Bulimia nervosa is a mental disorder with an eating disorder. It is characterized by recurrent bouts of overeating due to a sharp increase in appetite. After overeating, compensatory behavior sets in, a person experiences a strong feeling of guilt and remorse, tries to cleanse the body of excess food by taking laxatives and diuretics, artificially inducing vomiting, can exercise intensely, starve, or go on strict diets. On average, episodes of overeating occur one or more times a week, over several months. Bouts of overeating usually provoke the appearance of negative emotions, fatigue, anxiety, and depression.
What is an eating disorder (ED)? A group of psychogenically caused disorders in which there is a severe disturbance in the perception of nutrition and one’s own body. Eating disorders include anorexia, bulimia, compulsive overeating and mixed eating disorders.
Most often, bulimia develops between the ages of 15 and 25; about 90% of cases occur in women. The risk group mainly includes girls whose lifestyle is related to keeping in shape - dancers, gymnasts, models. Close people who criticize the child’s appearance have a great influence on the development of the disorder. Bulimia nervosa occurs in certain mental disorders, diseases of the endocrine and central nervous systems. People with bulimia seek medical help 2 times more often than people with anorexia. But timely diagnosis can be difficult due to a person’s concealment of his condition.
Bulimia often occurs hidden from others, especially in adolescents. Diagnosis of this type of mental eating disorder is possible based on the results of a clinical study and conversation. Relatives can assume the presence of bulimia if a person avoids sharing food, eats often and abundantly, but does not gain or gains little weight, eats large meals at night, and goes to the toilet every time after eating. Sometimes bulimia is accompanied by self-harm and suicide attempts.
As a result of limiting food intake, control over the amount of food eaten is lost, compulsive overeating occurs, which can lead to weight gain and even greater feelings of guilt because of this. Compulsive overeating lasts up to several hours, during which time a person consumes calories several times higher than the daily norm. It is often difficult to distinguish bulimia from anorexia; with these mental disorders, there is an independent restriction in the amount of food and inadequate compensatory behavior. If we consider compulsive overeating as an independent disorder, it is not accompanied by subsequent cleansing actions.
Bulimia causes physical health problems. Erosion of tooth enamel is possible due to the acidic environment of the vomit. Nutrient deficiency and dehydration, after constant use of drugs and induced bouts of vomiting, leads to electrolyte imbalance in the body, convulsions, heart rhythm disturbances and other consequences.
Causes
Bulimia is a polyetiological disorder. A combination of external and internal factors can provoke its development. There is no direct connection between gender and age, but it is most common in women. Many people with bulimia are of normal weight and have no previous history of eating disorders. On average, bulimia occurs at an older age; anorexia, on the contrary, is most susceptible to teenagers, and the cause of the development of the disorder is often a strong desire to lose weight. Self-esteem is usually low. The most common risk factors for the disorder are:
- heredity;
- female;
- end of puberty;
- affective lability;
- diseases of the endocrine system;
- organic brain lesions;
- metabolic disorders;
- unstable self-esteem.
Consequences for ENT organs
With bulimia, the throat often suffers. On the one hand, the cause is the same vomiting, which irritates the tissues. On the other hand, microtraumas have an effect - by pressing on the root of the tongue, a person often injures the mucous membrane. Against this background, a set of unpleasant symptoms appears:
- pain or soreness;
- constant desire to cough and clear your throat;
- inflammatory diseases due to wound infection.
It is not difficult to get an infection. If a patient does not control hunger, he is unlikely to think about keeping his hands clean. And vomit contains a lot of bacteria. Sometimes stomach contents end up in the nose. This often causes inflammation of the mucous membrane or sinuses.
Many patients have a chronic runny nose (although weakened immunity also affects this). But there is a more serious complication. Getting vomit into the nose is dangerous due to aspiration of the respiratory tract. It provokes, at a minimum, pneumonia, and at maximum, suffocation.
