Bulimia nervosa

What is bulimia

Violation of eating habits occurs due to genetic predisposition, malfunction of the hormonal system, brain injuries, heredity, and under the influence of cultural and social factors. Often, symptoms of the disease develop against the background of depression, obsessive-compulsive disorder, and stress.

The peculiarity of the disease is that attacks of hunger cannot be controlled. At one time a person can eat several daily doses of food. Then comes a feeling of guilt, fear of gaining weight, so the patient tries to get rid of food. “Cleansing” means may be used, including inducing vomiting, taking diuretics and laxatives. The anorexic course of the disease is characterized by long periods of fasting. Over time, symptoms can lead to the development of anorexia nervosa.

Causes of Bulimia Nervosa

The specialists of our clinic set themselves the identification of the main causative factor that caused the pathological failure as a priority. The disease is based on a dysfunction of the part of the brain responsible for the saturation center.

Malfunctions of neurons in this zone develop as a result of:

• Experiencing mental trauma in early childhood.
• A suspicious character, accompanied by low self-esteem, a search for external and internal shortcomings.
• Anxious accentuation of personality.
• Testing fears in ordinary situations, low stress resistance.
• Purposefully limiting oneself in food, as a result of which a constant feeling of hunger is formed, and all thoughts come down to food.
• Hereditary factors. If a patient suffers from eating disorders, they may also appear in close relatives.

Main symptoms

Symptoms of bulimia develop gradually, so the disease remains undetected for years. At the initial stage, external signs of the disease do not appear in any way. Therefore, neither the patient himself nor his relatives see the need to contact specialists.

Doctors recommend thinking about the problem if a person has become embarrassed to eat in public, adhere to food rituals (for example, eating one dish or eating only a certain group of foods). A significant increase in portions will also be a cause for concern - a patient can eat 3-6 thousand calories at a time. Despite frequent overeating, people do not gain weight. And over time, laxatives and diuretics are found in the house. Also, a person locks himself in the toilet for a long time after lunch and empties his stomach. Another cause for concern is constant conversations about appearance and diets.

Bulimia nervosa: symptoms

It can be quite difficult to recognize that a patient has problems, since he is quite skillful at hiding and disguising his illness. You can suspect that a person has bulimia based on the following symptoms:

• unconscious frequent overeating;
• sudden weight fluctuations;
• eating alone at night;
• inducing vomiting after overeating;
• abuse of diuretics and laxatives;
• swelling of the submandibular glands;
• discoloration or destruction of tooth enamel;
• depression;
• stomach colic;
• voluntary seclusion;
• bruising in the eyes;
• constant worry about your weight;
• unhealthy skin color, brittle hair and nails;
• low self-esteem, complex;
• constant feeling of shame and guilt;
• inflammation of the esophagus.

Consequences of the disease

If an eating disorder is left untreated due to overeating and inducing vomiting, the following consequences for the body are possible:

• calcium deficiency - problems with blood clotting appear, the condition of teeth and bones worsens, and the risk of osteoporosis increases;
• disturbed electrolyte balance, which negatively affects the functioning of the cardiovascular system;
• lack of chlorine – leads to dehydration, digestive dysfunction;
• damage to tooth enamel, irritation of the throat, mouth, ulcers on the tongue;
• bleeding in the stomach, stomach distension, regular constipation, pancreatitis, intestinal diseases;
• cancer of the esophagus or larynx.

It will take several years to eliminate the consequences, and complete restoration of the body may not be possible even with the help of medication. Sometimes diet and supportive care are needed throughout life.

Classification of bulimia nervosa

The following types of disease are distinguished:

• primary bulimia nervosa - the patient is constantly hungry and has an uncontrollable desire to absorb food;
• bulimia nervosa - occurs as a result of anorexia, when the patient experiences attacks of uncontrollable overeating, which are replaced by feelings of guilt and attempts to get rid of what they have eaten by inducing vomiting or other means.

Bulimia due to nervousness can occur in two types:

• the patient, after bouts of overeating, tries to cleanse the body with the help of vomiting, enemas, laxatives;
• the patient does not empty his stomach of consumed food, but goes on various diets, which he regularly breaks down with bouts of gluttony.

