Bulimia in Children
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Bulimia in Children
Bulimia is a disorder described as food binges, devouring large amounts of food in a very short period of time, followed by
immediate self-induced vomiting eliminating the body of the food just eaten. Binge eating involves consuming larger than average
portions of food within a 2-hour period. Some individuals with bulimia may take enemas, diet pills, or abuse laxatives to prevent
weight gain. Typically, bulimic behavior is performed secretly, because it is often accompanied by feelings of disgust or shame.
Some signs of bulimia include excessive exercise, unusual eating patterns or rituals, and frequent weighing.

Some studies have reported that individuals with bulimia average about 2 episodes per day of binge eating ensued by vomiting. To
be diagnosed with bulimia, however, a person must binge and purge at least twice a week for 3 months. Some experts believe
that going through the cycle only once a week is enough for a diagnosis. Bulimia nervosa is more common than anorexia, and it
usually begins early in adolescence.

Types of Bulimia Nervosa

•        Purging type – habitual self-induced vomiting or misuse of laxatives, diuretics, or enemas.

•        Non-purging type - uses other improper behaviors, such as fasting or excessive exercise, rather than regularly purging to
reduce caloric intake of excessive amounts.

Bulimia Complications

The complications of bulimia nervosa are serious and can adversely affect teeth, the esophagus, the reproductive cycle and
hormones, and electrolyte balances, which in turn can affect the heart. If left untreated, bulimia nervosa can lead to serious and
even life threatening problems, such as depression, anxiety disorders, heart damage, kidney damage, injury to all parts of the
digestive system, and severe dental damage from stomach acid. In addition, individuals with underlying depression may be at risk
of suicide. The menstrual cycles of females with bulimia nervosa can be altered, although few patients have long-term
interruption of periods.

Stomach acid can erode the enamel of teeth, making the teeth more susceptible to cavities. Dentists have many ways to repair
eroded enamel, including fillings, composites, root canals, crowns, and dentures. However, most dentists suggest not performing
these restorative procedures until the patient is in recovery from bulimia nervosa.

Bulimic behaviors can be quite dangerous and may lead to serious medical complications over time. For example, the stomach
acid which is raised into the esophagus (the tube from the mouth to the stomach) during frequent vomiting can permanently
damage this area. Those with bulimia nervosa are at risk for dangerous impulsive, self-destructive behaviors, such as self-
mutilation, alcohol and/or drug abuse, and sexual promiscuity.

Bulimia symptoms include:

•        Preoccupation with food, weight, and body shape
•        Severe dehydration from purging fluids
•        Dry mouth
•        Constant burning and or sore throat
•        Swollen glands in the neck area
•        Irregular menstrual periods
•        Suddenly eating large quantities of food or groceries disappear instantly
•        Frequently goes to the bathroom right after meals
•        Instability in weight / Is obsessively concerned about weight
•        Rashes and pimples
•        Feels guilty or ashamed about eating

The person suffering from bulimia usually knows that their eating pattern is abnormal and may experience fear or guilt associated
with the binge purge cycles. Although the behavior is usually secretive, body weight is usually normal, although the person may
perceive themselves as overweight. If bulimia is accompanied by anorexia, body weight may be extremely low.

Bulimia Causes

The exact cause of bulimia is unknown, but factors thought to contribute to its development are family problems, perfectionist
personality, and an overemphasis on physical appearance. Bulimia may also be associated with depression. Researchers do not
know why one particular person develops the disorder while another person with a very similar upbringing does not. Clinicians
have several theories about the causes of bulimia nervosa; however no single theory explains all possible causes and symptoms.
Pinpointing the causes of bulimia nervosa has proven difficult because the disorder has both mental and physical elements, and it
develops in many age groups, races, socioeconomic classes, and both sexes.

Bulimia is common among adolescent girls in the U.S. Many studies suggest that there has been an increase in the number of
cases of bulimia over the past 50 years in the U.S. It is estimated that 1-5% of adolescents have bulimia. Adolescents who
develop bulimia are more likely to come from families with a history of eating disorders, physical illness, and other mental health
problems, such as mood disorders or substance abuse. Other mental health problems, such as anxiety disorders, or depression,
are commonly found in teens with bulimia.

Many situations and feelings can trigger bulimic behavior: extreme emotional distress, anxiety, depression, dieting, exposure to
certain foods (especially high-sugar or high-fat foods), or disappointment with body image. People with bulimia nervosa have
reported extreme mood changes before, during, and after binge eating and purging or non-purging compensatory behavior. They
have also reported feeling depressed or anxious before binge eating, and then feeling temporary relief or even euphoria
afterwards. These feelings are often followed by feelings of guilt, shame, and self-loathing. Then purging or excessive exercise
occurs to regain feelings of self-control. Concerns about weight and body shape play a role in all eating disorders, the actual
cause of these disorders appear to result from many factors, including emotional and personality disorders. Genetics and biologic
factors may influence an individual’s susceptibility to developing an eating disorder.

Bulimia Treatment

A child psychiatrist or a qualified mental health professional usually diagnoses bulimia in children and adolescents. A detailed
history of the child's behavior from parents and teachers, clinical observations of the child's behavior, and, sometimes,
psychological testing contribute to the diagnosis. Treatment for bulimia, in adolescents, is usually a combination of individual
therapy, family therapy, behavior modification, often involves a combination of options and depends on the needs of the child.
Parents play a vital supportive role in any treatment process.

To reduce or eliminate binge and purge behavior, the individual may go through nutritional counseling and psychotherapy,
especially cognitive behavioral therapy or be prescribed medication. Some antidepressants for treating bulimia may help patients
who also have depression and/or anxiety. It also appears to help reduce binge eating and purging behavior, reduces the chance of
relapse, and improves eating mind-sets. Cognitive behavior therapy that has been customized to treat bulimia also has shown to
be effective in changing binging and purging behavior, and eating attitudes. Therapy may be individually oriented or group-based.

Specific treatment for bulimia will be determined by the child's physician based on:

•        the child's age, overall health, and medical history

•        degree of the child's symptoms

•        the child's tolerance for specific medications, procedures, or therapies

•        probability of progression from the condition

Bulimia nervosa can normally be treated on an outpatient basis, although more severe cases may require inpatient residential
treatment. The treatment plan should be developed by a multidisciplinary team after accurately evaluating the patient and
consulting with the individual and parents or guardians. Many interventions that do not involve prescription drugs or
psychotherapy have been used as supplements or supportive therapy; speak with a health professional regarding alternatives
available for treating bulimia.
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