Eating Disorders Self-Help and Recovery Tips

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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Bulimia Help Method

Endorsed by University Professors, Eating Disorders Specialists, Doctors and former bulimics, the Bulimia Help Method is a proven & trusted approach to lifelong recovery from bulimia. The Bulimia Help Method home treatment program gives you the insight, skills and tools needed to break free from bulimia and to make peace with food and your body. You are guided step-by-step along the way so you always know what to expect and what to do next. A powerful audio program will help to reprogram your old eating habits at a sub-conscious level, speed up your recovery and help you feel more calm and grounded.

Bulimia Help Method Summary


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Sleep Eating Disorders

There are two eating disorders associated with sleep, both of which are much more common in women than men. characterized by compulsive refrigerator raids during the night. People with this disorder are usually light sleepers who, upon awakening, feel that they won't be able to fall back to sleep unless they eat something. So they get out of bed, head to the refrigerator, and begin wolfing down food. The person is fully alert during the episode and can recall it the next day. This is more of an eating disorder than a sleep disorder, so it's usually best to seek treatment from a mental health professional who specializes in eating disorders. Since insomnia is a contributing factor, improving sleep hygiene often can help the individual's progress. Sleep-related eating disorder. This disorder is a variation of sleepwalking in which people get up and eat during a partial arousal from deep sleep. Often they consume unhealthy, high-calorie food that they would not eat during the daytime...

Object Relations and Eating Disorders

More recently, this line of theory and research has been applied to both men and women. Steven Huprich and colleagues (Huprich, Stepp, Graham, & Johnson, 2004), for instance, examined the connection between disturbed object relations and eating disorders hi a nearly equal number of female and male college students. Because eating disorders are much more common in women than in men (Bramion & Feist, 2004), the investigation by Huprich and colleagues was an important addition to the research on eathig disorders of both men and women. The researchers admin- The experimenters used three measures of object relations (1) interpersonal dependency (2) separation-individuation and (3) a general measure of object relations, which assessed alienation, insecure attachment, egocentricity, and social incompetence. The three measures of eatmg disorder assessed (1) anorexic tendencies, (2) bulimic tendencies, and (3) a persons sense of control and self-efficacy over compulsive eating. Results showed...

Starvation malnutrition and anorexia

Malnutrition has many causes, of which economic deprivation is the commonest. However, even in wealthy societies, ill health, gastrointestinal diseases, such as oesophageal cancer, and anorexia nervosa, as well as voluntary fasting, can all cause malnutrition and starvation.

Selective Serotonin Reuptake Inhibitors

Potential side effects include nausea, anorexia, more frequent or loose stools, anxiety, restlessness, sleep disturbance (insomnia or hypersomnia), headache, diminished sexual drive, orgasmic dysfunction, and apathy. Sinus bradycardia is an uncommon side effect but is rarely symptomatic. Most of these adverse effects are mild or transient, and thus most patients tolerate SSRIs well in the short term. Over the long haul, however, up to 20 percent of patients will discontinue these drugs because of persistent changes in sexual drive or function, and a smaller number will discontinue use because of apathy, gastrointestinal disturbance, or sleep disturbance. Sertra-line hydrochloride is most likely to cause diarrhea, and paroxetine hy-drochloride to cause hypersomnia.

Deadly Drugs For Euthanasia

Not see it as indicative of a rational desire to die. The author of Diseases says that persons with phrenitis, Being deranged, they do not accept anything worth mentioning that is administered to them and as time passes, they waste away and become emaciated as a result of their fever and of the fact that nothing is entering their body. . . . Finally everything becomes cold and the person dies. 18 Epidemics I describes a twenty-year-old man who was attacked by fever . . . thirst tongue dry no urine . . . took no drink until he slipped into a coma and died.19 In these cases, anorexia was seen as integral to a lethal disease rather than as a willful desire to die. There is nothing to suggest that the acquiescence of the physician to this process was analogous to giving a deadly drug.20

Vocabulary Builder

Gastroenteritis An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species consumption of irritating food or drink or psychological factors such as anger, stress, and fear. Called also enterogastritis. eu

Pathogenesis of BEFV Infection

The available evidence indicates that the clinical signs of BEFV infection are due primarily to a vascular inflammatory response. In experimental infections, the incubation period is usually only from 2 to 4 days, and viraemia and clinical signs are of short duration, persisting for only 1-3 days (Mack-erras et al. 1940 St. George et al. 1984 Uren et al. 1989, 1992). There is no evidence of extensive tissue damage other than a vasculitis affecting the endothelium of small vessel synovial membranes, tendon sheaths, muscles, fascia and skin (Mackerras et al. 1940 Basson et al. 1969 Kirkland 2002). Although the initial site of infection following transmission is not known, the virus is subsequently detected primarily in leucocytes and blood plasma (Mackerras et al. 1940 Young and Spradbrow 1980 St George 1993). The onset of fever and other clinical signs is accompanied by a marked leucopoenia, relative neutrophilia, elevated plasma fibrinogen, biochemical imbalance including...

