Bulimia, Pica and Rumination Disorder

by Helen Farrell, MD

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    00:01 Let's move on now to talk about some of the other eating disorders starting with bulimia.

    00:06 The life time prevalence is 1%, females are more affected than males, and the median age of onset is about 18 years old, so again, in the teens.

    00:15 Diagnostic criteria incur recurrent episodes of binge eating, eating in a discrete period of time within a 2 hour period, and a sense of lack of control.

    00:27 There's a recurrent inappropriate compensatory behavior to prevent weight gain and binge eating and inappropriate compensatory behavior both occur on average.

    00:39 Bulimia includes recurrent episodes of binge eating and then eating in either a discrete period of time within any 2 hour period with a sense of lack of control.

    00:52 There are recurrent inappropriate compensatory behaviors to help prevent weight gain and the binge eating and inappropriate compensatory behaviors can both occur. Their self-evaluation that's unduly influenced by body, shape, and weight, and the disturbance does not occur exclusively during episodes of anorexia.

    01:14 Patients with bulimia actually tend to have an average body weight.

    01:19 The major difference between bulimia and binge eating is that there is compensatory behavior influenced by guilt and a perception of appearance. So, what's the best treatment for bulimia? Well, it's individual psychotherapy, CBT, group therapy, and also pharmacology can help such as SSRI's which are usually the first-line agents.

    01:44 So, what's the difference between bulimia and anorexia? Well, in bulimia, patients find their symptoms ego-dystonic.

    01:52 In other words, they find their symptoms to be very distressing.

    01:55 Whereas in anorexia, patients find their symptoms ego-syntonic, they're not distressing at all.

    02:01 And in bulimia, patients are actually more likely to go to the doctor and ask for help.

    02:07 Whereas in anorexia, patients are very reluctant to get help from their doctor.

    02:12 Let's talk about Pica now. This is a repeated eating of actually non-food substances.

    02:18 Things like chalk, clay, cloth, dirt, and eating behavior is inappropriate to the patient's developmental level, and it's not culturally supported or a social norm.

    02:30 If the eating behavior occurs in the context of another mental disorder such as autism or schizophrenia or during a general medical condition, then that will better account for it. So, it's very important that you rule out things like other mental disorders and general medical conditions.

    02:48 It's also important to note that pica is very different from self-injurious behavior.

    02:54 So the difference is that somebody who has pica is eating non-food substances that can't actually harm them severely, things like chalk or dirt.

    03:05 Whereas somebody who's making a suicidal gesture, is actually ingesting something that could cause extreme injury, something like batteries, knives, needles, so something that could be extremely and acutely dangerous.

    03:20 Let's talk about rumination disorder. So this is repeated regurgitation of food which may be re-chewed, re-swallowed, or spit out.

    03:30 Regurgitation of food is not due to a general medical condition such as esophageal reflux disease.

    03:37 The regurgitation does not occur solely during the course of avoidant or restrictive food intake disorder. And if the eating behavior occurs in the context of another mental disorder or general medical condition, then that's going to be the more likely diagnosis.

    03:55 So, you need to make sure to rule these things out and make sure that the severity of the eating behavior warrants additional, clinical attention when it is due to something like a general medical condition.

    04:10 Now let's talk about unspecified feeding or eating disorder.

    04:15 The diagnosis unspecified feeding or eating disorder applies to patients with symptoms of a feeding and eating disorder that cause significant distress or impair psychosocial functioning but it doesn't meet the full criteria to be a specific eating disorder. We've reviewed now some of the eating disorders.

    04:37 You know a little bit about their diagnosis and a little bit about how to approach that patient and manage them.

    About the Lecture

    The lecture Bulimia, Pica and Rumination Disorder by Helen Farrell, MD is from the course Control Disorders. It contains the following chapters:

    • Bulimia
    • Treatment for Bulimia
    • Rumination Disoder
    • Unspecifies Feeding or Eating Disorder

    Included Quiz Questions

    1. Weight loss of 20% of initial body weight
    2. Binge eating is done every 2 hours with a lack of self-control
    3. Recurrent inappropriate compensatory behavior is seen to help prevent weight gain
    4. Self-evaluation is unduly influenced by body shape and weight
    5. The disturbance does not occur exclusively during episodes of anorexia nervosa
    1. Bulimia is ego-dystonic while anorexia is ego-syntonic.
    2. Purging is seen typically in anorexia.
    3. Bulimic patients tend not to seek help from doctors for treatment but anorexic patients tend to seek help from the doctors for treatment.
    4. Males tend to have anorexia more commonly than females.
    5. The median age of onset for bulimia is 30 years while that in anorexia is 25 years of age.
    1. Pica
    2. Bulimia nervosa
    3. Rumination disorder
    4. Attention deficit hyperactive disorder
    5. Obsessive-compulsive personality disorder
    1. Rumination disorder
    2. Pediatric binge eating disorder
    3. Pyloric stenosis
    4. Pica
    5. Gastroesophageal reflux disease.
    1. Batteries
    2. Chalk
    3. Hair
    4. Gum
    5. Clay

    Author of lecture Bulimia, Pica and Rumination Disorder

     Helen Farrell, MD

    Helen Farrell, MD

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