Anorexia nervosa and bulimia: the eating disorders

Bulimia nervosa: occurrence with psychoactive substance use disorders

The prevalence of bulimic symptomatology was determined in the female population of a state-funded chemical dependency treatment unit. Sixty women, 39 Caucasian and 21 Native American, all diagnosed with a psychoactive substance use disorder, were evaluated using both the Bulit-R and the eating disorder section of the Structured Clinical Interview for the DSM III-R to diagnose bulimia nervosa. The prevalence of bulimia was calculated to be 12% of the total subject group. Additionally, 3 anorectics were identified, resulting in a 17% rate of diagnosable eating disorders in the total group. Percentages of occurrence in the Caucasian group alone were 15% for bulimia and 23% for the combined eating disorders.

Orderly dieting and disordered eating: a case report

A moderately obese 49-year-old woman who was enrolled in a nutrition and weight control clinic quickly attained her target weight through an individualized program of balanced deficit diet, routine exercise, and weekly counseling. Weight loss continued until she was 15% below Metropolitan Relative Weight, when family members grew concerned that she had developed an eating disorder. Despite nutritional and behavioral counseling, she has rigorously maintained her exaggerated weight loss. This case report illustrates a potentially serious but often overlooked reason for careful monitoring of patients undergoing treatment for obesity. Health professionals involved in weight control programs should routinely assess patients for potential eating disorders.

Gastrointestinal symptoms in anorexia nervosa. A prospective study

Neither the natural history of gastrointestinal symptoms in patients with anorexia nervosa nor their response to refeeding have been well studied. We hypothesized that gastrointestinal symptoms in anorexia nervosa will decrease during refeeding despite high caloric intake, suggesting that delayed gastric emptying, where present, is a result rather than a cause of anorexia nervosa. Study goals were (a) to determine the type and frequency of gastrointestinal symptoms, (b) to follow symptoms during refeeding prospectively, and (c) to develop guidelines for gastrointestinal testing and intervention in hospitalized anorectic patients. Sixteen consecutive patients with anorexia nervosa were rated on 12 gastrointestinal symptoms before and after nutritional rehabilitation and followed up throughout treatment. All patients reported multiple gastrointestinal symptoms on admission; all symptoms except belching improved during treatment despite large calorie increases (p less than 0.0002); significant improvements occurred in appetite, bloating, constipation, vomiting, and diarrhea; and no patients required endoscopy, x-ray evaluation, or antipeptic regimens. We conclude that although severe gastrointestinal symptoms are common in anorexia nervosa, they improve significantly with refeeding. Specific gastrointestinal studies should be reserved for patients who do not gain weight or who have indications of independent digestive disease.

Physical illness encountered in patients with eating disorders

Careful evaluation for medical illness with a severity rating scale of 276 eating-disorder patients admitted to hospital revealed that patients with anorexia and bulimia were at risk for developing medical complications. Severe cardiovascular complications were most likely to occur in eating-disorder patients who were also diuretic and/or laxative abusers. Forty percent of patients with bulimia had significant medical complications. The findings suggest that a medical work-up should be carefully undertaken in both anorexic and bulimic patients admitted to hospital. A mixed history of severe anorexia nervosa alternating with periods of bulimia was most likely to lead to severe life-threatening illness. Seventy percent of the bulimic patients admitted required some medical treatment. Five percent were considered severely medically ill, while 34% suffered from a significant medical disorder. Ten percent of patients with restrictive anorexia or anorexia alternating with binge/purge required intensive care unit (ICU) placement. Most illnesses requiring medical treatment were unknown to the patient and the patient's physician at the time of admission.