Cases reported "Bulimia"

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1/12. Empowerment through giving symptoms voice.

    This paper takes the perspective that physical and behavioral symptoms can be viewed as a form of mind-body communication. If the symptoms are listened to and "given voice," they can point the way to addressing imbalances influencing the development of the symptoms or to examining factors that can empower clients to heal. The author contends that women's traditional gender socialization may play a role in developing symptomatic bodily expression. It is proposed that hypnosis provides a suitable method for hearing and translating the mind-body communication. The application of hypnotic techniques is illustrated through two case examples.
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2/12. binge-eating disorder and obesity. A combined treatment approach.

    patients presenting with both obesity and BED face multiple challenges: normalizing their eating, improving their physical health, and working to enhance their own acceptance of their body image. In an effort to feel better about themselves, they often have become trapped in a cycle of desperately attempting to diet, then losing control, binge eating, and gaining even more weight. Several psychological and pharmacologic treatment approaches have been used in this population. Most suppress binge eating in the short term, and some seem promising in the long term as well. However, sustained weight loss remains a largely unrealized goal. More recently, BED treatment programs have attempted to address these goals sequentially or in combination. In either approach, it is clear that adopting a long-term focus and promoting enhanced self-acceptance, which have so often been missing from these patients' previous attempts at recovery, are important tasks of treatment that are likely to lead to beneficial lifestyle changes and long-term improvements in physical and psychological health.
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keywords = physical
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3/12. Oral rehabilitation of a bulimic patient: a case report.

    bulimia nervosa is among the most common health problems in contemporary society. It is a self-induced weight loss syndrome associated with distinct dental manifestations involving physical and psychologic symptoms. It is characterized by recurrent binge-purge episodes that occur at least once a day. This article describes the complete-mouth rehabilitation of a bulimic patient with a generalized enamel erosion of her dentition and a poor esthetic appearance. Porcelain-fused-to-metal restorations were used as the definitive treatment. Good esthetics and high self-esteem were the final results. Comprehensive restorative therapy was applied in this clinical case report to achieve both function and esthetics in a demanding situation.
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keywords = physical
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4/12. Full-mouth rehabilitation of a patient with bulimia nervosa. A case report.

    Anorexia and bulimia nervosa are eating disorders seen mainly in adolescents or young patients. The dentist should be in the position to recognize early signs of the disorder and alert the patient (and the patient's parents, if necessary) of the possible physical, psychologi cal, and dental consequences. Such dental treatment may help motivate the patient to confront the problem. In this paper the full-mouth rehabilitation, using a combination of galvano- and metal-ceramic restorations, of a young patient suffering from bulimia nervosa is described.
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5/12. ipecac abuse: a serious complication in bulimia.

    ipecac abuse among bulimics is being increasingly reported. The case presented is a 19-year-old female with significant eating-related problems, including frequent binges and daily use of ipecac to induce vomiting. Medical evaluation revealed significant muscle weakness, cardiac impairment, and altered levels of serum enzymes. The physical debilitation caused by the ipecac use dissipated following apparent discontinuation of ipecac ingestion. The symptom presentation and management problems in this case are discussed to alert clinicians involved in consultation about ipecac abuse.
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keywords = physical
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6/12. Chemical and physical oral findings in a case of anorexia nervosa and bulimia.

    The deleterious effect on enamel of continual acid challenge from regurgitation of gastric contents in bulimic subjects is well documented. No previous reports, however, have been published on chemical and physical measurements of teeth from such subjects, or on the importance of fluoride in maintaining their dentition. Teeth were obtained from a deceased anorexic and bulimic patient. Shortly before death this patient had saliva analyses and in vivo enamel biopsies at our clinic, before and after a 3-week regimen of daily rinsing with 0.05% NaF. After 4 years of daily regurgitation there was an almost normal thickness of the enamel surfaces typically "at risk", i.e. the palatal surfaces of the maxillary anterior teeth, with normal hardness measurements 10 micron away from the outer surface. SEM micrographs showed an irregular topography, with crystalline deposits rich in calcium, phosphate and fluoride. These surfaces were more reactive to uptake of additional fluoride when given as a daily rinse, than the more protected, and therefore, presumed unaffected surfaces. Our findings suggest that frequent and meticulous oral hygiene measures can substantially minimize the erosive effect on tooth enamel of gastric contents in bulimic patients, especially if fluoride products are used regularly.
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keywords = physical
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7/12. Physical and psychological characteristics of five male bulimics.

    The case histories of five men who met DSM-III criteria for bulimia and details of their physical characteristics are given. Various eating disorder questionnaires were administered and the results indicated that most of these instruments would not have identified the men as suffering from an eating disorder. The necessity of caution in asserting the prevalence of bulimia using these measures is emphasised.
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keywords = physical
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8/12. Early trauma, dissociation, and late onset in the eating disorders.

    Although the majority of patients with anorexia nervosa and bulimia nervosa develop these disorders in their teens and 20s, some patients develop an eating disorder in their 30s, 40s, or 50s. We present a subgroup of patients with the following pattern of symptoms and historical detail: (1) severe sexual and physical abuse by family members; (2) relatively good premorbid professional and marital adjustment (considering later difficulties) though characterized by (3) hypomania, binge eating, and morbid obesity. A pronounced shift in eating behaviors follows (4) medical trauma (e.g., injury, cancer, surgery) that occurs after age 30, interrupts previous hypomanic adaptation, and leads to severe restriction, purging, and dramatic weight loss (e.g., 100 lb). Although only one patient met full criteria for anorexia nervosa, weight loss and starvation were serious enough to provoke further medical crises in all patients. Finally, (5) during both weight loss and weight restoration patients demonstrated significant dissociative disturbance, including dissociated mood and personality states (i.e., multiple personality disorder), self-destructive behavioral episodes repeating early trauma, and avoidance of food as a way to manage PTSD symptoms.
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9/12. Enlargement of salivary glands in bulimia.

    We report a unusual case of bulimia nervosa with bilateral swelling of parotid and submandibular glands as the only symptom of the underlying behavioural disorder. Histologically, sialadenosis was diagnosed in a parotid biopsy. The parotomegaly in bulimia may be a diagnostic primer as these patients often deny their eating disorder. B-scan ultrasonography is an important diagnostic tool to assess the nature of the parotid enlargement. Hyperamylasaemia occurs commonly in bulimic patients and may help to confirm the diagnosis. All patients with suspected bulimia should have a thorough medical history and physical examination to rule out other aetiologies of asymptomatic parotid swelling. As the enlargement is usually transient surgical intervention is only rarely required.
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keywords = physical
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10/12. Multiple personality in eating disorder patients.

    Although the overlap between childhood sexual and physical abuse and eating disorders is well known, little work has been done on the sequelae of childhood trauma in eating disorder patients. Dissociative phenomena are common in adult survivors of childhood abuse, with multiple personality disorder (MPD) being the most extreme form of dissociative disorder. We describe two women who presented for inpatient treatment of eating disorders who were subsequently found to have MPD. Because the eating pathology in these patients contained atypical features related to the MPD process, uncovering MPD was critical in the treatment of their eating behavior. MPD should be considered in any atypical or treatment-resistant eating disorder patient.
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