Definition of the Disease

Epstein-Barr virus is a human herpesvirus that is cytotropic for B lymphocytes. This virus occurs worldwide, and most people ( 90 ) become infected at some point during their lifetime.1 Primary infection tends to occur at an early age, especially in lower socioeconomic groups and developing countries. When infection occurs during early childhood, there are usually only very mild symptoms or no symptoms at all. However, if a primary EBV infection occurs during adolescence or adulthood, then infectious mononucleosis (IM) often arises. In a typical case of IM, a prodromal period consisting of malaise, anorexia, and or myalgias usually precedes the onset of the syndrome by a few days to a week. The syndrome is typically characterized by fever to 102- 104 F (39 -40 C) (90 of patients), cervical lym-phadenopathy (90 ), diffuse and exudative pharyngitis (33 ), and or rash (5 ). Splenomegaly is found in about half of IM patients, and usually occurs during the second or third week of illness....


Migraine presents as a paroxysmal headache disorder, with periods of relative quiescence between episodes. Headaches typically manifest as a unilateral, throbbing head pain lasting hours to days. Associated symptoms may include anorexia, nausea, vomiting, malaise, photophobia, phonophobia, or blurred vision. Migraine with aura presents with peculiar, transient neurosensory perceptions before or concomitant with the pain phase. Headaches may be precipitated by food intake (meats and cheeses with high nitrites, nuts, chocolate, alcohol ingestion), caffeine withdrawal, menstruation, bright lights, and exercise. Patients will often seek a dark, quiet room to help relieve the symptoms.

Effects and consequences

Chronic vomiting, as in bulimia, can cause acid damage to the teeth and gums. Furthermore, prolonged or profuse vomiting can deplete fluid and electrolytes, leading to dehydration and altered blood chemistry. Vomiting of gastric contents typically causes hypokalaemia, hyponatraemia and metabolic alkalosis, while loss of HCO3- in intestinal contents can cause metabolic acidosis.

Case Study 2 The Dangers of Special Nutrients

A 33-year-old white woman experienced severe fatigue and malaise for 2 weeks that intensified over the previous 3 days. She came to an emergency department complaining of the above symptoms plus fever, nausea, and abdominal pain. Because of a history of depression she had received paroxetine and fluphenazine for many months but she discontinued these drugs 2 weeks earlier. At the time of this admission she was off all medications except an over-the-counter natural product for weight loss. Although she weighed only 90 lbs and was 5 ft 3 in. tall, she was trying to lose weight and had succeeded to the extent of a 10-lb. loss over the past 2 weeks. Later on she was diagnosed with an eating disorder and psychiatric counseling was begun.

Maletomale transmission See transmission

Malnutrition in AIDS can result from many different factors. Inability to take in a proper amount of nutrients can be the result of impaired swallowing and taste due to infections in the mouth or the esophagus, AIDS medications that have anorexia, nausea, and vomiting as side effects, or limited financial resources that make three meals a day difficult to manage. Diarrhea and changes in absorption caused by bacteria, viruses, or parasites may impair nutritional intake. Some medications, particularly antibiotics, may change the normal bacterial composition of the intestine and interfere with breakdown of food. Finally, an increase in metabolism often occurs in many people with HIV and leads to an increased need for nutrients. The presence of HIV itself as well as some of its associated infections can increase the metabolic rate. These three factors diminished intake, malabsorption, and hypermetabolism usually occur simultaneously to deplete the body of nutrients.

Other protozoan infections

A number of other protozoa have been associated with food- and water-borne infections in humans. These include Microsporidium, that causes watery diarrhea and malabsorption, and are becoming an increasingly recognized problem in the immunocompromised. Various microsporida, including Enterocytozoon bieneusi and Septata intestinalis, cause human disease. Isospora belli, another apicomplexan protozoon, is an opportunistic pathogen in immunocompromised patients. Sarcocystosis is a rare zoonotic infection in humans that can, on occasion, cause necrotizing enteritis. Dientamoeba fragilis was originally thought to be a commensal but now appears to be associated with a variety of gastrointestinal symptoms, including abdominal pain, nausea, diarrhea, and anorexia. Balantidium coli is the only ciliate known to parasitize humans. Although most infections are asymptomatic, the disease may present itself as dysentery. Blastocystis hominis is a strict anaerobic protozoon that infects both...

Giant Cell Temporal Arteritis

Immune-mediated inflammation of the temporal and other extracranial arteries produces headache and temporal artery tenderness, often accompanied by palpable abnormalities in the temporal arteries. Suspect this disorder in elderly persons, especially those with associated systemic symptoms of polymyalgia rheumatica (myalgias, fatigue, malaise, and anorexia). The erythrocyte sedimentation rate usually (but not always) is markedly elevated, but prompt temporal artery biopsy should be obtained for diagnosis. Urgent corticosteroid therapy is indicated, lest delayed treatment result in ocular ischemia and permanent visual loss.

