ArticleLiterature Review

Medical complications and medical management of bulimia

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Abstract

The syndrome of bulimia is a common disorder and can be associated with serious psychological and physical morbidity. Unfortunately, many patients are reluctant to discuss their symptoms with their physicians and few clues can be found on physical examination to aid in the diagnosis. Possible physical signs include ulceration or scarring of the dorsum of the hand, salivary gland hypertrophy, and dental enamel erosion. In laboratory testing it is fairly common for patients with active bulimia to have fluid and electrolyte abnormalities, particularly hypokalemic alkalosis, and some also have elevated serum amylase levels. Rare complications include myopathies from misuse of ipecac, ruptured esophagus and pneumomediastinum associated with vomiting, and subtle abnormalities in neuroendocrine regulatory systems. Medical management including monitoring of fluid and electrolyte balance is essential during treatment.

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... In this section we highlight the medical problems associated with the range of eating disorders. (For more in-depth reviews, see Brotman, Rigotti, & Herzog, 1985;Goldbloom & Kennedy, 1995;Hsu, 1990;Mitchell, Seim, Colon, & Pomeroy, 1987.) Menstrual and reproductive problems. ...
... The absence of menses for 3 consecutive months in postmenarcheal women is a defining criterion for AN. Although not a core diagnostic feature of BN, menstrual dysfunction also is common in BN; for example, about one third of bulimic women report secondary amenorrhea (Mitchell et al., 1987). Seemingly inexplicable problems with fertility also can be traced to eating disturbances. ...
... Vomiting associated with eating disorders results in various problems of the gastrointestinal tract, ranging from the benign and common swelling of the parotid glands to complaints of constipation, bloating, and gastric discomfort to the rare and possibly fatal rupture of the stomach or esophagus (Palla & Litt, 1988). Disruptions of normal colon functioning also are common, especially for laxative abusers, and may result in long-term disability of the colon that requires surgical repair (Mitchell et al., 1987). Although it is rare, individuals with AN and BN occasionally develop gastric and duodenal ulcers and dilatation (Hsu, 1990). ...
... Moreover, the number of subclinical eating disorders is significantly greater than the pure types, as evidenced by one recent study that reported that only 14% of female college freshmen could be classified as nondieters, while the remainder showed various forms of disturbed eating pattems (Drewnowski, Yee, Kurth, & Krahn, 1994). As mentioned earlier, while some studies suggest that eating disorders are becoming more common (Mitchell et al., 1987), current research may only reflect the notion that eating disorders are being identified and treated more frequently. ...
... As the incidence of bulimia increases (Mitchell et al., 1987), new treatment approaches are being investigated. Currently, non-pharmacological approaches that are being used in the treatment of bulimia consist of cognitive, behavioral, and other forms of counseling (Goldstein, Wilson, Ascroft, & Al-Banna, 1999). ...
... Se debe evitar el cepillado vigoroso para no acelerar la erosión. 17,48 Por ser un padecimiento que el paciente generalmente oculta, dadas las prácticas en las que incurren, así como el sentimiento de culpa, será importante un escrupuloso interrogatorio enfocado a aspectos tales como la actitud mental y emotiva, hábitos dietéticos, ejercicios, uso de medicamentos (laxantes, diuréticos, anoréxicos, etcétera) y control de peso, así como observar meticulosamente signos físicos de la enfermedad, como sialoadenitis, erosión dental y cambios en piel del dorso de las manos. 49 ...
... Se puede utilizar desde una resina hasta rehabilitación protésica mediante coronas completas sin descuidar aspectos oclusales, ortodónticos y gnatológicos como dimensión vertical, sintomatología Articulación Temporo-Mandibular, mordida abierta,52,53 etcétera. Según sea el caso, el plan de tratamiento dependerá tanto de la etiología del trastorno de fondo como de la magnitud de la misma.48,51,53,54 Se sabe de las dificultades terapéuticas y de los fracasos en el tratamiento dental de estos desordenes alimenticios14,17,49 ; esto no debe desmotivar al clínico, al contrario, debe considerarse como un reto importante en la recuperación y mantenimiento del paciente dado que, al conseguir función y estética dental, éste recobrará, reforzará y retroalimentará su autoestima.17 ...
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1 Instituto de Ciencias de la Salud, U.V. 2 Hospital Escuela de Ginecología y Obstetricia, U.V. 3 Instituto de Investigaciones Psicologícas, U.V. 4 Estudiante de la Facultad de Odontología-Zona Xalapa, U.V. RESUMEN L os Trastornos de la Conducta Alimentaria (TCA), tales como la anorexia y la bulimia nerviosa de tipo purgativo compulsivo, se caracterizan por la autoinducción del vómito. Al presentarse esta conducta de manera periódica por un lapso de tiempo aproximado de dos años, los tejidos dentales se verán afectados. Dentro de sus principales manifestaciones destacan: erosión dental, caries, alteraciones en mucosa y parodonto. Aunque éstas no ponen en riesgo la vida, de no diagnosticarse y tratarse oportunamente, serán irreversibles. El odontólogo, al detectar boca seca, erosión y/o cambio en el pH salival, deberá descartar TCA, estando conciente que las más de las veces el paciente negará su problema. La instrucción y educación de aspectos tales como la erosión y los efectos que la deshidratación y la dieta tienen sobre los tejidos bucales serán el paso inicial en el tratamiento dental. Es necesario advertir que el tratamiento dental no será sencillo y que el clínico debe considerar como un reto importante la recuperación y el mantenimiento del paciente, pero por tratarse de un padecimiento multisistémico deberá tratarse por un equipo multidisciplinario especializado en el tratamiento de este padecimiento. Palabras clave: Trastornos de la Conducta Alimentaria, anorexia nerviosa, bulimia nerviosa, erosión dental, xerostomia, sialoadenitis. ABSTRACT Eating disorders, such as anorexia and bulimia nervosa of compulsive purgative type, are characterized by the self-induction of vomit. When appearing this behavior of periodic way by a time interval of two years approximated, oral tissue will be affected. Within its main manifestations of odontologic character it is emphasize: dental erosion, decay, alterations in mucous and periodontium. Although these manifestations do not put in risk life, they are some of the signs and symptoms of patients with eating disorders, those that, of not being diagnosed and treated on time, will be irreversible. The odontologist when detecting dry mouth, erosion and/or change in pH salivary, will have to discard eating disorders type, being conscientious that, most of the times, the patient will deny his problem. The instruction and education of aspects such as the erosion and the effect that the dehydration and the diet have on oral tissue will be the initial step in the dental treatment. The dental treatment of these cases will not be simple. The clinical must consider an important challenge the recovery and maintenance of the patient obtaining dental aesthetic function and improving self-esteem. Being a multisystemics suffering will have to be treated by a multidisciplinary specialized team.
... We note that our patient may not have had complete food impaction but developed esophageal rupture upon self-induced vomiting. Although pneumomediastinum has been reported in bulimia, only one case of esophageal rupture has been confirmed in these patients with no prior esophageal pathology [14], thus lending credence to inflammatory infiltration of EoE as a predisposing factor for esophageal perforation. In addition, this evident predisposition may be further substantiated by the history of recurrent spontaneous perforation in two patients with EoE. ...
