What is bulimia?

Bulimia is an eating disorder. It is characterized by uncontrolled episodes of

overeating, called bingeing. This is followed by purging with methods such as
vomiting or misuse of laxatives. Bingeing is eating much larger amounts of
food than you would normally eat in a short period of time, usually less than
2 hours. You may feel like you can’t stop or control these episodes of binge
eating.
• The binge-purge cycles can happen from many times a day to several
times a week.
• Often, people with bulimia keep a normal or above normal body
weight. This lets them hide their problem for years. Many people with
bulimia don’t seek help until they reach the ages of 30 or 50. By this
time, their eating behavior is deeply ingrained and harder to change.
There are 2 ways people with bulimia restrict
calories:

• Purging type. The person engages in self-induced vomiting or misuse

of laxatives, diuretics, or enemas, or other medicines that clear the
intestines.
• Nonpurging type. The person uses other behaviors, such as fasting or
excessive exercise, rather than purging behaviors.
•
 Who is at risk for bulimia?

• Bulimia most often affects females and starts during the teenage
years. But, it can also affect males. People with bulimia are more
likely to come from families with a history of eating disorders, physical
illness, and other mental health problems. Other illnesses, such as
substance abuse, anxiety disorders, and mood disorders are common
in people with bulimia.
 What causes bulimia?

• The cause of bulimia is not known. Society and cultural ideals that
assign value based on body weight and shape play a role. There is also
a genetic link as eating disorders tend to run in families.
 What are the symptoms of bulimia?
:
• Usually a normal or above average body weight
• Recurrent episodes of binge eating and fear of not being able to stop
eating
• Self-induced vomiting (usually secretive)
• Excessive exercise
• Excessive fasting
• Peculiar eating habits or rituals
• Inappropriate use of laxatives or diuretics
• Irregular or absence of menstruation
• Anxiety
• Discouraged feelings related to dissatisfaction with themselves and
the way their body looks
• Depression
• Preoccupation with food, weight, and body shape
• Throat is always inflamed or sore
• Tiredness and decreased energy
• Dental problems due to erosion of enamel from vomiting
Most people with eating disorders also share
certain traits including

• Low self-esteem
• Feelings of helplessness
• Fear of getting fat
• Intense unhappiness with their body shape and size
• binge reduces stress and ease anxiety.

• With binge eating comes guilt, disgust, and depression.

• Purging brings only short-term relief.

• The pt. may be impulsive and more likely to take part in risky
behaviors, such as alcohol and drug abuse.
 How is bulimia diagnosed?

• binging and purging secret. This is so family, friends, and healthcare

• Providers don’t know about it.
• Early treatment can often prevent future problems.
• Bulimia, and the malnutrition that results, can affect nearly every
organ system in the body. Bulimia can be deadly.
 How is bulimia treated?

