How to treat bulimia, how to get rid of and fight bulimia

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Bulimia nervosa is a disease that is characterized by a clear cyclical pattern. First, a person overeats in a fit of compulsion, and then follows one of the compensatory actions that are designed to help him avoid weight gain. He may, for example, induce vomiting, take laxatives, or fast. Research shows that two to three women out of a hundred will experience signs of bulimia nervosa at some point in their lives. In men, the rate is much lower - only two or three out of a thousand develop bulimia. Many people overeat throughout the day, consuming more calories than the body needs to function, but compulsive overeating in bulimia works differently: a person eats large amounts of food within a limited time - most often within two hours. During this period, he can eat a whole cake instead of a couple of pieces or a pound of ice cream instead of a hundred-gram glass. The Diagnostic and Statistical Manual of Mental Disorders describes two subtypes of bulimia nervosa, which differ in the method the patient uses to get rid of excess calories:

after overeating, the patient induces vomiting, takes laxatives or diuretics - this is the most common form;
after overeating, the patient performs physical exercises until exhaustion or fasts for one to several days.

The vicious circle of overeating and compensation becomes permanent.
The patient first eats so much that he feels physical pain, and then abruptly begins to compensate for his breakdown - so abruptly that he then feels terribly hungry. When the cycle is repeated at least twice a week for three months, the patient is considered to meet the official criteria for bulimia nervosa. Find out the causes of excess weight and ways to quickly lose weight

Diagnosis is often difficult, since patients with bulimia in most cases are ashamed of their eating behavior and hide the cycles of overeating and compensation from others. At the same time, since they destroy the calories consumed during overeating, their weight remains normal. But compensatory mechanisms are unhealthy and have a bad effect on the body. In the long term, people with bulimia risk a number of serious medical complications, including irregular or absent periods, dehydration from decreased fluid intake, problems with teeth and gums, cardiac arrhythmias, and gastrointestinal problems. Largely as a result of the development of complications, in 2005 and 2006 in America, patients with bulimia were hospitalized so often that they accounted for 24% of all those hospitalized in general.

Physiology, psychology, sociology

Research shows that bulimia nervosa is about 55% heritable, meaning that the risks posed by inherent genetic vulnerabilities are only slightly greater than those posed by environmental influences such as growing up in a culture that values low weight and thinness. On the topic: What are hormones? They also show that girls who are prone to perfectionism, have low self-esteem and problems with self-perception (especially their weight and figure), and have problems with mood and control of their own behavior are predisposed to the development of bulimia. Patients who have been sexually or physically abused, or whose family members are constantly in conflict with each other and criticize each other, are also at high risk of developing bulimia - and other eating disorders. The disease most often develops in youth - in teenagers and those who have just turned eighteen. Typically, the first episode of overeating is the result of stress, depression, extreme hunger, or a feeling of disgust with one's own weight and figure.

What are the main types and stages of development of bulimia?

Bulimia, as a neuropsychiatric disorder, is differentiated into 2 types: • Pubertal bulimia, which occurs in girls during puberty and is characterized by bouts of overeating, which alternate with periods of prolonged lack of appetite. • Nervous, which affects older people. Develops against the background of low self-esteem, hereditary predisposition or endocrine diseases. In addition, there are 3 forms of overeating: • Attacks of “wolf hunger”. By the way, bulimia translated from Greek means bovine hunger, which clearly indicates excessive overeating. People also often say (let’s not be shy): “He eats like a bull.” • Almost constant food intake. Such patients constantly chew something. • Large raids on the refrigerator at night, when the emerging feeling of hunger prevents sleep and requires immediate satisfaction. There are also different forms of compensation for gluttony. These are such as: • Forced emptying of the stomach and intestines through vomiting and bowel movements. • Exhausting workouts and exercise. • Strict and restrictive diets.

It should be said that bulimia is a disease that develops gradually and goes through 3 stages: • The stage of unconsciousness. It is characterized by eating at night, when the patient tries to hide his problem from loved ones and experiences a feeling of guilt. Manifestations can only be detected by a significantly decreasing number of chicken legs, cutlets or cakes in the refrigerator. • The stage of awareness of the problem with persistent uncontrolled overeating, against the background of which fears, phobias and depression join feelings of guilt. An overfilled stomach already causes discomfort, pain and dizziness, which can only be relieved after emptying it. • Stage of decision-making and action to get rid of the problem. At this stage, patients are ready to seek help from specialists, because understand the failure of self-treatment of eating disorder.

