Bulimia Nervosa

Bulimia nervosa, categorized by the Diagnostic and Statistical Manual of Mental

Disorders, Fifth Edition (DSM- 5) under Feeding and Eating disorders. It is characterized by a
persistent disturbance of eating or eating-related behavior that results in the altered consumption
or absorption of food and that significantly impairs physical health or psychosocial functioning.

The term bulimia is derived from two Greek words, bous meaning ox, and the
word limos, meaning hunger. The Oxford English Dictionary defines bulimia simply as morbid
hunger.  It suggests having the appetite of an ox, as well as the ability to consume an ox or as
much as an ox. 

Bulimia nervosa is a severe potentially, life-threatening eating disorder, developed during

adolescence or young adulthood. It includes both physical and psychological sequela and,
sometimes, it can lead to considerable impairment and distress. People who have bulimia
nervosa are feeling remorse and revulsion after eating. 
 Introduction

Definition of Bulimia Nervosa

Bulimia nervosa is an eating disorder. An individual suffering from Bulimia Nervosa

places an excessive emphasis on body shape or weight. Individuals with this disorder may
closely resemble those with anorexia nervosa in their fear of gaining weight, in their desire to
lose weight, and in the level of dissatisfaction with their bodies.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
(DSM- 5), symptoms of Bulimia Nervosa include; (A) Recurrent episodes of binge eating. An
episode of binge eating, characterized by both of the following: 1. eating in a discrete period of
time, an amount of food larger than what most individuals would eat in a similar period of time
under similar circumstances. 2. A sense of lack of control over eating during the episode. (B)
Recurrent inappropriate compensatory behaviors to prevent weight gain, such as self-induced
vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise. (C)
The binge eating and inappropriate compensatory behaviors both occur, on average, at least once
a week for three months. (D) Self-evaluation is unduly influenced by body shape and weight. (E)
The disturbance does not occur exclusively during episodes of anorexia nervosa.

Bulimia nervosa commonly begins in adolescence or young adulthood. Onset before

puberty or after age 40 is uncommon. Binge eating frequently manifests during or after an
episode of dieting to lose weight. Experiencing multiple stressful life events also can precipitate
the onset of bulimia nervosa.
However, appropriate treatments can help to cure Bulimia Nervosa. Specifically,
Cognitive- behavioral therapy and Family-based treatment. Psychotherapy, also known as talk
therapy or psychological counseling, is the leading treatment. Family-based treatment is the
leading treatment for youth with Anorexia Nervosa, while cognitive-behavioral therapy is the
leading intervention for adults with Bulimia Nervosa. (Hail and Le Grange, 2017)
Prevalence and Comorbidity

Bulimia nervosa is far less common in males than in females, with an approximately 10:1
female-to-male ratio. It also occurs roughly similar frequencies in most industrialized countries,
including the United States, Canada, many European countries, Australia, Japan, New Zealand,
and South Africa. In clinical studies of bulimia nervosa in the United States, individuals
presenting with this disorder are primarily white. However, the disorder also occurs in other
ethnic groups and with prevalence comparable to estimated prevalence’s observed in white
samples.

Comorbidity with mental disorders is common in individuals with bulimia nervosa. Most
are experiencing at least one other mental disorder, others experiencing multiple comorbidities.
Comorbidity is not limited to any particular subset but preferably occurs across a wide range of
mental disorders. There are increased frequencies of depressive symptoms, bipolar and
depressive disorders in individuals with bulimia nervosa.
In many individuals, the mood disturbance begins at the same time as or following the
development of bulimia nervosa, and individuals often ascribe their mood disturbances to the
bulimia nervosa. However, in some individuals, the mood disturbance precedes the development
of bulimia nervosa. There may also be an increased frequency of anxiety symptoms or anxiety
disorders. These mood and anxiety disturbances frequently remit following effective treatment of
the bulimia nervosa. The lifetime prevalence of substance use, particularly alcohol or stimulant
use, is at least 30% among individuals with bulimia nervosa. Stimulant use often begins in an
attempt to control appetite and weight. A substantial percentage of individuals with bulimia
nervosa also have personality features that meet the criteria for one or more personality
disorders, most frequently borderline personality disorder.

The Nature of Bulimia Nervosa

The Historical Record
The earliest historical descriptions of people experiencing symptoms consistent with
modern-day eating disorders date back to Hellenistic (323 BC-31 BC) and medieval times (5th
-15th century AD).

There is a report of an upper-class twenty-year-old Roman girl starving herself to death in

pursuit of holiness. There are additional accounts from the Middle Ages of extreme self-induced
fasting that often led to premature death by starvation— Catherina of Siena is one example.

Deprivation of food was seen as a spiritual practice and, women were disproportionately
afflicted. Some contemporary authors have dubbed these fasting habits “holy anorexia.”

The History of Bulimia Nervosa

Bulimia nervosa was first described as a variant of anorexia in 1979 by British
psychiatrist Gerald Russell. He argued that bulimia nervosa was a culture-bound condition and
did not believe that extrapolating to historical cases of overeating and vomiting were relevant to
our modern understanding of the disorder. Nevertheless, purging was a practice in ancient Egypt,
Greece, Rome, and Arabia, cultures in which it was used to prevent diseases believed to come
from food. Physicians also prescribed it. Some early Roman emperors were observed to eat to
excess and then vomit. Some writers have disagreed with Russell and propose this behavior was
an early historical variant of bulimia nervosa, lacking—as in the case of the early accounts of
anorexia nervosa—the modern drive for thinness.

Searches for descriptions of bulimia nervosa in the early medical literature have been less
fruitful than those for anorexia nervosa. Among the earliest cases that manifest resemblance to
modern bulimia nervosa is the case of Nadia, described by Pierre Janet in 1903. She displayed
dietary restriction, fear of fatness, and episodes of binge eating.