Phase i clinical trials in solid tumors

Recently, results of a phase I trial by Aghajanian et al. have been published. In this study, 43 patients in a variety of neoplasms were treated with single-agent bortezomib in doses ranging from 0.13 to 1.56 mg m2 dose. The tumor types included were non-small-cell lung cancer (NSCLC), colon, head and neck, melanoma, ovary, renal, prostate, bladder, cervix, endometrial, esophagus, gastric, and unknown primary. A total of 89 doses were administered, with an average of 2 cycles per patient. The median number of previous chemotherapeutic regimens was four. Reported DLTs were diarrhea and sensory neurotoxicity. Other side effects seen were fatigue, fever, anorexia, nausea, vomiting, rash, pruritus, and headache. There was no dose-limiting hematological toxicity. One partial response was seen in a patient with NSCLC. The maximum tolerated dose (MTD) was established at 1.56 mg m2. Pharmacodynamics studies showed a dose-related inhibition of 20S proteasome activity with increasing dose of...

Child and Adolescent Psychiatry

The mental, behavioral, and developmental problems that affect children and teenagers include autism, attention-deficit hyperactivity disorder, learning disorders, bulimia and anorexia, behavioral disorders, and emotional disturbances. In their diagnostic examinations, child psychiatrists look at many components, from physical to cognitive, and from genetic to emotional. They take an integrative biopsychosocial approach, and consult with physicians and professionals from schools, social agencies, and juvenile courts. Working with kids

Woman with a Rash and Lower Extremity Pain

The patient developed anorexia and lower extremity pain with weakness, nausea, and vomiting over the next week. On presentation to the emergency room, she also complained of fatigue, suprapubic pain, and fullness. The history was remarkable for frequent urinary tract infections over the prior 6 months, but no prior chronic health issues, surgeries, or pregnancies. Placement of a urinary catheter produced 1 L of clear output she was thus admitted with urinary retention and severe pain of the lower extremities. Further questioning revealed that the patient was involved in a long-term monogamous relationship (which included unprotected intercourse), that she had a cousin with lupus, that she smokes a pack per day, and that she had no known drug allergies.

Silvermans Experiments

Using other cues with other patient populations, Silverman claimed that unconscious arousal of the specific conflict identified by psychoanalytic theory to be associated with each diagnosis (e.g., oral conflict for schizophrenics and anal conflict for stutterers) could produce an increase or decrease of the symptoms (Silverman, Bronstein, & Mendelsohn, 1976). Among women with eating disorders, subliminal arousal of abandonment conflict led to increased eating in a bogus cracker-rating task (Patton, 1992). An appropriate stimulus ( Beating Dad is OK ) was even reported to improve dart-throwing performance in college males (Silverman, Ross, et al. 1978). If the stimuli were presented at longer exposures, so that they could be consciously recognized, there was no effect on the symptoms only unconscious dynamics produced changes.

Self Ideal Congruence and Mental Health

Higgins's theory has garnered much empirical attention since the mid-1980s. Some of the recent topics have ranged from alcohol consumption (Wolfe & Maisto, 2000), eating disorders (Veale, Kinderman, Riley, & Lambrou, 2003), procrastination (Orellana-Damacela, Thidale, & Suarez-Balcazar, 2000), and mental health hi general (Liao & Fan, 2003). For instance, Wendy Wolfe and Stephen Maisto (2000) tested the prediction that higher real-ideal self-discrepancy would be related to greater alcohol consumption in a sample of university students. Wolfe and Maisto reasoned that people who have large real-ideal self discrepancies look to relieve then negative affective states (anxiety, depression) by turning to alcohol. They went on to reason that this effect should be even stronger on those dimensions of self-concept that are particularly important and salient to the individual. In other words, they believed both the magnitude of the discrepancy and the salience of the discrepancy should be...

Psychiatric Referral of Depressed Patients

Patients at risk for malnutrition and dehydration should also be referred, but the primary care physician will be called on to manage potential medical complications as the psychiatrist speeds recovery from the depression. Patients with concurrent psychiatric illnesses (e.g., eating disorders, obsessive-compulsive disorder) should have a psychiatric consultation. Patients with a history of bipolar I disorder deserve similar referral, since antide-pressant treatment can precipitate mania. Patients who have failed to respond to two antidepressant drug trials should have at least a consultation with a psychiatrist to confirm the diagnosis and to evaluate any factors hindering the response to treatment.

Other Symbolic Therapy Techniques

Myths can provide meanings for patients' problematic behaviors, too. For example, the self-starvation eating disorder anorexia nervosa can be given larger meaning by interpreting this behavior as an unconscious acting-out of the ascetic ritual of fasting, which is intended as a spiritual exercise (Barrett & Fine, 1990). Thus the symptom, the illness, provides an unconscious connection with larger, and more healthy, spiritual meaning.

Relaxation Techniques

Especially Beneficial If you have an eating disorder or tend to hold in your stomach (may help you focus on your body in healthier ways) May Not Be Suitable If you have an eating disorder or have had recent surgery that affects body image or if you have a condition that makes tensing the body especially uncomfortable

Roles Of Orexin In The Regulation Of Feeding Behavior And Body Weight Homeostasis

These regulatory mechanisms of orexin neurons by feeding behavior-regulating factors suggest that orexin neurons are activated upon fasting and that orexin is involved in the system that regulates feeding behavior and body weight. Orexin might regulate motivational and emotional aspects of appetite, because orexin neurons interact with dopaminergic neurons and the limbic system, as well as arousal pathways (33). When orexins are administered centrally to rodents, they elevate sympathetic tone, plasma corticosterone levels (34), metabolic rate (35), food intake (4), locomotor activity (33) and wakefulness (34). Most of these effects resemble those observed in fasted animals (36-38). These observations suggest that orexin neurons are activated during fasting and elicit appropriate behaviors, including feeding. Orexin receptor agonists and antagonists might also be useful in novel treatments for obesity, eating disorders, or other autonomic metabolic disorders (10).