Article
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Background: Eosinophilic esophagitis, once considered a rare disorder, has been increasingly recognized as a leading cause of dysphagia and food impaction in children and adults over the last few decades. It predominantly occurs in young men with a history of atopy. Dysphagia and food impaction are the most common presentations. However, rarely, spontaneous perforation (Boerhaave's syndrome) may occur in association with eosinophilic esophagitis. Case presentation: A 40-year-old white woman with known history of eosinophilic esophagitis, who was non-compliant with treatment, presented with chest pain and developed acute spontaneous transmural esophageal perforation while eating a snack. Surgical repair was required. Conclusion: In a relatively young patient who presents with spontaneous esophageal perforation, eosinophilic esophagitis should always be ruled out as subsequent treatment may prevent recurrent perforation.
... Si el paciente vomita, se recomienda el empleo diario de soluciones neutras en forma de enjuague de fluoruro de sodio (0.05%), aplicaciones directas en gel de fluoruro de estaño (0.4%), así como el contenido de este en la pasta dental de uso diario que, además de proteger al esmalte ante la dilución ácida y erosión, ayuda a reducir la sensibilidad térmica de la dentina expuesta y la incidencia de caries. Sin embargo Mitchell J. (17). Ha reportado una reducción de la sensibilidad hasta de 30% en la erosión del esmalte dental después de la aplicación tópica de fluoruro de sodio al 0.23%, además de evitar el cepillado vigoroso para no acelerar la erosión, Julianelli J. (18), indica que la reducción de la sensibilidad en dientes erosionados se mejora con 4 topicaciones de flúor al 2% y además con una topicación de flúor estañoso después de 3 0 4 meses. ...
Article
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La Medicina en la Estomatología cada día cobra más importancia, debido a que existen innumerables número de enfermedades sistémicas que dan signos y síntomas a nivel de la cavidad bucal, y esto s irve a los especialistas en la odontología a poder reconocer diferentes enfermedades a través de sus manifestaciones que se presentan en boca. Objetivo: Caracterizar las lesiones bucales presentes en un paciente con diagnóstico médico de anorexia y bulimia Material: para la exploración, se utilizó material de inspección bucal pinza, espejo, explorador, paletas estériles, gaza estéril, cámara fotográfica de 16 pixeles. Método: Fue evaluado bucalmente un paciente con diagnóstico de anorexia y bulimia en un periodo de 4 meses de julio a octubre del 2014) L as lesiones bucales observadas fueron descritas clínicamente y su diagnósticomédico confirmo dicha enfermedad. Resultados: paciente con anorexia y bulimia de sexo femenino 23 años de edad, con presencia de sequedad bucal, xerostomía, erosión de esmalte y caries dental en zona gingival, mucosa labial escamativa con presencia de grietas sangrantes al tacto, lesiones tipo aftas herpéticas en la zona del paladar y labio superior, además de queilitis angular a consecuencia d e la enfermedad sistémica, Conclusiones: La enfermedad sistémica anorexia y bulimia en muchas ocasiones afecta la zona de la cavidad bucal, presentando lesiones en labios, queilitis angular, erosión del esmalte dental con sensación de dolor, presencia de caries en zona gingival de diversas piezas dentarias, dolor en las zonas blandas afectadas e inflamación.
... Las complicaciones médicas de la bulimia nerviosa pueden incluir disfunción menstrual y amenorrea (19), restricción dietética, hipercortisolismo, anomalías metabólicas y ejercicio excesivo (20). La osteopenia es considerada una complicación asociada en un subgrupo de pacientes con bulimia nerviosa, fundamentalmente en aquéllas con historia antigua de anorexia nerviosa (7). ...
... However, females are also more likely to identify themselves as bulimic than males. Other purging behavior patterns commonly seen in bulimia include prolonged fasting (90%), laxative abuse (60%), use of over the counter diet pills (50%), and abuse of diuretics (33%) (73). A minority will exercise compulsively (no numbers were reported), however this behavior is being seen more frequently. ...
Article
The prevalence of bulimia among active-duty United States Air Force (USAF) women has not been documented. However, in the general population, bulimia is believed to be occurring in increasing numbers of persons. This thesis consists of the development of a proposal for a program to screen active- duty USAF women for bulimia associated with pre-scheduled annual weighing. Prevalence rates will be determined based on age, race, rank, job, alcohol consumption, smoking and eating histories, Weight Management Program (WMP) activity status, weight and height, and overall body image. The thesis includes a review of the literature, a description of bulimic personality characteristics, a discussion of associated medical complications, hypothesized etiologies, treatment modalities and prognosis, as well as a discussion of the need for such a study.
... From 4 to 20 % patients with anorexia die as the result of loosing weight, although the direct cause of death are emaciation of the organism, acute circulatory failure and cardiac arrest [4,5]. Another, less common cause of death in people with anorexia is suicide [6,7]. 1 -2.4 % patients with bulimia [8,9,10] die of medical complications due to attacks of compulsive overeating and rapid purge [11,12] and due to suicide [13,14]. The consequences of compulsive overeating are: obesity and serious diseases of the digestive system and cardiovascular system. ...
Article
Full-text available
Current research on using adjunctive e-mail in psychotherapy of eating disordered patients is still in its in-fancy. Some authors underline potential benefits of this form of intervention, and, to prove it, they quote very enthusiastic opinions of their patients. Obviously, this medium of e-mail may help some patients with eating disorders, especially these who are shy, timid and harm-avoidant or who for various reasons have hindered access to treatment. Paradoxically, anonymity which is considered to be one of advantages of e-mail, may become the most serious danger for privacy of patients. Additionally, this feature may appear fatal in the case of self-destructive behaviours of disturbed patients. Cautious optimism of most patients about this form psychotherapy should be, aside from clearly cognitive reasons, an additional motivation for researchers, for a thorough empirical verification of it.
... For example, if physiologic measurements and physiologically based questions were included in a preparticipation examination, the process would not seem peculiar or extraordinary. 38,39 Our purpose was to develop and evaluate a physiologic screening test specifically designed for collegiate female athletes engaged in athletic competition or highly athletic performances in order to detect eating disorders/disordered eating. The present study was conducted to address the following research questions: (1) What are the epidemiologic results for the Physiologic Screening Test, including sensitivity, specificity, percentage of false positives, percentage of false negatives, positive predictive value, negative predictive value, yield, accuracy, and validity? ...