Another early description, the case of Patient D, was described by Mosche Wulff in 1932.
This patient engaged in periods of fasting alternating with periods of overeating and vomiting.
In 1960 US psychiatrists Bliss and Branch published case histories that included several cases of
bingeing and vomiting. The German psychiatrist Ziolko published papers in the 1970s describing
patients who engaged in compulsive food intake and vomiting and experienced increased weight
concerns.

The 1970s spawned case reports of patients with what more clearly resembles modern-
day bulimia nervosa. Gerald Russell published his case series of 30 patients between 1972 and
1978 who reported self-induced vomiting attempting to mitigate the effects of recurrent
overeating. It determined that these represented a syndrome different from anorexia nervosa but
shared the same fear of fatness.

His famous paper, published in 1979, called bulimia nervosa “an ominous variant of
anorexia nervosa.” In 1976, Christopher Fairburn also saw an early case of bulimia nervosa and
began studying it and developing a treatment for it. The disorder was barely audible before the
latter half of the 20th century. Since then, it has become relatively common. 
 “Bulimia nervosa in times of the COVID‐19 pandemic—Results from an online survey of
former inpatients”
Sandra Schlegl, Adrian Meule, Matthias Favreau, Ulrich Voderholzer

Abstract:

A research study by Schegl, S. et al, (2020) entitled “Bulimia nervosa in times of the
COVID‐19 pandemic—Results from an online survey of former inpatients” states that the
COVID‐19 pandemic might pose special challenges to patients with eating disorders (EDs) by
interfering with daily routines. The aim of this study was to investigate the impact of the current
pandemic on patients with bulimia nervosa (BN). Fifty‐five former inpatients with BN
completed an online survey on psychological consequences of the COVID‐19 pandemic as well
as on changes in health care utilization and on the use and helpfulness of different coping
strategies. Approximately one half to two‐thirds of former inpatients with BN experienced a
negative impact of the crisis on their ED symptomatology and quality of life. In challenging
times when face‐to‐face therapy options are restricted, e‐health treatments such as
videoconferencing therapy should be considered to ensure continuity of care.
https://scholar.google.com/scholar?as_ylo=2020&q=Bulimia+Nervosa&hl=en&as_sdt=0,5#d=gs_qabs&u=%23p
%3DfyEHMKjb670J

Analysis:

In our current situation, where in public health is at risk. All transactions and
communications are done online to meet the qualifications of the standard health protocols for
COVID-19. There is growing awareness that people with mental illnesses are substantially more
vulnerable to external stressors than resilient people. Individuals suffering from mental disorders
and eating disorders tend to use multiple coping strategies in this global crisis. According to an
International online survey conducted during the pandemic, physical activities and eating
behavior decreased during this pandemic.

The researchers surveyed to fulfill the validity of the research, the participants of this
research are those former in patients with BN. The survey questionnaire administered to the
participants, divided into seven parts that aim to assess psychological consequences during the
pandemic.

More than half of former inpatients with BN experienced a worsening of their ED

symptomatology as well as their quality of life during the crisis 80% of the patients increased
depressive and psychopathology symptoms. Almost half the participants show an Increase in
binge eating and one-third in self-induced vomiting.

Reference:

Schegl, S. et al, (2020) “Bulimia nervosa in times of the COVID‐19 pandemic—Results from an
online survey of former inpatients”

https://scholar.google.com/scholar?
as_ylo=2020&q=Bulimia+Nervosa&hl=en&as_sdt=0,5#d=gs_qabs&u=%23p
%3DfyEHMKjb670J
 “Altered regional gray matter volume in Chinese female patients with bulimia nervosa”

Xiao Li, Xiaowei Liu, Yu Wang, Lingfei Li, Linli Zheng, Yaya Liu, Jing Ma, Lan Zhang

Abstract:

A research study by Xiao. L, et al, (2020) entitled “Altered regional gray matter volume
in Chinese female patients with bulimia nervosa” states that Bulimia nervosa (BN) is a
psychiatric disorder with unclear pathophysiology. Several studies have associated BN with
structural and functional changes in the brain, but findings have been inconsistent. Here we
explored this potential association in a small group of Chinese women with BN. This
retrospective study examined 34 women with BN and 34 age-matched healthy controls, all of
whom underwent T1-weighted magnetic resonance imaging (MRI). Voxel-based morphometry
was carried out to explore alterations in regional grey matter volume (GMV) that may be
associated with BN. The BN group showed smaller GMV in the left medial superior frontal
gyrus (SFGmed.L), right superior temporal gyrus (STG.R), right median cingulate and Para
cingulate gyri (DCG.R), left median cingulate and Para cingulate gyri (DCG.L) and left
dorsolateral superior frontal gyrus (SFGdor.L). No regions showing GMV increases in BN were
identified.

https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02493-4

Analysis:

This study aimed to see if there was a connection between BN and altered GMV in the
brain and if these structural changes correlated with patient self-evaluation. Participants are the
small group of Chinese women who have BN and a group of healthy people as the control group.
The patients engaged in binge eating and compensatory behaviors at least once a week during the
three months before enrolment in the study and the controls. They recruited healthy age-matched
women who reported no history of any eating disorder. The groups were assessed by two
psychiatrists, no one has to take any medications, reported a history of major psychiatric
disorders, head trauma, substance abuse or dependence, or neurologic disease. And Nine BN
patients had mild anxiety and depressive symptoms based on the SCID.

