A mental disorder that belongs to the group of eating disorders and is characterized by bouts of uncontrolled overeating followed by stomach emptying is called bulimia. Overeating provokes self-loathing and forces the patient to resort to various methods of cleansing the body: vomiting, enemas, diuretics and laxatives, rigid diets, and intense physical activity. You will learn about the diagnosis and correction of bulimia in this article.
- General information.
- Classification and symptoms.
- Bulimia treatment.
- Prognosis and prevention.
The term “bulimia” in translation from Greek means “bull hunger”. Doctors have paid serious attention to the pathological condition since the 1970s, when the American J. Russell studied cases of alternating overeating and refusal of food in female university students. The pathological condition is synonymous with cinorexia, neurogenic bulimia, and wolf-hunger. The frequency of bulimia is twice that of anorexia. The prevalence among adolescents and young girls is about 2%, and among men it is 0.5%. The peak of the incidence is between the ages of 15 and 25. About 90% of patients whose weight is completely normal or slightly higher are employed in areas requiring weight control: artists, ballerinas, dancers, gymnasts, models, runners.
Bulimia is polymorphic; there are many triggers and triggers that predispose to the formation of the pathology. Most patients have a distorted perception of food itself, which is due to the involvement of a hormone in adipose tissue that controls eating behavior called leptin. Eating becomes a way to minimize emotional stress rather than satisfy hunger.
Bulimia triggers include:
- Somatic diseases: uncontrolled gluttony is provoked by trauma in some parts of the brain or metabolic disorders such as insulin and leptin resistance, hyperthyroidism or diabetes mellitus.
- Personal characteristics associated with the emotional background of the patient: an increased sense of responsibility, low self-esteem, unstable self-image. These people are prone to affect, suffer from feelings of hopelessness, helplessness and guilt.
- Upbringing, when overeating is transferred from the life of parents to the adult life of children, along with demands to finish portions, not to throw away food.
- Stress, which tasty food helps offset.
Bulimia forms on the basis of emotions like addictive behavior. Uncontrolled bouts of overeating are preceded by an increase in affect: anxiety, anger, sadness. The more intense the negative emotion, the stronger the feeling of hunger. There is a brief period of euphoria while eating, and the emotional tension subsides. Patients are unable to control their food intake, they do not feel full, since leptin is included in the pathological process, so they stop eating only when the gag reflex arises.
Euphoria is replaced by feelings of guilt, irritation, contempt for their own habits. Patients try to use laxatives and diuretics, after which the feeling of guilt becomes much less. After a while everything repeats. Thus, overeating acts as a controller of patients’ emotional life.
Classification and symptoms
The classic version of bulimia is divided into two types: cleansing and non-cleansing. In the first case, patients are able to overdo it with enemas, constantly induce vomiting, use diuretics and laxatives. In the second, gluttony is compensated by starvation, intense physical activity.
According to the nature of bulimia attacks there are three varieties of the pathology:
- Bbouts – overeating “comes up” on the patient suddenly some time after the cleansing procedures have been carried out. The period without gluttony lasts from 6 hours to several days.
- On a permanent basis – gluttony is replaced by cleansing and appetite grows again. It turns out almost continuous absorption of food.
- At night – the attack develops at night, during the day – everything is within normal limits.
The main symptom is bouts of gluttony: eating the maximum amount of food in a short time. The appetite grows spontaneously, at any time. It can be caused by anything from an intense frustration to an unpleasant memory. Patients’ behavior is impulsive; they look for an opportunity to eat somewhere secluded in order to satisfy their hunger; they choose the most caloric foods with maximum fat and carbohydrates. Such “grinding” of food is uncontrollable, accompanied by a sense of euphoria, relieving tension.
Patients do not understand when satiety sets in and eat until they run out of food or provoke a gag reflex. One meal is several thousand calories, many times the daily energy requirements. Many patients have a normal weight or slightly above it, but patients are worried about imaginary or real extra pounds, they do not like their shape, appearance.
Typical behavior is eating diet foods in public and then gluttony alone. Unlike anorexia nervosa, bulimia patients are critical of themselves and aware of the problem. They feel a sense of guilt and admit to others that they have the disease, so they are not socially isolated and are less prone to depression, drug addiction and alcoholism. Anxiety disorders are more frequent in bulimics.
Forced vomiting, diuretics, and laxatives provoke persistent somatization, kidney failure. Overeating and frequent vomiting can be a trigger for esophageal or gastric rupture. Vomiting traumatizes tooth enamel and causes cavities and gingivitis. Abuse of laxatives causes hypotension and constipation. Potassium and magnesium deficiency provoke arrhythmias and cardiomyopathies. On the emotional side, complications of bulimia are formed – it is affective bipolar and obsessive-compulsive disorders.
Proper diagnosis relies on the clinic and the collection of anamnesis, conversations with relatives of patients. The main symptomatology is considered neurotic disorders: depression, anxiety, guilt, somatic: weight fluctuations, digestive disorders. And behavioral: gluttony, artificial vomiting and diarrhea. Additionally, specific psychodiagnostic questionnaires are included. Bulimia is differentiated with pathologies of the digestive tube, psychopathological personality disorders.
There are three criteria for confirming the diagnosis:
- Gluttony attacks at least once a week for three or more months with consumption of large amounts of food and loss of control over satiety.
- Compensatory relapses at least once a week for three months to rid the body of food and weight loss: vomiting, anorectics, diuretics, laxatives, fasting, intense physical activity.
- Neurotic worries about excess weight and appearance.
Correction of the pathological condition requires a comprehensive approach. Most disorders are reversible. Treatment should be carried out by several specialists at once: complications involve the help of narrow specialists – gastroenterologist, dentist, cardiologist. In most cases, all efforts are made at the level of the outpatient clinic and their goal is to stabilize somatic status, normalize appetite, and eliminate pathological habits of cleansing the digestive system.
The most effective are:
- Psychotherapeutic sessions, which are designed to increase the patient’s motivation to eat normally, reduce anxiety, dissatisfaction with their appearance, eliminate the desire to overeat. A psychotherapist helps the patient cope with stress and reinforce normal eating habits. The effectiveness of this technique when used in isolation is about 50%, if this method becomes part of a comprehensive therapy, the effectiveness increases.
- Psychotherapy, aimed at identifying and resolving personal problems that can provoke gluttony. Sessions are conducted individually and in groups. Increasing self-esteem allows the patient to adjust social activity, allows to replace the incorrect way of balancing emotional tension, which includes overeating, with a useful one.
- The use of selective serotonin reuptake inhibitors (SSRIs), which have antidepressant and therefore mild anorexigenic properties, minimize feelings of anxiety, depression and reduce in parallel appetite, craving for high-calorie foods. Acceptance of drugs reduces the frequency of bouts of gluttony and subsequent reflexive vomiting.
Prognosis and Prevention
The bulimia correction set of measures is designed for six to eight months, but is able to provide 80% effectiveness. Patients are almost completely cured of negative eating habits. But increased attention to body weight and food intake remains, which leaves a high risk of recurrence of the pathology. The basis of prevention is a proper attitude toward food and acceptance of one’s appearance. Today, this is known as a special direction in dietary cosmetology and is called bodybuilding. The habit of healthy eating should be formed from childhood on the basis of a child’s high self-esteem and self-confidence. Food should not be rewarded for success or deprived of food as punishment for disobedience.