bulimia nervosa
Introduction
Introduction to bulimia nervosa Bulimia nervosa (BN), also known as bulimia, is an uncontrollable polyphagia with periodic episodes, which can occur in anorexia nervosa, but it is not necessarily accompanied by this symptom. This symptom group consists of two main components, one of which is the force of the cabinet to force itself to eat more, and the other is to try to vomit to avoid weight gain, and sometimes abuse laxatives. The weight of such patients is often kept within the normal range, and the menstruation of female patients is still normal. Women are more common. According to foreign reports, the prevalence of women with this disease is about 1% to 3%. The prevalence of men is about 1/10 of that of women. The prevalence rates are similar across the world. The disease often begins in late adolescence or early adulthood and can last for several years. Mostly chronic or periodic disease. The long-term prognosis is still unclear. basic knowledge The proportion of illness: 0.02% Susceptible people: no special people Mode of infection: non-infectious Complications: anxiety disorder depression metabolic alkalosis metabolic acidosis
Cause
Cause of bulimia nervosa
Bulimia nervosa (BN) is a modern disease whose etiology and pathogenesis are still unclear, but most studies suggest that the pathogenesis of BN is related to biological, psychological, and sociocultural factors.
Genetic factors (20%):
Family surveys have shown that genetic factors play a role in the pathogenesis of anorexia nervosa (AN). However, there are data indicating that the genetic predisposition of BN is not as obvious as AN, and the proportion of heredity in the pathogenesis of BN is still uncertain. The central neurotransmitters 5-HT and NE are thought to be involved in the pathogenesis of BN, and 5-HT deficiency is most closely related to BN.
Psychological factors (30%):
The onset of BN is related to psychological and personality factors, such as perfectionism, self-concept damage, emotional instability, impulsive control, poor ability to adapt to development and maturity, including adolescence, marriage, pregnancy, and family members and parents. Relationship problems, sexual problems encountered, etc., therefore, BN can be a way to deal with the stress events encountered in these processes. BN patients are more communicative, more angry, and more impulsive than AN patients, lacking super-ego control and self-power comparable to AN patients.
Social and cultural factors (30%):
Social and cultural factors play an important role in the pathogenesis of BN. Industrialization has led society to produce enough food and treat it as a quick food. This temptation has contradicted the slim aesthetics of women; the development of society has also led to changes in the roles of men and women, and womens The concern is directly related to the individual's self-esteem and self-worth; some social views, such as the more slim women, the more attractive, the diet and slimness promote success, making women extremely sensitive to their body shape.
Prevention
Bulimia nervosa prevention
(1) diet
The diet is light and nutritious, paying attention to the balance of the diet. Avoid spicy food, eat more fresh vegetables and fruits, fresh vegetables and fruits contain a lot of nutrients needed by the human body. Eat more immune-enhancing foods to improve your body's ability to fight disease. Control the patient's diet and pocket money, timing quantitative. 30 minutes of physical exercise every morning to ensure daily breakfast; in addition to proper work in the morning, take a 30-minute walk to ensure Chinese food; after afternoon labor, exercise equipment and music therapy (singing karaoke, Dance, etc.) to guarantee dinner.
(2) drug treatment
Because the patient lacks awareness of the disease, there is resistance to taking the medicine, and there is a phenomenon of Tibetan medicine. Therefore, two people are present at the time of drug delivery to help the patient take the medicine to ensure the efficacy of the drug treatment.
(3) Psychology
1 Introduce the meaning of psychotherapy to patients, help patients to relieve psychological barriers, enable patients to grow up, and correctly treat setbacks and difficulties. Repeatedly teaches the patient to gluttony, fasting, catharsis, weight loss and physical damage, and causes a series of physiological and psychological reactions, leading to social maladaptation.
2 ways to help patients relieve anxiety, such as deep breathing, running, listening to relaxed sounds. If you want to eat and control, the nurse can chat with the patient, talk, and transfer the patient's attention.
Complication
Neurological bulimia complications Complications anxiety disorder depression metabolic alkalosis metabolic acidosis
May be associated with depression or anxiety symptoms, most of which are related to body weight or body shape. In severe cases, water electrolysis and metabolism disorders may occur, manifested as hypokalemia, hyponatremia, etc., vomiting leads to decreased gastric acid and metabolic alkalosis. Diarrhea can lead to metabolic acidosis, which is fatal in the later stages of the disease due to complications such as the esophagus, gastrointestinal tract, and heart.
