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Bulimia is a type of eating disorder that does not have to be visible at first glance - contrary to appearances, most people who struggle with this problem have a he althy body weight. On the other hand, bulimia can have serious, sometimes even life-threatening consequences - so what are the symptoms of bulimia, how do you know if your loved one may have this problem and what treatment is used for bulimia nervosa?

Bulimia(also known as bulimia nervosa) is - next to anorexia - one of the most famous eating disorders. The first full description of it - by Gerald Russell - was written in 1979, in fact, however, the irregularities related to this problem had been mentioned earlier. The word bulimia itself is derived from the Greek language and it was created from the combination of the words bous and limos - these words mean bull and hunger respectively, therefore the disorder was sometimes referred to as "bull hunger".

The exact incidence of bulimia is difficult to quantify, but it is estimated that around 1% of young women worldwide may suffer from it at any given time. The female gender was intentionally mentioned here, because it is mainly her representatives who struggle with bulimia - the problem is encountered in women up to nine times more often than in men. Like anorexia nervosa, bulimia nervosa occurs primarily in young people, typically it occurs in people aged 16 to 35 (the disease usually occurs at a slightly older age than in the case of anorexia nervosa).

Bulimia: reasons

As in the case of other eating disorders, in bulimia nervosa it is usually quite difficult to distinguish one specific factor responsible for its occurrence. Generally, the causes of bulimia are biological and psychosocial factors.

There are many different scientific studies, the results of which indicate that genetic factors play an important role in the etiology of bulimia nervosa. In a situation where a close relative has just suffered from bulimia nervosa or some other type of eating disorder, the risk of the problem affecting family members is significantly increased.

Additionally, it is mentioned that they may have a connection with bulimiaabnormal levels of certain neurotransmitters in the central nervous system (primarily serotonin). However, further research is also underway to further search for the causes of bulimia - some of them focus on the relationship between eating disorders and brain levels of Brain Derived Neurotrophic Factor (BDNF).

Various psychosocial factors are important for the development of bulimia nervosa. Excessive focus on the weight of the child by the parents may contribute to this problem. The fact that the media often propagates the beauty model centered around thinness may also be related to the occurrence of eating disorders. It is also worth mentioning here that in some cases bulimia nervosa occurs in people who were overweight or obese in childhood or adolescence.

Sometimes it happens that one eating disorder turns into another - for example in people who have struggled with anorexia in the past. The time from the occurrence of one problem to the appearance of another may vary - for some it is months, and for others it is years, at least it should be emphasized here that not all people who have been treated for anorexia finally develop bulimia later. It is also worth mentioning that typically anorexia turns into bulimia nervosa in the future - the reverse relationship is rarely encountered.

Bulimia: symptoms

One of the biggest problems with bulimia is that most of the time, you don't see its manifestations - at least for a while. Contrary to all appearances, people suffering from this disorder do not have to have an incorrect weight - most often it is just the opposite and bulimics have the correct body weight.

The essence of bulimia is bouts of unrestrained overeating, which are later accompanied by attempts to reduce the effects of eating large amounts of food - in the course of the problem there is an intense fear of weight gain. Other problems that are symptoms of bulimia nervosa include:

  • focusing all your attention on eating (including by constantly counting calories),
  • post-binge eating behaviors to reduce the risk of weight gain: vomiting, use of laxatives or appetite suppressants, as well as diuretics and thyroid hormones; some patients with bulimia nervosa engage in vigorous exercise, while others engage in fasting, which usually ends with binge eating.

It's worth it hereemphasize that binge eating attacks are indeed very difficult to stop - during them, the patient is able to consume products with an energy value several times higher than his daily requirement, in addition, he sometimes eats combinations of products that, apart from the seizure, he would definitely not eat. The person with bulimia is aware of this and therefore, after the seizure, they take various actions to prevent them from gaining weight.

Bulimia: consequences

Typical of bulimia nervosa is that patients consume large amounts of food in secret, away from others. For this reason, even the household of the person affected by this problem may not be aware of what their loved one is struggling with.

On the other hand, bulimia is very dangerous, because even recurrent induction of vomiting can lead to dangerous disorders in the patient's body.

The possible somatic complications of bulimia nervosa include:

  • chronic gastroesophageal reflux disease,
  • hypokalemia,
  • dehydration,
  • esophagitis,
  • tooth damage (people with bulimia can demineralise the enamel, they also have an increased risk of tooth decay),
  • hypotension,
  • heart rhythm disturbance,
  • stomach ulcers,
  • swelling of the salivary glands,
  • fertility disorders,
  • defecation disorders (such as constipation or diarrhea).

Bulimia: recognition

Looking at how different and serious the complications of bulimia can be, it is definitely important to recognize it and start treatment as soon as possible. The problem - according to ICD-10 - is diagnosed when the patient has:

  • constant interest in eating combined with binge eating,
  • taking measures to prevent weight gain, such as the aforementioned inducing vomiting or the use of laxatives,
  • morbid fear of obesity.

The very diagnosis of bulimia is made by a psychiatrist, but first you need to see him or her or convince a person who may have bulimia to see a specialist. The following problems may lead to the suspicion of bulimia nervosa:

  • isolating your loved one during meals (especially when he or she previously ate them with the rest of the family),
  • finding various packages for food or laxatives in various unusual locations (it is also possible to find the remains of vomit, e.g. in clothes cabinets, pots or … animal litter boxes),
  • noticing significant, unjustified fatigue or lethargy, as well as deterioration of the condition of his skin or hair,
  • noticing unusual, small scars on the dorsal surface of the fingers (so-called Russell's symptom - it occurs in people who often provoke vomiting due to skin damage due to repeated contact with incisors).

Bulimia: coexisting problems

It is worth remembering here that bulimia is not infrequently the only mental disorder with which the patient is burdened. The problem, unfortunately, quite often coexists with other individuals. Among those that coexist with bulimia nervosa most often, there are depressive disorders, anxiety disorders and personality disorders.

Additionally, patients with bulimia nervosa also have an increased risk of substance abuse and addiction.

Bulimia: treatment

Therapeutic interactions play the greatest role in the treatment of bulimia nervosa. They focus on various areas, their aim is, inter alia, changing the patient's self-esteem (which is typically very low) and transforming inappropriate eating habits into correct ones. One of the most recommended therapies in the case of bulimia nervosa is cognitive-behavioral therapy, in younger patients, family therapy is also important.

Sometimes - especially when symptoms of other mental disorders coexist with bulimia - pharmacological treatment is also used. Typically in this case drugs from the group of serotonin reuptake inhibitors are used, in particular fluoxetine.

It is worth mentioning here that usually not only the patient but also his immediate surroundings are involved in the entire treatment process. Such a necessity may arise, inter alia, from the fact that people struggling with bullying are often convinced that they have no problem - it is difficult for them to start psychotherapy at all, and then they usually need a lot of support to stay in it.

Bulimia: prognosis

An important issue - especially for patients' families - is whether their loved ones will be able to recover fully. The prognosis for bulimia is happy and better than for anorexia.

After 10 years of starting therapy, full recovery is observed in up to half of the patients, in others it may not fully improve, while in some people the symptoms of bulimia - especially in the absence of cooperation - may persist for a very long time, and sometimes , unfortunately, even for life.

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Psychiatry