Bulimia Nervosa is a psychiatric eating disorder characterized by an excessive preoccupation with the control of body weight, leading to a pattern of recurrent binge eating, followed by feelings of guilt, depression, and self condemnation, leading to purging behaviors. BN can be classified into two types: Purging type of bulimics resort to self-induced vomiting, or use of laxatives, diuretics, and enemas to compensate for the binges, whereas non-purging bulimics resort to excessive exercising and/or fasting to prevent weight gain. This disorder shares many psychological features with anorexia nervosa (AN). In fact, some patients show history of an earlier episode of AN. Psychological symptoms of BN include constant dieting interspersed with recurrent episodes of binge eating, eating until the point of discomfort, self-induced vomiting, depression, and anxiety. Physical symptoms include abnormal bowel functioning, bloating, dehydration, fatigue, dry skin, amenorrhea, and others.
Treatment involves frequent monitoring of the patient's condition, vital signs, and hydration level. A form of talk therapy, called cognitive behavior therapy has been found to be most useful in the treatment of this condition. Medications administered include antidepressants. Severe cases may require hospitalization.
Ghazal et al. (2001) conducted a prospective analysis on the prevalence of Bulimia Nervosa and its characteristics in a Moroccan context in a randomly selected and representative sample of students attending six secondary schools in Casablanca. A second group composed of the students of the French secondary school of Casablanca was included in the survey in order to verify the influence of socio-cultural factors. Subjects completed a sociodemographic questionnaire and the Bulimic Investigatory Test of Edinburgh (BITE), a 33-item self-report measure of both the symptoms and severity of bulimia nervosa. A total of 2,044 subjects returned their questionnaires (participation rate = 75.8%). The group of Moroccan school included 1,887 subjects and the French school 157 subjects. Females were preponderant (59%). The mean age was 18.3 +/- 1.2 years (15-22 years). For the first group, at least one substance was taken by 290 (15.3%) students: 12.7% were addicted to tobacco and 5.7% consumed occasionally alcohol. 16.3% reported a familial history of disturbed eating behavior. According to the BITE, the overall prevalence of bulimia was 0.8% (1.2% in female and 0.1 in male subjects). The mean age of bulimic subjects was 18.6 +/- 1.7 years (16-24 years). Only a single male case was encountered and was aged 24 years. Analyses of correlates of bulimia nervosa in the Moroccan sample showed that the group of bulimic subjects did not differ from the non bulimic with regard to any sociodemographic characteristics except sex: the female sex was predominant (p < 0.005) with 14 cases, the prevalence of bulimic syndrome was 1.2% among girls. Ghazal et al. (2001) noted a higher rate of substance abuse (26.6% versus 15.2%, p > 0.5), familial histories of disturbed eating behavior (26.6% versus 16.2%, p > 0.3) and less regular practice of sportive activity (72.2% versus 92.3%, p > 0.1).
Al-Adawi et al. (2002) surveyed eating attitudes in Oman among adolescents and adults of both sexes. Data was collected by questionnaires distributed to 106 Omani students from three state schools in Muscat, 87 non-Omani students of Caucasian ethnic groups and 100 Omani adults, with exclusion of those with sensory or cognitive impairments. The eating disorder was assessed by the Bulimic Investigatory test, which was a 33-item self-report that measured symptoms and severity of bulimia nervosa, and was translated to Arabic for the Omani group. The test was scored according to the Henderson and freeman (1987) system, and those who scored 25 or more were described as having a bulimic disorder. The study found that the body mass index (BMI) of the two teenage groups, the Omani and non-Omani, differed significantly, as it was 21.91 SD 4.1 and 20.68 SD 3.32, respectively The results of data analysis revealed that 12.3% of the Omani teenage group had a tendency towards binge eating or bulimia, and their mean BITE score was 20.82 SD 3.36. In this group, 13.7% of the females and 10.9% of the males showed bulimic-like disordered eating pattern, while in the non-Omani group, 18.4% had a tendency towards bulimia with an average BITE score of 19.90 SD 4.25, and the males were significantly more likely to show signs of bulimia than the females, as 32.5% of the males while only 6.4% of the females showed bulimic disordered eating patterns. This study concluded that the Omani teenagers were 0.62 times as likely to show signs of bulimia. On the other hand, the prevalence of bulimia nervosa in the Omani adult group was only 1% and their mean BITE score was 16.5 SD 4.4. These results reflect the rarity of this disordered eating pattern among adult Omani population.