The most common causes of the disorder are:
Concomitant somatic diseases. Sometimes bulimia is provoked by physiological pathologies - metabolic disorders (insulin resistance, metabolic syndrome), damage to the center of the cerebral cortex (can lead to a constant feeling of hunger and uncontrolled food consumption), diseases with hormonal disorders (hyperthyroidism, diabetes mellitus).
Mental disorders. People with bulimia often have other mental disorders - the most common being anxiety and depressive disorders. There are concomitant anorexia nervosa, obsessive-compulsive disorder, schizophrenia, and some personality disorders. Often there are previous episodes of anorexia nervosa with remission between it and bulimia from several months to several years. The previous episode may be fully expressed or occur in a mild latent form with moderate weight loss and/or a transient period of amenorrhea (menstrual irregularities). Bulimia nervosa is usually a stage or variant of anorexia nervosa, but can be a separate syndrome in some mental illnesses.
Personal characteristics. The disorder mainly occurs in people with affective lability, low self-esteem, increased feelings of responsibility and guilt, problems with self-control, difficulty expressing feelings, and strong dissatisfaction with their body.
Social reasons. Eating “for company”, out of boredom, the habit of finishing a portion, even with a developed feeling of fullness. Sometimes bulimia becomes a consequence of poor nutrition in the family, with a low financial situation. Some parents push their child toward an eating disorder at an early age by using food as a comfort and reward. Children who are subject to criticism of their weight or body are highly vulnerable and at high risk of developing an eating disorder, and the same applies to children who have experienced inappropriate sexual treatment.
Psycho-emotional stress. People who do not tolerate stressful situations well or are constantly exposed to them often “eat” stress. In the early stages, severe emotional stress contributes to the development of the disorder. An attack of overeating begins from a feeling of strong internal tension, temporarily compensated by food intake. Overeating provokes feelings of guilt and remorse, as well as fear of weight gain. Compensatory behavior reduces feelings of guilt caused by overeating. Binges and purging progress over a short period of time and begin to appear much more frequently.
Literature:
- Gurova O.Yu. Metabolic and mental characteristics of obese patients: Author's abstract. dis. ...cand. honey. Sci. M., 2010..
- Fedorova I.I. Clinical, dynamic and psychotherapeutic aspects of eating disorders: Dis. Ph.D. honey. Sci. Tomsk, 2007.
- Dorozhevets A. N. Distortion of the image of the physical self in patients with obesity and anorexia nervosa: dissertation. - Moscow State University, 1986.
- Clinical Guide to Mental Disorders / Ed. D. Barlow. Translation from English, ed. Professor E.G. Eidemiller. — 3rd ed. - St. Petersburg: Peter, 2008. - 912 p. — ISBN 978-5-94723-046-8.
Symptoms
With bulimia, somatic and physiological abnormalities are expressed; pronounced psychosomatics predominate. Therefore, diagnosing the disorder is not difficult.
Symptoms of bulimia are considered to be:
- constant feeling of hunger and lack of feeling of fullness;
- regularly recurring bouts of overeating for an unlimited period of time;
- lack of control over systemic food intake; a person can eat more than 5,000 calories at one time;
- lack of full awareness of the process of eating - eating incompatible foods together, sometimes a person does not remember what and in what quantities he ate;
- visiting the toilet after each meal in order to “cleanse” the body (induced vomiting, taking laxatives and diuretic tablets, enemas, etc.)
- tendency to abuse physical activity in order to burn calories and use them as punishment for the food eaten;
- obsessive worries about your weight;
- frequent fluctuations in body weight;
- psychological dependence of the emotional state and self-esteem on food directly or indirectly (weight, body proportions, ability to follow a diet, etc.), failure to meet the criteria set for oneself provoke feelings of shame, guilt, and self-hatred.
Overeating is defined as eating a quantity of food that is significantly greater than the average amount consumed by most people under similar circumstances, accompanied by a feeling of loss of self-control.