Treatment Options

Treatment usually requires complex treatment, under the supervision of several doctors. The goal is not only to restore normal eating behavior, but also to compensate for complications and solve the psychological problems that initially caused the disease. Although the exact strategy depends entirely on the individual, the American Psychiatric Association's guidelines for treating bulimia nervosa suggest that it should begin by combining nutrition counseling with psychotherapy, preferably cognitive-behavioral therapy.

Nutrition consultation

To break the cycle, patients need to learn how to structure and pace their meals while still meeting the daily caloric intake needed to maintain weight. Usually it helps them to create a clear menu and schedule, and then follow it step by step, without deviations.

Cognitive behavioral therapy

Research shows that cognitive behavioral therapy for adults with bulimia nervosa is the most appropriate type of psychotherapy. She helps:

identify and change distorted ideas about yourself and about food, which became the cause of compulsive overeating;
Find better ways to cope with stress, which usually also plays a big role in overeating.

The full course of therapy includes twenty sessions over five months. At the same time, by the tenth session changes in behavior should appear; the symptoms should not disappear, but become less pronounced. If this does not happen, it is recommended to add drug therapy. Most doctors, however, believe that medications should be started immediately, since therapy with them gives better results than without them - this belief is confirmed by research. May psychotherapy be able to quickly break the cycle of overeating and compensating. Medicines will help the patient cope with symptoms and avoid relapses - in fact, they will become his support and support while working with the psyche.

Interpersonal therapy

Another option for psychotherapy is interpersonal therapy. She views any problem as a result of difficulties in relationships with people, and therefore helps the patient improve them. For some patients, this can be an excellent addition to cognitive behavioral therapy, especially if their overeating was caused by neglect from others. On the subject: How to take insulin

Self help

Self-help strategies are a good addition to psychotherapy. These include, for example:

communication with people in support groups for bulimia sufferers;
filtering information that can provoke a breakdown;
meditation;
self-support that can reduce stress.

Self-help is not a cure in itself, but it is easier to manage during the recovery period.

Antidepressants

The only approved antidepressant used to treat eating disorders is fluoxetine, also known as Prozac. Although most studies have been conducted on adults with bulimia nervosa, it is believed to work for teenagers as well. There have also been studies that have tested the response of bulimics to sertraline, aka Zoloft, and most have concluded that it may also be effective. But there were noticeably fewer of them than on the topic of Prozac, which is why many doctors doubt and prescribe what they are sure of. When treating bulimia nervosa, the dose of antidepressants is higher than when treating depression. It is often necessary to try several medications in succession to discover the one that works best for a particular patient. To reduce the risk of relapse, most doctors recommend taking the medication for at least nine months, preferably a year. Research shows that antidepressants quickly reduce the frequency of overeating and compensating behavior, and also improve mood. But they also show that patients who neglect complex treatment and take only pills abandon therapy earlier and are more prone to relapse.

Other medicines

If a patient does not respond positively to antidepressants, the doctor may try another class of medications, but the evidence for their usefulness is shaky. The most reasonable option is topiramate, which is part of Topamax. But it has many side effects, including significant weight loss. Many groups should be avoided in principle.

What specific tests can be used to diagnose bulimia?

Not many people know that there are scientific criteria to identify a tendency to eating disorder. For example, the EAT-26 eating attitude test, developed by the Clark Institute of Psychiatry in Toronto, which can be easily found on the Internet on psychological sites.

In addition, there is a way to check whether your weight is within the normal range using the BMI body mass index. The most accurate is the Quetelet index, determined by the formula I = m/h², where: • I is BMI. • m – body weight in kg. • h – height in meters. For example, a person’s weight = 55 kg, height = 160 cm. The body mass index in this case is calculated as follows: BMI = 55/(1.6 × 1.6) = 21.5

