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ATYPICAL BULIMIA NERVOSA DISORDERS IN CHILDREN

 

 

There have been no extensive published reports of childhood bulimia in association with purging. The appearance of bulimia nervosa in latency may be rare. Prepubertal children were thought to be insufficiently sophisticated to purge; and latency-age girls were thought to be less vulnerable to the social pressure to be thin. However, Herzog, et al. [16] noted a ten-year-old male, and Goodman [17] noted a fourteen-year-old female, each hospitalized with an affective disturbance with both binging and purging initiated in latency. Moreover, Walsh [18] has identified adolescent female bulimics who admitted to purging while in latency.

Two cases of bulimia and/or purging (vomiting) beginning in latency are reported. One patient had a severe affective disorder with lability and frequent wrist cutting when seen as an adolescent. Two case reports of male bulimia occurred in association with object loss featuring global impulsiveness, learning disability, and in one case, possible Attention Deficit Disorder [19].

There may be a subgroup of mildly obese, impulsive children (especially males) who have a variant of bulimia. A complete evaluation, including the way stressful events modify eating, the presence and frequency of binging, fluctuations in weight, depression and delineation of individual and family psychodynamics, is warranted in obese children. Bulimia in latency, while probably rare, does occur in atypical forms. Primary physicians and school nurses need to recognize these symptoms and carefully evaluate eating patterns of latency-age obese and impulsive children.

 

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