What you need to know about psychotherapy

The main symptoms of the disorder are associated with disturbances in body perception, lack of safe defensive reactions to stress, and problems with self-esteem.

An important tool in the fight against illness is psychotherapy. Cognitive behavioral therapy, art therapy, dance movement therapy, and other techniques can be used. Depending on the patient's problems, assistance may be required with:

• formation of an adequate perception of oneself, one’s body, the absence of dependence of self-esteem on weight;
• looking for other ways to encourage or deal with problems - food should not be the only remedy for negative or positive emotions;
• strengthening the correct patterns of behavior at cultural and family events, social adaptation;

The Importance of Group and Family Therapy

Patients with eating disorder often have two problems - strained relationships with family and lack of support. Loved ones often do not realize or understand the seriousness of the disease. Family psychotherapy will allow you to sort out conflicts, psychological trauma, help you understand the characteristics of the condition of a person diagnosed with bulimia, and teach you how to properly support your loved one.

Group classes are needed to understand problems and communicate with people with similar difficulties. This is an important stage for socialization, preparation for the challenges that arise when returning to a full life. Other patients can support, give strength to fight, and set a positive example.

Treatment with medications

Drug therapy for bulimia can be carried out in several directions. Firstly, to correct appetite. The drugs can suppress strong feelings of hunger to help the patient develop willpower and new eating habits.

Secondly, since an eating disorder is accompanied by anxiety, depression, and disturbances in the production of dopamine or serotonin, treatment of bulimia cannot be carried out without drugs aimed at correcting the psycho-emotional state.

Thirdly, drug treatment for bulimia is necessary for serious health problems. Vitamin and mineral complexes and medications for treatment of gastritis, stomatitis, ulcers and other concomitant diseases that occur due to constant vomiting and overeating may be prescribed.

Several types of bulimia

Symptoms and treatment for bulimia nervosa depend on the classification. A simplified manifestation of the disease is called non-purgative, when after overeating there is no need to perform enemas or artificially induce vomiting. In this case, frequent overeating only leads to disruption of the intestines and a feeling of heaviness in the stomach. Often people try to take medications aimed at improving metabolism. But this is not a treatment method.

Purging bulimia is characterized by the need to artificially cleanse the intestines or stomach.

Treatment for bulimia

Eating disorders are difficult to treat on your own. Without the help of specialists, it is impossible to accurately diagnose, understand the causes of the disease and select methods for recovery. You should not take treatment with antidepressants or other serious medications without consulting your doctor. Otherwise, many problems will not be solved, which will lead to the likelihood of a relapse or transition of the disease to anorexia.

People suffering from bulimia are often unaware of the dangers of their condition. Therefore, complex treatment methods, observation by professionals, and prompt correction of the applied techniques and medications are necessary, depending on the patient’s condition.

Symptoms

In addition to the inability to control food intake, people with bulimia sometimes use various medications unnecessarily and may drink heavily. Source: Emotional Eating, Binge Eating and Animal Models of Binge-Type Eating Disorders. Robert Turton, Rayane Chami, Janet Treasure2017 Jun;6(2):217-228. doi:10.1007/s13679-017-0265-8.

A doctor at SM-Clinic can identify bulimia nervosa by the following signs:

• redness of the gums and tooth decay;
• dehydration;
• problematic skin;
• frequent throat diseases due to microtraumas that the patient inflicts with his nails when artificially trying to induce vomiting.
• inflammation of the esophagus;
• prostration;
• internal bleeding;
• cramps (due to an imbalance of minerals and salts);
• intestinal disorders;
• enlarged salivary glands;
• disruption of the normal functioning of the liver and kidneys;
• irregular menstrual cycle;
• heart diseases.

Changing your relationship with food

After accepting the disorder, you will begin to change your eating habits under the supervision of a nutrition consultant. To combat the symptoms, drug treatment will be effective to reduce the feeling of hunger, restore hormonal levels and other body systems. To achieve the effect, you need strict control over your diet, taking into account calories, proteins, fats and carbohydrates.

Symptoms of bulimia may return over several years. Therefore, breakdowns are possible, you don’t need to blame yourself for them. It is important to analyze the causes of loss of control and exclude possible relapses. While eating, it is better to forget about TV or other distractions in order to eat food consciously and recognize the taste and smell of foods.