Article
The purpose of this study was to identify physical signs and symptoms indicating e[barbelow]ating d[barbelow]isorders/d[barbelow]isordered e[barbelow]ating (ED/DE) among female college athletes in order to develop an effective, valid , and quick-to-administer screening test. Psychosocial questionnaires may be less effective as screening tests due to response bias and the unwillingness of respondents to acknowledge ED/DE. Physical measures may be preferable to or used in conjunction with psychosocial screening tests because physical assessments are more objective and their purpose is more obscure. Subjects included 148 (84.5%) volunteer female Division I, club, and dance team athletes 18-25 years old who attended a large, Midwestern university. Self-report physical signs and symptoms questions were administered. The questionnaire was developed by the investigator and was called the Phys iological Aspects of Eating Behaviors Q[barbelow]uestionnaire (Phys-Q). The PHYS-Q assessed dizziness, abdominal bloating and pain, weakness, cold intolerance, leg edema, constipation, menstrual cycle frequency, and history of stress fractures. A physiological evaluation was used called the A[barbelow]thlete P[barbelow]hysical H[barbelow]ealth A[barbelow]ssessment Form (APHA). The APHA was used to record height, weight, body mass index, percent body fat, waist-hip ratio, blood pressure, caffeine use, water intake, parotid gland enlargement, and exercise, menstrual, weight, and dental histories. Last, a validated, structured, diagnostic interview (the E[barbelow]ating D[barbelow]isorder E[barbelow]xam, 12.0D; EDE), was used to identify those with or without ED/DE. Results showed a large number (35%; n = 51) of athletes were ED/DE. Six items from the PHYS-Q and 12 items from the APHA discriminated the ED/DE versus non-ED/DE subjects the best. The combination of these "best" items from both the PHYS-Q and APHA tests were more effective (sensitivity = 86% and specificity = 78%) in identifying ED/DE than the EDI-2 (sensitivity = 64% and specificity = 74%) and BULIT-R (sensitivity = 27% and specificity = 99%) questionnaires. Two possible reasons for the success of the physiologic items were the reduction and/or elimination of response bias and that the items were developed specifically for this population. Recommendations are to include a quick (~10 minutes long) and easy-to-administer physiologic screening test during mandatory pre-participation examinations.
... Endocrine abnormalities are also hallmark results of anorexia nervosa and bulimia nervosa. These abnormalities result in dysregulation of the hypothalamic-pituitary (HP) axes, the HP-gonadotropin (HPG), the HP-adrenal (HPA), and HP-thyroid (HPT) axes (Mitchell, Pyle, Eckert, Hatsukami, & Lentz, 1983;Mitchell, Seim, Colon, & Pomeroy, 1987). The HPG axes are responsible for the cessation of menstrual cycles in females, which is an overt symptom often recognized within the anorexia nervosa diagnostic criterion. ...
... In laboratory testing, patients with active bulimia may have fluid and electrolyte abnormalities, particularly hypokalemic alkalosis, and some also have elevated serum amylase levels. Rare complications include myopathies from misuse of emetics, ruptured esophagus and pneumomediastinum associated with vomiting, and subtle abnormalities in neuroendocrine regulatory systems (Mitchell et al., 1987). Because of the evidence of a continuance, the phrase " eating disorders not otherwise specified " (EDNOS) was introduced in the DSM-IV. ...
... Bowel dysfunctions including colonic mucosa inflammation and ulceration, ileocaecal sphincter dilation, colonic neuropathy, steatorrhoea and protein-losing gastroenteropathy have been reported with laxative abuse. [99][100][101][102][103][104][105][106] Other presentations include GI bleeding [107] and dehydration with various electrolyte abnormalities. [108] Diarrhoea may alternate with periods of constipation, which causes the patient to enter a vicious cycle alternating between the two. ...
Article
Full-text available
Laxatives have been used for health purposes for over 2000 years, and for much of that time abuse or misuse of laxatives has occurred. Individuals who abuse laxatives can generally be categorized as falling into one of four groups. By far the largest group is made up of individuals suffering from an eating disorder such as anorexia or bulimia nervosa. The prevalence of laxative abuse has been reported to range from approximately 10% to 60% of individuals in this group. The second group consists of individuals who are generally middle aged or older who begin using laxatives when constipated but continue to overuse them. This pattern may be promulgated on certain beliefs that daily bowel movements are necessary for good health. The third group includes individuals engaged in certain types of athletic training, including sports with set weight limits. The fourth group contains surreptitious laxative abusers who use the drugs to cause factitious diarrhoea and may have a factitious disorder. Normal bowel function consists of the absorption of nutrients, electrolytes and water from the gut. Most nutrients are absorbed in the small intestine, while the large bowel absorbs primarily water. There are several types of laxatives available, including stimulant agents, saline and osmotic products, bulking agents and surfactants. The most frequently abused group of laxatives are of the stimulant class. This may be related to the quick action of stimulants, particularly in individuals with eating disorders as they may erroneously believe that they can avoid the absorption of calories via the resulting diarrhoea. Medical problems associated with laxative abuse include electrolyte and acid/base changes that can involve the renal and cardiovascular systems and may become life threatening. The renin-aldosterone system becomes activated due to the loss of fluid, which leads to oedema and acute weight gain when the laxative is discontinued. This can result in reinforcing further laxative abuse when a patient feels bloated and has gained weight. Treatment begins with a high level of suspicion, particularly when a patient presents with alternating diarrhoea and constipation as well as other gastrointestinal complaints. Checking serum electrolytes and the acid/base status can identify individuals who may need medical stabilization and confirm the severity of the abuse. The first step in treating laxative misuse once it is identified is to determine what may be promoting the behaviour, such as an eating disorder or use based on misinformation regarding what constitutes a healthy bowel habit. The first intervention would be to stop the stimulant laxatives and replace them with fibre/osmotic supplements utilized to establish normal bowel movements. Education and further treatment may be required to maintain a healthy bowel programme. In the case of an eating disorder, referral for psychiatric treatment is essential to lessen the reliance on laxatives as a method to alter weight and shape.
... Table I lists potential medical complications of bulimia. 28 Experiencing any of these issues can have significant effects on a service member's performance both in training and combat. ...
Article
Eating disorders can have atypical presentations, be challenging to diagnose, and often result in treatment delay, as illustrated here. Bulimia nervosa is characterized by binge eating and inappropriate compensatory behaviors, and is ten times more common in females. Studies show increased prevalence over the past decade, with similar prevalence in young military members and civilians. Risk factors include dieting, gender preference, life-altering events, and history of a psychiatric condition. Relatively little research has focused on eating disorders among military males, but factors unique to this group include rigid weight standards, mandatory semiannual personal fitness assessments, and extended deployments. Bulimia and other eating disorders can have subtle or atypical presentations and are often overlooked in males. Other diagnostic obstacles include career concerns and stigma avoidance, along with provider time constraints, inexperience, or discomfort with the issue. Serious medical complications of bulimia are uncommon, but delayed diagnosis can lead to hospitalization and significant morbidity. This case emphasizes the importance of a thorough history and wide differential when faced with an unusual presentation. Recognizing risk factors and incorporating simple screening tools can aid the timely identification and treatment of service members with disordered eating before unit and mission effectiveness are compromised.
... An essential feature that is used in the diagnosis is the recurrent use of inappropriate compensatory behaviors to prevent weight gain. Vomiting is the most common compensatory behavior seen in bulimia nervosa [21]. This can provide relief from physical discomfort and reduce the fear of gaining weight. ...