The BMI obtained during calculation is checked against the following indicators: • If it is less than 16, then there is a pronounced deficiency in body weight. • 16-18.5 – underweight. • 18.5-24.99 is normal. • 25-30 – excess weight, interpreted as obesity. • 30-35 – 1-1 degree obesity. • 35-40 – 2nd degree obesity. • 40 or more – 3rd degree obesity. The BMI we calculated corresponds to normal values. It should be borne in mind that weight depends on many factors, in particular, on the state of the musculoskeletal system and the gender of the person. But approximately, the Quetelet index, when determined over time, may indicate trends in weight changes. This is especially important if changes have occurred abruptly. This is a reason to ring all the bells and seek help from specialists - an endocrinologist, gastroenterologist and, of course, a psychotherapist. Laboratory tests for hormones, primarily those of the thyroid gland, and determination of the concentration of potassium and calcium in the blood are indicated to identify their deficiency. Among the instrumental methods of examination, ECG, ultrasound of internal organs, CT scan of the brain are recommended to exclude organic lesions, as well as renal function tests and consultation with a dentist to assess the condition of the teeth.

If metabolic, hormonal and central disorders play a leading role in eating disorder, consultation with a psychologist for the initial manifestations of eating disorder or a psychotherapist is indicated if the mental disorder has been observed for a long time and in a more severe form. And even in the presence of non-psychogenic causes of eating disorder, psychotherapy still does not lose its relevance, because An eating disorder of any etiology invariably leads to a mental disorder.

Long-term treatment results

Although there are many treatment options for bulimia nervosa, their effectiveness in the short term remains discouragingly low. Without persistence, improvement is impossible. Research shows that only about 45% of patients with bulimia nervosa achieved short-term remission after treatment that combined psychotherapy and medication. 35% - after psychotherapy without drugs and 20% after drugs without psychotherapy. The long-term outlook is more encouraging. In studies that followed the condition of patients with bulimia for 10 years after treatment, the results were as follows: 70% completely recovered and did not suffer from relapses. Moreover, the sooner treatment is started, the less negative health consequences there will be. If treatment is delayed or not started at all, not only the patient’s mental health will begin to suffer, but also the physical condition of his body.

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.

Consequences of lack of treatment

Like anorexia nervosa, bulimia nervosa has many medical complications. They are all the result of a cycle of overeating and compensation. The most impactful methods of compensation are:

vomit;
laxative abuse.

These two methods are used by 90% of patients. Some of the complications are potentially extremely dangerous, and patients should be aware of them so that treatment can be more effective. Other methods of compensation, such as diuretic abuse, are much less common and will therefore be mentioned briefly.

Leather

Bulimia has an effect on the skin - research shows this. The reason may be:

Low body weight (mass index less than 20). The consequences are similar to the dermatological manifestations of fasting. The patient may develop pathological hair loss, abnormal dry skin, itching, brittle nails, and excessive hair growth in places not intended for this purpose.
Constantly self-induced vomiting. Patients who induce vomiting do so mechanically by inserting their fingers into the mouth. Ultimately, the skin is injured by the teeth, scratches, abrasions and, as a result, calluses form on the knuckles. They look quite characteristic and are a clinical sign of bulimia - this is called the “Russell sign”, named after the psychiatrist who first noted characteristic calluses in his patients.

The symptoms are not compensated for by care products: for example, hair loss without a cure for bulimia cannot be stopped either by burdock oil, or homemade masks, or a visit to a trichologist.

Eyes, ears, nose

Self-induced vomiting can lead to damage to blood vessels in the eyes and nose. The result is hemorrhages, causing the appearance of red spots on the whites of the eyes and severe nosebleeds. The first is relatively harmless, the second can significantly worsen the quality of life.

Teeth

The dentist will be the first to see that the patient has a habit of self-inducing vomiting. Abnormalities of the oral strip in people with bulimia are pronounced and noticeable:

Erosion of teeth. It usually occurs on the lingual surface of the teeth of the upper jaw. The teeth of the lower jaw may also be affected, but are somewhat protected from the effects of stomach acid by the tongue. Erosion appears within six months after the patient begins to regularly induce vomiting on his own. Their speed and severity is determined by the duration of the disease, the types of food consumed, oral hygiene, the frequency of vomiting and the initial quality of the dental structure.
Caries. An increased incidence of dental caries is usually reported as a result of high carbohydrate foods, increased consumption of carbonated drinks, poor oral hygiene, and exposure to stomach acid.
Gingivitis (bleeding gums) and periodontal disease. They occur as a result of repeated exposure to stomach acid, which leads to chronic irritation and bleeding.
Dryness. In patients who self-induce vomiting, the rate of salivation decreases and, as a result, constant dry mouth occurs.