Diagnosis of bulimia nervosa

The disease can be suspected if the patient has the above symptoms. In addition, patients with bulimia often express concern about their weight, believing themselves to be fat, while in fact their indicators are within the normal range.

Alarming symptoms that indicate advanced disease are erosion of the teeth, scars on the joints of the fingers (occur due to frequent vomiting), and enlarged parathyroid glands.

To make a diagnosis, two episodes of bulimia per week for three months or more are sufficient.

It is important to carry out a differential diagnosis and exclude other diseases in which vomiting is observed (pathologies of the kidneys, gastrointestinal tract, and so on). As a rule, the symptoms of bulimia are so characteristic that it is impossible to confuse this disease with another pathology.

Basics of proper nutrition

With bulimia, you need to give up strict diets, which only exacerbate an unhealthy perception of yourself. Fasting and excessively low-calorie nutrition are unacceptable. This all increases the feeling of hunger and leads to breakdowns. To cope with bulimia, you need to adhere to the rules of a balanced, healthy diet. Nutritionists recommend split meals. Small meals 5-6 times a day are a great way to cope with hunger.

To improve your mood, you should add fruits, berries, and yellow and orange vegetables to your diet. Gradually you need to increase the amount of products and monitor the food intake.

When treating the disease, a medicinal approach is often used to compensate for the lack of vitamins, macro- and microelements. Food products are also selected for the same purpose. It is important to restore the functioning of the gastrointestinal tract and improve digestion: create a diet consisting of vegetable soups, chicken broth, oatmeal, mashed potatoes, rye bread, fresh vegetables, fruits, herbs, and low-fat dairy products.

At first, you should not eat semolina porridge, mayonnaise, vegetable oil, spicy foods and a lot of spices, coffee, tea. This will relieve stress on the body, which is important after regular overeating.

Consequences of bulimia nervosa

If you feel like you're not coping, there's no shame in asking for help.

Bulimia entails:

1. Constantly peeled skin of the fingers, when artificial provocation of vomiting is performed with the fingers;
2. Bad teeth and gum disease are common problems for bulimics. Stomach acid is not only merciless to food;
3. Bursting blood vessels in front of the eyes from frequent use of radical methods;
4. Deterioration of nails, noticeable hair loss;
5. There is no clear perception of oneself, awareness of oneself in society and one’s appearance.

Bulimia can cause:

• Sleep disorders;
• Chronic diseases and inflammations of the mouth, pharynx, gastrointestinal tract;
• Infertility;
• Thoughts about suicide.

Drug therapy for bulimia

Drug treatment for bulimia is necessary to effectively combat the disease and restore organ function. With a long course of bulimia, the patient is often diagnosed with gastritis, dental problems, water-salt imbalance, and other problems.

Heavy stress on the nervous system contributes to frequent bouts of hunger, so the use of medications is effective. Only a doctor can prescribe the type and dosage. It is acceptable to use medications to relieve anxiety. With the help of medication, you can speed up recovery, reduce the number of breakdowns, and the likelihood of relapse.

Treatment for Bulimia Nervosa

After meeting the patient, the doctor at our medical center gives his opinion on the conditions under which the course of treatment should be undertaken. In uncomplicated situations, an outpatient option is sufficient; in more severe cases, hospitalization is required.

Indications for hospital stay:

• Suicidal tendencies.

• Severe dehydration and exhaustion.
• Deep depression.
• Failure of outpatient therapy.
• Concomitant pathology, pregnancy.

The main type of healing effect on patients is given to psychotherapy in combination with the prescription of medications.

The following drugs are used for kinorexia:

• Antidepressants.
• Antiemetics.
• Sedative medications.
• Normotimics.

The intake of pharmaceutical drugs occurs against the background of psychotherapeutic influence.

How long does treatment last?

The duration of psychological and drug therapy cannot be determined with certainty. The recovery period depends on factors such as:

• individual characteristics;
• the nature of the reasons that provoked the development of the disease;
• age, weight;
• duration of the course of the disorder.

It usually takes up to three years to form adequate habits, learn to feel the body, and perceive the body correctly. It is unacceptable to slow down the pace of therapy when the first improvements appear, because this increases the risk of the disease returning. In this case, recovery will take much longer.