Article
Full-text available
Mallory-Wiess Syndrome (MWS) is one of the common causes of acute upper gastrointestinal (GI) bleeding, characterized by the presence of longitudinal superficial mucosal lacerations. The esophageal lacerations that are seen with MWS stem from forceful retching and vomiting. The increased intraabdominal pressure causes gastric contents to be forced into the esophagus. The force itself has been postulated as being the cause of the Mallory-Weiss tears. The most common precipitating factors are considered vomiting and retching in correlation with a history of excessive drinking or physical findings consistent with chronic alcohol abuse. While chronic alcohol abuse is a well-known precipitating factor, other conditions such as hyperemesis gravidarum, bulimia nervosa, scleroderma, gastrointestinal reflux disease, and chemotherapy-induced hyperemesis can also lead to MWS. The diagnosis of MWS is suggested clinically by a typical history of hematemesis that is known to occur after one or more episodes of non-bloody vomiting. Diagnosis is achieved via upper GI endoscopy visualizing the Mallory-Weiss tears within the esophageal membrane. If the patient is stable, medical intervention is unnecessary. In the event that the amount of blood vomited is extensive, supportive management may be required such as blood transfusion, electrocautery, balloon tamponade.
... Gastrointestinal consequences range from mild dysfunction to life-threatening complications and include loss of tooth enamel, salivary gland enlargement, esophageal lesions varying from esophagitis to esophageal rupture, gastric rupture, cathartic colon, and severe constipation. [3][4][5][6] Furthermore, clinical reports suggest that gastrointestinal symptoms are common in bulimia nervosa and are often multiple and severe. 7 However, little is known about the occurrence of eructation (belching) in bulimia nervosa despite reports of life-threatening complications in chronic cases. ...
Article
Full-text available
This report offers the first detailed description of repetitive eructation (belching) in a patient with bulimia nervosa. The case was a man in his 30's with bulimia nervosa characterized by daily bingeing and purging behavior. Detailed assessment revealed repetitive eructation which was construed as a learned behavior precipitated and maintained by aerophagia (air swallowing) secondary to regular binge-eating. Eructation was associated with a strong sense of "relief" that shared a common phenomenology with other purging behaviors. Repetitive eructation was addressed as part of outpatient treatment using a cognitive-therapy approach. Eructation became less frequent during outpatient treatment but the patient disengaged after six sessions. We define a new term "eructophilia" where repetitive eructation takes on an ego-syntonic, self-contained, and autonomous quality which serves as a reinforcing stimulus in itself. Issues of phenomenology and motivating factors are further discussed.
... From 4 to 20 % patients with anorexia die as the result of loosing weight, although the direct cause of death are emaciation of the organism, acute circulatory failure and cardiac arrest [4,5]. Another, less common cause of death in people with anorexia is suicide [6,7]. 1 -2.4 % patients with bulimia [8,9,10] die of medical complications due to attacks of compulsive overeating and rapid purge [11,12] and due to suicide [13,14]. The consequences of compulsive overeating are: obesity and serious diseases of the digestive system and cardiovascular system. ...
Article
Full-text available
Actual research on using adjunctive e-mail in psychotherapy of eating disordered patients is still in its infancy. Some authors underline potential benefits of this form of intervention, and, to prove it, they quote very enthusiastic opinions of their patients. Obviously, this medium of e-mail may help some patients with eating disorders, especially these who are shy, timid and harm-avoidant or who for various reasons have hindered access to treatment. Paradoxically, anonymity which is considered to be one of advantages of e-mail, may become the most serious danger for privacy of patients. Additionally, this feature may appear fatal in the case of self-destructive behaviours of disturbed patients. Cautious optimism of most patients about this form psychotherapy should be for researchers additional, except clearly cognitive reasons, motivation for thorough empirical verification of it.
... Bowel dysfunctions including colonic mucosa inflammation and ulceration, ileocaecal sphincter dilation, colonic neuropathy, steatorrhoea and protein-losing gastroenteropathy have been reported with laxative abuse. [99][100][101][102][103][104][105][106] Other presentations include GI bleeding [107] and dehydration with various electrolyte abnormalities. [108] Diarrhoea may alternate with periods of constipation, which causes the patient to enter a vicious cycle alternating between the two. ...
Article
Full-text available
Laxatives have been used for health purposes for over 2000 years, and for much of that time abuse or misuse of laxatives has occurred. Individuals who abuse laxatives can generally be categorized as falling into one of four groups. By far the largest group is made up of individuals suffering from an eating disorder such as anorexia or bulimia nervosa. The prevalence of laxative abuse has been reported to range from approximately 10% to 60% of individuals in this group. The second group consists of individuals who are generally middle aged or older who begin using laxatives when constipated but continue to overuse them. This pattern may be promulgated on certain beliefs that daily bowel movements are necessary for good health. The third group includes individuals engaged in certain types of athletic training, including sports with set weight limits. The fourth group contains surreptitious laxative abusers who use the drugs to cause factitious diarrhoea and may have a factitious disorder. Normal bowel function consists of the absorption of nutrients, electrolytes and water from the gut. Most nutrients are absorbed in the small intestine, while the large bowel absorbs primarily water. There are several types of laxatives available, including stimulant agents, saline and osmotic products, bulking agents and surfactants. The most frequently abused group of laxatives are of the stimulant class. This may be related to the quick action of stimulants, particularly in individuals with eating disorders as they may erroneously believe that they can avoid the absorption of calories via the resulting diarrhoea. Medical problems associated with laxative abuse include electrolyte and acid/base changes that can involve the renal and cardiovascular systems and may become life threatening. The renin-aldosterone system becomes activated due to the loss of fluid, which leads to oedema and acute weight gain when the laxative is discontinued. This can result in reinforcing further laxative abuse when a patient feels bloated and has gained weight. Treatment begins with a high level of suspicion, particularly when a patient presents with alternating diarrhoea and constipation as well as other gastrointestinal complaints. Checking serum electrolytes and the acid/base status can identify individuals who may need medical stabilization and confirm the severity of the abuse. The first step in treating laxative misuse once it is identified is to determine what may be promoting the behaviour, such as an eating disorder or use based on misinformation regarding what constitutes a healthy bowel habit. The first intervention would be to stop the stimulant laxatives and replace them with fibre/osmotic supplements utilized to establish normal bowel movements. Education and further treatment may be required to maintain a healthy bowel programme. In the case of an eating disorder, referral for psychiatric treatment is essential to lessen the reliance on laxatives as a method to alter weight and shape.
... Measurement of the urine Cl concentration usually distinguishes unexplained self-induced vomiting from BS and Gitelman syndrome [26,37]. ...