During episodes of overeating, a person prefers to eat foods high in fat and carbohydrates (flour, sweets, confectionery, fried foods, etc.). The amount of food consumed varies, but the value is always several times higher than average. Overeating is usually episodic and often triggered by psychosocial stress.
Weight is not a defining symptom in bulimia nervosa. Women suffering from this disorder may have normal body weight, or be underweight or overweight. With anorexia and bulimia, patients are afraid of gaining weight and strive to lose weight due to dissatisfaction with their figure.
Bulimia is usually carefully hidden from family, as it is accompanied by feelings of shame and guilt. The binge-vomiting cycle can occur anywhere from several times a week to several times a day.
At the onset of bulimia, symptoms and disorders are subtle—visible symptoms associated with sudden weight changes or nutritional deficiencies. Over time, as the disorder progresses, the patient loses control over the situation, due to a deficiency of substances, the body requires more and more food, and vomiting has to be induced more often.
Bulimia always leads to disruptions in the functioning of various body systems.
- hair loss, brittle nails, dry and flaky skin;
- inflammation of the oral cavity;
- thinning of tooth enamel, increased sensitivity of teeth, risk of caries - with frequent induction of vomiting;
- swelling of the cervical and submandibular salivary glands;
- dehydration;
- electrolyte imbalance;
- gastroenterological problems;
- menstrual irregularities up to amenorrhea;
- anemia and its accompanying symptoms - deterioration in general health, dizziness, weakness, increased fatigue, fainting;
- depressive symptoms, alternating with euphoria or irritability, tearfulness.
- this does not apply here;
How to save a loved one
As already mentioned, people suffering from overeating do not want to admit their problem, hide it, and thereby harm themselves. The task of relatives and loved ones who notice the symptoms of bulimia is to gently push the patient to the decision to visit a doctor. The following will help you gain trust and explain the need to consult a specialist:
- Study as much information as possible about eating disorders, its manifestations and dangers, in order to fully and clearly convey it to the bulimic.
- The patient may strongly dislike the fact that you have found out his secret; he is capable of showing aggression. You need to be patient and try to build trust.
- You cannot put pressure on a person, and if at the moment he does not want to talk, postpone the conversation until he gathers his strength and wants to listen to you.
- Convince the patient that you do not want to humiliate him, but simply to help.
- Encourage the bulimic to express emotions about their life and condition.
- Focus the conversation on the fact that it is very difficult for any person to admit to addiction, so your interlocutor is great if he can do this.
- Promise the patient that you will not tell anyone about his illness. However, this can be done if he is ready to turn to specialists.
- Convince the bulimic that if he decides to undergo treatment, he will definitely succeed.
When communicating with such a patient, you cannot say that you are nervous about him, putting your feelings above his, manipulate, or behave as if you know everything. Under no circumstances should you say to him the following words: “Can’t you stop eating so much? Eat normally, you’re not fat.” This devalues the problem.
The difference between bulimia and anorexia
Anorexia nervosa is an eating disorder characterized by an obsession with losing weight and a distorted body image. Anorexia is a serious and often life-threatening condition, and in some cases difficult to treat. A person’s life becomes focused on the topic of weight and food, and their emotional state and quality of life deteriorate. Anorexia occurs 20 times more often in women than in men.
With anorexia, weight loss comes to the fore, due to severe restriction of the amount of food or fasting, while with bulimia, the main phenomenon is overeating followed by ridding the body of the food eaten. Bulimia is usually a stage of anorexia.
