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Background:

For thousands of years humans have engaged in occasional eating binges when adequate food supplies became available. The practice of vomiting after overeating also dates back thousands of years. Examining and defining abnormal eating patterns as eating disorders did not occur until roughly 20 years ago. Bulimia nervosa (BN) was first described in 1979 as a disorder involving binge eating followed by inappropriate behavior to avoid weight gain. Criteria for the diagnosis of BN did not emerge until provided by the American Psychiatric Association in 1980.

Criteria for the diagnosis of bulimia include preoccupation with eating and overeating large amounts of food in short time periods, also described as binge eating. This behavior is then followed by inappropriate behavior to avoid weight gain, most notably, self-induced vomiting. Other methods of avoiding weight gain include laxative and diuretic abuse and excessive exercise. BN is a disease with a highly focused patient population; it is predominantly found in women and is virtually nonexistent in nonindustrialized countries.


Pathophysiology: BN is a disease that most likely emerges from a complex integration of many factors. These factors may be psychological, cultural, environmental, and societal. Many proposed associated factors are involved in the development of bulimia. These factors can include chemical imbalances in neurotransmitters, such as serotonin or pancreatic polypeptides (eg, pancreatic peptide YY [PYY]). Psychological and psychiatric problems also are thought to contribute to the development of bulimia. Another contributing factor is family problems. Participation in extracurricular activities that emphasize body shape and image also has been linked to the development of bulimia.

The binge and purge cycle characteristic of bulimia affects multiple organ systems. The GI system can be affected by the overeating associated with binge episodes. This overeating can stretch the stomach or delay gastric emptying. Purging can induce esophagitis or esophageal rupture due to vomiting. Pancreatitis also can occur. Electrolyte abnormalities can include hypokalemia and hypochloremia. Cardiovascular abnormalities can lead to arrhythmias, arrest, cardiac rupture, or pneumomediastinum. The pulmonary system can be damaged by aspiration of gastric contents upon vomiting. Renal function impairment is also possible.

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It must of started in very old times, cave man times.
' The cave, remember your failure in the cave' One would say