Bulimia nervosa, or simply bulimia, is an eating disorder (EID) mental illness characterized by excessive weight anxiety, binge eating, and regular attempts to clear food from the body .
How to suspect bulimia
Bulimia can be suspected by the following:
1 Concern about your weight , perception of yourself as being too fat, obsessive fear of getting fat.
2 Severe hunger is an obsessive, uncontrollable desire to eat.
3 Regular episodes of overeating. Overeating can be objective and subjective. With objective overeating, a person consumes or more daily calories per meal. Subjectively , he eats a small amount of food at a time, but he himself considers this as overeating. The frequency of episodes is at least twice a week for three months. These episodes evoke extremely strong negative emotions – guilt, anger, despair.
4 Practice cleansing techniques – getting rid of food and counteracting weight gain. This includes induction of vomiting, laxatives and appetite-reducing drugs, and periods of fasting. Such techniques cause a feeling of shame and hide from others.
One or two symptoms may not indicate a disease; with bulimia, all four should be observed. The diagnosis can only be made by a psychiatrist after examining the patient, a detailed conversation with him and his relatives.
The diagnosis can only be made by a psychiatrist after examining the patient, a detailed conversation with him and his relatives.
Bulimia nervosa is also accompanied by self-criticism, feelings of helplessness and loneliness, low mood and depression. Because of loneliness and rejection, a person with bulimia finds thematic communities about bulimia and anorexia on the Internet.
Launched bulimia leads to somatic diseases (diseases of internal organs and metabolic disorders).
In some people develop bulimia
Bulimia nervosa develops with a combination of biological, social, and psychological factors.
- female gender – women are more susceptible to bulimia nervosa and anorexia than men;
- heredity – having a family member with an eating disorder increases a person’s risk of developing bulimia ;
- hunger or overfeeding during early development.
Sociocultural factors: Risk increases in countries and families that emphasize physical appearance, ideals and beauty standards.
Psychological factors: perfectionism, low self-esteem, impulsivity, increased emotional sensitivity.
All of these factors increase a person’s susceptibility to developing an eating disorder.
How bulimia limits a person’s life if left untreated
Bulimia is a very expensive disease in every sense. Let’s take a look at what price you have to pay for it.
1 Wastes time. A person spends several hours a day studying the energy value of foods, drawing up diets, and carefully choosing products in the store. With food, it lasts longer, taking into account an attack of overeating and subsequent cleansing techniques. Time is spent on thematic groups in social networks – communication, exchange of experience, the search for new ways of purification and motivating illustrations, slogans, stories.
We counted with one client how much time she spent on the above tasks – it turned out an average of 27 hours per week.
2 It spoils relationships with people. A person loses or spoils relationships with relatives, friends and acquaintances. Secrecy and engagement with food and cleansing rituals makes communication on other topics problematic. Depressed mood reduces the desire to socialize and meet people. Because of the fear of “breakdowns” and the need to perform cleansing procedures after eating, a person begins to avoid eating places.
From a client’s story: “If my friends order pizza, I can get lost. I hung out with fellow students several times , but they started teasing me because I don’t eat with them. I don’t want to answer stupid questions about food, and vomiting in public is problematic. ”
3 Deteriorates physical health. The longer a person suffers from bulimia, the more damage it causes to health. The harm depends on how long the person has been ill with bulimia and what cleansing techniques they use.
The most common physical health problems in people with bulimia are:
- digestive disorders – constipation, gastritis, ulcers, colon prolapse;
- destruction of tooth enamel and deterioration of the condition of the teeth, inflammation of the mucous membrane of the mouth and skin in the corners of the mouth due to the acid contained in the vomit;
- heart and kidney failure, which develop due to a violation of electrolyte metabolism – useful minerals are lost with vomiting; typical problems – swelling, weakness, heart rhythm disturbances, difficulty breathing;
- nails crumble and peel off, hair becomes thinner and falls out due to a lack of trace elements;
- decrease in cognitive abilities, memory, concentration.
4 Takes away money. All of the above requires additional financial costs. Here are my client’s rough estimates for the week:
- 4000 rubles – additional food, which you could do without;
- 200 rubles – laxatives, preparations for cleansing the body;
- 1,500 rubles – medicines that help reduce appetite
Even such an incomplete list of the consequences of bulimia shows how significantly it affects a person’s life, changes his physical and psychological state, and reduces social functioning.
Bulimic patients themselves may not be aware of the consequences of the disease and their severity, which is also a manifestation of the disease.
How to treat bulimia
Bulimia treatment requires an interdisciplinary approach – involving several specialists from various fields of medicine. The team of specialists includes: general practitioner, psychiatrist, psychotherapist. According to the indications, a cardiologist, nephrologist, endocrinologist, gynecologist can be included. In Ideally, all team members must have special knowledge, skills and experience in the field of eating disorders, and to be in one and that same position, to be in the communication and work in harmony. Therefore, there are special clinics and departments for the treatment of eating disorders.
Treatment consists of three components – restoration of physical health, drug treatment of bulimia and psychotherapy.
Restoration of physical health. The restoration of physical condition can be carried out on an outpatient basis or in a hospital, depending on the severity of the manifestations. This stage of treatment is mandatory, since as long as the body is depleted, psychotherapy will have no effect.
Cognitive behavioral therapy (CBT) has been shown to be effective in treating bulimia.
Medical treatment. During or after the recovery of the body’s forces, the psychiatrist can prescribe drugs that normalize the exchange of neurotransmitters in the central nervous system and thereby improve mood, reduce stress, and make a person’s behavior more flexible and adequate. In many cases it is not necessary to prescribe drug therapy; psychotherapy alone may be sufficient for treatment.
Psychotherapy. Cognitive behavioral therapy (CBT) has been shown to be effective in treating bulimia . For the treatment of eating disorders, a special method has been developed – CBT-E (CBT-E, Advanced Cognitive Behavioral Therapy for Bulimia).
CBT-E takes place in four phases over a period of about twenty weeks:
1 Therapy begins with psychoeducation and informed consent to therapy.
2 Then begins the stage of formulating the processes that support the disorder and the problems that should be guided in therapy. In parallel, BMI and behavior are monitored .
3 The next step is a personalized program of changes in the underlying mechanisms that support the disorder.
4 The final stage (sessions 18–20, weeks 15–20) is relapse management, which ensures that the improvements achieved in the course of therapy are maintained and that relapses are prevented.
Effectiveness of cognitive behavioral therapy for bulimia:
- in 45%, complete remission is observed – the symptoms of the disorder disappear and do not return if the doctor’s recommendations are followed;
- in 27% there is a significant improvement in the condition and a decrease in the effect of the disease on functioning;
- in 23% there is a chronic type of flow and the lack of treatment effect.
The decision about treatment always remains with the patient (after 18 years), however, the support of relatives and friends plays an important role at any age .