The presence of a disorder can be assumed if the following manifestations are present:
- complete refusal of food (fasting), often explaining this as health improvement (therapeutic fasting, yoga);
- maintaining a strict diet with a daily calorie content of less than 1500 kcal (does not meet the body’s needs for nutrients and energy);
- poor nutrition (a person adheres to a diet, eating exclusively a certain type of food - vegetables, cereals, fruits)
With bulimia nervosa, the volume of a single meal is large. Preventing weight gain occurs by disrupting the absorption of food in the digestive tract, using drugs, vomiting and other methods. With anorexia, weight loss occurs due to the body's destruction of muscle tissue to replenish energy. But various drugs that reduce appetite, diuretics, laxatives, etc. can also be used. Over time, cachexia (severe exhaustion) develops. Cachexia leads to disruption of the functioning of all internal organs, which can become irreversible. Therefore, people who suffer from bulimia need urgent psychiatric help.
Typically, compared with anorexics, patients with bulimia nervosa are more aware of their behavior and feel more regret or guilt about it. They are less socially isolated and prone to impulsive behavior and alcohol and substance abuse. Depressive and anxiety disorders are common in such patients. A person suffering from anorexia does not realize that he is ill. He explains his behavior by the presence of excess weight (even in its absence); according to him, any meal leads to a feeling of even greater weight gain.
Definition of disease
A person suffering from bulimia considers himself too obese. Looking at the reflection in the mirror, patients have the idea of being overweight beyond the norm in the direction of obesity, they experience a feeling of shame, they do not understand, they are not aware of reality. The subconscious creates an illusion, so people do not notice negative changes in a person until, in his understanding, the desired and actual appearance differ significantly. This is described by publications and articles on the websites of Moscow medical centers (including addresses, OGRN of a medical organization, client comments about specialists, information on the cost of services, dates for registering patients, e-mail, telephone numbers). Each client can anonymously leave feedback on the services provided.
Due to the lack of acceptance of one’s appearance, strong psychological stress, and against the background of bulimic attacks, patients develop neurosis, therefore treatment and rehabilitation therapy are mandatory. With mental disorders, the human nervous system completely cannot withstand the load. The patient develops a reflex: eat a large amount of food. Because of the fear of gaining extra pounds, he is freed from it. To cleanse, it tends to induce vomiting several times a day. Along with bulimia, there is a disorder called compulsive overeating - eating in unlimited quantities for several hours without a feeling of satiety against the background of neurological problems.
Wikipedia says: from Greek the word “bulimia” is translated as hunger, but in a person suffering from the disease, it is uncontrollable and becomes dependent on food. Satiety occurs only after overeating. A disorder is a disorder of mental state. Forcing, inventing personal problems, including the lack of desire to accept the body, suggests gluttony. Bulimia requires treatment in a medical clinic. The disease is also treated in children during adolescence, which requires special attention. +
Classification and stages of development of bulimia
Bulimia develops in two forms - primary and secondary, and has a different clinical picture.
Primary
The disorder is characterized by a constant feeling of hunger
Secondary.
Occurs as a consequence of anorexia Accompanied by a constant feeling of hunger and the likelihood of compulsive overeating After overeating ends, a person induces vomiting or uses other methods to “cleanse” the gastrointestinal tract, amid feelings of guilt. In the absence of guilt, usually after overeating, a person begins to limit his diet more.
The stages of bulimia are difficult to differentiate and are conditional. The course depends on the intensity of the manifestation of the main symptoms. Stages can replace each other over time, periods of remission and relapses are possible.
Initial stage.
The initial stage of the development of bulimia can be considered the intensity of “purging” 1-3 times a month. With this course, bulimia can develop up to several years. Parents and close people who have authority with the child have a great influence. Habits and possible actions to overcome problems are formed. As the disorder develops, the results of weight loss are perceived positively and shift attention away from underlying subconscious problems. With a lack of nutrients and an increase in hunger, a large amount of food is perceived by the body as positively. As bulimia develops, the desire to lose weight and cravings for food intensify. The amount of food necessary for normal well-being increases, but brings less pleasure. Under the influence of thoughts about losing weight or after one of the overeatings, inappropriate compensatory behavior occurs. The initial stage responds well to treatment with group therapy on an outpatient basis.
