Talk:Bulimia nervosa/Archive 1

Anti-psychotics
"Anti-psychotics are also used, but in smaller doses than are used for treating schizophrenia. With an eating disorder, the patient perceives reality differently and has difficulty grasping what it is like to eat normally."

I think this needs a goof reference, because I haven't read a word about sucessful pharmacological treatment with anti-psicotic drugs in BN in all my life. I mean in serious articles and books about Eating Disorders. The kind of "wrong perceptions" of reality that can experiment a posicotic person are completely different. Eating Disorders are NOT Psicotic Disorders at all!!!



I'd like to know why were my contributions deleted. They are completely logical!

Can we edit or take out the part about Homosexual males being at risk? The source cites "gender identity" which is not connected to homosexuality.


 * I agree; I was just coming here to say that. The article refers to gay males as "gender-conflicted" which is extremely offensive. Ichelhof 16:03, 20 January 2006 (UTC)

DSM-IV critera
We've got one sentence saying "The following six criteria must all be met for a patient to be diagnosed", but then another saying "note that these diagnosis criteria are only a guide". So either the second sentence should be removed, or the word "must" in the first sentence should be changed. Also, why is "guide" in the second sentence in bold? Also, "many doctors will diagnose bulimia nervosa if only one is not present" would be clearer, I think, as "many doctors will diagnose bulimia nervosa if five of the six are present". (But the reason I'm not being bold and making this change is that the first three times I read the sentence, I read it as "many doctors will diagnose bulimia nervosa if only one is present", and I'm not sure that's not what was meant.)

Also, the parenthetical "Some anorectics may demonstrate bulimic behaviours in their illness: binge-eating and purging themselves of food on a regular or infrequent basis at certain times during the course of their disease. Alternatively, some individuals might switch from having anorexia to having bulimia..." is long and somewhat confusing. Would it be accurate to say "A patient expressing both sets of behaviors is generally considered anorexic, and indeed some anorectics may demonstrate binge-eating or other bulimic behaviours during the course of their disease. Alternatively, some individuals might switch from expressing primarily anorexic to primarily bumemic symptoms."?

The reason it sounds confusing is because it is, bulimics can have anorexic tendencies and anorexics can have bulimic tendencies. But a bulimic with anorexic tendencies is not considered simply anorexic unless (or until) they fit the definition of that disease. Therefore, a bulimic who engages in anorexic behavior is still a bulimic until they meet specified criteria. Make sense?

Also, are there truly six criteria in the DSM-IV? The section head used to say "The Five DSM-IV critera". Presumably one was added later -- is it legitimate?

Steve Summit (talk) 16:00, 26 February 2006 (UTC)

I added the word "classic" to the second part to make it a little better —The preceding unsigned comment was added by Stui (talk • contribs) 4 June 2006 (UTC)

In patients expressing both anorexic and bulimic behaviors, the final catagorazation is genarally made based on weight and status of amnorhia (anorexia being amnoria and BMI of <17.5)If the patient is sub-threshold for both weight and frequency requirements, that would be defined as ED-NOS. --Emiyorkie 02:30, 11 July 2006 (UTC)

As a practicing psychiatrist, let me clarify that the DSM is a research tool, used to help scientists obtain a reasonably homogenous group of study participants, since psychiatric diagnoses are clinical. You can't do a blood test or some other definitive diagnostic procedure, so to help increase the likelihood that your test subjects all actually have a certain disorder, the criteria are published. Even then, there is the very real possibility that a person who "meets criteria" will erroneously be included in the study, who actually suffers from a distinct (heterogeneous) condition of some sort and who should not be studied with the rest of the group because his response to treatment, other interventions will be different than the group under study. Clinically, psychiatrists do not (or should not, anyway) adhere to the DSM criteria rigidly. Diagnoses are based on many factors, including family history, presentation, and the overall differential diagnoses, regardless of how many "criteria" can be verified. If a checklist were sufficient for diagnosis, anybody could do it and we wouldn't need experienced experts like myself to weigh the entire clinical picture and decide if a person does or does not have an eating disorder (or any psychiatric syndrome), and how best then to proceed.