Article
Full-text available
Background Bartter syndrome (BS) is a group of inherited, salt-losing tubulopathies presenting as metabolic alkalosis with normotensive hyperreninemia and hyperaldosteronism. It is a consequence of abnormal function of the kidneys, which become unable to properly regulate the volume and composition of body fluids because of defective reabsorption of NaCl in loop of Henle. A first consequence of the tubular defect in BS is polyuria, which is responsible for particular complications of pregnancy − that is, polyhydramnios and premature delivery. Low potassium levels in the blood may result from overactivity of the renin–angiotensin II–aldosterone hormone system that is essential in controlling blood pressure. To date, at least five genes have been linked to BS, and they characterize five types of BS. Aim The aim of this work is to study the clinical and laboratory data of infants and children with BS attending Alexandria University Children’s Hospital during a 10-year period (January 2004–December 2013). Participants and methods A retrospective analysis of children diagnosed with BS attending Alexandria University Children’s Hospital during a 10-year period (January 2004–December 2013) was carried out. On the basis of the clinical, biochemical features, and ultrasonographic findings, 20 children were diagnosed with BS. Their demographic, clinical, biochemical, and hormonal profiles were analyzed. Follow-up data and outcomes were recorded. Results The majority of cases had perinatal history of polyhydraminos. All cases had high urinary chloride in spot urine analysis. The mainstay of treatment in BS is potassium supplementation and indomethacin. Correction of hypokalemia and hyperprostaglandinemia are mandatory for improving the symptoms (vomiting, polyuria) and chronic sequalae such as FTT and growth retardation. Conclusions According to this study, BS should be suspected in any child with a history of failure to thrive and metabolic alkalosis. Early diagnosis and treatment with NSAIDs are life-saving.
... Eating disorders like bulimia nervosa are psychosomatic diseases, which are, in turn, associated with severe physical impairments and accompanied with sequelae [3,4]. Recently, particular attention has been focused on long-term effects, which are noticeable only after prolonged persistence of the disease [5,6]. At the beginning, loss of dental enamel on the surface of the teeth usually occurs painlessly [7]. ...
... Eating disorders like bulimia nervosa are psychosomatic diseases, which are, in turn, associated with severe physical impairments and accompanied with sequelae [3,4]. Recently, particular attention has been focused on long-term effects, which are noticeable only after prolonged persistence of the disease [5,6]. At the beginning, loss of dental enamel on the surface of the teeth usually occurs painlessly [7]. ...
Chapter
Dialectical Behaviour TherapyIndividual TherapyDBT and Eating DisordersConclusion References
Chapter
IntroductionThe Biology of Appetite and Weight HomeostasisPeripheral Signals of Energy HomeostasisMotivation and RewardDysregulation of Appetite and Weight Homeostasis in Eating DisordersBed and ObesityConclusions References
Chapter
• Paradoxically eating disorders are not the issue in the primary prevention of eating disorders • Disease prevention should be integrated in a health promotion perspective • Health promotion includes both schools, and a supportive environment to enable teachers, parents and other adults to be good role models • Empowerment in health promotion means learning personal skills to cope with stress in order to be able to take charge over one's own life • Preventive programmes should take on a longitudinal and multicomponent approach • The Internet may become an important arena for doing preventive work • Prevention programmes should be evaluated using a variety of research methods • Health promotion may highlight difficult, conflicting political priorities in the development of society.
Chapter
IntroductionThe Purpose of Cognitive-behavioural ModelsGeneral Principles of Cognitive-behavioural ModelsSpecific Vs General Cognitive-behavioural ModelsAnorexia NervosaBulimia NervosaObesitySummary and Conclusions AcknowledgementsReferences
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Structural neuroimaging techniques: • There is sufficient evidence of a relationship between eating disorders and altered brain structures. • Morphological brain alterations are most likely a consequence of endocrine and metabolic reactions to starvation, regardless of whether starvation leads to an underweight state ('pseudoatrophy'). • However, there are individual cases in whom the brain alterations continue to exist. • Improvement in MRI technique will shed more light on the regional distribution of structural brain abnormalities. Functional neuroimaging techniques: • The functional abnormalities may be partly secondary to weight loss but may also reflect underlying primary brain dysfunction. • Cognitive activation and symptom provocation paradigms might elucidate typical brain activation patterns in eating disorder patients. • Re-assessment should be performed upon recovery to determine if the structural and functional abnormalities are strictly secondary to the abnormal eating behavior or related to underlying traits. • The enormously rapid development of new technology in structural and functional neuroimaging techniques will allow more precise observation of the brain. Serotonin activity: • Disturbances of brain serotonin activity have been described in patients with anorexia nervosa and bulimia nervosa. • Whether abnormalities are a consequence or a potential antecedent of pathological eating behavior remains a major question. • There are distinct differences in serotonin activity between recovered and ill patients with anorexia or bulimia nervosa (challenge tests, CSF 5-HIAA). • It cannot be ruled out that subjects at risk of an eating disorder might have trait abnormalities in the regulation of brain serotonin function that might make them vulnerable to abnormal eating behavior (as a way to 'treat' abnormal serotonin activity) or to dietinginduced decreases in plasma tryptophan. • In addition, a disturbance of serotonin activity may also explain associated psychopathological features (e.g. obsessionality, depression) that are common to both anorexia and bulimia nervosa. Other neurochemicals: • Altered regulation in several neurotransmitter systems (e.g. dopamine) may contribute to the disorder.
Article
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Eating disorders are multifaceted problems with various risk factors, including the sociocultural context, social media, society's beauty standards, personality, and genetics. The coronavirus disease 2019 (COVID-19) pandemic has been a cause of stress among university students, as well as inducing changes in their physical activity and eating habits. Objective The objectives of this study were to evaluate the changes in body mass index and risk of developing eating disorders among university students during the COVID 19 pandemic. Methods This was a cross-sectional study of 1004 female students recruited from a university in Riyadh, KSA. Data were collected from December 2020 to March 2021 through a self-administered questionnaire comprising three parts: sociodemographic items, the Eating Attitudes Test, and an evaluation of behavioral changes during the COVID-19 pandemic. Results Most participants were aged 18–24 years, single, lived with their parents, and had a moderate to high family income. There was a significant relationship between the risk of developing eating disorders and marital status (p < 0.001). College type (p < 0.003), fast food consumption (p = 0.010), and engaging in exercise (p < 0.001) were also significant factors. Based on categorizations of risk levels derived from the literature, about 31.5% of the participants had a high risk of developing eating disorders. Conclusion According to our results, eating disorders are relatively common among Saudi female undergraduate students. Thus, educational programs that aim to increase this population's awareness concerning appropriate nutrition and body weight are needed.
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IntroductionTheory of Complex DiseasesHeritability of Complex DiseasesHeritability of Eating DisordersHeritability of Human ObesityMolecular Genetic Methodology for Identifying Susceptibility Genes for Complex DiseasesChoosing the Phenotype for Molecular Genetic StudiesIdentification of Susceptibility Genes for Eating Disorders and ObesityConclusion References
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IntroductionService DevelopmentGuidelines and Standards for Specialist Eating Disorders ServicesWhat Should a Service Look Like?Problems in Providing a ServiceWhat Services Should be Offered?Users and CarersConclusions References
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The present paper provides an overview of the guiding theory and descriptive features of the cognitive-behavioral approach to psychosocial interventions for youths. Cognitive-behavioral treatment has been applied to various disorders including anxiety, aggression, depression, attention deficit-hyperactivity disorder, pain, and learning disabilities. Research on the nature of these disorders, a description of related treatment strategies, and an illustrative review of treatment outcome data is provided. Discussion focuses on a consideration of familial involvement, developmental factors, and methodological issues (i.e., comorbidity and normative comparisons) that require research attention.
