooperativeness, self-transcendence, and greater motor impulsivity. Logistic regression showed that the predictors of GD + CSB, which remained in the final model, were being male, a diagnosis of bulimia, greater gambling severity, and less self-transcendence.Discussion and conclusionGiven those with GD + CSB evidence greater psychopathology, greater attention should be allocated to this often under studied comorbid condition to ensure adequate treatment opportunities.

Payments to Physicians, Medical Schools to Be Illuminated Under New Reform Law

but that does not get rid of everyone in [EDNOS]; what you are doing is cutting the cake finer and finer,” Fairburn said. “Some people, and I am one of them, would say, ‘What’s the point?’” Fairburn is intrigued with the idea that specific eating disorders may just be manifestations of an underlying psychosis. A recent small study he conducted with colleagues appears to bolster his contention. The researchers enrolled 154 patients with a DSM-IV eating disorder who were not markedly underweight (patients with a diagnosis of bulimia or EDNOS) and treated them using 2 forms of cognitive behavioral therapy. After 20 weeks of treatment and a 60-week follow-up, 51.3% of the patients had a global Eating Disorder Examination (an interview conducted by a clinician assessing the psychopathology associated with the eating disorder diagnosis) score close to normal, and treatment outcome did not depend on eating disorder diagnosis (Fairburn CG et al. Am J Psychiatry. 2009;166[3]:311-319). There is another reason to be cautious in creating definitive eating disorder categories: overdiagnosis. “We do not want people in the community to be labeled as having a psychiatric disorder, with that information available to patients, physicians, and insurers, if they do not have a psychiatric disorder,” Walsh said. “If the criteria are not applied with some rigor, a label may be inappropriately applied, and patients may be told of problems that are inaccurate.” Final recommendations from the work group are expected within 18 months, with the DSM-5 scheduled to be released in May 2013.

Journal Digest

Journal Digest

Patterns of adaptation to conflict in bulimia and temporo-mandibular joint disorder.

Two age- and education-matched groups of 45 women, respectively, with the diagnoses of Bulimia and of Temporo-mandibular Joint Disorder, were administered the Serial Color-Word Test, to assess differences in the pattern of adaptation to conflict (the latter being represented by the Stroop task). Three types of norms (clinical, nonclinical and based on reading times) and the functions derived from a previous cluster analysis were employed. Comparisons utilizing clinical norms and cluster analytical functions did not significantly differentiate between groups. According to both nonclinical norms and norms based on reading times, the two clinical groups were significantly different concerning the distribution of adaptation patterns. Bulimic patients resorted more often to the Dissociative pattern (high nonlinear change of reading times), while temporomandibular patients were characterized by the Cumulative pattern (high linear change) and, secondarily, by the Cumulative-Dissociative pattern (high linear and nonlinear change). Intergroup differences were more marked when employing the new norms based on reading times.

Bulimia nervosa in Rochester, Minnesota from 1980 to 1990.

Numerous studies have estimated the frequency of bulimia nervosa among high school girls and college women, but population-based trends in incidence in a community have not been reported. In this study we determined the incidence of bulimia nervosa by identifying persons residing in the community of Rochester, Minnesota, who had the disorder initially diagnosed during the 11-year period from 1980 to 1990. Using our comprehensive population-based data resource (the Rochester Epidemiology Project), we identified cases by screening 777 medical records with diagnoses of bulimia; feeding disturbance; rumination syndrome; adverse effects of cathartics, emetics, or diuretics; polyphagia; sialosis; or vomiting. We identified 103 Rochester residents (100 female and 3 male) who fulfilled DSM-III-R diagnostic criteria for bulimia nervosa during the 11-year study period. Mean +/- S.D. age for females at the time of diagnosis was 23.0 +/- 6.1 years (range, 14.4 to 40.2 years). Yearly incidence in females rose sharply from 7.4 per 100000 population in 1980 to 49.7 in 1983, and then remained relatively constant around 30 per 100000 population. The annual age-adjusted incidence rates were 26.5 per 100000 population for females and 0.8 per 100000 population for males. The overall age- and sex-adjusted annual incidence was 13.5 per 100000 population. Bulimia nervosa is a common disorder in adolescent girls and young women from 15 to 24 years of age. Histories of alcohol or drug abuse, depression, or anorexia nervosa were higher than expected in the general population.

