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Sunday, 1 December 2013

Eating Disorders: Bulimia nervosa - The Diagnosis

Bulimia nervosa is defined as a medical condition of  consuming a large amount of food in a short amount of time or one setting (binge eating), followed by self induced vomiting, taking a laxative or diuretic and/or excessive exercise, etc. to compensate for the binge. Bulimia nervosa also effects almost 90% of female. Unlike anorexia nervosa, people suffering from bulimia nervosa are usually normal or slightly over weight.

V. Diagnosis and tests
Diagnosis of bulimia nervosa is difficult, as people with Bulimia vervosa are very good in hiding the health problems and related symptoms, but certain signs of a person can be helpful.
A. Criteria
Based on the results of the clinical follow-up study of 41 female patients, diagnostic criteria of bulimia nervosa that should be used in clinical studies are suggested as follows:
(1) presence of anorexia nervosa or transitory amenorrhea in the premorbid period;
(2) eating attacks with losing of the control over food consumption not less than twice a week during 3 months;
(3) compensatory behavior in the form of spontaneous vomiting, abuse of purgative and diuretic medications etc;
(4) fear of obesity;
(5) cycloid affective changes with higher impulsivity, reduction of the control over primitive drives and/or expressed anxiety disorders; inclination to alcohol and drug abuse and nicotine dependence;
(6) changes of the body mass index;
(7) absence of amenorrhea. The disease dynamics is characterized by formation of the pathological cycle "diet--overeating--compensatory behavior" on the background of cyclothymic affective disorders. Two types of bulimia nervosa--with and without other drive disorders--have been singled out(25).

Others suggested that A diagnosis of bulimia nervosa is made when a person has recurrent episodes of binge eating, a feeling of lack of control over behavior during binges, regular use of self-induced vomiting, laxatives, diuretics, strict dieting, or vigorous exercise to prevent weight gain, a minimum of 2 binge episodes a week for at least 3 months, and persistent overconcern with body shape and weight. Patients with eating disorders are usually secretive and often come to the attention of physicians only at the insistence of others(25a).

B. Blood, urine tests and X ray
After taking the complex physical exam, including detail of absence of period and the examination the symptoms of Bulimia nervosa, Blood and urine tests may be ordered
a. Blood tests 
The aim of the Blood tests are to check for signs of malnutrition, including levels of  potassium levels and electrolyte imbalances.
b. Urine steroids
 The increased level of the stress marker allo-tetrahydrocorticosterone refers to the involvement of stress in these diseases, but the relevance of hormone alteration to the pathophysiology of eating disorders remains to be elucidated(26)
c. X ray
The aim of the X ray to check for broken bones, pneumonia. In some cases, dual energy X-ray absorptiometry may be necessary to test for the presented osteopenia and osteoporosis(27) 
 d. Etc. 

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Sources
(25) http://www.ncbi.nlm.nih.gov/pubmed/16841479
(25a)http://www.ncbi.nlm.nih.gov/pubmed/1475950 
(26) http://www.ncbi.nlm.nih.gov/pubmed/15560936
(27) http://www.ncbi.nlm.nih.gov/pubmed/22137016