Bulimia nervosa is characterized by recurrent episodes of binge eating followed by unadäquaten compensatory behaviors such as purging behavior (self-induced vomiting, misuse of laxatives or diuretics), fasting or extreme sport; the episodes everybody gets over 3 months at least 1 time / week. Diagnosis is based on history and examination findings. The treatment consists of psychotherapy (therapy of choice) and antidepressants.
Bulimia nervosa affects about 1.6% of adolescent girls and young women and 0.5% of men in the same age. Sufferers constantly and excessively concerned with their figure and weight. In contrast to patients with anorexia nervosa patients are normal weight with bulimia nervosa often or above the normal weight.
Bulimia nervosa is characterized by recurrent episodes of binge eating followed by unadäquaten compensatory behaviors such as purging behavior (self-induced vomiting, misuse of laxatives or diuretics), fasting or extreme sport; the episodes everybody gets over 3 months at least 1 time / week. Diagnosis is based on history and examination findings. The treatment consists of psychotherapy (therapy of choice) and antidepressants. Bulimia nervosa affects about 1.6% of adolescent girls and young women and 0.5% of men in the same age. Sufferers constantly and excessively concerned with their figure and weight. In contrast to patients with anorexia nervosa patients are normal weight with bulimia nervosa often or above the normal weight. Pathophysiology Occasionally, serious fluid and electrolyte imbalance, particularly hypokalemia on. In extremely rare cases, gastric and Ösophagusrupturen lead during a Essanfalls or detoxification episode to life-threatening complications. Since no substantial weight loss occurs, there are the serious deficiencies that exist in anorexia nervosa, not before. when used to induce vomiting in long-term abuse of ipecac syrup (d. Talk .: Ipecac syrup n. / ipecac syrup), can cause cardiomyopathy. Symptoms and signs Patients typically describe a bulimia behavior. In binge eating very quickly large amounts of food are consumed over and above what definitely what most people (in a similar period under similar circumstances z. B., the amount that is considered excessive for a normal meal, compared to a be different meal during the holidays). This goes along with the feeling of loss of control. Patients tend to consume sweet and foods high in fat (eg. As ice cream, cakes). The consumed at a binge eating amount of food varies, sometimes thousands of calories are added. The binges usually occur episodically, are often triggered by psychosocial stress, several times can occur daily and are usually carried out in secret. compensatory behavior follows the binge eating: self-induced vomiting, use of laxatives or diuretics, excessive exercise and / or fasting. Patients are normal weight generally; a minority is overweight or obese. However, patients are overly concerned with their mKörpergewicht and / or externals busy; they are often dissatisfied with their bodies and think they have weight. Most symptoms and physical complications are a result of the purging behavior. Self-induced vomiting can cause erosion of the enamel of the incisors, a painless enlargement of the parotid glands (parotid gland) and an inflamed esophagus. Among the physical signs Swollen parotid gland include scars on the knuckles (by self-induced vomiting) erosion of the teeth patients with bulimia nervosa rather their behavior are, unlike patients with anorexia nervosa, aware they regret it and type in questioning by a sensitive clinicians their suffering to even more. They are also less socially isolated and more likely to show a tendency to impulsive behavior, drug and alcohol abuse and manifest depression. Anxiety (eg. B.The weight on and / or social situations) and anxiety disorders may occur more frequently among these patients. Diagnosis Clinical criteria Clinical criteria for diagnosis are: Recurrent episodes of binge eating (uncontrolled eating unusually large amounts of food) that are accompanied by feelings of loss of control over eating and occurring at least 1 time per week for 3 months. Recurrent inappropriate compensatory behavior in order to influence the body weight (at least 1 time per week for 3 months) The Selbstbeuteilung is influenced excessively by figure and weight treatment Cognitive behavioral therapy (CBT) interpersonal psychotherapy (IPT) SSRI CBT is the therapy of choice. in general, the therapy involves 16-20 sessions over 4-5 months, but it can also be done as a group therapy. The treatment aims to increase the motivation to change, to replace dysfunctional dieting by regular and flexible eating habits to reduce the excessive concern for figure and weight and prevent relapses. CBT leads to remission of binge eating and purging behavior at about 30-50% of patients. Many more patients show improvements; Some drop out of treatment or do not speak it at. The improvements can be maintained in the long term usually. In the IPT focuses on helping patients identify and change current interpersonal problems that could maintain the eating disorder. The treatment is not yet direktiv interpretative and focuses directly on the symptoms of the eating disorder. An IPT can be considered as an alternative consideration when CBT is not available. (Note to the German-speaking countries: IPT does not count in Germany about the policy process and therefore is not paid by the payers.) SSRI alone reduce the frequency of binge eating and vomiting, but the long-term results are not encouraging. SSRIs are also effective in the treatment of comorbid anxiety and depression. Fluoxetine 60 mg p.o. 1 time / day is recommended (this dose is higher than that which is typically administered for depression). Important points to bulimia nervosa igehören recurrent episodes of binge eating followed by compensatory behaviors unadäquaten as self-induced vomiting, misuse of laxatives or diuretics, fasting or extreme sports. In contrast to patients with anorexia nervosa, patients often lose a lot of weight or developing nutritional deficiencies. Recurring self-induced vomiting can cause tooth enamel and / or lead to esophagitis. Cognitive behavioral therapy has been used, sometimes together with an SSRI.