Chronic bulimia
. The chronic course of bulimia is considered to be its duration of more than 5 years with daily attacks of overeating and “purging” or more than 7 years with the frequency of attacks once a week. Constant discomfort begins to express itself in the development of depressive states, neuroses and phobias. The feeling of control over your life disappears.
Clinically complex cases of bulimia
. Bulimia negatively affects the condition of the entire body, impairing the normal functioning of organ systems. A clinically complex course of the disorder is considered to be the presence of concomitant diseases and complications. Most often, treatment is carried out in a hospital setting, for emergency reasons.
Treatment prices:
| Service | Price, rub) |
| Consultations | |
| Consultation with a psychologist in person or via Skype | 3 000 ₽ |
| Consultation with a narcologist | 3 000 ₽ |
| Psychiatrist consultation | 5 000 ₽ |
| Consultation with the head physician | 10 000 ₽ |
| Psychodiagnostics / pathological diagnostics | 7 500 ₽ |
| Family psychotherapy | 6 000 ₽ |
| Intervention session | 12 000 ₽ |
| Help for relatives | |
| Support groups for loved ones of addicts | for free |
| Webinars for relatives of addicts | for free |
| School for codependents 1 month | 5 000 ₽ |
| Motivating an addict for treatment | 6 000 ₽ |
| Accompanying the patient to the clinic | 6 000 ₽ |
| Advanced hospitalization | 15 000 ₽ |
| Service | Price, rub) |
| Rehabilitation | |
| Social rehabilitation of addicts | specify |
| Basic rehabilitation program | 40 000 ₽ |
| Standard rehabilitation program | 75 000 ₽ |
| Intensive rehabilitation program | 100 000 ₽ |
| Premium rehabilitation program | 350 000 ₽ |
| Online rehabilitation for addicts | 39 000 ₽ |
| Outpatient rehabilitation in Moscow | 55 000 ₽ |
| Rehabilitation of age-related alcohol addicts | 75 000 ₽ |
| Adolescent social-psychological-pedagogical rehabilitation | 60 000 ₽ |
| Rehabilitation Montenegro, Israel | 300 000 ₽ |
| Medical and social rehabilitation (14-21-28 days) | 90 000 ₽ |
| Transfer support | negotiable |
| Analyzes | |
| Drug testing urine analysis | 2 500 ₽ |
| Drug testing blood test | 12 500 ₽ |
| Hair drug test 3 months | 18 000 ₽ |
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Diagnostics
Diagnosis is made based on clinical criteria and conversation with the patient. To identify the presence of complications, additional laboratory and instrumental studies are prescribed.
Diagnostic clinical criteria for bulimia nervosa include recurrent bouts of overeating, accompanied by loss of control over the amount of food consumed and inadequate compensatory behavior, on average once a week, for more than 3 months. Self-esteem directly depends on body weight.
When to see a doctor
The effectiveness of treatment for this disease depends on how promptly the patient consults doctors. The disease is treated by a psychotherapist who can refer the patient for consultation with a psychiatrist and nutritionist.
You should seek medical help as soon as possible if:
- there is no feeling of satiety;
- periodically there are attacks of overeating, which the patient does not control;
- there is a fear of gaining excess weight;
- the patient is dissatisfied with the appearance;
- Eating alone is preferable;
- the patient is afraid to start eating because he will not be able to stop;
- after eating, a feeling of irritation and anger appears;
- behavior becomes impulsive.
JSC "Medicine" (academician Roitberg's clinic) in Moscow offers the services of qualified psychotherapists and psychiatrists in the field of treatment of bulimia. The clinic is located at the address: 2nd Tverskoy-Yamskaya lane, building 10, a 5-minute walk from the Moskovskaya metro station. Highly qualified psychotherapists and the use of modern treatment methods allow patients to be confident in the success of therapy.
