Bulimia Nervosa

Generality

Bulimia is a disorder of eating behavior that, in the affected person, is responsible for large binges of food, followed by guilt and abnormal behavior aimed at the "neutralization" of the caloric intake of what is ingested.

Bulimia is a typically female problem, which mainly affects women between the ages of 16 and 40.

To "neutralize" the caloric intake of large food binges, the bulimic adopts various strategies; the most common ones are: self-induced vomiting, improper laxative intake, the adoption of a highly restrictive diet and strenuous exercise.

The treatment of bulimia requires the intervention of a team of specialists and revolves mainly around psychotherapy.

What is bulimia?

Bulimia, also known as bulimia nervosa, is a disorder of eating behavior that - in the carrier person - is a cause of great binges of food, followed by a strong sense of guilt and abnormal behavior, designed to "neutralize" the calorie intake of what is ingested.

Among the abnormal behaviors of the bulimic subject (ie the individual with bulimia), the most frequent are: self-induced vomiting, improper laxative and diuretic intake, the adoption of a restrictive diet for several days and strenuous exercise .

Epidemiology

Like most eating disorders, bulimia is a problem that mainly affects women .

However, it is good to point out that, in recent decades, male subjects with bulimia nervosa are increasingly on the rise, probably due to the greater attention paid by the male population to the aesthetic aspect and to the control of body weight.

Statistical studies conducted on samples of hospital patients, young people of high school age and university, have shown that:

The male people with bulimia were between 0.1% and 1.4% (ie every 1, 000 male individuals, at most 14 were bulimics).
The female people with bulimia were between 0.3% and 9.4%. (ie every 1, 000 female individuals there were from a minimum of a 3 to a maximum of 94 affected by bulimia).

As for the exclusively female population, bulimia can occur at any age, although it generally affects women aged between 16 and 40 years .

Bulimia can also affect children, but it is an extremely rare event.

ORIGIN OF THE BULIMIA NAME

The word bulimia derives from the Greek word " boulimía " ( βουλιμία ), which in Italian means "voracious hunger".

To be precise, " boulimía " is the result of the union between:

Bous ( βοῦς ), which means "voracious", and
Limos ( λιμός ), which means "hunger".

BULIMIIA AND NERVOUS ANORESSIA

Another quite common eating behavior disorder in the female population is anorexia nervosa or more simply anorexia .

Anorexia nervosa causes the person who is suffering from it to take minimal or no amount of food and to constantly monitor their body weight, for fear of gaining weight and in some way spoiling their body image.

Causes

The precise causes of bulimia have, for decades, been the subject of debates and discussions with experts in the field of eating disorders.

Surely, at the base of the behavior of the bulimic, there is a distorted perception of one's weight and body image .

The contribution that seems to derive from some hypothesized biological, psychological or environmental factors remains to be clarified.

BIOLOGICAL FACTORS

Some research has shown that close relatives of people with bulimia have a marked tendency to develop the same disorder (exactly 4 times more than an individual who has no bulimic relatives).

These findings have led researchers to think that bulimia can, in some way, be linked to a genetic predisposition .

In other words, they believe that the expression of certain genes is a factor favoring bulimia nervosa.

Currently, the aforementioned theory (which could be defined by the genetic adjective) still presents some question marks, which only future studies can definitively clarify.

PSYCHOLOGICAL FACTORS

By evaluating the psychological profile of people with bulimia, experts in the field of eating disorders have observed that many bulimics have in common a certain type of character / behavior . For this reason, they thought that the appearance of bulimia nervosa is linked, in some way, to the personality and behavioral traits of an individual.

Going into the details of the aforementioned findings, the people predisposed to become bulimic would be:

Those who have a marked tendency to suffer from anxiety or depression .
Those who have difficulty managing stress .
Those who have low self-esteem . For these subjects, the fact of losing weight, even in a pathological manner, confers safety and increases self-esteem.
Those who are easily worried by thinking about the future or who are, for some reason, afraid.
Those who have obsessions / compulsions or who suffer from the so - called obsessive-compulsive disorder.
Those who suffer from post-traumatic stress disorder .
Those who have some personality disorder .

ENVIRONMENTAL FACTORS

Premise: an environmental factor is any circumstance, event or habit that can affect the life of an individual to a certain extent.

In the opinion of the experts, the most important environmental factor, associated with the appearance of bulimia, would be the media exposure to the myth "thin equal beautiful", typical of modern Western culture.

Moreover, any magazine and television continually propose advertisements that have women and / or men as their protagonists, so often successful, with a dry body and no blemishes.