MRI was obtained using a Philips 3.0 T system. All subjects underwent 3D T1-weighted
volumetric. Both subjects were instructed to relax, keep their eyes closed without falling asleep,
and keep their heads as still as possible during the MRI. They were also instructed not to think
about anything specific during the procedure. The BN group showed smaller GMV in the left
medial superior frontal gyrus (SFGmed.L), right superior temporal gyrus (STG.R), right median
cingulate and paracingulate gyri (DCG.R), left median cingulate and paracingulate gyri (DCG.L)
and left dorsolateral superior frontal gyrus (SFGdor.L). No regions showing GMV increases in
BN were identified

Reference:

Xiao. L, et al, (2020) “Altered regional gray matter volume in Chinese female patients with
bulimia nervosa”

https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02493-4
 “Association of Bulimia Nervosa with Long-term Risk of Cardiovascular Disease and
Mortality among Women”

Rasmi M. Tith, Gilles Paradis, Brian J. Potter,   Nancy Low,  Jessica Healy-Profitós, 

Siyi He, Nathalie Auger

Abstract:

An investigation by Tith. R, et al, (2020) entitled “Association of Bulimia Nervosa with

Long-term Risk of Cardiovascular Disease and Mortality among Women” states that Bulimia
nervosa is associated with short-term cardiovascular complications in women, but its long-term
consequences on cardiovascular health are unknown. In this longitudinal cohort study, 416 709
women hospitalized in Quebec, Canada, including women hospitalized for bulimia nervosa and
those for pregnancy-related events as a comparison group, were followed up for 12 years from
2006 to 2018 to identify incidences of cardiovascular disease and death. The study participants
were followed up to identify future incidences of cardiovascular disease and deaths. Cox
proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs to assess
the association of bulimia nervosa with future outcomes after adjustment for patient
characteristics.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2752386

Analysis:

Bulimia nervosa is one of the most common psychiatric diseases in women, with a
lifetime prevalence of 1.5%, despite a large body of evidence linking mental health to
cardiovascular disease later in life.

The article aims to know the link between bulimia nervosa and a woman's long-term risk
of cardiovascular disease and mortality. According to the findings of this study, bulimia nervosa
is linked to a higher long-term risk of cardiovascular disease in women, including ischemic heart
disease and conduction disorders, as well as death. According to the findings, women with a
history of bulimia nervosa should be screened for ischemic cardiovascular disease regularly and
may benefit from prevention.
Reference:
Tith. R, et al, (2020) “Association of Bulimia Nervosa with Long-term Risk of Cardiovascular
Disease and Mortality among Women”
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2752386
 “Early Diagnosis and Management of Bulimia Nervosa in Type 1 Diabetes”

Ahmed Saeed Yahya, Shakil Khawaja, Jude Chukwuma, Chisolum Chukwuma

Abstract:

A Narrative review by Yahya, A.S. et al. (2020) entitled “Early Diagnosis and
Management of Bulimia Nervosa in Type 1 Diabetes” states that Treatment outcomes for
bulimia nervosa in type 1 diabetes are worse than those for conventional bulimia nervosa. These
outcomes may be a consequence of late detection and subsequent management. The combination
of these disorders has been referred to as diabulimia; however, this is not an official diagnosis
and is a colloquial term used by patients and the media to describe the associated maladaptive
pattern of compensatory behaviors. Early intervention is required to prevent short- and longer-
term complications, with intensive treatment approaches having the best current evidence.
Collaboration is required between specialist services for patients to receive optimal care. This
narrative review summarizes the latest published evidence in the formulation, detection, and
subsequent management of bulimia nervosa in type 1 diabetes, while highlighting the need for
higher-quality research in the assessment and treatment of these comorbidities.

https://www.psychiatrist.com/pcc/psychiatry/bulimia-nervosa-in-type-1-diabetes/#top

Analysis:

According to estimates, 3.7 million people in the United Kingdom have diabetes, with
type 1 diabetes accounting for about 10% in total (T1D). 1 Eating disorders are more common in
people with T1D and linked to a higher risk of death. 2–6 Those with dual conditions had higher
death and morbidity rates. Females with T1D are more prone to develop eating disorders,
according to studies13-17, and they are twice as likely to develop an eating disorder as those
without T1D. Bulimia nervosa (BN) was shown to be three times more common in T1D patients
than in controls.
Reference:

Yahya, A.S. et al. (2020) “Early Diagnosis and Management of Bulimia Nervosa in Type 1
Diabetes”

https://www.psychiatrist.com/pcc/psychiatry/bulimia-nervosa-in-type-1-diabetes/#top
 “Bulimia Nervosa: Is Body Dissatisfaction a Risk Factor?”

Natalia Solano-Pinto, Miriam Valles-Casas and Raquel Fernández-Cézar

Abstract:

A research study by Solano- Pinto, N. et al, (2019) entitled “Bulimia Nervosa: Is Body
Dissatisfaction a Risk Factor?” states that eating disorder studies are often carried out with
adolescents. However, having a normal weight and the appearance of a seemingly healthy body
makes many young people wait for years before seeking out professional consultation with a
specialist. Therefore, after a review of the literature we will reflect on the role of body
dissatisfaction in the development and persistence that occur in bulimia nervosa. It will be linked
to the data found by our research group, both in samples of adolescents and adult women.
Results on risk scores in purgative behaviors associated with bulimia nervosa, dieting, eating
habits, physical activity, self-esteem, social skills, and body dissatisfaction will be described.
They will be contrasted in a descriptive way with data from clinical study participants diagnosed
with bulimia nervosa, leading to a predictive model of the role body dissatisfaction plays as a
risk factor in the development of bulimia nervosa.

https://www.intechopen.com/books/anorexia-and-bulimia-nervosa/bulimia-nervosa-is-body-dissatisfaction-a-risk-factor-

Analysis:

The article suggests that a negative development of body image constitutes a risk factor
for psychological problems such as depression, suicidal thinking, low self-esteem, unhealthy
behavior to control one's weight, and eating disorders. The researchers conduct the study to
identify the variables associated with the development of body dissatisfaction. The researchers
find similar factors between males and females, but mostly with body dissatisfaction are females
desire to be thinner, exhibiting behaviors for losing weight, and negative comments about their
weight.

