Bulimia-Purging Type - Essay Example

 Introduction Bulimia is an an eating disorfer characterized by food binges, or recurrent episodes of significant overeating, which is accompanied by a sense of loss of control. Various methods like vomiting or laxative abuse is then used to prevent weight gain. Women are more affected, and the disorder is most common in adolescent girls. The person is usually aware that their eating pattern is abnormal and may experience fear or guilt associated with the binge-purge episodes. The exact cause of bulimia is unknown, but various factors contribute. Clinical features There are two types of bulimia nervosa, purging type and non-purging type. Non-purging bulimics use other compensatory behaviors including fasting and excessive exercise to prevent weight gain. In the purging type, individuals compensate for the binge eating with self-induced vomiting, laxative abuse, diuretics, or enemas. (ED Referral.com). The affected person consumes large amounts of food in a short period of time, and in order to compensate for the excess calories consumed and prevent weight gain, they try to purge it from their system. These methods include the use of self-induced vomiting, laxatives, diuretics or fasting. Bulimic patients often feel they have no control over what or how much they are eating. Purging helps them regain a feeling of control, which, however, is a false and temporary sense of control. Unlike anorexics who are often abnormally thin, bulimics are often normal or above normal weight. Bulimia nervosa is more affects about 3 to 4 percent of young women in the middle-to-upper socioeconomic level. It is more common in adolescent girls. (Deborah L. Angell) Bulimia nervosa can cause a variety of physical signs and symptoms. The most common sign is erosion of tooth enamel caused by stomach acid in the mouth due to vomiting. Diuretic and laxative use can cause loss of potassium (hypokalemia) resulting in cardiac arrhythmia or irregular heartbeat. The frequent use of ipecac to induce vomiting can cause heart failure or death. Repeated vomiting can also cause tears in the esophagus or enlargement of the salivary glands giving the bulimic a "chipmunk cheek" appearance. Calluses can develop on the back of the hand caused by the teeth with repeated induced vomiting (Russell's sign). Some of the warning signs in a bulimic can include: making frequent excuses to go to the bathroom after meals, mood swings, buying large amounts of food which suddenly disappears, unusual swelling around the jaw, frequently eating large amounts of food on the spur of the moment, laxative and diuretic wrappers found frequently in the room, and avoiding eating with other people (Deborah L. Angell.) Pathophysiology: Bulimia and other eating disorders may be related to abnormal neurotransmitter systems. The serotonin system, which is involved in the regulation of food intake, has been specifically implicated. Evidence exists to support the role of serotonin (5-hydroxytryptamine) in bulimia. A variety of indirect evidence, including low levels of 5-hydroxyindole (a precursor to serotonin) in the cerebrospinal fluid, elevated platelet 5-HT, and blunted prolactin responses to serotonergic challenges, successful treatment of patients with bulimia using drugs that increase serotonin levels or otherwise modulate the 5-HT system, provides additional support for this theory (Foster T, Coggins RS, 2005). Leptin, the protein product of the OB gene, acts on the central nervous system to decrease food intake, and thereby influences weight regulation. Studies conducted on patients with bulimia have noted impaired satiety, decreased resting metabolic rate, and abnormal neuroendocrine regulation. These alterations could be associated with impaired leptin function. Ghrelin, a hormone produced primarily by the stomach, increases food intake and is thought to play a role in long-term regulation of body weight. Ghrelin may blunt the appetite-reducing effect of leptin. Research is ongoing regarding the potential roles of other chemical mediators in the pathogenesis of eating disorders. For example, multiple studies have shown that patients with eating disorders have higher levels of cortisol than control subjects (Foster T, Coggins RS, 2005.) Causes: A variety of factors may predispose to the development of the condition. These include, sociocultural (prevalent in cultures in which thinness is idealized), familial, individual, and neurohumoral factors. Other predisposing factors include, female gender, familial obesity, and dieting. Binges may occur habitually or may be triggered by feelings of anger, anxiety, or depression. Guilt and dysphoria are common feelings after binges. (Foster T, Coggins RS, 2005) Patients with a familial history of depressive disorders, alcoholism, or obesity are at an increased risk for development of an eating disorder. Personal factors could include, a sense of personal helplessness, fear of losing control, self-esteem highly dependent on the opinions of others, and childhood abuse, particularly sexual abuse of a female child by her father or another adult male. (Foster T, Coggins RS, 2005.) Investigations: This may include the following: 1. Dental exam- may show dental cavities, gum infections (such as gingivitis), erosion or pitting of the enamel of the teeth. 2. Blood electrolytes may show an electrolyte imbalance like hypokalemia. (Medline Plus, 2004) 3. Imaging Studies: Upright chest radiograph is to be done if abdominal pain is present, to evaluate for gastric rupture, and also to evaluate pneumomediastinum secondary to esophageal rupture. CT scanning may rule out perforation or pancreatitis (Foster T, Coggins RS, 2005.) Complications    Pancreatitis, dental cavities, inflammation of the throat, electrolyte abnormalities, dehydration constipation, hemorrhoids, esophageal tears/rupture (Medline Plus, 2004.) Treatment Psychotherapy: includes, cognitive-behavioral therapy, interpersonal psychotherapy, family therapy, and group therapy. (Goldsmith T, Craven S, 2001.) Antidepressants - as of now, only fluoxetine (Prozac) is approved by the FDA for the treatment of bulimia nervosa. This medication has been found to decrease the number of binges as well the desire to vomit in people with moderate to severe bulimia nervosa. Naltrexone, which works on the opiate system in the pleasure center of the brain, has yielded some success. (Goldsmith T, Craven S, 2001.) Emergency treatment can include placement of a nasogastric tube if hematemesis or melena has occurred, and electrolyte replacement. (Foster T, Coggins RS, 2005.) A randomized, controlled trial to verify the efficacy of sertraline, a selective serotonin reuptake inhibitor, in a group of patients with a diagnosis of bulimia, confirmed that sertraline is well tolerated and effective in reducing binge-eating crises and purging in patients with bulimia (Milano W, Petrella C, Sabatino C, Capasso A, 2004.) Support groups: self-help groups like Overeaters Anonymous may help some people with bulimia. (Medline Plus, 2004) Conclusion Bulimia Nervosa is an eating disorder probably related to abnormal neurotransmitter systems and with various predisposing factors like sociocultural, familial, and personal factors. The treatment includes psychotherapy, support groups and the use of antidepressants like fluoxetine. Drugs like sertaline and naltrexone also have shown promise. *************************************************************************** References Deborah L. Angell, n.d. Eating Disorders Awareness: Bulimia Nervosa. Retrieved November 17, 2205, EDReferral.com, n.d. Retrieved November 17, 2205, Foster T, Coggins RS, 2005, emedicine. Bulimia. Retrieved November 17, 2205, Goldsmith T, Craven S, 2001. Treatment for Bulimia. Retrieved November 17, 2205, Milano W, Petrella C, Sabatino C, Capasso A. 2004. Treatment of bulimia nervosa with sertraline: a randomized controlled trial. Adv Ther. 2004 Jul-Aug; 21(4): 232-7 Medline Plus, 2004. Bulimia. Retrieved November 17, 2205, Read More