Bovine Ephemeral Fever in Australia and the World

Abstract Bovine ephemeral fever (BEF) is a disabling viral disease of cattle and water buffaloes. It can cause significant economic impact through reduced milk production in dairy herds, loss of condition in beef cattle and loss of draught animals at the time of harvest. Available evidence indicates clinical signs of BEF, which include bi-phasic fever, anorexia, muscle stiffness, ocular and nasal discharge, ruminal stasis and recumbency, are due primarily to a vascular inflammatory response. In Australia, between 1936 and 1976, BEF occurred in sweeping epizootics that commenced in the tropical far north and spread over vast cattle grazing areas of the continent. In the late 1970s, following several epizootics in rapid succession, the disease became enzootic in most of northern and eastern Australia. In Africa, the Middle East and Asia, BEF occurs as also epizootics which originate in enzootic tropical areas and sweep north or south to sub-tropical and temperate zones. The causative...

The Recovered Memory Controversy

One controversial technique that was used by a small minority of therapists has now been discredited recovered memory therapy. The idea behind this therapy, consistent with psychoanalytic ideas, was that traumatic sexual experiences in childhood had led patients to develop a variety of symptoms (depression, promiscuity, eating disorders, and others) and also to repress the memory of the abuse. If memory for the traumatic event could be restored, it was thought, a therapeutic benefit would be obtained aim (Blume, 1995 Freyd, 1994, 1996 Whitfield, 1995). Unfortunately, belief in this model was so zealous among a few therapists that they jumped to a conclusion of sexual abuse with minimal evidence, even over the objections of patients (who were thought to be actively repressing the memory), and through suggestion, therapists gradually convinced many patients of their traumatic past. Sometimes these inferences are true. Sometimes they are false. Occasional reports are so bizarre,...

Alveolar proteinosis See pulmonary alveolar

Amenorrhea Absence or suppression of menstruation. Amenorrhea is normal before puberty, after menopause, and during pregnancy and lactation. Primary amenorrhea is the failure of the menstruation cycle to begin at puberty this may result from a congenital defect in the reproductive organs. The term usually refers to a condition caused by reasons other than these. secondary amenorrhea is the suspension of menstruation after it has been established at puberty, and may result from an illness, a change of environment, or irradiation or removal of the uterus or ovaries. it is also associated with certain metabolic disorders (obesity, malnutrition, diabetes) and certain systemic diseases (syphilis, tuberculosis, nephritis). Amenorrhea may also result from emotional causes (excitement, anorexia nervosa), pituitary disorders (hormonal imbalance of estrogen, progesterone, or follicle-stimulating hormone), or eating disorders (obesity, anorexia).

Differential Diagnosis

The etiologies of hypoglycemia are numerous, with 100 reported causes.1 A convenient way to classify the disorder is by the age of onset and general health of the individual. Common causes in neonates include prematurity, maternal diabetes mellitus, sepsis, or respiratory distress syndrome. In infants and children unexplained hypoglycemia evokes consideration of Reye's syndrome, congenital hyperinsulinism (also called persistent hyperinsulinemic hypoglycemia of infancy, caused by mutations in an ATP-dependent potassium channel resulting in alterations of the b-cell glucose-sensor and unrestrained insulin release even at very low glucose levels), and inborn errors of metabolism. The last category includes disorders of glycogenolysis, gluconeogenic defects, hereditary fructose intolerance, organic acidemias, or defects in amino acid and fatty acid metabolism. Common causes of hypoglycemia in a healthy-appearing adult without known coexisting disease include insulinoma, factitious...

Universal precautions In 1985 the centers for

Uremia A toxic condition caused by chronic or acute renal failure, resulting in an excessive amount of nitrogenous substances in the blood that are normally excreted by the kidneys the constellation of symptoms associated with this condition, including anorexia, nausea, and vomiting.

Bronchopneumonia See pneumonia

Bulimia A destructive pattern of overeating followed by vomiting or other purging behaviors in order to control weight. Unlike girls with anorexia, those with bulimia eat large amounts of food and then get rid of the excess calories by vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively. Some use a combination of all of these. Because many girls with bulimia binge and purge in secret and maintain normal or above-normal body weight, they often can successfully hide their problem from others for years. Bulimia becomes a serious problem when a girl is bingeing and purging at least twice a week for three months, while becoming excessively worried about her body shape and weight. Dieting heavily between episodes of bingeing and purging is common eventually, half of girls with anorexia will develop bulimia. About 2 percent to 3 percent of young girls develop bulimia. Certain personality characteristics seem to be associated with bulimia, including a fear of...