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IntroductionAnorexia NervosaBulimia NervosaBinge Eating DisorderObesityReferences
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PURPOSE: Rectal prolapse is a condition in which, when complete, the full thickness of the rectal wall protrudes through the anus. Bulimia nervosa is an eating disorder characterized by periodic food binges, which are followed by purging. Purging usually takes the form of self-induced vomiting, laxative abuse, and/or diuretic abuse. We report seven cases of rectal prolapse associated with bulimia nervosa. METHODS: The case histories of seven women with rectal prolapse and bulimia nervosa, average age 29 (range 21–42) years, seen over a period of 11 years (1987–1997) were reviewed. An analysis of the clinical data, including history, presenting physical examination, surgical treatment, and outcome was performed. RESULTS: All seven patients had a diagnosis of bulimia nervosa, made either before or with a diagnosis of rectal prolapse. Rectal prolapse was confirmed in each patient at anorectal examination. Five patients underwent sigmoid resection with proctopexy, one died before operative therapy, and one awaits further treatment. One of the five surgical patients had a recurrence that was managed by a perineal rectosigmoidectomy. CONCLUSION: To our knowledge, despite extensive review of both bulimia nervosa and rectal prolapse as seen in the medical literature, an association between the two has not been described previously. Several aspects of bulimia nervosa, including constipation, laxative use, overzealous exercise, and increased intra-abdominal pressure from forced vomiting are likely causes for the probable relationship with rectal prolapse. The possibility that an atypically young female presenting with rectal prolapse may also have bulimia nervosa should be taken into account by clinicians. This may assist the diagnosis of bulimia nervosa, a disease with multiple morbidities. Conversely, a patient being treated for bulimia nervosa who develops anorectal symptoms may come to earlier diagnosis and treatment for rectal prolapse.
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The purpose of this article is to thoroughly review the medical complications associated with bulimia nervosa and their evidenced-based or typical treatments. A thorough review of medical literature to cull pertinent and best articles which guide the diagnosis and treatment of the medical complications of bulimia nervosa was performed. There are many different medical complications of bulimia nervosa which are caused by the mode and frequency of purging. Some are fluid and electrolyte alterations from the utilized mode of purging and some are due to the local damaging effects of purging behaviors on those body sites. Bulimia nervosa is a serious mental health disorder which has many medical complications associated with it. Most are reversible with treatment.
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IntroductionAttachmentAttachment and Eating DisordersOther Influences on DevelopmentDiscussionReferences
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Bulimia nervosa, often characterized by self-induced vomiting, is complicated by medical manifestations that affect nearly every organ system in the body. Effects range from superficial skin and dental findings to esophageal pathology, electrolyte abnormalities, cardiac arrhythmias, and in extreme cases, death. Ultimately, cessation of vomiting is necessary to cure most associated medical complications. Improper management of medical complications may lead to significant psychological distress to the patient. Fortunately, efficacious treatments do exist both to ease symptoms and ideally help the patient make a smooth transition to cessation of self-induced vomiting behavior.
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Bulimia nervosa is a common medical problem among young women of childbearing potential. Although many bulimic women improve their eating while pregnant, some do not and continue to binge eat, vomit, and/or use laxatives. This study is a retrospective comparison of the outcome of 38 pregnancies in 20 actively bulimic women and 50 pregnancies in 31 control women. The results indicate that the risk of fetal loss, primarily through miscarriages, was approximately twice as high in first bulimic pregnancies. However, this difference was not statistically significant.
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In a survey of 32 consecutive outpatients with anorexia nervosa and/or bulimia nervosa, about 9% of patients had elevated serum uric acid levels at the time of their initial assessment. These patients had a history of regular strenuous exercising and prolonged or periodic starvation, in the absence of other potential causes for the hyperuricemia, i.e., dehydration, a purine-rich diet, recent alcohol use or use of thiazide diuretics. One patient had a history of gout and experienced a relapse of her gouty symptoms in association with resumption of a restrictive dietary pattern and compulsive exercising. Increased net degradation of cellular adenosine triphosphate during strenuous exercising and decreased renal clearance of uric acid during starvation were the most likely causes for the hyperuricemia. The overall significance of this previously unreported finding among eating-disordered patients is discussed. Monitoring of serum uric acid levels, a relatively inexpensive and easily available test, may prove to be a useful adjunct in the assessment of certain indices of illness severity in eating disorders.
Article
Results of a survey administered to 85 Native American girls and women, aged 12–55, revealed that 74% were trying to lose weight and that 75% of those who were dieting to lose weight were employing potentially hazardous techniques. The results also showed that 24% of the dieters used one or more purging behaviors. The mean age of those using pathogenic weight-control methods was 28.8 years. Subjects with higher body mass indexes were more likely to use dangerous weightcontrol methods. These findings suggest that Native American women should be included among the groups at risk for eating disorders and that older and heavier women in this population also should receive attention.
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Three lines of evidence have suggested that electrophysiologic abnormalities may play a role in bulimia: (1) findings of abnormal EEGs in bulimic patients, (2) evidence that bulimia may respond to anticonvulsant medications, and (3) a possibly elevated frequency of seizures in bulimic patients treated with antidepressant medications. A review of these findings, together with new data from our center and others suggests that electrophysiologic abnormalities do not play a major role in bulimia (although such abnormalities may perhaps be more common in individuals with “atypical” eating disorders). However, the apparently increased frequency of seizures in bulimic patients treated with bupropion remains unexplained. Further research is needed to clarify this finding.
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In clinical practice, psychodynamic approaches represent an important component of the treatment for young people with eating disorders (EDs), even though the research literature remains modest regarding the most effective treatment for children, adolescents, or adults with an ED. Although there are very few clinical research studies of individual or family psychodynamic treatments of EDs, there is some evidence for efficacy from clinical trials. This article reviews studies of psychodynamically informed therapies for the treatment of EDs and discusses how the findings, although limited, suggest that further research into psychodynamic treatments of EDs in youth is warranted.
Article
Background: Eating disorders are one of the "great masqueraders" of the twenty-first century. Seemingly healthy young men and women with underlying eating disorders present to emergency departments with a myriad of complaints that are not unique to patients with eating disorders. The challenge for the Emergency Medicine physician is in recognizing that these complaints result from an eating disorder and then understanding the unique pathophysiologic changes inherent to these disorders that should shape management in the emergency department. Objective: In this article, we will review, from the perspective of the Emergency Medicine physician, how to recognize patients with anorexia and bulimia nervosa, the medical complications and psychiatric comorbidities, and their appropriate management. Conclusions: Anorexia and bulimia nervosa are complex psychiatric disorders with significant medical complications. Recognizing patients with eating disorders in the ED is difficult, but failure to recognize these disorders, or failure to manage their symptoms with an understanding of their unique underlying pathophysiology and psychopathology, can be detrimental to the patient. Screening tools, such as the SCOFF questionnaire, are available for use by the EM physician. Once identified, the medical complications described in this article can help the EM physician tailor management of the patient to their underlying pathophysiology and effectuate a successful therapeutic intervention.
