Bulimia as one of the types of eating disorders, its differences from anorexia. What is its relevance? Causes and symptoms of the disease, as well as signs that should alert the patient and his loved ones. Who is most likely to suffer from bulimia and why? Methods of treatment and prevention of bulimia. We asked these questions to a practicing psychiatrist, psychiatrist-narcologist and psychotherapist (what is the difference between a psychologist and a psychotherapist), Chief Medical Officer Vladislav Sipovich. What is bulimia, how does it differ from anorexia and what is the relevance of the problem? Bulimia is a type of eating disorder of a psychogenic nature, in other words, an eating disorder (ED). In total, there are three forms of eating disorder: • Anorexia is a mental disorder manifested by an obsessive fear of being overweight, cellulite and other manifestations of obesity. At the same time, patients with anorexia see a distorted reflection of their body in the mirror, which, in their opinion, does not correspond to modern standards of beauty. Even having achieved frightening thinness, having completely lost the fat layer, they still find some non-existent signs of fullness. These patients are characterized by a psychological attitude toward achieving too low a weight limit. As a result, body weight becomes less and less, damage to internal organs, metabolic disorders, changes in hormonal status develop, which can lead in especially severe cases to irreversible complete exhaustion of the body and death. Moreover, these are not isolated cases; according to statistics, every tenth patient with anorexia dies. • Bulimia, unlike anorexia, is associated with overeating and has a different psychological background. Bouts of overeating, caused by various, often mental, reasons, cause feelings of guilt and shame for one’s behavior, as well as fears of weight gain. As a result, patients begin to diligently control their weight and, at the slightest shift towards increase, begin to take actions available to them. Most often this comes down to inducing vomiting, taking laxatives and diuretics. No particularly significant weight loss is observed, but disturbances in the water-salt balance occur with dehydration of the body and, accordingly, functional disorders of the vital systems of the body. Quite often, bulimia develops after anorexia goes into remission. • Psychogenic (aka compulsive) overeating is associated with loss of control over food intake. It manifests itself in the fact that a person “gets used” to eating a lot even without feeling hungry, first “eating” stress, and then, even for no apparent reason, absorbing a large amount of food in a short period of time. As with bulimia, it is accompanied by a feeling of guilt, isolation, disgust for oneself and one’s lack of will. Eating disorders are considered a female pathology; according to statistics, 97% of patients with eating disorders are women. Moreover, it develops most often in tender adolescence or girlhood - in the range from 10 to 18 years (80% of all those experiencing eating disorder). In 16% of patients, disorders developed between 18 and 25 years of age, and only in a small number of patients - after 25 years of age. Approximately 42% of eating disorders are due to anorexia, 17% to bulimia, 21% to a combination of both, and 4% to binge eating disorder. A fairly significant number of patients have a combination of all forms of eating disorders, developing simultaneously or replacing each other - about 10%. Loss of appetite affects 6% of patients. The young and even young age of patients, the devastating consequences for the physical and mental state of the body and possible fatal consequences confirm the relevance of the problem of eating disorder, prevention and treatment of all its types, including bulimia.
What can cause the development of bulimia?