The results show, as body dissatisfaction increases, it puts people at risk and moves them
away from healthy behaviors. Some will feel ill at ease with their body. By the given result of
this research, it seems clear that body dissatisfaction can be considered a risk factor. It is also
present once the disease has been developed, and it seems to maintain the typical manifestations
of bulimia nervosa.

Reference:

Solano- Pinto, N. et al, (2019) “Bulimia Nervosa: Is Body Dissatisfaction a Risk Factor?”
https://www.intechopen.com/books/anorexia-and-bulimia-nervosa/bulimia-nervosa-is-body-
dissatisfaction-a-risk-factor-
 “Bulimia nervosa in obese patients qualified for bariatric surgery – clinical picture,
background and treatment”

Marzena Sekuła, Iwona Boniecka, and Krzysztof Paśnik

Abstract:

A review paper by Sekuła, M. et al, (2019) entitled “Bulimia nervosa in obese patients

qualified for bariatric surgery – clinical picture, background, and treatment” states that eating
is a basic human physiological need which is necessary to keep the body alive. Eating disorders are diagnosed
when eating (or not eating) and associated body weight gain anxiety becomes the main interest of an individual
and all other spheres of life depend on it. Bulimia nervosa is a psychiatric disorder which is more and more
commonly diagnosed in patients suffering from obesity and in patients after surgical treatment of obesity. In
patients eligible for bariatric surgery this disorder should be diagnosed appropriately early and treated
successfully before the procedure, because bulimia nervosa does not regress spontaneously. When untreated, it
may last for years, reducing the efficacy of a surgical treatment of obesity, or even lead to complications that are
health- and life-threatening for patients.

https://doaj.org/article/fd746cc21536460e9bc303393649cf4a

Analysis:

Bulimia nervosa can also lead to obesity, which is defined as a condition in which the amount of
adipose tissue in the body exceeds physiological reference ranges. Currently, bariatric procedures are thought to
be the most effective method for reducing body mass in patients with extreme obesity.

As stated in this article, Bulimia nervosa is a mental illness frequently associated with obesity. It has
serious psychological, social, and health consequences if left untreated. When left untreated, it can last for years,
reducing the effectiveness of an obesity surgical treatment or even causing health and life-threatening
complications for patients.
Reference:

Sekuła, M. et al, (2019) “Bulimia nervosa in obese patients qualified for bariatric surgery –
clinical picture, background, and treatment”

https://doaj.org/article/fd746cc21536460e9bc303393649cf4a
 “Family-based Treatment of Eating Disorders”

Sasha Gorrell, Katherine L. Loeb, Daniel Le Grange

Abstract:

A narrative review by Gorrell, S. et al (2019) entitled “Family- based Treatment of

Eating Disorders” states that eating disorders (EDs) are pernicious illnesses that are associated
with significant psychiatric and medical morbidity and mortality, considerable distress and
impairment, marked caregiver burden, and high treatment costs. Because EDs commonly onset
in adolescence and young adulthood, and with consistent evidence that early intervention results
in the most promising treatment outcomes, an increasing amount of research has been devoted to
the treatment of adolescent EDs. Although still less researched than adult presentation of EDs,
the historical record of adolescent ED treatment over the last half-century principally supports
family therapy. Current published clinical guidelines recommend an ED-specific family therapy
as the first-line treatment of adolescents with anorexia nervosa (AN) and as a recommended
treatment of adolescents with bulimia nervosa (BN). The number of treatment trials for
adolescent AN has slowly grown over the last few decades and, more recently, family
interventions include protocols extending to new populations and diagnoses, including BN. This
narrative review summarizes existing family-based approaches to the treatment of adolescent
EDs, integrating recent research findings. This article also includes discussion of methods, both
current and proposed, those expands and adapt current family-based approaches in efforts to
improve the breadth and scope of ED treatment in adolescence and young adulthood.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764593/

Analysis:

There have been three randomized controlled trials investigating the treatment efficacy of
FBT for BN to date. 85 adolescents with BN or an eating disorder not otherwise described were
randomized to either family therapy or self-guided cognitive behavior therapy in a trial assessing
an adaptation of family therapy for AN for use with individuals with BN (CBT). CBT was self-
guided and supported by a health care professional in this trial, which is considered the first line
of treatment for individuals with BN. Abstinence from binge eating and vomiting after 6 months
of therapy and at a 12-month follow-up were the primary goals; supplementary outcomes were
attitudinal bulimic symptoms and treatment cost. Patients who received self-guided CBT
experienced significant decreases in binge eating at 6 months, but these differences vanished at
the 6-month follow-up. Furthermore, there were no variations in purging behavior or attitudinal
symptoms between groups. CBT lowered the direct cost of treatment, but there were no
differences between groups in other cost categories. The findings imply that self-guided CBT is
preferable to family treatment in terms of reaching binge-eating abstinence more rapidly, but the
advantages are not long-lasting.