Depth and area of dental erosions, and dental caries, in bulimic women.

Dental caries and the severity (depth) and area of erosions of tooth substance were studied in 11 bulimic subjects and 22 matched controls. Erosions were seen in 69% of the bulimics' teeth and in only 7% of the controls' (p less than 0.001). Depth of penetration was greater in the bulimics, extending even into the pulp, and the area of erosion was also larger. Scores for dental caries were higher in bulimics (mean DMFS 27.9, median 36) than in controls (mean DMFS 19.1, median 13.5), although the difference was not statistically significant. This study suggests that when erosions are present on the lingual surfaces of maxillary anterior teeth, as well as on the buccal surfaces of maxillary canines, premolars, and maxillary incisors, a diagnosis of bulimia is likely. Patients with these signs should be referred for medical help.

Body-image disturbances and bulimia nervosa: An empirical analysis of recent revisions of the DSM-III

In the recent revision of the DSM-III, the diagnosis of “bulimia nervosa” includes the criterion of “persistent overconcern with body shape and weight,” which may be conceptualized as a form of body-image disturbance. The new diagnostic criteria for bulimia nervosa include only those who exhibit a binge-purge eating patern, excluding binge-eaters who, in the older DSM-III, receive a diagnosis of bulimia. This study was conducted to investigate body-image disturbances in bulimia nervosa and simple bulimia (i.e., binge-eating without purging). The experimental design included two control groups, obese and normal subjects, in order to determine whether the binge-eater had body-image disturbances different form those of normal and overweight samples. The study evaluated 596 subjects (417 normals, 109 bulimia nervosa subjects, 50 binge-eaters, and 30 obese subjects) in terms of perception of current body size and selection of ideal body size. Results indicated that the bulimia nervosa group selected a current body size larger than that selected by normals and an ideal body size smaller than that chosen by normals. However, bingeeaters did not differ from the obese control group on either current or ideal body size. These results are discussed in terms of the recent debate regarding the diagnosis of bulimia nervosa and sociocultural influences upon body-image disturbances.

Bulimia: symptoms and syndromes in an urban population.

The widely used DSM-III criteria for the diagnosis of bulimia essentially define bulimia as a syndrome of guilty, secretive and subjectively hard to control binge over-eating. A self-report questionnaire for bulimic behavior was administered to three community and two hospital populations in South Australia. 13% of females in the community samples could be categorized as bulimic according to the DSM-III criteria. Those criteria did not adequately define the behaviour of patients in treatment for bulimia in a Weight Disorders Unit, 85% of whom not only binged, but induced vomiting afterwards. When diagnostic criteria were more closely aligned to clinical experience, the prevalence of bulimia in the community appeared closer to 1-2%. New DSM criteria (DSM-III-R) have been proposed and prevalence rates using them fell within the 1-2% range.

Bulimia

Bulimia is a serious and increasingly prevalent eating disorder involving both the ingestion of large quantities of food and the subsequent purging of the ingested calories. Nurse practitioners can effectively intervene in cases of bulimia because of their ability to assess the bulimic's potential medical problems and provide the health education and counseling necessary to stop the dangerous binge/purge cycle. Clues aiding in the diagnosis of bulimia include frequent weight fluctuations, enlargement of the patient's parotid glands, dental erosion, menstrual irregularity, electrolyte imbalance and depression. Interventions should address the patient's medical problems, disrupt the binge/purge cycle, help the patient to establish normal eating patterns, raise the bulimic's self-esteem and help resolve underlying depression.