In addition to the exaltation of media thinness, other environmental factors that seem to contribute, more or less markedly, to the development of bulimia are:

The practice of sports or work activities where it is important to have an extremely thin body. This is the case, for example, of those who do dance or artistic gymnastics or models and models that parade by profession. For all these individuals, weight control is a must.
Emotional stress that can sometimes result from the death of a loved one, a change of residence or school, the loss of work, the end of a couple's relationship, etc.
Anatomical changes due to puberty. During the years of puberty, the human body undergoes various modifications. If particularly evident, these modifications could represent a profound discomfort for some individuals, especially if the latter are the object of ridicule or particular attention by their peers.
This explains, in part, why bulimia nervosa is frequent among subjects who have just finished pubertal development.
Membership in the female sex. Compared to men, women pay more attention to body weight and this could be the reason why they are more prone to getting bulimia.
The presence, in the family, of people with bulimia or other eating disorders (anorexia nervosa). Situations of this kind could involve, emotionally, some family members and induce, in the latter, the development of problems of the same nature. In general, the subjects who are most impressed by the sight of a family member with bulimia are adolescents.
Being victims of physical violence or sexual abuse. According to some studies, there is a certain correlation between episodes of this kind and bulimia nervosa.

Symptoms and Complications

The symptoms of bulimia range from a series of behavioral manifestations and psychological disorders to a series of physical manifestations, often dependent on behavioral ones.

BEHAVIORAL EVENTS

As stated, from the behavioral point of view, the subject with bulimia becomes the protagonist of large binges of food, followed by drastic, almost "violent" attempts to neutralize the caloric intake of what is ingested .

In the bulimic, food binges are recurrent episodes, so that they are repeated with a certain regularity. They consist in ingesting very large quantities of food, even without a real need: the bulimics eat whatever they have available; in some cases, they go to supermarkets to buy food of all sorts that they can devour with voracity as soon as they return home.

The establishment of spasmodic food cravings is a very rapid process, just as the act of eating out of proportion is sudden.

The behaviors designed to neutralize the caloric intake of binge eating (NB: in technical jargon they represent the so-called " bulimic bleeding" ) are the result of a sudden sense of guilt, a hatred towards oneself and / or low self-esteem, as far as done and for the amount of food ingested.

The most common methods of bulimic purging are self-induced vomiting and improper use of laxatives .

This is followed by excessive use of diuretics, the adoption of highly restrictive diets, periods of non-ingestion of food, unlimited exercise, etc.

PSYCHOLOGICAL SPHERE

Psychologically, the bulimic shows:

An obsessive attitude towards food and eating.
An unrealistic view of your body weight and your physical appearance in general.
Moments of depression and anxiety.
Tendency to isolate and a lack of interest in interpersonal relationships.

PHYSICAL MANIFESTATIONS

The behaviors induced by bulimia have physical repercussions.

In fact, bulimics have a tendency to present:

Dental problems . It is a consequence of self-induced vomiting: the food that rises from the stomach, in fact, is acid and this results in damage to the dental enamel.
Bad breath, recurrent inflammation of the throat and swelling of the salivary glands . Other consequences of self-induced vomiting.
Menstrual cycle abnormalities, in women. In the most serious cases, they culminate in the absence of menstruation.
Sexual problems, such as infertility (in women) and erectile dysfunction (in men).
Thinning, breakage and / or hair loss .
Skin changes . The skin becomes dry or becomes yellowish.
Electrolyte imbalances, which particularly affect sodium, potassium and chlorine concentrations. Electrolyte imbalances can lead to: a sense of recurrent fatigue, a state of generalized weakness, abnormal heart rhythm, kidney damage, convulsions and muscle spasms.
Intestinal problems, including constipation due to improper use of laxatives.
Heart problems, such as mitral valve prolapse, cardiac arrhythmias and heart failure (or heart failure).
State of malnutrition, for example due to periods of incorrect nutrition.

Diagnosis

In general, in the face of a suspected case of bulimia, the doctors resort to a meticulous physical examination, to some laboratory analyzes, to an evaluation of the psychological profile and to some instrumental tests to evaluate the health of certain vital organs (heart first ).

Even if they are not specific, these tests allow to establish, with a certain degree of security, the current problem and its severity (presence of complications, etc.).

For the purposes of a correct diagnosis of bulimia nervosa, it is also important to remember the importance of consulting the so-called Diagnostic and Statistical Manual of Mental Disorders (DSM).

The DSM is a collection of all the peculiar characteristics of known mental and mental illnesses, including the respective criteria required for diagnosis.

WHO IS THE DIAGNOSIS FOR?

Usually, the diagnosis of bulimia requires the involvement of a team of professionals, including psychiatrists, psychologists, dieticians, doctors experienced in eating disorders, nurses with specific skills in mental health, etc.

EXAMINATION OBJECTIVE

The objective examination consists in the medical evaluation of the general state of health of the patient.

