Bulimia Nervosa Definition Bulimia nervosa is an eating disorder characterized by episodes of binge eating followed by compensatory behaviors such

as guilt, humiliation, and depression. A binge is consuming abnormally large amount of food within a limited period of time usually within two hours. The victims usually binge at least twice a week. However in severe cases, it can be up to several binge episodes in a day. They may or may not plan on binging. The food usually include high-calorie, high carbohydrate foods like cakes and ice cream. People with bulimia nervosa binge on food not because of they are hungry but because they lose control over eating. Therefore, they feel ashamed of their eating behavior and binge secretly. This feeling cause them to engage in self-induced vomiting or laxatives or diuretics use, dieting, fasting, or a combination of these measures to overcome the fear of gaining weight. Incidence The incidence of bulimia nervosa can be seen among more women than men. It affects nine women for every man. Bulimia usually begins in adolescence or early adulthood and can occur together with anorexia nervosa. Statistics show that there is a significant increase in recent years in young women from the ages of 15 to 24. In the United States approximately 25 million people are struggling with 'Binge eating disorder. However, this condition has not been recognized in developing countries. Pathophysiology Pathophysiology of this disorder is not clear. Genetic studies suggest that these neurotransmitter systems are dysfunctional in individuals with bulimia nervosa; and the

frequent comorbidity of bulimia nervosa with major depressive and obsessivecompulsive disorders, conditions in which multiple alterations of brain biochemical functions have been demonstrated. The levels of norepinephrine and serotonin are lower in individuals with bulimia nervosa than in healthy individuals. Levels of dopamine are also lower than those in controls. After remission of the disorder, norepinephrine function returns to the normal level, whereas dopaminergic and serotonergic function rebound to levels higher than those in controls. Signs and Symptoms The patients usually eat foods that are more than what normal people would eat. During binge-eating episodes, they experience sense of lack of control which causes them to eat continually until they are stopped by abdominal pain, sleep, or another person. They usually prefer to eat foods that are sweet, soft and high in calories and carbohydrates. Physically, they appeared thin, normal, or slightly overweight appearance with weights that are always changing. They sometimes weigh within normal range with the use of diuretics, laxative, vomiting, and exercise. They would experience persistent sore throat and heartburn from vomited stomach acids. The back of their hands and knuckles normally have calluses or scarrings from inducing vomiting. Through repetitive vomiting, they would experience salivary gland swelling, hoarseness, throat lacerations, and dental erosion. They would also have abdominal and epigastric from acute gastric dilation. Female patients will experience amenorrhea from weight loss, hormonal imbalance.

Through repeated purging and use of diuretics and laxatives, they will have fluid and electrolyte imbalances. Psychosocially, they are people with perfectionism, distorted body image, exaggerated sense of guilt, and feelings of alienation. They also experience recurrent anxiety, acute or chronic depression, poor impulse control, low tolerance for frustration, self-consciousness, difficulty expressing anger, impaired social or occupational adjustment. Their images are portrayed as the perfect student, mother, daughter, and child. Behaviorally, they may present evidence of binge-eating, such as disappearance of large amounts of food over short periods. They may also have frequent trips to the bathroom after meals, sounds, and smells of vomiting, a presence of diuretics and laxatives. They have distinctive eating habits or rituals. They would exercise excessively despite poor weather, fatigue, illness, or injury. They have complex schedule to make time for binge-and purge sessions. They have withdrawal from friends and usual activities. They would have hyperactivity and frequent weighting. Risk factors Exact cause is unknown, however interplay of genetic, biological, behavioral, environmental, family and psychosocial factors are suspected. There is a strong link in specific area of chromosome 10p linked to family with history of bulimia nervosa. There is also possible importance of family influences as well. In some studies, there is an altered role of serotonin levels in patients. The patients may be also influenced by

societys over emphasis on appearance and thinness. The patients may be experiencing family disturbances or conflict, sexual abuse, learned maladaptive behavior, and struggle for control or self-identity. Current medical treatment Early treatment is crucial because the patients behavior pattern will become stronger and will have more resistant to change. Hence, the patients treated early in the disease course are more likely to recover fully than are those who delay treatment for years. The treatment should centers on the issues that cause the behavior, not the behavior itself. Have the patient to participate in self-help group such as Overeaters Anonymous, drug rehabilitation program, individual, group, and family therapy, nutrition counseling and medications plan if necessary. They should be in high degree of structure and a behavioral treatment plan based on the patients weight and eating behaviors. Patients may need continuing treatment for several years, long-term psychotherapy and medical follow-up are essential. Psychotherapy and psychological medications such as tricyclic antidepressant (TCA), selective serotonin reuptake inhibitor (SSRI) may be necessary. If patient is hospitalized with medical or psychiatric reason because of binge-eating and purging caused serious physical harm. Pharmacological treatment of bulimia nervosa that is directed at correction of the neurochemical alterations observed is difficult because of the complexity of the impairments. However, such treatment is necessary and should be continued long after symptomatic remission to ensure reinstitution of cerebral biochemical homeostasis. Nursing Care for patient with the disorder

As a nurse, engage with the patient in a therapeutic way to gain full commitment to treatment. Also promote an accepting, nonjudgmental atmosphere; control your reactions to the patients behavior and feelings. Supervise the patient during mealtimes and afterward. Encourage patient to recognize and verbalize her feelings about her eating behavior and also of her stressful issues such as achievement, independence, socialization, sexuality, family problems and control. Patient also should to be educated of risk of laxative, emetic, and diuretic abuse. Encourage family to stay with the patient during treatment. Most importantly, assess and monitor the patients suicide potential. Summarize findings Bulimia is a binge-eating and vomiting secretly after the binge eating. People with bulimia prefer foods that are sweet, soft, and high in calories and carbohydrates. They binge not because they are hungry, but because they lose control of eating. Bulimia can take control of victims physically and psychologically in a destructive way. Women are affected more than man. The victims weights are also changing. They have calluses or scarring on the back of their hands, tooth staining or discoloration, and amenorrhea. They can be treated with proper structural environment and treatments. The primary goal of treatment is to restore physical health and normal eating patterns. Establish a pattern of regular, non-binge meals for them. Encourage healthy exercise and patient to recognize and verbalize her feelings about her eating disorder.

Bibliography Williams, L., & Wilkins, (2006). Straight A's in Psychiatric & Mental Health Nursing .Ambler, PA: A Walters Kluwer. Eby, L, & Brown, N (2009). Mental Health Nursing Care.Upper Saddle River: Pearson Education. Brambilla , F (2009). Aetiopathogenesis and pathophysiology of bulimia nervosa: biological bases and implications for treatment. Retrieved February 28, 2009, from Public Meds Web site: http://www.ncbi.nlm.nih.gov/pubmed/11460890 (2009). Bulimia Nervosa. Retrieved February 28, 2009, from wrongdiagnosis.com Web site: http://www.wrongdiagnosis.com/b/bulimia_nervosa/intro.htm Vivekanand, (2009). Bulimia Nervosa. Retrieved February 28, 2009, from mediaindia.net Web site: http://www.medindia.net/patients/patientinfo/bulimianervosa-reference.htm