New resource link - Bulimia Nervosa Resource Guide for Family and Friends
I've used the Wikipedia in the past but this is the first time I've tried to contribute. ECRI recently published an online resource guide focusing on bulimia nervosa and I think it would be a valuable addition to your the list of external resources. The project was funded by a grant from the Hilda and Preston Davis Foundation and the reports and website are freely available to the public.



Here's the blurb from the site.

This Web site provides a one-stop comprehensive resource on bulimia nervosa for anyone who wants to understand the disorder and how to support a family member or friend with bulimia nervosa. This information was developed in response to questions and concerns voiced by patients and families affected by bulimia nervosa and clinicians treating bulimia nervosa. Patients seeking treatment for bulimia nervosa may also find this Web site useful. Included here are scientific findings on how well various treatments for bulimia nervosa work based on the most comprehensive analysis completed to date on treatments for bulimia nervosa. You'll also find easy-to-use check lists and tips on how to start a discussion about bulimia nervosa with a friend or family member who might have bulimia. If you are seeking bulimia nervosa treatment facilities, the find a treatment center database can help.

About this Resource Guide

The content presented here on bulimia nervosa was researched and developed by ECRI (www.ecri.org) an international independent nonprofit agency and Collaborating Center of the World Health Organization, under a grant from a private foundation, The Hilda and Preston Davis Foundation. An external advisory committee of bulimia nervosa patients, families, and clinical experts reviewed all content. ECRI is designated as an Evidence-based Practice Center (EPC) by the U.S. Agency for Healthcare Research and Quality. ECRI's mission is to improve the safety, quality, and cost-effectiveness of healthcare. It is widely recognized by the healthcare community as one of the world's leading independent organizations committed to advancing the quality and safety of healthcare.

bylie 14:19, 10 March 2006 (UTC)


 * This looks like a good call. I reviewed the site, and it seems to contain some valuable information, from a somewhat less disease-centered perspective.  In addition, ECRI is a credible agency with a demonstrable track record.  I vote add.  --Sadhaka 14:31, 10 March 2006 (UTC)

At risk groups: Females, Males???
What's the point of specifically stating that females and males are at risk groups for bulimia? Almost everyone is included in these two categories, making the mentioning of females and males meaningless. Theshibboleth 03:38, 14 May 2006 (UTC)

You know how people can be, picky picky picky.

"Males are just as prone to having eating disorders as women" This is absolutely WRONG. False, false, false. The statistics show an overwhelmingly greater prevalence among females than males. Additionally (though perhaps anecdotally) many males with eating disorders are gay.

Cleanup tag
Hi there,

I'm going to add a 'cleanup' tag to this page, as it is badly in need of it. It lacks coherent referencing to scientific studies, is unstructured, confused in places and contains lots of personal advice from someone. There's plenty of great information in the article, I think it just needs thorough going through by specialist in the field.

- Vaughan 10:34, 30 May 2006 (UTC)

Added a link to "See also"
I added "Eating disorder not otherwise specified" to the "see also" section, as EDNOS also covers binging and purging behaviors. Please let me know if you believe this is inappropriate.

Melange fiesta 00:41, 31 May 2006 (UTC)

POV?
This seems irrelovent: 5% or less of bullimics are male. Assuming 10% (a rather high estimate) of men are gay, that puts the percentage of gay bullimics much lower than 5%. Not to mention it does not effect homosexuals more than straight people, but people people who find it a 'female condition' are less likely to have it recognized/diagnosed. Homosexuals are not "gender identity conflict" victims. Homosexuality should not be mentioned. The paragraph should read, "Some males, who find Bulimia nervosa a female disorder, are at a higher risk of the disorder not being recognized and diagnosed. Dark jedi requiem 03:41, 2 July 2006 (UTC)

In my opinion homosexuals are far more at risk, gay men are in a world where image is pushed to the extreme and many forms of research back this up

Your opinion doesn't really matter in this forum, we need facts. Can you cite just one of these "many forms of research" to back up your claim? I did a Google search and came up with nothing.