Reference:

Gorrell, S. et al (2019) “Family- based Treatment of Eating Disorders”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764593/
 “Bulimia Nervosa – A Psychiatric Eating Disorder”

Bhaskaran Sathyapriya, Purushothaman Lakshmanan, Govindarajan Sumathy, Jinu Merlin

Koshy, Balasubramanian Chandrakala and Elayaperumal Gokulalakshmi

Abstract:

A research study by Sathyapriya, B. et al, (2018) entitled “Bulimia Nervosa – A

Psychiatric Eating Disorder” states that Bulimia nervosa (BN) is a distressing and disabling
disorder. It consists of recurrent episodes of binge-eating, followed by inappropriate
compensatory behaviour (American Psychiatric Association 1994). In the binge episodes,
exceptionally large amounts of food are eaten, and a sense of loss of control is experienced, e.g.
the individual feels unable to stop eating even if she /he wanted to. Compensatory behaviour may
include self-induced vomiting, fasting, strict dieting, excessive exercise or inappropriate use of
laxatives and diuretics which intend to impede or avoid weight gain. Great concern and
preoccupation with body weight and shape is also usually present. This may involve feeling fat,
obsessive weighing or rigid calorie counting. The disorder has many features in common with
anorexia nervosa (AN). However, unlike those with AN, those with BN always have a normal or
above normal body weight. This article reviews the key features, associated problems, the
relevant psychological theories, major psychological features and different treatment approaches
of bulimia nervosa.

https://www.actascientific.com/ASMS/pdf/ASMS-02-0033.pdf?
fbclid=IwAR1ex0HTGKenbzn3gotv2kDadQbVQYrPnSwv3iMljqjdsX4AHUxEFDQDpKU

Analysis:

Bulimia Nervosa is defined as repeated occurrences of binge- eating accompanied by

compensatory behaviors like self-induced vomiting, fasting, over-exercise or inappropriate use of
laxatives, enemas, or diuretics. Individuals with Bulimia Nervosa have distorted thinking about
body shape that may lead to low self-esteem and self-worth being defined by their physical
appearances.
 As stated in this article, the development of Bulimia Nervosa varies from person to
person but, the exact cause of the said disorder is still unknown. It is anticipated that
amalgamation of genetic, biological, psychological, social, and behavioral factors and
environmental factors is the stem of Bulimia Nervosa. Bulimia Nervosa is a curable disease if
diagnosed early, and abnormalities in eating habits are prevented. The article also provides the
different treatments and other medications to cure Bulimia Nervosa.

Reference:

Sathyapriya, B. et al, (2018) “Bulimia Nervosa – A Psychiatric Eating Disorder”

https://www.actascientific.com/ASMS/pdf/ASMS-02-0033.pdf?
fbclid=IwAR1ex0HTGKenbzn3gotv2kDadQbVQYrPnSwv3iMljqjdsX4AHUxEFDQDpKU

“Bulimia Nervosa in Adolescents: Prevalence and Treatment Challenges”

 Lisa Hail and Daniel Le Grange

Abstract:

A journal by Hail, L. et al, (2018) entitled “Bulimia Nervosa in Adolescents: Prevalence

and Treatment Challenges” states that Bulimia nervosa (BN) is a serious psychiatric illness that
typically develops during adolescence or young adulthood, rendering adolescents a target for
early intervention. Despite the increasing research devoted to the treatment of youth with
anorexia nervosa (AN) and adults with BN, there remains a dearth of evidence for treating
younger individuals with BN. To date, there have been four published randomized controlled
trials comparing psychosocial treatments, leaving significant room to improve treatment
outcomes. Family-based treatment is the leading treatment for youth with AN, while cognitive-
behavioral therapy is the leading intervention for adults with BN. Involving caregivers in
treatment shows promising results, however, additional research is needed to investigate ways in
which this treatment can be adapted further to achieve higher rates of recovery.

https://www.dovepress.com/bulimia-nervosa-in-adolescents-prevalence-and-treatment-challenges-peer-reviewed-fulltext-article-
AHMT

Analysis:

The purpose of the article is to find the best treatment that the professionals can use to
treat the two different eating disorders; (1) Anorexia Nervosa (AN) which, occurs at young ages,
and (2) Bulimia Nervosa (BN) which, occurs in the adolescent stage.

The research tests different therapies suited to prevent and reduce the strength of the two
distinct disorders. Testing therapies for individuals who meet the diagnostic criteria of having an
eating disorder in different stages of life is the way of the researchers to gather data and
information about the effectiveness of the therapy used in the particular subject.

The research aims to determine the prevalence of Bulimia Nervosa (BN) and Anorexia
Nervosa (AN) and the difficulties in treating both disorders. The analysis yielded a positive
result, assisting the research in meeting the criteria for usefulness and relevance. The study
shows that Family-based treatments are the best option and the best treatment you can give to
young people who suffer from Anorexia Nervosa (AN). While Cognitive Behavioral Therapy
(CBT) shows that it can abstain and alleviate the unhealthy pattern of overeating, self-inducing
vomiting, and other recurrent symptoms of the eating disorder Bulimia Nervosa (BN).

Reference:

Hail, L. et al, (2018) “Bulimia Nervosa in Adolescents: Prevalence and Treatment Challenges”
https://www.dovepress.com/bulimia-nervosa-in-adolescents-prevalence-and-treatment-
challenges-peer-reviewed-fulltext-article-AHMT

“Research on Bulimia Nervosa”

 Tracey D. Wade

Abstract:

A research study conducted by Wade, T. (2018) entitled “Research on Bulimia

Nervosa” suggests that estimates of lifetime bulimia nervosa (BN) range from 4% to 6.7%
across studies. There has been a decrease in the presentation of BN in primary care but an
increase in disordered eating not meeting full diagnostic criteria. Regardless of diagnostic status,
disordered eating is associated with long-term significant impairment to both physical and
mental quality of life, and BN is associated with a significantly higher likelihood of self-harm,
suicide, and death. Assessment should adopt a motivationally enhancing stance given the high
level of ambivalence associated with BN. Cognitive behavior therapy specific to eating disorders
outperforms other active psychological comparisons.

https://pubmed.ncbi.nlm.nih.gov/30704637/

Analysis:

The eating disorder Bulimia Nervosa (BN) is a type of eating disorder wherein the
subject tends to have an unusual eating pattern. Bulimia Nervosa (BN) may lead to different
illnesses and disorders if not treated well. (examples: anxiety disorder and depression).