Complications of bulimia
The development of most complications of bulimia nervosa is associated with compensatory behavior. Frequent vomiting can lead to erosion of tooth enamel, inflammatory gum disease, oral ulceration, esophagitis, dehydration and other complications.
Hormonal imbalances are mainly manifested by amenorrhea, which can affect fertility in the future. After recovery, over time, the menstrual cycle returns to normal. It is worth considering that during pregnancy, if a woman has a history of bulimia, there may be a risk of relapse if she begins to focus on weight gain.
Anemia and deficiency of macroelements (potassium, calcium, sodium) is associated with dehydration, as a result of which the electrolyte balance is disrupted and can provoke heart attacks.
Changes occur in the cardiovascular system (arrhythmia). Disturbances in the digestive system become noticeable most quickly; most often a person is bothered by constipation and heartburn. The functional capacity of the liver and kidneys decreases. Dry skin, hair loss, and sleep disturbances are noted.
Most complications are short-term and disappear after the person’s condition normalizes with treatment. Serious complications occur mainly due to poor nutrition, and their occurrence also depends on the duration and intensity of the disorder.
Diabetes. People with bulimia tend to eat foods high in carbohydrates and fat. Constantly elevated blood sugar can sometimes lead to the development of diabetes, and high cholesterol can sometimes lead to atherosclerosis.
Bone fragility. Calcium deficiency in children and adolescents leads to brittle bones in the future. Normalization of nutrition helps strengthen bone tissue, but the risk of developing osteopenia and osteoporosis in later life remains high, which will contribute to frequent fractures due to falls and sports.
If the disorder is diagnosed at an early stage and treatment is prescribed, there is virtually no risk of complications. The doctor will assess the general condition of the body and the likelihood of developing osteoporosis, diabetes and other complications of bulimia nervosa. Long-term progression of the disorder with high intensity symptoms and without treatment significantly increases the risk of death.
Consequences for the oral cavity
A common symptom of bulimia is erosive destruction of tooth enamel. The reason for this is frequent episodes of vomiting. Along with food, the stomach also expels a small amount of juice. It contains hydrochloric acid, which corrodes enamel. The more often a person vomits, the stronger the acid attack on the teeth. In addition to caries, the following are observed in the patient’s mouth:
- unpleasant odor due to constantly introduced bacteria;
- salivary glands enlarged due to inflammation;
- ulcers on the mucous membrane (injuries are usually caused by nails when inducing vomiting).
The patient’s teeth often turn yellow, become sensitive, and react to cold and hot foods. The gums become inflamed, which, if left untreated, can lead to periodontal disease. Without timely treatment, this threatens tooth loss.
Consequences for the endocrine system
The endocrine system suffers due to poor nutrition and human interference in the process of food absorption. Bulimia can cause diseases:
- thyroid gland (usually hypothyroidism);
- parathyroid gland (due to calcium deficiency);
- adrenal glands (due to increased production of the stress hormone cortisol);
- ovaries (up to anovulation).
Even women who have recovered from bulimia often face reproductive problems in the future. Since obstacles arise that prevent the body from absorbing nutrients from food, metabolism is disrupted. This is dangerous due to a deficiency of vital elements and diseases: diabetes, anemia, atherosclerosis, gout.
Effects on the digestive system
Since with bulimia a person interferes with the normal functioning of the gastrointestinal tract, numerous disorders are observed in this area:
- Esophagitis. The most common symptom of this disease. The esophagus becomes inflamed under the influence of hydrochloric acid.
- Gastritis. It is directly caused by a violation of the diet.
- Stomach ulcer. Since a person hides a mental disorder, gastritis does not receive proper treatment.
- Constipation, flatulence, bloating. These are the consequences of poor eating behavior.
- Disorder of intestinal motility. Occurs with laxative abuse.
One of the dangerous consequences of bulimia is gastrointestinal cancer. They are caused by chronic injuries to the mucous membranes, which disrupt the normal process of cell division.