Article
Primary care providers are increasingly confronted with managing patients with eating disorders. The management of these disorders can be challenging and requires a thorough knowledge of eating disorder assessment, medical complications, and advances in treatment.
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Intraoral symptoms have been reported as somatic symptoms of patients with eating disorders. In order to elucidate the actual states, we performed research including taking medical histories, intraoral diagnoses, saliva tests, bacteriological examinations, etc on a patient group with eating disorders (female, 51 subjects) and a control group (female, 64 subjects). The results are as follows. 1. Thirty-six subjects had experiences of anorexia as an abnormal eating habit. And 42 subjects had experiences of hyperorexia. Among them, 33 subjects had experiences of self-induced vomiting. 2. We checked for oral lesions that have been pointed out by specialists of eating disorders. Among such lesions, it has been suggested that cervical caries and cervical parenchymatous losses are useful observation for an early detection of eating disorders. 3. Periods of sickness, self-induced vomiting and irregular eating habits during hyperorexia periods, abnormal eating habits such as excessive consumption of sugar in hyperorexia, low saliva flow and occurrences of dryness in oral cavities during anorexia periods were inferred to be factors causing caries in patients with eating disorders. 4. It has been suggested that oral symptoms as somatic symptoms of patients with eating disorders provide important information for the detection of eating disorders. Thus, it is presumed that dentists should assume a heavy responsibility for and be active in treatment, prevention and early detection of eating disorders, which are burgeoning.
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Trait impulsivity is a temperamental factor that may influence the development of bulimia nervosa in youth. This chapter will review the literature on trait impulsivity from a developmental perspective. The nomenclature of impulsivity varies widely, with definitions range from behaving with lack of foresight to novelty seeking. We provide a review of the multi-faceted model of impulsivity including negative urgency, (lack of) premeditation, sensation seeking, and (lack of) perseverance (Whiteside & Lynam, 2001), and how these four facets of impulsivity may be related to childhood temperament and thus to the development of eating pathology in children and adolescents. A review of the interaction between temperament and environment will also be provided. In large scale genetic studies, shared environment appears to contribute to risk for eating pathology prior to puberty, which genetic influences and non-shared environment contribute to risk following puberty. We propose that increased vulnerability to maladaptive behaviors develops from high levels of negative urgency. We also describe a process by which an adolescent's environment shapes their expectancies, which can in turn influence decision making, which may be moderated by high levels of negative urgency. Finally, we propose that negative urgency is plausible endophentype candidate for the heritable genetic influence on BN expressed after puberty, while thinness expectancies may capture shared and non-shared environmental influences.
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O padrão do corpo ideal tem variado culturalmente. Nos anos 50, os ideais de beleza feminina ainda associavam elegância com voluptuosidade. A partir dos anos 60, os modelos começaram a apresentar uma simetria entre busto e anca. Perder peso tornou-se, crescentemente, sinónimo de esmero pessoal, sucesso e atracção. A obsessão por uma silhueta magra converteu-se hoje num modo de tirania que afecta um número cada vez maior de adolescentes, especialmente do sexo feminino. A maioria das mulheres e homens quer emagrecer e, mesmo depois de atingirem o peso normal, continuam a querer emagrecer mais. Estas mudanças são acompanhadas, além da expansão da prática de dietas, frequentemente também pelo abuso de medicamentos para emagrecer, laxantes, diuréticos e pelo aumento da prevalência dos distúrbios alimentares - anorexia (falta de apetite) e bulimia (excesso de apetite) e o síndroma de hiperfagia incontrolada (voracidade alimentar e compulsiva). Anorexia e bulimia parecem opostas, mas, na verdade, podem coexistir na mesma pessoa em épocas distintas. Na verdade, os anorécticos não têm falta de apetite, no sentido estrito, pelo contrário, sentem fome, embora ocultem o facto. Todavia, para mais de 60% dos anorécticos, chega o dia em que perdem o controle, quebram o duríssimo regime, comendo muito mais do que aquilo que se permitem habitualmente. Assim, a bulimia pode desenvolver-se em congruência da anorexia, mas pode também surgir como uma doença independente. Um bulímico acometido chega a ingerir níveis elevadíssimos, como 10.000 calorias numa única refeição. Nesses momentos, uma terrível sensação o acomete: a percepção da perda de controle. Para compensar, provoca vómitos, ingere quantidades excessivas de anorexígenos, laxativos, diuréticos ou exercita-se excessivamente. Um dos propósitos do estudo é identificar populações em risco e obter alguns dados acerca da prevalência dos Transtornos do Comportamento Alimentar (TCA) na amostra. Esta é constituída por 549 indivíduos - 325 do sexo feminino e 224 do sexo masculino - adolescentes e jovens adultos entre os 12 e os 22 anos, da Escola C+S Eugénio de Castro e Escola Secundária D. Duarte (Coimbra), Faculdade de Ciências do Desporto e Educação Física da Universidade de Coimbra e do Instituto Superior Miguel Torga. A fim de reconhecer a população em risco e a prevalência dos distúrbios alimentares, foram utilizados dois critérios. Para a identificação da população em risco, o Inventário EDI-2 (Eating Disorders Inventory-2), de Garner e Olmstead (1984) - traduzido e aplicado pela autora da tese e pelo orientador. Para o conhecimento da prevalência provável de distúrbios alimentares, recorre-se aos critérios de diagnóstico da DSM-IV (Diagnostic and Statistical Manual of Mental Diseases, da Associação de Psiquiatria Americana, 4a actualização) e do ICD-10 (International Classification of Diseases, da OMS, 10a actualização). Para uma maior confiança nos dados, é feito uso de alguns mecanismos de segurança, cruzando as respostas do EDI-2 com os dados obtidos acerca dos peso e altura para avaliação do Índice de Massa Corporal (IMC). A média do peso é de 61 kg e a altura 1,70, registando um IMC médio de 20,7 kg/m2 (20,9 nos rapazes e 20,6 nas raparigas). A avaliação do IMC demonstra que existem, significativamente, mais raparigas do que rapazes com tendência para a magreza e que, relativamente à tendência para a obesidade (IMC superior a 25), não existem diferenças de IMC entre os sexos. O grau de insatisfação corporal é superior nas raparigas, uma vez que 82,8% pontuam positivamente na subescala do EDI-2 que mede a insatisfação corporal (IC), em contraposição com 39,7% dos rapazes que pontuam da mesma forma. Entre as jovens, a insatisfação corporal aumenta no mesmo sentido que o IMC, isto é, quanto maior é o IMC maior é a IC. Entre os rapazes, uns estão insatisfeitos, porque têm peso a mais e outros, porque têm peso a menos. De entre os 19,3% (105) que referem fazer dietas com frequência, 15,2% (16) são do sexo masculino e 84,8% (89) do sexo feminino. A utilização de laxantes, diuréticos e exercício físico com o objectivo de controlar o peso, a tendência para a classificação dos alimentos em ‘bons’ ou ‘maus’, a ocultação da ingestão e a realização de dietas obtêm, entre as raparigas, as frequências mais elevadas. Relativamente aos episódios de ingestão compulsiva, 6,8% da amostra apresenta este sintoma, dos quais 57% são rapazes e 43% raparigas. Os resultados indicam ainda que, entre os indivíduos que, em simultâneo, fazem dieta e têm episódios de ingestão compulsiva, 60% são raparigas e 40% rapazes. Contudo, os rapazes que fazem dieta são também os que registam a maior percentagem de episódios de ingestão compulsiva. Por outro lado, o estudo indica que os indivíduos que assumem fazer dietas com frequência têm índices de perturbação psíquica mais elevados. Assim, tanto as raparigas como os rapazes que fazem dieta com frequência manifestaram perturbação, quer no Índice de Severidade Psicopatológico Global (ISG), quer nas restantes subescalas, com aparente relevância para a ideação paranóide nos rapazes, à excepção das subescalas ansiedade fóbica e psicotismo. As raparigas que referiram fazer dieta foram aquelas que assinalam maior número de sintomas, diferindo estatisticamente, de forma significativa, dos grupos que referem não fazer dietas. Neste quadro, dos 6 indivíduos com bulimia nervosa, 5 encontram-se numa situação psicológica que pode ser muito grave, sendo o grupo feminino o mais afectado. Quanto ao quadro clínico da ingestão compulsiva, a prevalência deste distúrbio é de 19% para o sexo feminino e 5,5% para o sexo masculino. A pesquisa revela ainda que é provável que 5,3% da população em estudo tenham ou desenvolvam, a curto prazo, uma anorexia tipo restritivo; 4% uma anorexia tipo bulímico; 4,9% uma bulimia nervosa; 43,5%, finalmente, parecem apresentar uma personalidade vulnerável à contracção de qualquer um destes distúrbios.