Stress and other environmental factors can trigger and make the individual take so much
food rather than usual intakes, followed by a compensatory behavior. The Disorder mainly
affects the mental state of the individual. It gives an intense fear of gaining weight after the
intake of too much food. It also affects the physical condition due to improper consumption of
food. Taking too much food and making oneself vomit is not proper or usual to an individual
with a normal lifestyle.

Individuals suffering from Bulimia Nervosa (BN) may undergo therapy to reduce and
abstain from unhealthy eating patterns. As stated in the article, Cognitive Behavioral Therapy
(CBT) focused on comparing different stimuli that help the individual feel better. In other
researches, Cognitive Behavioral Therapy shows excellent outcomes. It serves as proof of
recommending Cognitive Behavioral Therapy in treating individuals who met the diagnostic
criteria of Bulimia Nervosa (BN). The research shows that Bulimia Nervosa (BN) may be fatal to
both; physical and mental quality and may lead to any severe disorder.

Reference:

Wade, T. (2018) “Research on Bulimia Nervosa”

https://pubmed.ncbi.nlm.nih.gov/30704637/

“Neuroimaging in Bulimia Nervosa and Binge Eating Disorder: A Systematic Review”

 Brooke Donnelly, Stephen Touyz, Phillipa Hay, Amy Burton,  Janice Russell, Ian Caterson

Abstract:

A research review by Donnelly, B. et al, (2018) entitled “Neuroimaging in Bulimia

Nervosa and Binge Eating Disorder: A Systematic Review” states that in recent decades there
has been growing interest in the use of neuroimaging techniques to explore the structural and
functional brain changes that take place in those with eating disorders. However, to date, the
majority of research has focused on patients with anorexia nervosa. This systematic review
addresses a gap in the literature by providing an examination of the published literature on the
neurobiology of individuals who binge eat; specifically, individuals with bulimia nervosa (BN)
and binge eating disorder (BED).

https://pubmed.ncbi.nlm.nih.gov/29468065/

Analysis:

Neuroimaging is a clinical specialty concerned with producing a snapshot of the brain by

non-invasive techniques such as computed tomography and magnetic resonance imaging in the
brain.

The purpose of this review is to view the structural and functional brain changes of a
person who meets the diagnostic criteria of binge-eaters and persons who suffered from Bulimia
Nervosa (BN). It will help to discover how the brain works and give signals to the system of a
person who is diagnosed with Binge-eating Disorder (BED) or Bulimia Nervosa (BN). It will
help to discover how the brain works and give signals to the system of a person who is diagnosed
with Binge-eating Disorder (BED) or Bulimia Nervosa (BN).

Studies included in this review are heterogeneous, preventing many robust conclusions
from being drawn. The precise neurobiology of BN and BED remains unclear and, ongoing,
large-scale investigations are required. The finding is that illness severity, exclusively defined as
the frequency of binge eating or bulimic episodes, is related to considerable neural changes. The
results of this review indicate additional research is required, particularly extending findings of
reduced cortical volumes and diminished activity in regions associated with self-regulation (front
striatal circuits) and further exploring responses to disorder-related stimuli in people with BN
and BED.

Reference:

Donnelly, B. et al, (2018) “Neuroimaging in Bulimia Nervosa and Binge Eating Disorder: A
Systematic Review”
https://pubmed.ncbi.nlm.nih.gov/29468065/

“The Effectiveness of Internet-Delivered Cognitive Behavioural Therapy for those with

Bulimic Symptoms: A Systematic Review”
 Alexandra Pittock, Laura Hodges, and Stephen M. Lawrie

Abstract:

In article review by Pittock, A. et al, (2018) entitled “The Effectiveness of Internet-

Delivered Cognitive Behavioural Therapy for those with Bulimic Symptoms: A Systematic
Review” looked at internet-delivered cognitive behavioural therapy (iCBT) as a possible
treatment for patients with bulimic symptoms. CBT has been established as an effective
treatment; however, waiting lists lead to delayed initiation of treatment. iCBT is a possible
delivery method to combat this. Medline, EMBASE and PsycInfo were searched for controlled
trials using iCBT as a treatment for patients with bulimia nervosa (BN), sub threshold BN or
‘eating disorders not otherwise specified’ with bulimic characteristics (EDNOS-BN). The
literature search returned 482 papers. 5 met the review criteria and were compared in
characteristics, methodological quality and outcomes. Outcomes were analysed by calculation of
effect sizes; iCBT was evaluated on reduction in binge eating and purging post treatment and at
follow-up. Results Participants were mostly female with an average age range of 23.7–31 years.
4 studies demonstrated good methodological quality. 1 did not report all of the outcome data,
increasing the likelihood of bias. Only 1 study showed widespread benefit over waiting list
controls. iCBT was shown to reduce behaviours but was not found to be superior to bibliotherapy
or waiting list. Further large-scale studies are required to make conclusive recommendations.

https://doaj.org/article/c3859d9ba2db491ebc868e0a8b5d8074

Analysis:

DSM-5 defines bulimia nervosa (BN) as frequent episodes of binge eating followed by
compensatory behaviors such as self-induced vomiting to avoid weight gain. Women are three
times more likely than men, with a lifetime prevalence of 1.5 percent and a point prevalence of
0.5 percent. Women under the age of thirty are at the greatest risk of contracting the disease.
Cognitive-behavioral therapy (CBT) is an accepted form of treatment; however, funding
limitations can lead to waiting lists. One proposal to address this is delivering CBT via another
medium. We felt it was significant to focus on BN because of its prevalence. NICE recommends
CBT for BN because it is more effective than other types of eating disorders. The goal of this
study is to see if iCBT is effective for adults with BN.