The level of object relations and severity of symptoms in the normal weight bulimic patient

Forty-nine self-referred female patients who met the D.S.M. III criteria for the diagnosis of bulimia were given a self-administered questionnaire to elicit data on the severity of symptoms and the Blatt Assessment of Qualitative and Structural Dimensions of Object Representations to measure the level of object relations. It was found that a combination of five symptom variables can predict the level of object relations to a multiple R of 59, p < .01: (1) days per week laxative use, (2) use of starvation, (3) days per week vomiting, (4) drinks per day when drinking, and (5) residence status.

Serum amylase and its isoenzymes in normal weight bulimia

Bulimia is a relatively common eating disorder with many serious medical complications. In 11 normal weight patients with bulimia, serum amylase isoenzymes were elevated above control values. Both P (pancreatic origin) and S (salivary gland origin) isoenzymes were elevated to approximately equal degrees. These elevations correlated with the time elapsed since the previous meal but did not correlate with any measures of severity of bulimic behavior or clinical estimations of parotid gland enlargement. Saliva amylase was not different from controls. When serum from these patients was sent to the routine clinical chemistry laboratory, total amylase values were reported to be elevated in two patients and near the top of the normal range in an additional patient. Bulimic behavior must be added to the list of conditions that are associated with mild elevations in serum amylase. Serum amylase determination may be useful to clinicians in confirming the diagnosis of bulimia.

Characteristics of patients with bulimia only, bulimia with affective disorder, and bulimia with substance abuse problems.

Characteristics of patients with a diagnosis of bulimia only (N = 46), bulimia with a history of affective disorder (N = 34), and bulimia with a history of substance abuse (N = 34) were compared. Results showed that compared to patients with bulimia only or with bulimia and affective disorders, patients with bulimia and substance abuse experienced a higher rate of diuretic use to control weight, financial and work problems, stealing before and after the onset of the eating disorder, previous psychiatric inpatient treatment, and greater amount of alcohol use after the onset of the eating disorder. Both the substance abuse group and affective disorder group showed a higher incidence of attempted suicide, more social problems, and greater overall treatment rate than the bulimia only group. There were no significant differences among groups in their family histories.

Neuropsychological test performance of bulimic patients.

Thirty subjects with DSM-III diagnoses of bulimia were compared to 30 matched controls on the Luria-Nebraska Neuropsychological Battery. The bulimics showed poorer performance on tasks associated with functioning of the right frontal cortical area, primarily tasks involving speed of drawing geometric figures. The similarities of the findings to previous findings with anorexic samples and patients with affective disorders are discussed.

Bulimic symptoms: Prevalence and ethnic differences among college women

A self-report measure of bulimia, validated by interviews, was used to survey the eating habits of 689 college women. The results revealed (1) a continuous dimension of “problem eating” defined as weight concern, dieting, and binge eating; (2) high base rates of bulimic symptoms with 40% of women binge eating at least once a month; (3) ethnic differences, with Caucasian women scoring higher on “problem eating” than Asian-American women; and (4) a range of 6-14% of the Caucasian women with a diagnosis of bulimia. An additional measure of eating patterns was administered to 102 women. On the basis of the eating measures and degree of overweight, four groups of women were identified: Bulimic, Snacking Overweight, Non-snacking Overweight, and Sensible Eaters. Eating habits of the four groups were compared. Bulimic symptoms are discussed in the context of normative eating habits among college women.

The prevalence of bulimia and binge eating in adolescent girls

This research investigated the prevalence of bulimia and binge eating in 363 adolescent girls in the ninth through twelfth grade (X age = 16.0 years). Substantial proportions of these girls reported episodes of binge eating (46.0%) and acknowledged the use of self-induced vomiting (11.2%), laxatives (4.7%), and fasting (36.4%) as methods to control their weight. While 7.7% of the girls met the DSM-III criteria for the diagnosis of bulimia, the prevalence rate decreases to 2.8% when these criteria are modified to require the presence of at least weekly binging and purging only via self-induced vomiting or the use of laxatives. An additional 4.4% of the girls engaged in “problematic” binge eating. Comparisons with previous research are offered and diagnostic issues discussed.