Article
Introduction The identification of children and adolescents with bulimia nervosa (BN) or syndromes including binge-eating has been an area of development in recent years. This chapter will review this increasingly important area, providing an overview of the nature of these phenomena, risk factors for their development and the medical complications of these disorders. Definition Bulimia nervosa was first described by Russell in 1979, appearing in the Diagnostic and Statistical Manual-III (DSM-III) in 1980. The current diagnostic criteria found in DSM-IV (American Psychiatric Association, 1994) include recurrent episodes of binge eating characterized by eating in a discrete period of time (2 hours or less) an amount that is larger than most people would eat under similar circumstances; a sense of loss of control over eating during a binge episode; as well as, recurrent inappropriate compensatory behaviours in order to prevent weight gain. These compensatory behaviours can include selfinduced vomiting, misuse of laxatives, diuretics and other medications, fasting or excessive exercise. The binges and inappropriate compensatory behaviours must occur on average and least twice a week for 3 months. Self-evaluation is unduly influenced by body shape and weight, and the disturbance does not occur during episodes of anorexia nervosa (AN). Bulimia nervosa is typed as either purging, where self-induced vomiting or misuse of laxatives, diuretics and enemas are part of the presentation and non-purging, where these compensatory behaviours do not regularly occur and are replaced by behaviours such as exercising and fasting. © Cambridge University Press 2007 and Cambridge University Press, 2009.
Article
In eating disorders (anorexia, bulimia, obesity), we find lesions to hard and soft tissues, due to bad habits, nutritional deficiency and overeating. These lesions are symptoms of the base disease. As a result, the mastication changes, as well as the salivary digestive function during the 3 chewing phases and the formation of food bolus. In these 3 pathologies, which sometimes are combined, lesions are related to enamel thinning, decay, teeth abrasion due to bruxism, gengivitis and periodontal diseases, angular cheilitis, xerostomia, greater salivary glands hypertrophy. Dentist dealing with these diseases should consider that prognosis depends on a psycological recovery in peopole with eating disorders. Dentists should also study patients' symptoms as a whole.
Chapter
The diagnostic criteria for anorexia nervosa, according to the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association, 1993), are summarized as follows: (1) refusal to maintain a body weight over a minimally normal weight for age and height (e.g., weight loss leading to maintenance of a body weight less than 85% of that expected, or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected); (2) intense fear of gaining weight or becoming fat, even though underweight; (3) disturbance in the way that body weight, size, or shape is experienced; and (4) amenorrhea in females (absence of at least 3 menstrual cycles). The new DSM-IV criteria formalize earlier overlapping conventions for subtyping anorexia nervosa into restricting and binge eating/purging types based on the presence or absence of the bingeing and/or purging (i.e., self-induced vomiting, or the misuse of laxatives, or diuretics). This is consistent with recent research favoring purging over bingeing as the marker for defining anorexia nervosa subtypes(Garner, Garner & Rosen, 1993 It is important to note that patients move between these two subtypes with chronicity leading toward aggregation in the binge eating/purging subgroup (Hsu, 1988).
Article
Objectives: Cases are common in which a patient with Eating Disorder Accompanied by Self-induced Vomiting Complains of cold-water pain due to acid erosion caused by gastric acid or vomitus during vomiting. Unless such vomiting is ameliorated via usual dental treatment to counteract this, the acid erosion will progress and recur repeatedly. Therefore, we ascertained the efficacy against cold-water pain by wearing a mouth guard in order to protect the dental surface from being exposed to acid during vomiting. Subjects and Methods: We assessed 4 subjects among patients with eating disorders, who visited the Clinical Center of Psychosomatic Dentistry, Nippon Dental University, School of Dentistry, who repeatedly complained of cold-water pain on the maxillary anterior teeth due to acid erosion, with recurring symptoms even after usual treatment, and who also agreed to receive the treatment using a mouth guard. To counteract these symptoms, we instructed the patients to wear a mouth guard for the maxillary dental arch when vomiting and examined both the frequency of wearing the mouth guard and the frequency of the recurrence of cold-water pain. Results: The cold-water pain did not reoccur in 3 subjects who had worn the mouth guard almost every time. Furthermore, in 1 subject who had worn the mouth guard occasionally, the cold-water pain did recur, but the interval before the recurrence was clearly longer than the time before wearing the mouth guard. Conclusion: Wearing a mouth guard during vomiting may therefore lead to a reduction in the autopurification of the mouth, but the efficacy against cold-water pain due to acid erosion was observed. It is believed that this is because the prevention of vomitus and gastric acid from coming into direct contact with the dental surface was capable of delaying the progress of acid erosion and promote the formation of secondary dentin as a response to protect the dental pulp. In addition, regarding the effect of this treatment against eating disorders, the use of such a mouth guard may enable prolonged vomiting behavior, but further investigation will be necessary to determine this aspect, because the time lag from the impulse to vomit until the actual occurrence of vomiting due to the need to affix a mouth guard may be applicable to the field of supportive psychotherapy or cognitive behavior therapy.
Article
Ipecac abuse must be considered when working with individuals at risk, particularly those with eating disorders. Medical complications such as myopathy and gastrointestinal and other toxic effects can occur with ipecac abuse, the gravity of which must not be underestimated. Education about ipecac abuse and toxicity is extremely important. Discontinuation of ipecac use usually results in recovery from the harmful effects. College healthcare professionals can play an important role in the education and treatment of this potentially hazardous method of weight control.
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