Generality
Bulimia is an eating behavior disorder which, in the affected person, is responsible for large binges of food, followed by feelings of guilt and abnormal behaviors aimed at "neutralizing" the caloric intake of what is ingested.
To "neutralize" the caloric intake of large food binges, the bulimic adopts various strategies, the most common are: self-induced vomiting, improper intake of laxatives, the adoption of a highly restrictive diet and strenuous physical exercise.
The treatment of bulimia requires the intervention of a team of specialists and mainly revolves around psychotherapy.
What is bulimia?
Bulimia, also known as bulimia nervosa, is a disorder of eating behavior which - in the carrier - is the reason for large binges of food, followed by a strong sense of guilt and abnormal behaviors, aimed at "neutralizing" the "caloric intake" than ingested.
Among the anomalous behaviors of the bulimic subject (ie of the individual with bulimia), the most frequent are: self-induced vomiting, improper intake of laxatives and diuretics, the adoption of a restrictive diet for several days and strenuous physical exercise.
EPIDEMIOLOGY
Like most eating disorders, bulimia is a problem that mostly affects women.
Statistical studies conducted on samples of hospital patients, young people of high school age and university, have shown that:
- Male people with bulimia were between 0.1% and 1.4% (ie for every 1,000 male individuals, at most 14 were bulimic).
- Females with bulimia were between 0.3% and 9.4%. (ie for every 1,000 female individuals there were from a minimum of 3 to a maximum of 94 affected by bulimia).
As for the exclusively female population, bulimia can arise at any age, although it generally affects women between the ages of 16 and 40.
Bulimia can also affect children, but it is extremely rare.
ORIGIN OF THE NAME BULIMIA
The word bulimia comes 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 ANOREXIA
Another eating disorder quite common in the female population is anorexia nervosa or more simply anorexia.
Anorexia nervosa causes the affected person to take little or no food and to constantly monitor their body weight, for fear of gaining weight and disfiguring their body image in some way.
Causes
The precise causes of bulimia have been debated and discussed for decades by experts in the field of eating disorders.
Surely, at the base of the bulimic's behavior, 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 may, in some way, be linked to a genetic predisposition.
In other words, they believe that the expression of certain genes is a contributing factor to bulimia nervosa.
Currently, the aforementioned theory (which could be defined with the adjective genetic) still presents some question marks, which only future studies will be able to definitively clarify.
PSYCHOLOGICAL FACTORS
By assessing the psychological profile of people with bulimia, eating disorder experts have observed that many bulimics have a certain type of character / behavior in common. For this reason, they thought that the onset of bulimia nervosa is related, in some way, to an individual's personality and behavioral traits.
Going into the details of the aforementioned findings, people temperamentally predisposed to becoming 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 way, confers security and raises self-esteem.
- Those who worry easily about the future or who are, for some reason, afraid of it.
- Those who have obsessions / compulsions or who suffer from so-called obsessive-compulsive disorder.
- Those suffering from PTSD.
- 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.
According to experts, the most important environmental factor associated with the appearance of bulimia would be the "media exposure to the myth" thin equals beautiful ", typical of modern Western culture.
After all, any magazine and television continuously propose advertisements that have as protagonists women and / or men, often successful, with a lean physique and free of imperfections.
In addition to the media's exaltation of 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 in which it is important to have an extremely thin physique. This is the case, for example, of those who do dance or artistic gymnastics or models who parade as a profession. For all these individuals, weight control is a must.
- The emotional stress that can sometimes derive from the death of a loved one, from a change of home or school, from the loss of work, from the end of a couple relationship, etc.
- Anatomical changes due to puberty. During the years of puberty, the human body undergoes several changes. 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 from their peers.
This explains, in part, why bulimia nervosa is common among people 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 bulimia.
- The presence in the family of people with bulimia or other eating disorders (anorexia nervosa). Situations of this kind could emotionally involve some family members and induce, in the latter, the development of problems of the same nature. Generally, the subjects on which the sight of a family member with bulimia arouses the greatest impression are adolescents.
- L "having been 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
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 MANIFESTATIONS
As stated, from the behavioral point of view, the subject with bulimia becomes the protagonist of large food binges, followed by drastic, almost "violent" attempts to neutralize the caloric intake of what is ingested.
In the bulimic, food binges are recurring episodes, so they recur with some regularity. They consist in the ingestion of very large quantities of food, even without a real need: bulimics eat whatever they have available; in some cases, they go to supermarkets to buy all sorts of food that they can devour greedily as soon as they return home .
The establishment of the spasmodic desire for food is a very rapid process, as is the act of overeating.
The most popular methods of bulimic purging are self-induced vomiting and the misuse of laxatives.
This is followed by the excessive use of diuretics, the adoption of highly restrictive diets, periods of non-ingestion of food, unlimited physical exercise, etc.
PSYCHOLOGICAL SPHERE
From a psychological point of view, the bulimic demonstrates:
- 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 themselves and a low interest in interpersonal relationships.
PHYSICAL EVENTS
The behaviors induced by bulimia have repercussions on a physical level.
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 acidic and this causes damage to the dental enamel.
- Bad breath, recurrent inflammation of the throat and swelling of the salivary glands. These are other consequences of self-induced vomiting.
