Bulimia ========

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Bulimia ========

Post  counselor on Mon Oct 15, 2012 10:32 am

Bulimia

It's a conduct disorder characterized by repeated episodes food characterized by the ingestion of large amounts of food in a limited period of time, often accompanied by mood swings and conducted aimed at the elimination of the ingested food or neutralizing its effect on increasing weight. The b. nervosa is far more frequent in females and the percentage of males is 10-15.età the most common presenting is around 18 years (even though it has declined to 15-16 years), with a range between 12 and 35 years. The mean disease duration was 5 years. The white race and socio-economic class high average they are more severely affected. For a short time the disorder has obtained independent nosological autonomy anorexia or obesity, although there may be a partially overlapping symptom (presence of binge eating, restricted calorie intake, fear of weight gain, purging, altered perception of the body). According to the DSM-IV-R has replaced the term bulimia nervosa to bulimia to indicate that the entire syndrome b. part and not just the symptom characteristics of binge. Usually, crises occur in isolation and are precipitated by a particular mood, such as boredom, anguish, anxiety, irritability, or the sight of particular foods considered prohibited. The amount of food ingested can be very high. The patient's attitude is characterized by an uncontrollable compulsion, with marked greed and lack of concern for the quality of food, eaten without attention to taste and / or flavor. There are also strong feelings of guilt and shame, with a strong sense of worthlessness and a loss of control over food, or the feeling of not being able to stop eating and can not control modes. After a certain period of persistence of the disorder, subjects report that the episodes are no longer characterized by a sense of loss of control, as the alteration of the control, such as difficulty in resisting ingestion or stop once started. Another important criterion is the occurrence of inappropriate compensatory behavior to prevent weight gain. The most common compensatory technique is the induction of vomiting (called purging), present in 80 to 90 0ei cases. Such conduct brings a sense of relief to the physical discomfort and reduction of fear of gaining weight. Other compensatory behaviors are represented by the use of laxatives or diuretics. More rarely the subjects using rettoclismi. Sometimes patients undergo hyperactivity and excessive exercise, which may affect significantly the daily routine where they occur in inappropriate places or times and the patient persists in such behavior despite concomitant disease or other medical contraindications. Rarely comes to taking thyroid extracts or, if this one diabetes, a reduction in the proportion insulin in order to reduce the metabolism of food consumed during bulimic access. Individuals with b. nervosa have an over-emphasis in the evaluation of their body and weight, they become factors for self-esteem. In this sense, they resemble the anorexic patients in their fear of weight gain, the desire to lose and the level of dissatisfaction on their appearance. The evolution of the disorder that, following a debut at a young age and frequently due to dietary restrictions or loss events, a progressive increase in seizure frequency, up to a radical subversion of eating habits. Are consequently present weight fluctuations caused by alternating binges and fasts, with a progressive impairment in functional individual and social adaptation, although in some cases it is still maintained a good payment behavior. It is not uncommon in the detection of an anorexic disorder comorbidity. The frequent presence in personal or family history of mood disorders, the disorder occur during depressive symptoms, some neuroendocrine manifestations, and response to treatment with antidepressants, have led to carefully consider the association of these disorders with the depression, although these correlations are still unclear. It is not uncommon to identify parallel and disorders of impulse control: kleptomania, alcoholism, substance abuse, suicide attempts, the latter are mostly inadequate and implemented in a sudden and impulsive. More frequent is the association with borderline personality disorders, obsessive-compulsive and histrionic. The possible complications of a medical derive mostly from the use of unsuitable methods of elimination. The main electrolyte imbalances are represented by metabolic alkalosis, hypokalemia, hypochloremia, and dehydration, which can lead to heart rhythm disturbances or renal failure of varying severity. The frequent abdominal pain may be justified by the abuse of laxatives, more rarely may occur rupture of the esophagus and gastric lacerations are potentially lethal. There are no reliable data on the etiopathogenesis of the disorder. According to the psychoanalytic model b. represents only a symptom and not a disease in itself; may then be present both in neurotic patients (most frequently in the paintings of hysteria), both in psychotic patients (most frequently in paintings schizophrenics). Treatment is aimed, therefore, the resolution of unconscious conflicts that caused the symptom. The hypothesis that the expected behavioral b. nervosa tend to stay on their own, once the patient learns that the tantrum is associated with positive stimuli (the pleasure of ingestion of food) and negative reinforcement (relief from anxiety, depression, stress). A further negative reinforcement is represented by vomiting, which allows the introduction of large amounts of calories without the risk of weight gain. The cognitive-behavioral psychotherapy aims to change some cognitive processes of the patient to make him learn new conceptual schemes and behavior. According to the theory of addiction model, or model of food addiction, b. would be considered a general predisposition to substance abuse. There would in fact analogies with such behavior as, for example, the compulsive search of the substance, loss of control on the assumption, the secrecy with which it occurs, social withdrawal and functional impairment. It was also reported a close relationship of binge eating with obesity and dietary restrictions, confirmed by a high familial incidence of obesity. Similarly seem to correlate mood disorders, both for the individual and family high incidence of this disease, and for the common analogies and the neuroendocrine response to antidepressants. Finally, it was still assumed a central serotonergic dysfunction: in this context, b. would be compatible with un'ipofunzione serotonin inserted into the obsessive-compulsive spectrum. Drug therapy is based on clinical observations have shown similarities between b. and obsessive-compulsive disorder (sometimes uncontrollable binge eating preceded by intense anxiety), the other a close correlation with mood disorders (high familial incidence of affective disorders, abnormal neuroendocrine response to common antidepressant). Therefore, in addition to the use of oral medications, tricyclics and MAOIs, is effective use of serotonergic drugs (SSRIs). Other agents play an additional role: anxiolytics, which serve to reduce the fear of eating, lithium, carbamazepine and verapamil to stabilize any concomitant bipolar disorder; fenfluramine to reduce the urgency of binge-eating. Remains highly controversial whether antidepressants act directly on bulimic behaviors or concomitant depressive disorder, which is often the element slatentizzante the bulimic behavior. Finally, the finding of an involvement of the endogenous opioid system in the regulation of feeding behavior has led to the use, yet to be explored, opioid antagonists, such as naloxone and naltrexone. More difficult to use are the anorectic of dopaminergic (eg., The methylamphetamine), unlike those of type serotoninergic (fenfluramine, dexfenfluramine) which, while with similar structure to amphetamine, do not share the properties psychostimulants and have reduced of tolerance and dependence.

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