Tapeworms???
Okay... who the heck added tapeworms to purging methods? I've talked with a LOT of bulimics, and not a single one has ever used a tapeworm. I don't think it is even possible for people to obtain tapeworms! Can we please remove this ridiculous "purging method"??? Melange fiesta 15:00, 21 April 2007 (UTC)

I didn't add that part to the page but, oddly enough, I have heard of people using tapeworms. In fact, try doing a google search with the words "tapeworm" and "diet" and you'll be quite suprised at the results, I know I was. I am a practicing bulimic, and I would never use tapeworms as a method to control my weight... but again, I know people who have. I think we should leave it. if u use tapeworms....wont it kill u?? y shove a tapeworm up into ur stomach when some ppl who actually have tapeworms are trying 2 get rid of them??

Another small thing ...
The use of "Caucasian race" is problematic, for several reasons; 1) This is a medical article and "Caucasian" is not a scientific term. 2) It is not an Environmental Factor. 3) It is American-centric and this is an international encyclopedia. If the intention is to describe a White American demographic, simply use "White American". See Caucasian race.

I would consider the use of the term "Caucasian" to be far more appropriate than the use of the political division "American"; I can only assume that this comment has previously been edited to obscure the original author's intent, because as it stands, it makes little sense. —Preceding unsigned comment added by 172.159.52.99 (talk) 16:57, 18 October 2007 (UTC)

Stop trying to make it sound normal...
Bulimia is common especially among young women of normal or nearly normal weight.[1] This is a misquote. Here's the reference text: ...a habitual disturbance in eating behavior mostly affecting young women of normal weight All it shows is that the group it most affects is young women, not that the problem is commonplace. —Preceding unsigned comment added by 86.151.235.32 (talk) 14:17, 26 November 2007 (UTC)

Shortened form
Who say, "mia?" is that an official word or just some guy's slang? 64.191.211.54 (talk) 21:44, 7 February 2008 (UTC)

NPOV and otherwise very bad paragraph removed
I am removing the following paragraph for reasons of very poor language, NPOV and breaching several Wikipedia standards:

''High mortality rates might be directly related to Western society's routine grave denial of the seriousness and widespread effect of eating disorders. In a culture where diet and weight loss industries ever grow along side obesity rates, and where thinness is glamourized in every magazine on every stand, it is no wonder that those with eating disorders aren't treated as seriously as say individuals with schizophrenia. Mental illnesses such as schizophrenia offer huge profits for pharmaceutical companies and inpatient treatment centers. In simple economic terms, a recovering schizophrenic means profit. A recovered bulimic does not. Bulimics that lose weight are often congratulated by others for their weight loss and "control". Losing weight is usually associated with success rather than illness in Western culture. And further, the general misconception of eating disorders being just a temporary adolescent trend remains. In some cultural circles, it isn't just thinness that is glamourized, but the eating disorder itself, as seen on pro-ana/mia and thinspiration websites. Unfortunately, all of these attitudes, misconceptions and market forces only perpetuate the growing epidemic of eating disorders and the likelihood of death for those afflicted''

The text is of some, although not crucial value to the article. Its content should be rewritten, large parts left out and better parts added, but I do not have the expertise to do so. 81.93.102.185 (talk) 22:16, 21 February 2008 (UTC)
 * Edit: The title of this said "hardly NPOV", I changed it later.

bulimia why?
why would any one want to go bulimic who cares what other people think you are your own individual and you control your life no one else. If you let people tell you what you should look like your weak weak i tell you dont let anyone i mean anyone tell you how you should be. All i want you to be is yourself not no one else if your a guy just tell everyone you love food if your a girl tell everyone you love food. If people keep on doing this to themself they will eventually die.

Bulimia isn't about what other people think. It's not even entirely about weight. I think you need to do some reading on the disease before you go on another offensive rant.

i dont understand....y do u need 2 overstuff urself w/food when u r lackin mental/emotional control. i mean, it's not lik the food is even going 2 stay very long in ur stomach....how does eating a whole bunch of food and then forcing it out of ur body before it's even fully digested help u cope w/ur "mental stress"??