Clinical manifestations

Palpable Purpura

Although normally asymptomatic, local symptoms may include pruritus, pain, or burning. Complaints of systemic symptoms, including fever, arthralgias, myalgias, anorexia, or gastrointestinal pain should raise the suspicion that a cutaneous vasculitis may be associated with a systemic vasculitis. In a study conducted by Ioannidou (2002) renal involvement in patients with CSVV led to the reclassification as Henoch-Schonlein purpura, microscopic polyangiitis, or Wegener's granulomatosus in 29-90 patients.

Definition of Alcoholic Liver Disease

Alcoholic Hepatitis The diagnosis of alcoholic hepatitis (AH) is usually based on a history of prolonged alcohol intake and clinical findings of abdominal pain, anorexia, nausea, vomiting, fever, leukocytosis, and tender hepatomegaly.2 Serum AST is characteristically elevated but

Hypocretin Hcrtr1 And Hcrtr2 Mutation Screening

Only one case, clinically different from those usually observed, was found to have a mutation likely to cause narcolepsy (32). This case is unusual because of the very early onset of cataplexy at 6 mo of age. Sleep onset REM periods during the MSLT, period leg movements (PLMs), and nocturnal bulimia were also reported. The patient is HLA negative and has undetectable CSF hypocretin-1. The mutation was not present in the unaffected mother, and the father's genomic DNA was unavailable. To understand the functional significance of this latter mutation, we developed a DNA construct fused to a green fluorescent protein and trans-fected it into neuroblastoma cells. The mutant peptide did not go through the trans-Golgi network into mature secretory vesicles, rather, the mutant construct accumulated in a compartment likely to be the smooth endoplasmic reticulum, demonstrating that the mutation results in an abnormal trafficking of the peptide precursor. We hypothesized that this effect may be...


Ciency or lack of secretion of adrenocortical HORmones. It may be a result of tuberculosis or autoimmune-induced adrenal disease. Its symptoms include occasional discoloration of the skin and mucous membranes, irregular patches of vitiligo (depigmentation of the skin), black freckles over head and neck, fever, tumors, hemorrhagic necrosis, weakness, fatigue, hypotension, nausea, vomiting, anorexia, weight loss, and sometimes hypoglycemia. If not treated, it is usually fatal. See adrenal function and adrenal

Hair loss

Because anorexia is basically self-starvation, the body is denied the essential nutrients it needs to function normally. As a result, it is forced to slow down all of its processes to conserve energy. This slowing down can have serious medical consequences, including an abnormally slow heart rate and low blood pressure. The risk for heart failure rises as heart rate and blood pressure levels sink lower and lower. Thyroid function slows, menstrual periods stop, and even breathing slows down. Nails and hair become brittle, the skin dries and yellows. Girls may become very thirsty and urinate often, as dehydration contributes to constipation and reduced body fat leads to lowered body temperature. Children with anorexia also can develop osteoporosis, muscle loss and weakness, severe dehydration leading to kidney failure, fainting, fatigue, and overall weakness, hair loss, and growth of a downy layer of hair called lanugo all over the body, including the face. As the girl's weight...


As with any patient, the first step is to obtain a good history (Fig. 1). Because most of the symptoms of thyroid dysfunction are nonspecific, the PCP must first think about possible thyroid disease from the presenting complaints. For example, the patient might present with weight loss. The physician might think about hyperthyroidism as a diagnostic possibility along with such entities as infection, neoplasm, and anorexia.

Taking a History

In general practice settings, the existence of major depression may be obscured by somatic complaints because insomnia, anorexia, diminished libido, fatigue, and feelings of ill health are common during depressive episodes. When patients have such symptoms, it is therefore important for the physician to inquire about other manifestations of a mood disorder. Moreover, medical illnesses and major depression frequently coexist, and both types of disorder deserve appropriate assessment. Changes in appetite are similarly variable. The typical patient with major depression complains of diminished appetite and consequent weight loss. Others, however, overeat (often consuming junk food) and gain weight with every depressive episode. The physician should therefore inquire about not only anorexia, but also any recent change in appetite or weight. The physician should also assess past psychiatric illnesses other than mood disorders. Panic disorder, eating disorders, and obsessive-compulsive...

Rules of the Road

Binge eating disorder An eating disorder that resembles bulimia but without the vomiting (purging). Girls with binge eating disorder feel that they lose control of themselves when eating, gorging themselves with huge amounts of food until they are uncomfortably full. usually, they have more problem losing weight and keeping it off than do girls with anorexia or bulimia. In fact, most girls with the disorder are obese and have a history of weight fluctuations. About 3 percent of all teenage girls develop binge eating disorder.

Clinical Features

Clinical features usually depend on the rate at which hyponatremia develops. In general, slowly progressive hyponatremia is associated with fewer and less severe clinical symptoms than is an equivalent degree of hyponatremia that is acute in onset.4 Mild, chronic hyponatremia may be asymptomatic. When the serum sodium concentration falls below 125 mmol L, mild CNS symptoms such as confusion, lethargy, fatigue, anorexia, nausea, and muscle cramps may develop. More severe CNS symptoms can occur with a further fall in serum sodium and include hypothermia, delirium, coma, seizures, Cheyne-Stokes respiration, and pathologic reflexes. Sudden death can occur when there has been rapid development of hyponatremia to values below 115 mmol L.