There are other, less common, disorders. For example, hypertrophy of the salivary glands occurs in 50% of those who induce vomiting. It is usually bilateral, and has a non-inflammatory nature and unclear pathogenesis. As with other symptoms, problems with teeth and oral cavity go away only after the cause is eliminated and are not amenable to symptomatic treatment in principle.

Pharynx

Frequent, self-induced vomiting leads to damage to the sphincters of the esophagus, and, as a result, to the appearance of acid reflux - that is, to the reverse flow of gastric juices up to the pharynx. Regurgitated acidic contents can come into contact with the vocal cords and surrounding areas, causing associated symptoms, including:

hoarseness and change in voice timbre;
pain when swallowing;
chronic cough;
burning in the throat;
pain.

Scientists once studied eight singers suffering from bulimia. Each of them had anomalies of the throat - one or several at once: swelling after swallowing, swelling of the vocal fold, thick mucus covering the larynx, hypertrophy of the posterior commissure, the appearance of polyps. Similar results of self-induced vomiting are observed in almost all patients suffering from bulimia.

Gastrointestinal tract

Patients who self-induce vomiting usually complain of symptoms: reverse reflux, problems with swallowing and chest pain after eating. All these complaints are the result of the development of esophageal abnormalities. With repeated vomiting, the esophagus suffers from repeated exposure to the acidic contents of the stomach and from microtrauma. The consequences are erosion, ulcers, bleeding. In the worst case, Barrett's esophagus will develop, a condition in which the normal smooth epithelium of the esophagus is replaced by the columnar epithelium characteristic of the intestine. This is, in fact, a precancerous condition that is clearly visible during screening, to which patients with persistent chronic reflux symptoms that are not amenable to treatment should be referred. It is also possible to develop Boerhaave's syndrome (also known as spontaneous rupture of the esophagus), which is accompanied by a whole range of symptoms: chest pain, shortness of breath, pain when yawning, rapid breathing, tachycardia, severe stress. If this happens, urgent surgery will be required. However, fortunately, Boerhaave syndrome is very rare. It is interesting that despite the frequency of complaints, the endoscopic picture in patients is almost normal or shows minor erosions. Therefore, upper endoscopy is prescribed only to those who have suffered from bulimia for several years and have been vomiting for all these years. Or those who develop objective new symptoms from the gastrointestinal tract. Studies of esophageal motility do not show a difference between sick and healthy people. Also, scientists do not yet know why the frequency of complaints about the gastrointestinal tract does not correlate in any way with the objective results of endoscopy. Perhaps the complaints are the result of psychosomatics, but there is no evidence yet that could confirm the absolute veracity of this theory.

Hormonal system

Repeated vomiting can lead to dehydration and subsequent disturbances in the regulation of the steroid hormone system. The mechanism is simple: the hormone aldosterone is produced by the adrenal glands. Its function is to determine how much water the body needs to retain. If a person vomits frequently, the body suffers from dehydration, low blood pressure and exhaustion, and begins to produce more aldosterone to retain more water and somehow compensate for the adverse effects. As a result, the kidneys begin to retain more salts, because it is with their help that it is easiest to retain water, the blood becomes denser, and the level of potassium in it, on the contrary, drops. All together it adds up to a pseudo-barter syndrome. At the same time, even after the patient stops inducing vomiting, aldosterone continues to be produced in increased quantities. The kidneys retain salts, water is retained in the body, there is no more outflow - the result is severe peripheral edema, especially severe if the patient is injected with salt-containing fluids into the blood in order to relieve dehydration. Moreover, if the patient does not vomit constantly, but periodically, the hormone content in his blood will be normal, since the body will not consider the condition close to dehydration.

Heart

Dehydration as a result of repeated vomiting leads to unpleasant cardiovascular symptoms. Among them:

tachycardia, which is manifested by a rapid, erratic increase in heart rate;
hypotension, which is manifested by a strong decrease in blood pressure;
orthostasis, in which the patient feels nausea and dizziness when getting out of bed;
hypokalemia, in which the level of potassium in the blood decreases.