It's what people do to cope with stress. You might yell, you might go and play golf, you might work out. Whatever. Those who don't use it to lose weight, use it as a mechanism to cope with things.

I don't know why i do it. I just 'have to'. During a purge i hate it, feel repulsed, but it's like a game i guess. "ooh! there's a little more, I'm sure i can squeeze out just a bit more". though that kinda had a comical note to it, but it's not funny, i tell you. Alot of the stuff here is true. Social isolation, yup, lack of understanding of a normal diet, i can't remember what that is any more (only a year or so later), i look at my body and think "i like it, but i can't let putting weight on spoil it - ironic i binge..? Also, is it major if i'm binge/purging several times a day.. that's kinda worrying.. my poor gut.. those consequences really make me want to stop.. throat cancer.. -MALE!! 17, european new zealander. (i found this info here helpful, i really don't want to keep eating like this just keep forgetting that's what i want.. feel i may be able to get over it soon tough, i feel so guilty when i purge a nice meal.) —Preceding unsigned comment added by 00iddy (talk • contribs) 23:44, 11 December 2007 (UTC)

I am not a good editor, but I think something should be added here about the background conditions. Bulimics and anorexics report having had a higher incidence of childhood sexual abuse. . Also, there should be a discussion of various treatments for bulimia, including SSRI's and therapy. As a recovering/recovered? bulimic/anorexic (I haven't practiced in 13 years, I'm 29, go recovery), I find some of the discussions hear to be very disturbing. People suffering from the disorder need to understand the background risks and the options for treatment. Another thing worth mentioning is that purging behavior (especially that involving the use of laxatives or diuretics) disturbs electrolyte balance which can cause heart problems. I remember meeting a 30 year old woman at an Overeaters Anonymous meeting when I was 15 and having a slice of reality when she recounted how she had caused herself a heart attack.

128.195.86.231 (talk) 23:05, 21 April 2008 (UTC)

Famous people affected?
Would there be space in this article for mention of some well-known people affected by the condition, such as Diana, Princess of Wales and John Prescott? It might give more of a human face to what is a highly scientific looking article.--Oxonian2006 (talk) 23:39, 20 April 2008 (UTC)

Genetics
Why is there no mention of this? Men do not get bulemia.

It's obviously genetic. But just theory. —Preceding unsigned comment added by 69.155.105.249 (talk) 19:16, 4 April 2008 (UTC)


 * I think the above comment was supposed to say something like this:


 * Why is there no mention of the genetic factor involved in the development of bulimia? In my opinion the genetic factor is obviously the most significant cause of the condition's appearance, although I must say that this is only a theory. Furthermore, men do not suffer from bulimia.


 * First, it is clearly inaccurate to say that there are no men with bulimia. They represent a smaller proportion of the people known to suffer from the condition but that is not the same thing. Secondly, if somebody believes there is a genetic factor involved it would be worth providing some evidence, rather than simply saying that it is obvious and then qualifying the statement with the admission that it is merely a theory. There is also no suggestion of whose theory it is; the person's own theory, or a widely accepted theory in specialist circles?--Oxonian2006 (talk) 10:46, 26 April 2008 (UTC)

atypical sufferers
This sentence, which I added earlier today, has been removed without explanation:
 * Although bulimia is overwhelmingly a disease of young women, it can affect others. British politician John Prescott says he developed bulimia in his 60s.