• Bulimia is usually treated with both individual therapy and family

therapy. The focus is on changing your behavior and correcting any
nutritional problems.
• Therapy looks at the link between your thoughts, feelings, and
behaviors. The therapist will explore the patterns of thinking that lead
to self –destructive actions and help change that thinking.
• Medicine (usually anti-depressants or anti-anxiety medicines) may
help
• A family can play a vital supportive role in any treatment process.
• In some cases, a hospital stay may be needed to treat electrolyte
problems.
• healthcare provider and a nutritionist will be part of the care.
 What are the complications of bulimia?
• Stomach rupture
• Heart problems due to loss of vital minerals and electrolytes, such as
potassium and sodium
• Dental problems, the acid in vomit wears down the outer layer of the teeth
• Inflamed esophagus
• Swollen glands near the cheeks
• Irregular menstrual periods
• Kidney problems
• Diminished sex drive
• Addictions, substance abuse, and/or compulsive behavior
• Depression, anxiety, obsessive-compulsive disorder, and other mental
health problems
• Suicidal behavior
 What is anorexia nervosa?
• A person with anorexia nervosa will intentionally restrict Trusted
Source their food intake as a way to lose weight or avoid gaining
weight. A person with anorexia nervosa will often have an intense
fear of weight gain, even if they have severely low body weight.
• Dietary restrictions can lead to nutritional deficiencies, which can
severely affect overall health and result in potentially life threatening
complications.
• The emotional and psychological challenges of anorexia nervosa can
be hard for a person to overcome.
 Anorexia nervosa symptoms
• severe loss of muscle mass
• listlessness, fatigue, or exhaustion
• low blood pressure
• lightheadedness or dizziness
• low body temperature with cold hands and feet or, possibly, hypothermia
• bloated or upset stomach
• dry skin
• swollen hands and feet
• hair loss
• loss of menstruation or less frequent periods
• infertility
• insomnia
• loss of bone density, increasing the risk of fractures
• brittle nails
• constipation
• irregular or abnormal heart rhythms
• lanugo, which is fine downy hair on the body
• increased facial hair
• bad breath and tooth decay in people who vomit frequently
The person may also demonstrate certain
behaviors, such as:
• limiting their overall food intake or the range of foods they consume
• showing excessive concern with weight, body size, dieting, calories, and
food
• exercising a lot, taking laxatives, or inducing vomiting
• assessing their body weight and size frequently
• talking about being “fat” or having overweight
• denying feeling hungry or avoiding mealtimes
• developing food rituals, such as eating foods in a specific order
• cooking for others without eating
• withdrawing from friends and social interaction
• showing signs of depression
 Anorexia nervosa causes
• Concerns about body weight and shape are often features of anorexia
nervosa, but they may not be the main cause. Experts do not know
exactly why the condition occurs, but genetic, environmental,
biological, and other factors may play a role.
• For some people, anorexia nervosa also develops as a way of gaining
control over an aspect of their life. As the person exerts control over
their food intake, this feels like success, and so, the behavior
continues.
 Anorexia nervosa risk factors
• past criticism about their eating habits, weight, or body shape
• a history of teasing or bullying, especially about weight or body shape
• a sense of pressure from society or their profession to be slim
• low self-esteem
• anxiety
• having a personality that tends toward obsession or perfectionism
• sexual abuse
• a history of dieting
• pressure to fit in with cultural norms that are not their own
 Biological and genetic factors
• A person may also have a higher chance of developing an eating
disorder if:
• a close relative has had a similar disorder
• there is a family history of depression or other mental health issues
• they have type 1 diabetes
• In 2015, researchers foundTrusted Source that people with anorexia
nervosa may have different gut microbial communities than those
without the condition. This could contribute to anxiety, depression,
and further weight loss.
 Diagnosis
• Early diagnosis and prompt treatment increase the chance of a good outcome.
• The doctor may ask the person questions to get an idea of their eating habits,
weight, and overall mental and physical health.
• They may order tests to rule out other underlying medical conditions with similar
signs and symptoms, such as malabsorption, cancer, and hormonal problems.
• In addition to a physical exam, this may include Trusted Source:
• blood tests, including coagulation tests, a complete blood count, and a
comprehensive metabolic profile
• urine tests
• electrocardiogram
• imaging tests, such as a computed tomography (CT) scan or bone density scan
 Treatment and recovery
• cognitive-behavioral therapy (CBT), which can help the person find
new ways of thinking, behaving, and managing stress
• family and individual counseling, as appropriate
• nutritional therapy, which provides information on how to use food to
build and maintain health
• medication to treat depression and anxiety
• supplements to resolve nutritional deficiencies
• hospital treatment, in some cases
 Complications
• the cardiovascular system
• the blood, such as a low white or red blood cell count
• the digestive system
• the kidneys
• hormonal imbalances
• bone strength
• Some of these issues can be life threatening. In addition to the
physical effects of poor nutrition, the person may have an increased
riskTrusted Source of suicide.
 violence
The United Nations defines violence against women as "any act of
gender-based violence that results in, or is likely to result in, physical,
sexual, or mental harm or suffering to women, including threats of such
acts, coercion ‫قسر‬or arbitrary‫ تعسفي‬deprivation of liberty, whether
occurring in public or in private life.
 Intimate ‫ حميم‬partner violence

• refers to behavior by an intimate partner or ex-partner that causes

physical, sexual or psychological harm, including physical aggression,
sexual coercion, psychological abuse and controlling behaviors.
 Sexual violence

• is "any sexual act, attempt to obtain a sexual act, or other act

directed against a person’s sexuality using coercion, by any person
regardless of their relationship to the victim, in any setting.
• It includes rape, defined as the physically forced or otherwise
coerced penetration of the vulva or anus with a penis, other body
part or object, attempted rape, unwanted sexual touching and other
non-contact forms".
.
• A 2018 analysis of prevalence data ‫ بيانات االنتشار‬from 2000-2018
across 161 countries and areas, conducted by WHO on behalf of the
UN Interagency working group on violence against women, found that
worldwide, nearly 1 in 3, or 30%, of women have been subjected to
physical and/or sexual violence by an intimate partner or non-partner
sexual violence or both
• Over a quarter of women aged15-49 years who have been in a
relationship have been subjected to physical and/or sexual violence
by their intimate partner at least once in their lifetime (since age 15).