Emesis Vomiting

Ipecac is relatively innocuous despite the fact that cephaline is cardiotoxic. The amounts used in poisoning therapy are too low to constitute a cardiac threat however, there are cases of persons who abused ipecac by using it in a bulimic manner and such persons exhibited cardiac arrhythmias. There are also a number of cases of


Hypochondriacal beliefs (e.g., no bowel movements for many weeks without evidence of constipation), ideas of poverty (e.g., complaints of no money, insurance, or clothing when that is not the case), or guilt and self-blame (e.g., unfounded beliefs that the person has harmed others). Because depressed patients often feel unwell, with insomnia, anorexia, and lethargy, they may present to their primary care physicians with somatic complaints.

Major Depression

Physical complaints are very common in major depression. Lack of energy, gastrointestinal symptoms, anorexia, weight loss, sexual dysfunction, and vague pains or headache may be the patients chief complaint. Typical findings of a low mood, poor self-esteem, feelings of hopelessness, suicidal thoughts, and signs of slowed psychomotor activity support the diagnosis of major depression. Some patients have a delusional belief that they have cancer, AIDS, or another terrible disease. There may be previous episodes of depression or mania and a family history of affective disorder. It is not understood why some patients with major depression present to physicians with primarily physical complaints while others do not. The former patients may have different premorbid personalities (e.g., more introverted), have had different early life experiences (e.g., more losses), or be products of a different sociocultural environment (e.g., a culture that disapproves of emotional expression). The...

Related Research

Both object relations theory and attachment continue to spark some empirical research. For example, object relations has been used to explain the formation of eating disorders. This research rests on the assumption that having unresponsive or inconsistent caregivers leads to children's inability to reduce anxiety and frustration. As applied to eating disorders, when these individuals feel anxious, they look for comfort hi external sources and food is a primary means of soothing and regulating then anxiety. Prior research has supported these assumptions, primarily hi women. For instance, Smolak and Levine (1993) found that bulimia was associated with overseparation (detachment) from parents, whereas anorexia was associated with high levels of guilt and conflict over separation from parents.

Flucytosine 185

Flucytosine is not used much anymore. It requires a large number of pills, too many times a day. It was initially used together with amphotericin b to treat cryptoccocal illness. However, the side effects of flucytosine are very difficult to manage in combination with use of amphotericin B. These include bone marrow toxicity, which leads to low platelet, white, and red blood cell counts nausea vomiting anorexia bloating diarrhea and elevated liver enzyme levels. Renal functions can also be tough to manage on this medication. It is easier to manage in combination with fluconazole. The combination of flucytosine and fluconazole is effective in treating cryptococcal meningitis to

Fluid retention

Fluoxetine hydrochloride An antidepressant that is approved for treatment of major forms of depression. It is also used to treat obsessive-compulsive disorder, bulimia nervosa, and premenstrual dys-phoric disorder (commonly referred to as PMS). Fluoxetine works by slowly restoring normal levels of a nerve transmitter (serotonin). Possible side effects are decreased appetite and weight loss. Some patients have reported conversion of depression to mania in manic-depressive (bipolar) disorders, but this effect is rare. Although press reports suggested fluoxetine caused major depression and suicidal ideation in many people who used it, a review of literature on this subject reveals that development or intensification of suicidal thoughts during treatment (regardless of the severity of depression) has been documented for many anti-depressant drugs in use. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI), referring to its family of drugs. (Trade name is Prozac.)

Adolescent Medicine

In this growing subspecialty, prominent areas of prevention and treatment include substance abuse, eating disorders, acne, sexually transmitted diseases, pregnancy, and depression. In addition, adolescent medicine emphasizes the management of chronic diseases that begin in childhood and continue into adulthood, such as asthma, cystic fibrosis, congenital heart disease, and diabetes. Practice settings include high school- and university-based student care centers, mobile clinics, and outpatient clinics. Many adolescent medicine specialists work within large academic medical centers or in the public health sector.

Hepatitis A virus

Hepatitis A is an RNA virus belonging to the family Picornaviridae and is present throughout the world. Hepatitis A is usually spread by direct contact from one person to another via the fecal-oral route. There have been many examples of outbreaks of hepatitis A due to contaminated food or water. Some of the incriminated foods include raw shellfish, milk, potato salad, and orange juice. The incubation period following exposure is around 30 days, with a range of 15-50 days. This long incubation period can make tracing the source of infection very difficult. Clinically, hepatitis A may be mild or even asymptomatic, especially in children. In adults, it usually begins with flulike symptoms of headache, myalgia, anorexia, nausea, vomiting, and headache. This is then followed by the development of jaundice. In hepatitis A, the rule is that the disease is self-limiting and long-term consequences are unusual, but occasionally the hepatitis can become fulminant. While during the acute...


Megestrol A synthetic derivative of the female sex hormone progesterone, megestrol is an appetite stimulant. It has also been used for the treatment of breast and endometrial cancers. Megestrol is available in two different forms. The oral liquid is prescribed for the treatment of anorexia and unexplained weight loss in people with HIV. The tablets are prescribed for treatment of symptoms of breast or endometrial cancer. Megestrol does not affect the course of breast cancer, endometrial cancer, or HIV it simply alleviates the symptoms. patients on megace, the brand name for megestrol, tend to gain fat, according to studies. patients should notice a return of appetite and some weight gain within the first six weeks.