- Abnormalities of the menstrual cycle in women. In severe cases, they culminate in the absence of menstruation.
- Sexual problems, such as infertility (in women) and erectile dysfunction (in men).
- Hair thinning, breakage and / or loss.
- Skin alterations. The skin becomes dry or takes on a yellowish tint.
- Electrolyte imbalances, which particularly affect the concentrations of sodium, potassium and chlorine. Electrolyte imbalances can result in: a feeling of recurrent fatigue, a state of generalized weakness, heart rhythm abnormalities, kidney damage, convulsions and muscle spasms.
- Bowel problems, including constipation due to improper use of laxatives.
- Heart problems, such as mitral valve prolapse, heart arrhythmias and heart failure (or heart failure).
- State of malnutrition, for example the result of periods of incorrect nutrition.
Diagnosis
Generally, when faced with a suspected case of bulimia, doctors resort to a scrupulous physical examination, some laboratory analyzes, an evaluation of the psychological profile and some instrumental tests to evaluate the health of certain vital organs (heart in primis ).
Even if they are not specific, these tests allow to establish, with a certain degree of certainty, the current problem and its severity (presence of complications, etc.).
For the purposes of a correct diagnosis of bulimia nervosa, it is also good 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 psychic 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, dietitians, doctors with expertise in eating disorders, nurses with specific expertise in mental health, etc.
OBJECTIVE EXAMINATION
The physical examination consists of a medical assessment of the patient's general state of health.
The subject of observation: the so-called body mass index (to understand the weight conditions of the suspect patient), the appearance of the skin and hair, heart rhythm, teeth, muscle tone, the appearance of the throat, etc.
In addition, the physical examination also involves a series of questions relating to the menstrual cycle (if the subject being analyzed is a woman) or erectile function (if the subject is male).
LABORATORY ANALYSIS
Laboratory tests 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 health status 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 assessment of the psychological profile is usually the responsibility of 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, habits and 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:
- It has repeatedly become the protagonist of abnormal food binges, which most people are unable to make.
- He completely loses control during binges, hardly finding a way to stop.
- It uses self-induced vomiting, strenuous exercise, laxatives, diuretics and other drugs to neutralize the caloric intake of freshly ingested food.
- He becomes the protagonist of "bulimic purges" at least once a week for three months.
- Seeing his body causes low self-esteem and depression.
- He is not affected by anorexia nervosa.
Treatment
The treatment of bulimia is quite complex and has as its main objective that of re-establishing, in the patient, a healthy attitude towards food.
To succeed in this aim, the use of psychotherapy is essential, sometimes associated with the intake of specific antidepressant drugs.
For further information: Drugs for bulimia nervosa "
Furthermore, for all those patients in a state of malnutrition, the planning of a diet is essential ad hoc, which makes up 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 patient's awareness of suffering from a serious illness, which requires treatment, is the starting point for achieving healing.
Subjects with bulimia nervosa, who reject their condition as sick, do not undergo any treatment or, in any case, struggle to follow the planned therapeutic path regularly.
WHERE DOES THERAPY TAKE PLACE?
For most cases of bulimia, treatment is outpatient. This means that the patient receives all the care he needs, attending a specialized hospital center every day 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 have taken care of him. Outpatient treatments are very advantageous, because they avoid the inconvenience of hospitalization for the patient.
Treatment involves hospitalization when, in the opinion of doctors, the disease is at an advanced or severe stage. In these situations, in fact, patients need continuous medical assistance.
PSYCHOTHERAPY
Psychotherapy for bulimia includes several types of treatments:
- Cognitive-behavioral therapy. It consists in preparing the patient to recognize and dominate the behavioral symptoms (in specialist jargon, these 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 mastery techniques. - Interpersonal therapy. It is based on the "idea that interpersonal relationships and with the outside world in general have a" decisive influence on a person's mental health.
According to those who practice this type of psychotherapy, bulimia is attributable 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 find out which interpersonal relationships and with the outside world have triggered the development of the eating disorder and, once this is clarified, to 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 argue 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) also know the characteristics of the disease.
Family therapy is particularly suitable for younger patients who share the plight of bulimia with their family.
PHARMACOLOGICAL TREATMENTS
Antidepressant drugs used to treat bulimia are so-called selective serotonin reuptake inhibitors (SSRIs).
SSRIs have the particularity that, once taken, they work after several weeks.
In other words, their effects are noticeable only after several days from the beginning of the administration.
A recurring problem in establishing SSRI-based therapy is the most appropriate drug dosage: psychiatrists often start with low doses, and then increase them if the results are unsatisfactory.
As a rule, patients taking SSRIs must undergo periodic medical check-ups in order to see how drug treatment is progressing.
HEALING FROM BULIMIA: WHAT DOES IT MEAN?
A bulimic individual can call himself cured of bulimia if:
- Change your eating habits.
- Take a healthy attitude towards food.
- He is normal weight and not underweight.
Prognosis
It is possible to recover from bulimia, however it requires time and considerable willpower on the part of the patient.
According to doctors and experts in the field of eating disorders, the sooner treatment begins, the greater the likelihood of recovery from bulimia.
