Bolemia: Evaluation and Treatment

Bolemia is the psychiatric disorder that has the most significant degree of significant physical dysfunction because of the aberrant eating patterns and the problems that occur relative to nutrition. It is a disorder that occurs primarily in We are seeing bolemia gradually extend down into the lower socioeconomic classes. It primarily affects females between the ages of 12 and 20. The instance has increased from about 1:250 twenty years ago, to about 1:100 at the present time. There has indeed been a marked increase in the last 15 -18 years for this disorder. It is commonly seen in individuals who are involved in appearance-related sporting activities or in activities where appearance is a primary determinant of scoring; such as gymnastics, dance, modeling and acting. There’s a significant female predisposition to this with a female to male ratio of eating disorder.

The mortality rate early on was 5% to 10%, and that was primarily because of starvation. The two most likely ways in which an anorexic individual will subsequently lose her life, are from suicide or from organ failure, particularly cardiac dysfunction and cardiac arrhythmias. While one would have expected the mortality rate hopefully to have improved, as we learn a little bit more about this disease. We continue to see, over the course of about six to eight years.

Bolemia nervosa most commonly affects white middle and upper class individuals. Again, females aged 15 to 20. A little bit older. Anorexia we start seeing at 11, 10, 12 years of age. Bulimia oftentimes not until they are 14 or 15 years of age. Incidence is much higher than anorexia nervosa, 2% to 5% in the general population. Much greater than the 1% for anorexia nervosa. And up to 20% in some college surveys. In some surveys of college individuals, up to 20% will have either full-fledged bulimia or at least a lot of bulimic behaviors. There has been a marked increase in the last 15 years. These are again occurring in well-educated, white middle to upper class individuals, 70% have had one to four years of college. About 45% to 50% have gone on to graduate school. Strong female to male ratio of about 10:1. And again, mortality about 2% to 5%. Same causes for mortality in this as in anorexia. Suicide and cardiac arrhythmias.

These individuals begin dieting, but they can’t control the diet to the extent that the anorexic individual ultimately is able to. They get frustrated with the diet. Continue to want to lose weight and try to devise some shortcut by which they can get the weight loss to begin. So they being experimenting with purging behaviors. At first that really is an experimentation. At first, if they overeat just a little bit, "I think I’ll just throw up. I’ll get rid of it by purging by some means." Unfortunately what happens in those individuals is it happens to be an experiment at the front end, maybe doing it once a week, maybe once every couple of days. Then it rapidly evolves over about a month or two to where they are doing it on a daily basis, and then it begins to control them rather than them being able to control it. Evolving then into a typical picture of bolemia nervosa. Again, it’s often a spontaneous thought or perhaps they’ve known another individual or read about it in their health class, about how to get of calories and that’s how the whole process starts.

They then develop progressive escalation of purging behaviors. They are extremely secretive about their behaviors. Even more so than the anorexic. I have had some individuals who have been able, for over 15 years, to hide this from their husband, to hide it from other family members, to hide their bulimic purging behaviors from other individuals. We had a secretary once who worked with about 15 other secretaries.

What are the diagnostic criteria for bolemia nervosa? They are listed on this slide. There are five of those. Again, this is important to have general knowledge of. First of all, they have a problem with eating. They eat in a discreet period of time an amount of food that is definitely larger than most people would eat in a similar time and under similar circumstances. So they have a period of engorgement and during this process they can eat for two, two-and-a-half hours at a time. They can consume up to - not uncommonly - 3,000 to 4,000 calories during a sitting.


Another overview :
- Bulimia: An Overview
- Causes of Bulimia
- Health Consequences of Bulimia
- Treating Bulimia
- Bulimia and Pregnancy
- Helping Someone With Bulimia

For more info : http://www.medical-library.org/journals3a/bolemia.htm