Bulimia nervosa and a stepped care approach to management

Article Abstract:

Bulimia nervosa is an eating disorder afflicting about one percent of young women. It is characterized by intermittent, recurring bouts of overeating (bulimia), extreme behavior designed to control weight (e.g. vomiting and the use of laxatives), and a morbid fear of becoming fat. The patients' weight is generally within the normal range. These symptoms may or may not be accompanied by other symptoms. The causal factors in the development of bulimia nervosa are not known. In the most common case, normal adolescent dieting progresses gradually to the point (usually when the patient reaches her mid-20s) where outside help is sought. The guilt and shame which invariably accompany this disorder make it imperative that doctors consider this diagnosis when apparently healthy young women complain of bloating, abdominal fullness or pain, or other gastrointestinal problems for which there is no obvious explanation. Treatment for bulimia nervosa is either administration of antidepressant medication, or short-term psychological counseling. Antidepressants, while effective in controlling the behavioral disorder in the short term, have no effect on the underlying disturbed perceptions of body weight. This may explain the high rate of relapse among patients treated with these drugs. Psychological counseling is more effective in the long run, but requires about 20 treatment sessions with a specialist trained in eating disorders. A stepped care approach is suggested, whereby patients with bulimia nervosa are given increasingly intensive therapies until they respond. The initial level is self-help using written materials. Increasing levels of outside intervention are imposed, with day patient or inpatient care being given to the most resistant cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Antidepressants

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Integrative medicine: the team approach

Article Abstract:

An integrative approach to healthcare involving traditional western medicine and alternative practices such as acupuncture, homeopathy, and massage can enhance care and better meet patient's healthcare needs. As insurance companies start to cover certain alternative healthcare practices, healthcare providers need to recognize the effectiveness and value of nontraditional medical services. Encouraging patients to explore alternative approaches to their healthcare can empower the patient and educate both the physician and patient.

Editorial, Usage, Alternative medicine

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Bulimia nervosa

Article Abstract:

The complications and treatment of bulimia are reviewed. People with bulimia engage in binge eating followed by self-induced vomiting on a regular basis. Bulimia is 10 to 20 times more common in girls than boys and many people also have a coexisting psychiatric problem such as anxiety or depression.

Complications and side effects

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