• The prevalence estimates of lifetime intimate partner violence range

from 20% in the Western Pacific, 22% in high-income countries and
Europe and 25% in the WHO Regions of the Americas to 33% in the
WHO African region, 31% in the WHO Eastern Mediterranean region,
and 33% in the WHO South-East Asia region.
• Globally as many as 38% of all murders of women are committed by
intimate partners. In addition to intimate partner violence, globally
6% of women report having been sexually assaulted by someone
other than a partner, although data for non-partner sexual violence
are more limited. Intimate partner and sexual violence are mostly
perpetrated by men against women.
 What is the cause of violence against women?

• Research has shown that the significant drivers of violence against

women include: the unequal distribution of power and resources
between men and women; and. an adherence to rigidly defined
gender roles and identities i.e., what it means to be masculine and
feminine.
What are the example of violence against women?

• Reproductive age Abuse by intimate male partners, marital rape;

dowry abuse and murder; partner homicide; psychological abuse;
sexual abuse in the workplace; sexual harassment; rape; forced
prostitution and pornography; trafficking; abuse of women with
disabilities.
 What are 5 effects of violence?

• Consequences include increased incidences of depression, anxiety,

posttraumatic stress disorder, and suicide; increased risk of
cardiovascular disease; and premature mortality.
• The health consequences of violence vary with the age and sex of the
victim as well as the form of violence.
 What are 5 main types of violence?
• Using these as a basis, we shall distinguish five inter-related types of
violence:
• physical violence.
• verbal violence (including hate speech)
• psychological violence.
• sexual violence.
• socio-economic violence.
Other factors which can be causes of violence
include:
• The influence of one's peers.
• Having a lack of attention or respect.
• Having low self-worth.
• Experiencing abuse or neglect.
• Witnessing violence in the home, community, or medias.
• Access to weapons.
 How can we stop violence?
• Tips for Youth to Stop Violence
• Tell someone. If you are the victim or are witness to violence, tell
someone. ...
• Take all violence and abuse seriously.
• Take a stand.
• Be an individual.
• Take back the power.
• Remember, putting others down doesn't raise you up.
Be a friend.
 violence can be prevented
• . A four-step public health approach offers a useful framework for
preventing violence, including
• (1) defining the problem;
• (2) identifying causes and risk factors;
• (3) designing and testing interventions,
• (4) implement and scale up effective interventions, supported by
continuous monitoring and evaluation.
 Why is it important to stop violence?
• Violence has lifelong consequences.

Toxic stress associated with repeated exposure to violence in early

childhood can interfere with healthy brain development, and can lead
to aggressive and anti-social behaviors, substance abuse, risky sexual
behavior and criminal activity.
 what is rape
• Rape is a type of sexual assault usually involving sexual intercourse or
other forms of sexual penetration carried out against a person
without their consent.
• The act may be carried out by physical force, coercion, abuse of
authority, or against a person who is incapable of giving valid consent,
such as one who is unconscious, incapacitated, has an intellectual
disability, or is below the legal age of consent.
• The term rape is sometimes used interchangeably with the
term sexual assault.
 Emotional and psychological
• Frequently, victims may not recognize what happened to them was
rape. Some may remain in denial for years afterwards.
• Confusion over whether or not their experience constitutes rape is
typical, especially for victims of psychologically coerced rape.
• Women may not identify their victimization as rape for many reasons
such as feelings of shame, embarrassment, non-uniform legal
definitions, reluctance to define the friend/partner as a rapist, or
because they have internalized victim-blaming attitudes.
• The public often perceives these behaviors as 'counterintuitive' and,
therefore, as evidence of a dishonest woman.
 Trauma symptoms
• Trauma symptoms may not show until years after the sexual assault
occurred.
• Immediately following a rape, the survivor may react outwardly in a
wide range of ways, from expressive to closed down; common
emotions include distress, anxiety, shame, revulsion,‫االشمئزاز‬
helplessness, and guilt.
• Denial is not uncommon
 Psychiatric and emotional consequences
•
can be apparent immediately after the rape and it may be necessary to treat these very
early in the evaluation and treatment.
• Other treatable emotional and psychiatric disorders may not become evident until some
time after the rape.
• These can be Eating disorders, anxiety, fear, intrusive thoughts, fear of crowds,
avoidance, anger, depression, humiliation, post-traumatic stress disorder (PTSD)
hyperarousal, sexual disorders (including fear of engaging in sexual activity), mood
disorders, suicidal ideation, borderline personality disorder, nightmares, fear of situations
that remind the patient of the rape and fear of being alone, agitation, numbness and
emotional distance.
• Recovery from sexual assault is a complicated and controversial concept, but support
groups, usually accessed by organizations are available to help in recovery.
• Professional counseling and ongoing treatment by trained health care providers are often
sought by the victim.