Bulimia nervosa
Definition :
- Recurrent and frequent episodes of eating unusually large amounts of food (e.g., binge-eating)
- Feeling a lack of control over the eating
- Followed by a type of behavior that compensates for the binge, such as purging (e.g., vomiting, excessive use of laxatives or diuretics), fasting and/or excessive exercise.
- In Western, industrialized countries, only about 1 percent to 3 percent of women experience bulimia during their life.
- The rate of bulimia in men is about one-tenth of that in women.
- Bulimia often begins in late adolescence or early adulthood — transitional periods that are often accompanied by increasing peer pressure, dieting and emotional upheaval.
- Bulimia is more common in college students than in adolescents.

Symptom :
chronically inflamed and sore throat
swollen glands in the neck and below the jaw
worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acids
gastroesophageal reflux disorder
intestinal distress and irritation from laxative abuse
kidney problems from diuretic abuse
severe dehydration from purging of fluids

Causes:
· Biological
Some people may be genetically vulnerable to bulimia nervosa. Those with sisters or mother having this type of eating disorder are at a high risk. Studies of twins support that idea. A naturally occurring brain chemical, may influence eating behaviors because of its connection to the regulation of food intake.
§ Psychological.
They may have low self-worth, for instance, as well as perfectionism. They may have trouble controlling impulsive behaviors, managing moods or expressing anger. The families of people with bulimia may tend to have more conflicts, along with more criticism and unpredictability. There may be a history of sexual abuse.
· Sociocultural.

Modern Western culture generally cultivates and reinforces a desire for thinness. Success and worth are often equated with being thin. Peer pressure may fuel this desire to be thin, particularly among young girls.

Risk factors:
Dieting
People who lose weight are often reinforced by positive comments from others and by seeing their own changing appearance. That dieting can trigger a binge episode, leading to purging and then more dieting — and consequently a vicious cycle.
Puberty
They also may face increased peer pressure and may have a heightened sensitivity to criticism or even casual comments about their weight or body.
Transitions
Whether it's heading off to college, moving, landing a new job or a relationship breakup, change can bring emotional distress.
Sports, work and artistic activities
Eating disorders are particularly common among ballerinas, gymnasts, runners and wrestlers. Coaches and parents may contribute to eating disorders by suggesting that young athletes lose weight.
Media and society
The media, such as television and fashion magazines, frequently feature a parade of skinny beauties. Exposure to these images may lead girls and young women — and their male counterparts — to believe that thinness equates to success and popularity.



Physical complications of bulimia include:
Death
Anemia
Heart problems, such as abnormal heart rhythms and heart failure
Tooth decay
In females, absence of a period
Gastrointestinal problems, such as constipation, bloating or nausea
Electrolyte abnormalities, such as low blood potassium, sodium and chloride

Psychological Complications:
Depression
Suicide
Anxiety disorders
Drug abuse
Alcohol abuse
Excessive stress
Self-injury behaviors

Treatment :
· Nutritional counselling

· Psychotherapy ( Eg. Cognitive Behavioral therapy)

· Antidepressants (Eg. Fluoxetine – the only approved one by the US FDA)

· Helps patients with anxiety or depression
· Reduces binge and purging behaviour
· Reduces chances of relapse
· Improves eating behaviour
· A type of selective serotonin reuptake inhibitor (SSRI)

· Hospitalization






Binge eating disorder

Definition

Compulsive overeating in which people consume huge amounts of food while feeling out of control and powerless to stop.

Key features of binge eating disorder are:
· Frequent episodes of uncontrollable binge eating
· Feeling extremely distressed or upset during or after bingeing
· No regular attempts to “make up” for the binges through vomiting, fasting, or over-exercising.
According to the National Institutes of Health, 2 percent of all U.S. adults suffer from compulsive overeating—making binge eating disorder more common than bulimia or anorexia.
Unlike other eating disorders, which primarily occur in women, binge eating disorder also affects a significant number of men.
Usually begins in late adolescence or early adulthood, often after a major diet.

Signs and symptoms
Behavioral symptoms of binge eating and compulsive overeating
· Inability to stop eating or control what you’re eating
· Rapidly eating large amounts of food
· Eating even when you’re full
· Hiding or stockpiling food to eat later in secret
· Eating normally around others, but gorging when you’re alone
· Eating continuously throughout the day, with no planned mealtimes
Emotional symptoms of binge eating and compulsive overeating
· Feeling tension that is only relieved by eating
· Embarrassment over how much you’re eating
· Feeling numb while bingeing—like you’re not really there or you’re on auto-pilot.
· Never feeling satisfied, no matter how much you eat
· Feeling guilty, disgusted, or depressed after overeating
· Desperation to control weight and eating habits

Causes:
Biological causes of binge eating disorder
The hypothalamus (the part of the brain that controls appetite) may not be sending correct messages about hunger and fullness. Researchers have also found a genetic mutation that appears to cause food addiction. Finally, there is evidence that low levels of the brain chemical serotonin play a role in compulsive eating.
Psychological causes of binge eating disorder
According to the U.S. Department of Health and Human Services, up to half of all binge eaters are either depressed or have been before. There is further evidence that low self-esteem, loneliness, and body dissatisfaction are involved in compulsive overeating. People with binge eating disorder may also have trouble with impulse control and managing and expressing their feelings.
Social and cultural causes of binge eating disorder
Social pressure to be thin can add to the shame binge eaters feel and fuel their emotional eating. Some parents unwittingly set the stage for bingeing by using food to comfort, dismiss, or reward their children. Children who are exposed to frequent critical comments about their bodies and weight are also vulnerable. Another factor which has been linked to binge eating is sexual abuse in childhood.

Effects:
Common physical effects of binge eating disorder include:
Type 2 diabetes
Gallbladder disease
High cholesterol
High blood pressure
Heart disease
Certain types of cancer
Osteoarthritis
Joint and muscle pain
Gastrointestinal problems
Sleep apnea




Treatment:

Therapy :

Cognitive-behavioral therapy

Focuses on the dysfunctional thoughts and behaviors involved in binge eating

Interpersonal psychotherapy
Interpersonal psychotherapy for binge eating disorder focuses on the relationship problems and interpersonal issues that contribute to compulsive eating.
Dialectical behavior therapy
Dialectical behavior therapy combines cognitive-behavioral techniques with mindfulness meditation. Emphasis of therapy is on teaching binge eaters how to accept themselves, tolerate stress better, and regulate their emotions.

Medications:
Antidepressants
Research shows that antidepressants decrease binge eating in people with bulimia. Antidepressants may also help people with binge eating disorder, but studies also show that relapse rates are high when the drug is discontinued.

Appetite suppressants
Studies on the appetite-suppressing drug sibutramine, known by the brand name Meridia, indicate that it reduces the number of binge eating episodes and promotes weight loss.
Topamax
The seizure drug topiramate, or Topamax, may decrease binge eating and increase weight loss. However, Topamax can cause serious side effects, including fatigue, dizziness, and burning or tingling sensations.