This alkaloid is a natural product whose commercial presence is limited to ipecac syrup. As described in Chapter 3, it is recommended as a means of inducing vomiting to reduce absorption of other toxins. Emetine is toxic in its own right but only when used on a chronic basis. Two situations in which this has occurred are ipecac use by individuals suffering from bulimia and in the context of child abuse. Emetine has been shown to accumulate in the heart and cause histopathological changes and abnormal electrocardiograms. As with many other toxins, the exact mechanism of toxicity is not clear but it probably relates to an impairment in myocardial energy production.

Pain threshold

Alternate routes of administration of drugs is an important element in pain management. Dehydration, malnourishment, and electrolyte imbalance due to vomiting, diarrhea, and anorexia impede the effectiveness of oral medication. In the case of vomiting, rectal or topical routes are advised. For difficulties with swallowing, liquid or rectal preparations are suggested. Few people with AIDS require injected opiates if the appropriate analgesics are prescribed in adequate doses via the most suitable route. However, skin patches releasing fentanyl, designed to last up to 72 hours, are a convenient way to administer topical pain relief.


Candidates will be expected to have a broad knowledge of the theoretical and practical aspects of psychiatry including the clinical approach to the patient. The ability to elicit a comprehensive history and adequately assess the patient's mental state will be necessary. Assessment may include personality development, organic psychiatric syndromes, schizophrenia, the affective disorders, the clinical neuroses, personality disorders, alcoholism and drug abuse, eating disorders, mental handicap, common childhood psychiatric disorders, psychosomatic disorders, forensic psychiatry, psycho sexual problems and common psychiatry.

Sports Medicine

Sports medicine is a 1-year fellowship that provides great freedom for pediatricians. You can work as a general pediatrician and use the training to be the team physician for schools in your community, or you can join an orthopedics practice and work full-time helping children and adolescents with all types of injuries. With high-achieving athletes, watch closely for signs of eating disorders and irregular menses, and with certain fractures in children, carefully consider whether the mechanism of fracture merits further investigation. Fellowships in sports medicine are very competitive and can also be entered from family practice and internal medicine.

Skinny Women

Who starve themselves into fashionable shape. The weight of the Miss Americas falls steadily year after year. So does that of Playboy centerfolds. Both categories of women are 15 percent lighter than the average for their ages.' Slimming diets fill the newspapers and the wallets of charlatans. Anorexia and bulimia, diseases brought on by excessive dieting, maim and kill young women.


Biliary disease often causes nausea and anorexia. Symptoms may be aggravated by fatty meals, which stimulate cholecystokinin release, which in turn stimulates gallbladder contraction. Abdominal pain, localized to the right upper quadrant, is caused by distension of the gallbladder and bile ducts, and a tender, inflamed gallbladder may be palpable. The pain is typically colicky, or episodic, aggravated by waves of ineffective peristalsis. Pancreatitis and bacterial infection cause severe, persistent pain, which may be accompanied by fever and rigors.

Personal Constructs

Kelly's philosophy assumes that people's interpretation of a unified ever-changing world constitutes then reality. In the chapter opener, we introduced Arlene, the student with the broken-down automobile. Arlene's perception of her transportation problem was not a static one. As she talked to a mechanic, a used-car dealer, a new-car dealer, a banker, her parents, and others, she was constantly changing her interpretation of reality, hi similar fashion, all people continually create their own view of the world. Some people are quite inflexible and seldom change their way of seeing things. They cling to their view of reality even as the real world changes. For example, people with anorexia nervosa continue to see themselves as fat while their weight continues to drop to a life-threatening level. Some people construe a world

The Azoles

Voriconazole Synthesis

Ketoconazole pharmocokinetics corresponds to a dual model with an initial half-life of 1-4 h and a terminal half-life of 6-10 h, depending on the dose. This drug highly binds to plasma proteins and penetrates poorly into the CSF, urine, and saliva. Peak plasma concentrations of approximately 2, 8, and 20 g ml are measured 1-4 h after corresponding oral doses of 200, 400, and 800 mg. The most common and dose-dependent adverse effects of ketonazole are nausea, anorexia, and vomiting (Table 4.2). They occur in 10 of the patients receiving a 400-mg dose and in approximately 50 of the patients taking 800-mg or higher doses. Another limiting factor of ketoconazole therapy is its numerous and significant adverse interactions with other concomitant drugs (see Table 4.3 for a summary of the interactions of the azoles with other drugs administered to patients during azole therapy).

Common disorders

Abdominal pain, diarrhoea, flatulence, weight loss and nutritional deficiencies are the main symptoms of small intestinal disorders. Obstruction of the small intestine may be caused by disease within the intestine, or by external compression, or twisting, as in a strangulated hernia. Typical symptoms are pain, anorexia and vomiting.