Reference:

Pittock, A. et al, (2018) “The Effectiveness of Internet-Delivered Cognitive Behavioural

Therapy for those with Bulimic Symptoms: A Systematic Review”

https://doaj.org/article/c3859d9ba2db491ebc868e0a8b5d8074

“Bulimia nervosa following bariatric surgery: a case report”

Lale Gonenir Erbay, Ibrahim Sahin, Cuneyt Kayaalp, and Rifat Karlidag
Abstract:

A case report by Erbay, LG. et al, (2017) entitled “Bulimia nervosa following bariatric
surgery: a case report” states that Bariatric surgery is an obesity treatment method gaining
popularity in recent years. Since it may cause rapid weight loss and improvement in comorbid
conditions, it is a preferred modality in some obese patients. Both obesity and bariatric surgery
interact with psychiatric disorders and require a thorough psychiatric evaluation. It has been
shown that eating disorders diagnosed in the preoperative period may continue postoperatively as
well. However, the development of eating disorders in the postoperative period for the first time
is quite rare. Here, we present a patient who was diagnosed with bulimia nervosa after she had
bariatric surgery for obesity. After a psychiatric evaluation, she was diagnosed with bulimia
nervosa that developed after bariatric surgery. Medical and cognitive behavioral therapy
programs were initiated. A partial improvement in her disturbed body perception was observed.
She is still on medical and cognitive-behavioral therapies. An eating disorder like bulimia
nervosa may develop even in patients whose preoperative psychiatric evaluation is normal.
Therefore, we suggest not only preoperative but also postoperative detailed psychiatric
evaluation and follow-up in obese patients who are a candidate for bariatric surgery. 

https://doaj.org/article/4397ceaabf5b40d28ca5dbdeb710e882

Analysis:

Obesity and mental health have a significant relationship and have a unique relationship
with major depression, bipolar disorder, panic disorder, and eating disorders. Bariatric surgery is
becoming a more popular treatment option for morbid obesity. It is very effective in treating
obesity as well as its medical and psychological complications.

The distinction between pathology and normal eating behavior following bariatric
surgery, as noted in the article, is a contentious issue. Bariatric surgery requires significant
changes in eating behavior. The fundamental method of weight loss is a gastric restriction, which
involves a significant reduction in the amount of food taken at any given meal.
 The candidates for bariatric surgery must undergo a thorough preoperative and
postoperative psychological evaluation, according to the study. It's important to remember that
an eating disorder like bulimia nervosa can develop even in patients with a usual preoperative
psychiatric evaluation.

Reference:

Erbay, LG. et al, (2017) “Bulimia nervosa following bariatric surgery: a case report”

https://doaj.org/article/4397ceaabf5b40d28ca5dbdeb710e882

“CBT4BN: A Randomized Controlled Trial of Online Chat and Face-to Face Group
Therapy for Bulimia Nervosa”
 S.C. Zerwas, H.J. Watson, S.M.  Hofmeier, M.D. Levine,  R.M. Hamer, R.D. Crosby,
C.D. Runfola, C.M. Peat, J.R. Shapiro, B. Zimmer, M. Moessner, H. Kordy,
M.D. Marcus, C.M. Bulik

Abstract:

A Journal by Zerwas, S.C. et al, (2017) entitled "CBT4BN: A Randomized Controlled

Trial of Online Chat and Face-to Face Group Therapy for Bulimia Nervosa” states that
although cognitive-behavioral therapy (CBT) represents the first-line evidence-based
psychotherapy for bulimia nervosa (BN), most individuals seeking treatment do not have access
to this specialized intervention. We compared an Internet-based manualized version of CBT
group therapy for BN conducted via a therapeutic chat group (CBT4BN) to the same treatment
conducted via a traditional face-to-face group therapy (CBTF2F). In a two-site, randomized,
controlled non- inferiority trial, we tested the hypothesis that CBT4BN would not be inferior to
CBTF2F. A total of 179 adult patients with BN (2.6% males) received up to 16 sessions of group
CBT over 20 weeks in either CBT4BN or CBTF2F, and outcomes were compared at the end of
treatment and at the 12-month follow-up. At the end of treatment, CBT4BN was inferior to
CBTF2F in producing abstinence from binge eating and purging. However, by the 12-month
follow-up, CBT4BN was mostly not inferior to CBTF2F. Participants in the CBT4BN condition,
but not CBTF2F, continued to reduce their binge-eating and purging frequency from the end of
treatment to the 12-month follow-up. CBT delivered online in a group chat format appears to be
an efficacious treatment for BN, although the trajectory of recovery may be slower than face-to-
face group therapy. Online chat groups may increase accessibility of treatment and represent a
cost-effective approach to service delivery. However, barriers in service delivery such as state-
specific license and ethical guidelines for online therapists need to be addressed.

https://www.karger.com/Article/FullText/449025

Analysis:
 Videoconferencing, mobile self-monitoring, text messaging, chat groups, digital
coaching, and online self-help training are examples of mental health services that have emerged
to fill gaps in service delivery and have shown promise in treating bulimic symptoms. The chat
group format has the advantage of providing anonymity to all meeting participants, which can
help with sensitive topics and promote openness and self-disclosure. Patients in chat-group
psychiatric treatment have also reported high levels of support and acceptance, which are
comparable to face-to-face treatment acceptability ratings.

The goal of this study was to compare the efficacy of a therapist-moderated BN chat
group (CBT4BN) to a traditional face-to-face CBT for the BN group (CBTF2F). We
hypothesized that an online group chat would be a suitable platform for disseminating evidence-
based BN treatment and that CBT4BN would not be inferior to CBTTF2F.