All together leads to long QTc intervals. Simply put, the patient has an increased risk of developing arrhythmia, which will be accompanied by shortness of breath, fainting, radiating pain, and uneven heartbeat. Among the arrhythmias, there is even a specific type of ventricular tachycardia, which can be fatal. Also, although most patients use their own fingers or something hard to induce vomiting, some use a special syrup that was once used to treat acute poisoning and ingestion of foreign objects. Many people abuse it because they do not perceive reality quite adequately. The active ingredient in the syrup is emetine, a substance that has a long half-life and can accumulate to toxic levels with chronic use. Its toxicity can lead to damage to cardiac tissue, causing congestive heart failure, ventricular arrhythmia, and sudden death from heart attack or stroke.

Fertility

Although bulimia is not linked to fertility as prominently as anorexia, it does have an impact on the patient's health and her chances of bearing a child. In certain cases, if your body weight is very low, your periods may disappear. In addition, studies show that patients with bulimia have a greater risk of miscarriage than healthy girls, even if their weight is within the normal range.

Lungs

Vomiting, it would seem, should not have an effect on the lungs and, meanwhile, bulimia has unpleasant consequences in this area:

Aspiration is the entry of vomit into the lungs due to carelessness. An X-ray will show clouding of the lower lobes of the lungs, and the main symptom will be sudden difficulty breathing and shortness of breath.
Pneumomediastinum is the entry of air into the tissue of the lung wall.
The presence of a foreign body in the lung - when swallowing an object that caused vomiting.

Complications in the pulmonary area are relatively rare, but they still cannot be discounted.

Consequences of laxative abuse

Patients with bulimia nervosa have many ways of compensating. Self-induced vomiting is the most popular. The second most popular is the abuse of laxatives. They can be grouped into five groups, depending on their mechanism of action:

bulk laxatives;
osmotics;
surfactants;
thinning;
stimulating.

Typically, most patients with bulimia abuse stimulant laxatives containing phenolphthalein, senna, bisacodyl and anthraquinone. They act quickly and directly increase peristalsis (i.e. mobility) of the large intestine, resulting in the passage of large quantities of watery, loose stool.

The medical consequences of laxative abuse are numerous and all of them affect the gastrointestinal system:

Decrease in circulating blood volume due to fluid loss.
Electrolyte metabolism disorders.
Cathartic syndrome in which the colon loses mobility due to the habit of stimulant laxatives. As a result, the intestine expands and loses its ability to push feces. You can see this on an x-ray.
Degradation of certain parts of the intestine caused by the toxic effects of laxatives.
Problems with the epithelium inside the intestines and with the cells working in it.

As a result, everything develops into classic symptoms: slow stool, practically absent without laxatives. In this case, the patient may be more or less susceptible to the laxative, and this determines how destructive the effect will be in relation to his body. In the worst case scenario, colon catharsis is potentially irreversible. In the best case, constipation will gradually go away if you are patient when quitting laxatives. The systemic consequences of laxative abuse result from a decrease in circulating blood volume and electrolyte disturbances that develop as a result of diarrhea and the body's attempts to somehow compensate for the damage caused. Electrolytes that are lost due to laxatives are chloride, calcium, bicarbonate and potassium. A lack of potassium further leads to a slowdown in intestinal motility, plus there is a risk of severe edema if laxatives are abruptly stopped. Chronic diarrhea is also among the symptoms experienced by people who abuse laxatives. General changes in blood composition in accordance with the method of compensation

Payment method	Sodium	Potassium	Chloride	Bicarbonate
Diuretics	Decreases or remains normal	Decreases	Decreases	Increasing
Laxative (short-term use)	Decreases or remains normal	Decreases	Increasing	Decreases
Laxative (long-term use)	Decreases or remains normal	Decreases	Decreases	Increasing
Vomit	Decreases or remains normal	Decreases	Decreases	Increasing

Due to the fact that most patients with bulimia abuse laxatives, the therapist should ask the patient relevant questions, even if he is silent about such a symptom. Many people with bulimia are of normal weight and have trouble recognizing their own disorder—they find it painful to tell a doctor about laxative abuse, so probing questions are needed. Stool and urine tests and toxicology tests can also help with diagnosis. If the patient complains of chronic diarrhea for which there is no obvious source, the physician will also suspect that he is taking laxatives. Research shows that at least 15% of bulimics take them, despite the fact that almost everyone denies it. This is why it is so important for the patient to trust the therapist. The sooner real treatment begins, the sooner recovery will begin, and after laxatives it can take weeks, if not months.

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.

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.

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.

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;