Is this not legitimately encylopedic, to include information that might not be expected? BrainyBabe (talk) 16:55, 27 May 2008 (UTC)
 * There is already too much unsourced information in this article. That addition is borderline per WP:BLP. -- JLaTondre (talk) 01:14, 28 May 2008 (UTC)
 * Thanks for responding. Prescott speaks openly about it -- it was his decision to go public -- which seems to cover BLP concerns.  It has been extensively covered, e.g. by the BBC. Is there any other reason not to include it? BrainyBabe (talk) 14:56, 28 May 2008 (UTC)
 * I don't see much use in a single example, but I don't object as long as you cite the source. -- JLaTondre (talk) 22:56, 28 May 2008 (UTC)
 * Thanks, re-added. BrainyBabe (talk) 13:03, 30 May 2008 (UTC)

i need some help
OK my girlfriend has bulimia and i want to help her so i decided the best thing to do is learn about what it is and so far wiki hasn't answered my question am i contributing to her bulimia i want to help her and need to find out ways to help because its unhealthy for her to be starving her body well i guess i just want to know what to do with her do i try to confront her about it or try to comfort her about her body image and hope she feels better about herself to get her to stop i just don't know why she is doing it she is very attractive and thin and i don't know why and i just hope it isn't to make me feel better im happy with her appearance and i just want to know what to do can someone please help me —Preceding unsigned comment added by Ak-kronos (talk • contribs) 11:56, 21 July 2008 (UTC)
 * The article explains some of the basics of the condition - which should help to start with. Try a Google search and you should see lots of other websites, or talk to a doctor. Barrylb (talk) 11:40, 2 August 2008 (UTC)

I removed a section entitled "How to Help" because it was not referenced and sounded like personal advice. Instead, the article could be improved with a "Treatment" section. Barrylb (talk) 11:44, 2 August 2008 (UTC)

Cleaning up a bit
I started cleaning up a bit, re-worded some things in the Diagnosis section and added the "according to the DSM" part. Will work on the other sections later.

Wecanbehiros (talk) 15:27, 11 September 2008 (UTC)

Bulimia a Dangerous Disea
bulumia is a dangerous disea so take care...

too right, and those with it are generally sufferers of other psycological affectors. Thus, be careful what is on the page, those seeking help may come here, and see something which can further their anguish.. more links to help/supports site would be a great addition and also more "guys also get bulimia" too. I read this article somewhere once " ##% or guys are bulimic.. 20% of guys with bulimia identify as being gay" that can really hurt aguy who is bulimic and unsure of his sexual interests/uncomfortable being associated with homosexuality, as is the general concensus i have found from personal experience.. 118.92.184.1 (talk) 04:17, 30 December 2008 (UTC) 00iddy basically - be careful and considerate of what you put on this page :) 00iddy —Preceding unsigned comment added by 118.92.184.1 (talk) 04:19, 30 December 2008 (UTC)

What?
Is binge eating something fat or skinny people do? 97.118.63.76 (talk) 05:00, 30 January 2010 (UTC)

Cleaning up widows
There are a number of widowed sentences and sections through this article. I'm going to go through and do a clean-up. Ethan Mitchell (talk) 12:29, 16 January 2011 (UTC)

Removed the following, as it makes no sense by itself:

People who suffer from bulimia are less likely to end up in hospitalisation and can be treated in outpatients most of the time. — Preceding unsigned comment added by Ethan Mitchell (talk • contribs) 12:37, 16 January 2011 (UTC)

Concerned
This article seems to me to imply that this is a physical illness, but I believe it is clearly a mental disorder, caused by fear of being seen as ugly or not being accepted for who one is, which leads to faulty logic that one can eat to satisfy the craving to eat, but stay the same weight by removing the food, which of course causes problems because human beings require actual food intake, not partial. This is most likely triggered during childhood when the child doesn't know any better, and it becomes a self-sustaining cycle or addiction in a sense.

It also seemed, in some parts, to imply that the mental disorder is caused by the physical symptoms... I know it probably wasn't meant to, but it should be clarified that the physical signs are caused by a mental issue.

I am also not sure about whether this should actually be classified as a disease... it is merely a problem mindset.. unless there is no mental aspect in which case it is not caused by a way of thinking, then it would be something different...

