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1/6. sertraline in underweight binge eating/purging-type eating disorders: five case reports.

    DISCUSSION: Control trials show that antidepressants are efficacious in eating disorders. Although selective serotonin reuptake inhibitors (SSRIs) are used in clinical practice, there are relatively few controlled or open trials demonstrating that SSRIs are effective. We report five cases of underweight women with binge eating/purging-type eating disorders who gained weight and had reduced core eating disorder behaviors in response to sertraline.
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2/6. bulimia nervosa in hong kong Chinese patients.

    In contrast to the West, bulimic disorders are rarer than anorexia nervosa in hong kong. Four female normal-weight bulimic patients with mostly typical clinical features and conspicuous morbidity are reported. The case histories support the hypothesis that binge-eating is used to regulate unpleasant effect.
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3/6. Topiramate for binge eating disorder.

    Topiramate is a new anti convulsant agent that acts on the voltage-activated sodium channels and on the glutamate and GABA receptors; it is furthermore able to reduce hunger and therefore contributes to loss of weight. The authors report the case of a patient suffering from binge eating disorder, who was unresponsive to several therapeutic plans but was successfully treated with topiramate.
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4/6. An adolescent with vomiting and weight loss.

    A 17-year-old female complained of difficulty swallowing and recurrent vomiting of one year duration. She stated that she was trying to gain weight. She felt that a weight at the 5th percentile for age was appropriate for her 70th percentile height. She denied binge eating, self-induced vomiting, concern over abnormal eating, or depressed mood. She had low normal intelligence, long-standing problems with school and peer relationships, and was experiencing significant conflict with her stepfather. The mother noted that her daughter's symptoms had begun at the time her prized horse went lame. physical examination was unremarkable except for thinness. At a two-week follow-up visit, all vomiting had ceased and the patient had gained 1.6 kg. Plans for a barium esophagogram were cancelled and psychiatric consultation was arranged. A six-week followup revealed no vomiting, although weight gain had not progressed. Six months later, the patient was seen with a two-month history of recurrent vomiting. A barium esophagogram revealed achalasia. Pneumatic dilation of the lower esophageal sphincter was successful. Seventeen months after the initial visit the patient was asymptomatic, happy, and seemingly well adjusted.
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5/6. anorexia nervosa at normal body weight!--The abnormal normal weight control syndrome.

    Disgust with "fatness" and a consequent preoccupation with body weight, coupled with an inability to reduce it to or sustain it at the desired low level, characterizes the abnormal normal weight control syndrome. Individuals remain sexually active in a biological sense and often also socially. Indeed their sexual behaviour may be as impulse ridden as is their eating behaviour, which often comprises phases of massive bingeing coupled with vomiting and/or purgation. The syndrome is unlike frank anorexia nervosa in that the latter involves a regression to a position of phobic avoidance of normal body weight and consequent low body weight control with inhibition of both biological and social sexual activity. In abnormal normal weight control there is a strong and sometimes desperate hedonistic and extrovert element that will often not be denied so long as body weight does not get too low. Individuals nevertheless feel desperately "out of control" and insecure beneath their bravura. The syndrome is much more common in females than in males. There is a clinical overlap with anorexia nervosa and obesity in many cases as the disorder evolves. depression, stealing, drug dependence (including alcohol) and acute self-poisoning and self-mutilation are common complications. Clinic cases probably only represent the tip of the iceberg of the much more widespread morbidity within the general population. Like anorexia nervosa and for the same reasons the disorder is probably more common than it used to be.
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6/6. Early trauma, dissociation, and late onset in the eating disorders.

    Although the majority of patients with anorexia nervosa and bulimia nervosa develop these disorders in their teens and 20s, some patients develop an eating disorder in their 30s, 40s, or 50s. We present a subgroup of patients with the following pattern of symptoms and historical detail: (1) severe sexual and physical abuse by family members; (2) relatively good premorbid professional and marital adjustment (considering later difficulties) though characterized by (3) hypomania, binge eating, and morbid obesity. A pronounced shift in eating behaviors follows (4) medical trauma (e.g., injury, cancer, surgery) that occurs after age 30, interrupts previous hypomanic adaptation, and leads to severe restriction, purging, and dramatic weight loss (e.g., 100 lb). Although only one patient met full criteria for anorexia nervosa, weight loss and starvation were serious enough to provoke further medical crises in all patients. Finally, (5) during both weight loss and weight restoration patients demonstrated significant dissociative disturbance, including dissociated mood and personality states (i.e., multiple personality disorder), self-destructive behavioral episodes repeating early trauma, and avoidance of food as a way to manage PTSD symptoms.
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