Reference:

Zerwas, S.C. et al, (2017) "CBT4BN: A Randomized Controlled Trial of Online Chat and Face-
to Face Group Therapy for Bulimia Nervosa”

https://www.karger.com/Article/FullText/449025
 “Bulimia nervosa – its prevalence, symptoms and treatment with special attention to oral
health”

Agata Osińska, Marta Mozol-Jursza, Marta Tyszkiewicz-Nwafor, Agnieszka Słopień, and

Elżbieta Paszyńska

Abstract:

A study by Osińska, A. et al, (2016) entitled “Bulimia nervosa – its prevalence,

symptoms and treatment with special attention to oral health” states that bulimia nervosa is a
serious and complex health problem encountered by many professionals, including general
practitioners and dentists. The aim of the study was to describe the problem of bulimia (its
prevalence, symptoms, special situations, treatment), with particular emphasis on the aspect of
the oral health. The paper presents the causes and factors contributing to the disease, diagnostic
criteria, the onset and the possible course of the disease, dental and oral mucosa pathologies due
to bulimia as well as other comorbidities (including diabetes). The paper is of descriptive nature.
The research method was based on the analysis of the available literature on bulimia nervosa
supplemented by our own experience. It was concluded based on the analysed sources that
appropriate diagnosis and treatment of bulimia nervosa is possible only with the cooperation of
many specialists: psychiatrists or paediatric psychiatrists, dentists and general practitioners as
well as other doctors if necessary. Psychotherapy is a necessary and integral aspect of treatment.
Early treatment onset is essential for good treatment outcomes. Due to the low sense of illness,
some patients would never meet a psychiatrist if not for the intervention of a family doctor or a
dentist.

https://doaj.org/article/01f74e9982b5413484903eb6bc9bc81d

Analysis:

This study was conducted to determine the cause, course, and symptoms of bulimia
nervosa. The cause and how bulimia nervosa develops involved internal and external factors.
This study finds out the personality, biological, family, and sociocultural factors that contribute
to the development of symptoms.

People with bulimia nervosa lose dental tissue due to tooth surface attribution and
erosion and, some of them are more salivary. This variety of symptoms that can occur in people
with purging types of eating disorders is typical and important for diagnosis.

Reference:

Osińska, A. et al, (2016) “Bulimia nervosa – its prevalence, symptoms and treatment with special
attention to oral health”

https://doaj.org/article/01f74e9982b5413484903eb6bc9bc81d
References:

Schegl, S. et al, (2020) “Bulimia nervosa in times of the COVID‐19 pandemic—Results from an
online survey of former inpatients”

https://scholar.google.com/scholar?
as_ylo=2020&q=Bulimia+Nervosa&hl=en&as_sdt=0,5#d=gs_qabs&u=%23p
%3DfyEHMKjb670J

Xiao. L, et al, (2020) “Altered regional gray matter volume in Chinese female patients with
bulimia nervosa”

https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02493-4

Tith. R, et al, (2020) “Association of Bulimia Nervosa with Long-term Risk of Cardiovascular
Disease and Mortality among Women”
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2752386
Yahya, A.S. et al. (2020) “Early Diagnosis and Management of Bulimia Nervosa in Type 1
Diabetes”

https://www.psychiatrist.com/pcc/psychiatry/bulimia-nervosa-in-type-1-diabetes/#top

Solano- Pinto, N. et al, (2019) “Bulimia Nervosa: Is Body Dissatisfaction a Risk Factor?”
https://www.intechopen.com/books/anorexia-and-bulimia-nervosa/bulimia-nervosa-is-body-
dissatisfaction-a-risk-factor-

Sekuła, M. et al, (2019) “Bulimia nervosa in obese patients qualified for bariatric surgery –
clinical picture, background, and treatment”

https://doaj.org/article/fd746cc21536460e9bc303393649cf4a

Gorrell, S. et al (2019) “Family- based Treatment of Eating Disorders”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764593/

Sathyapriya, B. et al, (2018) “Bulimia Nervosa – A Psychiatric Eating Disorder”

https://www.actascientific.com/ASMS/pdf/ASMS-02-0033.pdf?
fbclid=IwAR1ex0HTGKenbzn3gotv2kDadQbVQYrPnSwv3iMljqjdsX4AHUxEFDQDpKU

Hail, L. et al, (2018) “Bulimia Nervosa in Adolescents: Prevalence and Treatment Challenges”
https://www.dovepress.com/bulimia-nervosa-in-adolescents-prevalence-and-treatment-
challenges-peer-reviewed-fulltext-article-AHMT

Wade, T. (2018) “Research on Bulimia Nervosa”

https://pubmed.ncbi.nlm.nih.gov/30704637/
Donnelly, B. et al, (2018) “Neuroimaging in Bulimia Nervosa and Binge Eating Disorder: A
Systematic Review”
https://pubmed.ncbi.nlm.nih.gov/29468065/

Pittock, A. et al, (2018) “The Effectiveness of Internet-Delivered Cognitive Behavioural Therapy

for those with Bulimic Symptoms: A Systematic Review”

https://doaj.org/article/c3859d9ba2db491ebc868e0a8b5d8074

Erbay, LG. et al, (2017) “Bulimia nervosa following bariatric surgery: a case report”

https://doaj.org/article/4397ceaabf5b40d28ca5dbdeb710e882

Zerwas, S.C. et al, (2017) "CBT4BN: A Randomized Controlled Trial of Online Chat and Face-
to Face Group Therapy for Bulimia Nervosa”

https://www.karger.com/Article/FullText/449025

Osińska, A. et al, (2016) “Bulimia nervosa – its prevalence, symptoms and treatment with special
attention to oral health”

https://doaj.org/article/01f74e9982b5413484903eb6bc9bc81d