I could be wrong though. I just find it a little hard to follow, maybe it needs to be re-worded in some places. —Preceding unsigned comment added by 64.91.166.20 (talk) 22:24, 21 January 2011 (UTC)

comment
I think it should be changed from "mostly known as 'mia'.." because I have never heard anyone call bullimia 'mia.' —Preceding unsigned comment added by 208.71.223.76 (talk) 21:58, 26 February 2008 (UTC)

Gluttony
Dont forget to add this as a raeson, a knee jerk reaciton against gluttony is this dieseas. —Preceding unsigned comment added by 99.56.3.230 (talk) 00:06, 20 April 2011 (UTC)

Necessary?
Sorry, I'm not entirely sure how to use this, but I was wondering, is this sentence necessary:

"The groups listed below are considered to be at the highest risk: ... those with/without a history of anorexia ..."

It doesn't actually mean anything.


 * It means little. I suspect the original editor was trying to say 'there may be some link with a history of anorexia, but we don't actually know what sort of link that is yet'. Njál (talk) 23:24, 1 October 2011 (UTC)

Ox?
Maybe is not that important to the issue itself, but if the etimological root is given I guess it would be helpful to know what an ox has to do with this. Paranoidhuman (talk) 12:49, 28 July 2011 (UTC)
 * Paranoidhuman, I believe it refers to the appetite of a creature larger than a human. Njál (talk) 23:15, 1 October 2011 (UTC)

Gluttony as a reason
Dont forget this reason, especially for those with high-metabolism who really had no reason to have any eating restrictions at all (because they cannot get fat), who when realizing gluttony exists go into shock mode and spiral into an extreme of bulima. — Preceding unsigned comment added by 69.234.121.129 (talk) 16:28, 2 October 2011 (UTC)

Etiology section
It's written like complete crap. It's written like a graduate text book. It was probably cut and pasted from one. Which you may think is good, but not for an encyclopedia. It should be readable to normal people, not just experts in psychology. And all the "so and so, et al" in the sentences are rediculous. That's why we have the numbered citations at the end. This section is next to useless and needs to be fixed. If it's not, I'll fix it by deleting it. — Preceding unsigned comment added by 134.11.154.97 (talk) 14:23, 8 March 2012 (UTC)

Adding information
Hello. I would like to add some information regarding bulimia nervosa. Studies have shown that young females that read fashion magazines tend to have more bulimic symptoms than those females who do not. This further demonstrates the impact of media on the likelihood of developing the disorder. --Anonediter (talk) 22:20, 20 April 2014 (UTC)

Percentage of Women who are Bulimic
I found that the original Wikipedia article stated that between 90-95 percent of individuals who suffer from bulimia are women. However, I found on the National Eating Disorders website that this number was a little bit high. The website states that only 80 percent of all individuals who are bulimic are women. This number makes a bit more sense to me, as I understand that even though it is more usual for women to suffer from an eating disorder than men, there are still males who have eating disorders. This is also the case for bulimia, and I feel that the original percentage (90-95) was just a little bit on the higher side.

–Ashtaystew (talk) 19:11, 18 April 2014 (UTC)
 * Hi Ashtaystew! Thank you for your edit. It is not so much about what you feel is right though - even though it is really hard not to be guided by your own ideas - but about which sources are best. I added a higher percentage from a very good source, the DSM-5. With friendly regards,  Lova Falk     talk   15:42, 14 May 2014 (UTC)

Additional Editing to Signs
I've decided to add an extra criteria in the "Signs" section of the page to include, "Frequent consumption of abnormally large portions of food." I feel this addition is necessary because it is a core and conspicuous sign to identify the possibility of someone having bulimia nervosa. I noticed it was already included in the section that a person makes frequent visits to the bathroom, so I feel like in conjunction with that it should also be noted that an obvious sign is someone who frequently consumes abnormally large amounts of food. --A151859 (talk) 21:59, 5 December 2014 (UTC)

Additional Characteristics of Bulimia Nervosa
I am adding this information to the topic of diagnosis because in order to fully help a patient suffering from bulimia nervosa, one must understand the underlying symptoms associated with it.