The following are subject to observation: the so-called body mass index (to understand the weight conditions of the suspected patient), the appearance of the skin and hair, the heart rhythm, the teeth, the muscle tone, the appearance of the throat, etc.

Furthermore, the physical examination also involves a series of questions relating to the menstrual cycle (in the case in which the subject analyzed is a woman) or to erectile function (in the case of a male subject).

LABORATORY ANALYSIS

Laboratory analyzes generally include a complete blood count and an assessment of the level of the various electrolytes .

Based on the results of the laboratory tests, the doctor is able to establish the state of health of important organs, such as the kidneys or the heart, and understand the reason for certain physical symptoms (muscle spasms, convulsions, etc.).

PSYCHOLOGICAL EVALUATION

The evaluation of the psychological profile is generally up to an expert in the field of mental and psychological illnesses.

Briefly, it consists of a questionnaire in which the specialist asks the patient to describe their thoughts, their habits and their relationship with food.

DIAGNOSIS ON THE BASIS OF DSM

According to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, an individual suffers from bulimia if:

He has repeatedly been the protagonist of binge eating anomalous food, which most people are unable to do.
It completely loses control during binges, finding it hard to stop.
It uses self-induced vomiting, strenuous exercise, laxatives, diuretics and other drugs, to neutralize the caloric intake of the newly ingested food.
He becomes the protagonist of "bulimic bleeding" at least once a week, for three months.
The vision of his body causes low self-esteem and depression.
He is not suffering from anorexia nervosa.

Treatment

The treatment of bulimia is quite complex and its main objective is to re-establish a healthy attitude towards food in the patient.

To succeed in this, the use of psychotherapy, sometimes associated with the use of specific antidepressant drugs, is fundamental.

To learn more: Drugs for bulimia nervosa »

Moreover, for all those patients in a state of malnutrition, the planning of an ad hoc diet is essential, which compensates for all the nutritional deficiencies present

For further information: Diet for bulimia nervosa "

Bulimia therapy is the responsibility of the same team of specialists who made the diagnosis (ie psychiatrists, psychologists, dieticians, experts in eating disorders etc.).

Fundamental point: the awareness of the patient of suffering from a serious illness, which requires treatment, is the starting point for achieving recovery.

Subjects with bulimia nervosa, who refuse their condition as patients, do not undergo any treatment or, in any case, struggle to regularly follow the intended therapeutic course.

WHERE IS THERAPY?

For most cases of bulimia, treatment is outpatient . This means that the patient receives all the necessary care, attending a specialized hospital daily and returning home at the end of each therapeutic session.

In other words, the patient has a schedule of appointments to follow, established by the team of doctors who took care of him. Outpatient treatments are very advantageous, because they prevent the patient from having the inconvenience of hospitalization.

The therapy foresees the hospital stay, when, according to the doctors' opinion, the illness is at an advanced or serious stage. In these situations, patients need continuous medical assistance.

PSYCHOTHERAPY

Psychotherapy for bulimia includes different types of treatments:

Cognitive behavioral therapy . It consists in preparing the patient to recognize and dominate behavioral symptoms (in specialized jargon, they are the so-called "inactive behaviors" or "distorted thoughts"), induced by bulimia nervosa.
It includes a part "in the studio", with the psychotherapist, and a part "at home", reserved for the exercise and improvement of the domain techniques.
Interpersonal therapy . It is based on the idea that interpersonal relationships and the external world in general have a decisive influence on a person's mental health.
According to those who practice this type of psychotherapy, bulimia is due to feelings of low self-esteem, anxiety and insecurity, born as a result of a problematic relationship with food, first of all, and with other people, secondly.
The therapeutic goal is to discover which interpersonal relationships and with the external world have started the development of the eating behavior disorder and, once this has been clarified, find a possible remedy.
Family therapy . It is a type of psychotherapy that affects the whole family of the patient.
Those who practice this type of treatment maintain that an individual can recover from a disorder such as bulimia nervosa, only if his family members (who spend a lot of time with him) know the characteristics of the disease.
Family therapy is particularly indicated for younger patients, who share the drama of bulimia with the family.

PHARMACOLOGICAL TREATMENTS

Antidepressant drugs, used for the treatment of bulimia, are the so-called selective serotonin reuptake inhibitors ( SSRIs ).

The SSRIs have the peculiarity that, once taken, they act after several weeks.

In other words, their effects are noticeable only after several days from the beginning of the administrations.

A recurrent problem in establishing SSRI-based therapy is the most appropriate pharmacological dosage : psychiatrists often start with small doses, only to increase them if the results are unsatisfactory.

As a rule, patients taking SSRIs must undergo periodic medical checks in order to see how the drug treatment proceeds.