Symptom
Symptoms of bulimia nervosa common symptoms weight gain bulimia anxiety depression
(1) There is a history of binge eating, the amount of food intake is far more than normal, and patients often eat it uncomfortable.
(2) Inappropriate compensation measures should be taken immediately after binge eating to prevent weight gain, and the number of occurrences is at least 2 times on average for 1 week and lasts for more than 3 months.
(3) In the early days, patients were shy about their binge eating behavior, often secretly.
(4) Overeating behavior can be triggered by the following factors: emotional irritability, poor interpersonal relationship, feeling hungry after dieting, or dissatisfaction with body weight and body shape. Overeating can delay irritability, and soon the patient is dissatisfied with himself and depressed.
(5) At the beginning of the onset, the patient's ability to control eating behavior is weakened, and the self-control ability at the end of the disease is completely destroyed.
(6) The most common method of weight control is vomiting. You can use your hands or other equipment to stimulate the throat. You can also take vomiting with vomiting. After a period of time, you don't need to vomit. The patient will vomit when he thinks of vomiting, even if he only eats a small amount of food. Vomiting.
(7) About one-third of patients use a cathartic agent to lose weight, and very few patients even use the enema method.
(8) Some patients do not use the method of directly removing food, but increase physical exertion, such as rapid activity, increase physical exercise, etc., the amount of activity greatly exceeds normal, and affects normal life.
(9) The patient is overly concerned about his body shape and often feels dissatisfied.
(10) may be accompanied by symptoms of depression or anxiety, most of which are related to body weight or body shape.
(11) In severe cases, water electrolysis and metabolism disorders may occur, manifested as hypokalemia, hyponatremia, etc., vomiting causes a decrease in gastric acid and metabolic alkalosis, and catharsis can lead to metabolic acidosis.
(12) In the later stage of the disease, there is a fatal danger due to complications such as esophagus, gastrointestinal tract, and heart.
Examine
Check for bulimia nervosa
Mainly check the organ system for the presence or absence of lesions, identify whether it is epilepsy, schizophrenia and other secondary binge eating. Neurogenic bulimia (also known as bulimia nervosa) is an eating disorder characterized by recurrent and irresistible feeding desires and binge eating behavior. Patients have fears of getting fat, often taking methods such as vomiting, catharsis, and fasting. To eliminate extreme measures caused by binge eating. It can be alternated with anorexia nervosa. Both have similar pathological and psychological mechanisms and gender age distribution. Most patients are the continuation of anorexia nervosa. The age of onset is later than that of anorexia nervosa, not an organic systemic lesion.
Diagnosis
Diagnosis and diagnosis of bulimia nervosa
Diagnostic points:
(1) The irresistible appetite desire or behavior of a seizure can enter a large amount of food at a time. Attack at least 2 times a week for at least 3 months.
(2) There is fear of getting fat.
(3) often use methods such as vomiting, catharsis, and increased exercise to eliminate obesity caused by binge eating.
(4) It is not a binge eating caused by organ diseases of the nervous system, nor is it a secondary binge eating such as epilepsy or schizophrenia.
Differential diagnosis:
(1) Anorexia nervosa: If an anorexia nervosa, or alternating frequent anorexia and intermittent overeating symptoms, has been diagnosed, it should be diagnosed as anorexia nervosa.
(2) Klein-levin syndrome: also known as periodic sleepiness bulimia syndrome, manifested as paroxysmal sleep (day and night) and bulimia, lasting for several days. When the patient woke up, they ate, ate and slept. Weight gain was evident after one illness. There is no vomiting, catharsis and other weight-control behaviors, and there is no dissatisfaction with body shape or weight, so it is easy to identify with bulimia nervosa.
(3) major depression: patients may have excessive diet, but there is no compensation for inappropriate weight loss, such as vomiting, catharsis, etc., it is different from neuropathic nervosa.
(4) schizophrenia: patients with this disease can be followed by binge eating behavior, the patient is silent, without any weight control behavior, and other symptoms of schizophrenia.
(5) Epileptic and other organic diseases: can occur binge eating behavior, medical history, physical examination and various experiments involving EEG and other functional tests, have organic disease basis, do not consider bulimia nervosa, and such patients lack Control the inappropriate behavior of weight.