Purging often is a common characteristic of a more severe case of bulimia nervosa. --Snance90 (talk) 17:32, 15 April 2015 (UTC)

Updating the Diagnostic Section
With the publication of the DSM-5, the different subtypes of bulimia have been eliminated and the wikiarticle should reflect that. Also I think it should be mentioned that during the binge episode, in addition to eating a large amount of food in a discrete period, the DSM-5 also lists "a sense of lack of control over eating during episodes" as a criteria for diagnosis. PaintRae (talk) 00:10, 17 April 2015 (UTC)
 * I would just add this into the article after the first sentence in the third paragraph of the diagnosis section. "The diagnostic criteria utilized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association includes repetitive episodes of binge eating (a discrete episode of overeating during which the individual feels out of control of consumption) in conjunction with feelings of having no control over the act of eating. Binges are then compensated for by excessive or inappropriate measures taken to avoid gaining weight. The diagnosis is made only when the behavior is not a part of the symptom complex of anorexia nervosa and when the behavior reflects an overemphasis on physical mass or appearance." PaintRae (talk) 12:36, 17 April 2015 (UTC)

Anachronism in section: "History - before the 20th century"?
In "(Kyron -) Anabasis", probably written by greek Xenofon around 370 before our time, the line mentioning "oxhunger" ...(a direct translation from greek "boulimia": 'bous'- ox and 'limos'-hunger)

... is taken from Book IV:5, and goes in one translation like this: "Leaving these quarters, they marched the whole of the next day over snow, and many of the men were afflicted with "boulimia" (or hunger-faintness). Xenophon, who was guarding the rear, came upon some men who had dropt down, and he did not know what ailed them; but some one who was experienced in such matters suggested to him that they had evidently got boulimia; and if they got something to eat, they would revive. Then he went the round of the baggage train, and laying an embargo on any eatables he could see, doled out with his own hands, or sent off other able-bodied agents to distribute to the sufferers, who as soon as they had taken a mouthful got on their legs again and continued the march."

It is clear to me (I am reading the text in swedish: "Kyrosexpeditionen", Forumbiblioteket, 1972, translation from greek by Ebbe Linde, the word in the swedish translation is 'oxhunger', same word/meaning as in english) that the meaning of 'bulimia' in this context does not refer to any purging or to any anacronistic psychological (a 'science' originating 1850) modern pathologizing. But instead to to the soldiers exhaustion by traveling in snow, after sleeping in it, and with sparse food resources.

I would suggest a rewriting of the reference to the book, that instead focus on the usage of the word oxhunger, taken from greek, and given a new specific meaning in the psychology subject, to refer to a diagnosis used by that same 'science'. Otherwise they have nothing to do with eachother, the book and the condition.

Detärjag (talk) 10:32, 22 June 2015 (UTC)

Assessment comment
Substituted at 14:27, 1 May 2016 (UTC)

Medications Additions
The only part of this section I would edit would be the section where it states that it is unknown if a combination of pharmacological and psychological interventions worked better than choosing just one approach. In a cochrane review it was found that although the assessments found limited improvement to a single oriented approach, in repeated studies it was found that a combination of both pharmacological and psychological treatments showed the greatest improvement in symptoms. — Preceding unsigned comment added by Leearnoldml (talk • contribs) 01:59, 5 December 2015 (UTC)

Bulimia nervosa and anorexia nervosa
This article could mention how sometimes, bulimics have had anorexia and there are cases where individuals fluctuate between the two extremes. Vorbee (talk) 13:40, 10 December 2017 (UTC)

Photos
The photos of "teeth erosion" can easily be caused by an overbite and grinding teeth while sleeping. The "erosion" in both photos is consistent with overbite wear. — Preceding unsigned comment added by 73.131.146.228 (talk) 17:12, 21 October 2018 (UTC)
 * This case was due to bulimia however. Doc James  (talk · contribs · email) 08:24, 30 April 2020 (UTC)

Mass of primary sources
I have trimmed a mass of primary sources here condensing it around the secondary sources provided. Others thoughts?

Not sure a small primary source from 1987 for example deserve any weight. With this being a well research area we should stick with secondary sources. Doc James (talk · contribs · email) 08:25, 30 April 2020 (UTC)