Roxithromycin 431

Ritonavir A protease inhibitor manufactured by Abbott Laboratories and approved for the treatment of HIV disease. The most common adverse effects associated with ritonavir are gastrointestinal nausea, vomiting, diarrhea, and anorexia. Circumoral and peripheral paresthesias have also been reported. Common laboratory abnormalities include elevated liver enzymes in the blood and elevated cholesterol and triglycerides. Metabolic abnormalities, redistribution of body fat, and diabetes have been associated with regimens containing protease inhibitors. Initial adverse effects associated with ritonavir may be because of high drug concentration in the blood during the first two weeks of therapy. The manufacturer recommends a dose-escalation protocol to increase tolerance. Ritonavir is a potent inhibitor of the cytochrome P450 3A4 isoenzyme, an important metabolic pathway for many common drugs. Other P450 pathways are induced by ritonavir and some drug levels are lowered. Note that all approved...

Anion gap

Anorexia Lack or loss of appetite for food (sometimes known as inappetence). This is common in the onset of fevers and systemic illnesses, certain psychiatric illnesses, depression, and malaise, and in disorders of the alimentary tracts, especially the stomach. It also is a common result of alcoholic excesses and drug addiction. Many drugs and medical procedures have the undesired side effect of causing malaise with concurrent anorexia. Because anorexia is a common HIV disease-related complication, a patient's appetite is a key piece of clinical information causes of inappetence may include undiagnosed or untreated opportunistic infections. Many drugs used against HIV have side effects that include nausea and anorexia. As the number of medications given to an HIV AIDS patient grows, the impact on his or her overall well-being, including nutritional status, must continually be reassessed. Small, frequent meals and calorically dense foods and beverages are often recommended shared meals...

Cestodes And Worms

H. nana, the dwarf tapeworm, is very common in humans and is transmitted via the fecal-oral route. This worm does not require an intermediate host. The majority of infections are asymptomatic but diarrhea, abdominal cramping, and anorexia may occur. The diagnosis is dependent on identifying the typical double lumen eggs in the stool and treatment with praziquantel should be curative.

Protease paunch

Medical complications of advanced HIV disease can also influence the use of combination anti-retroviral therapy. Wasting and anorexia can prevent individuals from following the dietary requirements necessary for effective absorption of protease inhibitors. Protease inhibitors may pose a greater risk of liver effects for individuals with HIV-related liver dysfunction. Because of the broad possibilities for detrimental drug interactions, individuals taking antiretroviral therapy should always discuss with the physician any new drugs they may consider taking, including over-the-counter and alternative medications.


Including profound diarrhea lasting 1 to 3 weeks. Clinical signs include weight loss, nausea, anorexia, vomiting, and abdominal cramping (Herwalt, 2000). Among immunocompromised individuals (e.g. HIV-infected), cyclosporiasis symptoms may be exacerbated. However, drug treatment is generally effective in controlling infection and relapse (or reinfection) can be averted by maintenance or prophylactic drug dosages (Pape et al., 1994 Verdier, et al., 2000).

The Oral Stage

The hypothesized relationship between oral fixation and behavior that is conforming and dependent is sometimes supported. People with oral imageiy on the Rorschach test conform more to others' judgments on an Asch-type judgment task, particularly in the presence of a high-status authority figure (Masling, Weiss, & Rothschild, 1968 Tribich & Messer, 1974), and they are more likely to indicate on personality tests the need for help (O'Neill & Bornstein, 1990). They are capable of disagreeing too, though, if that will create a favorable impression to an authority figure, according to Bornstein (1997), who advocates understanding dependency in terms of relationships with other people (object relations), instead of orality (Bornstein, 1996). Studies suggest that oral concerns in the most literal sense, that is, preoccupation with food and eating, might be unrelated to dependency (Bornstein, 1992, p. 17), contrary to Freud's theory (Young-Bruehl, 1990). Developments in psychoanalysis since...


In hypnosis, an individual (the subject) experiences a highly suggestible state, often called a trance, in which the suggestions of a hypnotist strongly influence what is experienced or recalled. The hypnotist may suggest that the subject's arm will rise in the air automatically, without the subject intending it, or that the subject will be unable to do something that is usually easy to do, like bending an arm. Suggestions can also alter perceptions, causing subjects to see things that are not there, to not see things that are there, or to not feel pain. In the popular mind, hypnosis can be used to compel people to do what they otherwise would not do, including criminal or sexual acts. In fact, the research evidence does not support these claims (Gibson, 1991), but through posthypnotic suggestion, in which the hypnotist suggests that a particular action or experience (sensation) will occur when the hypnotic trance is ended, therapeutic benefits can occur. For example, a hypnotist may...

Clinical Findings

However, the severity of dysentery varies widely from severe to asymptomatic infection (asymptomatic infections are common in highly endemic areas where up to 50 of all Shigella infections may be asymptomatic). In experimentally infected volunteers, the classical triad of shigellosis (fever, abdominal pain, and passage of blood and mucus in diar-rheal stools) was observed only in half of those infected (DuPont et al., 1969). The disease usually begins with fever, anorexia, fatigue and malaise. Patients presenting with high fever, frequent bloody stools of small volume (sometimes grossly purulent), abdominal cramps or tenesmus, and showing large clumps of leukocytes in their feces, can be given presumptive diagnosis of bacillary dysentery. The typical illness usually begins with fever (38-40 C), with lower abdominal pain, watery diarrhea and malaise. Watery diarrhea may be brief or even absent. Severe dehydration is not a typical picture. However, in malnourished...

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