The causes of bulimia are most often mental in nature. Considering that from 10 to 18 years the body is in the stage of growth and formation, proper and nutritious nutrition is necessary for the development of the musculoskeletal system, internal organs, and secondary sexual characteristics. All these processes are accompanied by changes in hormonal balance and enormous emotional and mental stress. Adolescents' resistance to stress is practically minimal, so any critical remark regarding appearance, figure or weight is perceived as something tragic and requiring immediate action to correct the so-called “shortcomings.” The simplest thing a teenage girl or a girl aged 18-25 can do is simply eat less or go on a diet. Many people try to lose weight and get closer to standard “skinny beauty” through intense physical activity in gyms or gyms. But the growing body demands its toll, hence the inevitable breakdowns and bouts of overeating, after which patients begin to hate themselves for their weakness and try to get rid of the consumed food as quickly as possible using artificially induced vomiting or taking laxatives. Awareness of the wrongness and harm of such actions comes much later, when health and psyche begin to suffer. At the same time, all mental and emotional potential is spent not on studying or communicating with friends, but on constant thoughts about losing weight and monitoring the readings of the scale. Such fixation leads to a decrease in cognitive abilities, quality of life, loss of emotional connections with family and peers, and psychological isolation. In fact, all the delights and joys of youth become inaccessible to patients with bulimia, further exacerbating the problem of loneliness. It seems to patients that all problems will be solved when they manage to reach a certain weight and approach the so-called standards. In addition, the process of cleansing the stomach through vomiting brings not only physical but also emotional relief, one might even say pleasure. This is most likely due to the production of endorphins (hormones of joy) when getting rid of food that overwhelms the stomach. At the same time, patients experience a joyful feeling of crystal purity. This is how a kind of mental dependence on artificially induced vomiting develops. Other causes of bulimia may include the following factors: • Hereditary predisposition. This is evidenced by the increased risk of bulimia in individuals whose family had relatives suffering from this pathology. • Strict diets and dietary restrictions leading to imbalances and nutritional deficiencies. • Pathological processes in the food center of the brain. • Metabolic and hormonal disorders. The most common sensations experienced with bulimia are: • hopelessness and helplessness; • hatred of one's body and personality; • anger and anger at yourself and others, especially those who talk about food; • anxiety for your health and destiny; • panic attacks and hysterics, • feeling of loss of control over the body and life; • feeling of loneliness, uselessness, etc. All these conditions sooner or later lead to depression, even if there is a temporary feeling of pride in one’s determination and willpower not to eat or to get rid of food taken artificially. In its extreme manifestations, depressive disorders can provoke thoughts and even suicide attempts.
People most susceptible to developing bulimia and other types of eating disorders are people who have low self-esteem, who have experienced psychological trauma or stress, who are prone to perfectionism, and who are already depressed.
The danger of bulimia is that the health problems that arise as a result often remain for life (especially over a long period of time). These are primarily disturbances in the gastrointestinal tract, metabolic processes, cardiovascular system and kidneys. In addition, it is impossible to restore crumbled and fallen teeth. Even with prolonged remission, bulimia can start again due to a word or event that becomes a trigger for a new process. Therefore, even a significant reduction in bulimia attacks is already progress in the fight against the disease.
Products at risk
More often, such addiction is associated with the consumption of sweets, fast food and other “junk” foods. In most cases, the factor of addiction is not hunger and the need for food, but the desire to pamper yourself with “sweets.” We choose food with certain taste properties, which are evaluated by our receptors in the oral cavity, sending signals to the satiety center, which creates a persistent dominant pleasure. Taste buds adapt and “get used” to chocolate, carbonated drinks, spicy, smoked, and food from fast food outlets. Thus, they prevent the perception of the natural taste of other “healthy” foods, suppressing the feeling of fullness. A similar thing happens with products containing monosodium glutamate, which enhances the taste of this food by acting on a certain group of receptors on the tongue, forming a chemical dependence at the physiological level. A predisposition to food addiction occurs in early childhood, which is associated with incorrect parenting methods, when food, often sweet, becomes a reward. Thus, along with psychological dependence, physiological dependence is formed.
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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.
The background of the disease
Symptoms of bulimia were described back in the 40s of the twentieth century, but not as a separate disease, but only as one of the manifestations of anorexia. The disease was identified as an independent category only in 1980 thanks to an American doctor. He observed female students at several universities alternating between overeating and fasting.
The term is of Greek origin and literally translates as “wolf hunger.” Despite the recent formulation of the concept, its cases were noted in the Middle Ages. Back then, feasts were famous for their sophistication and quantity of dishes. In order to try all the dishes, the participants of the feast were forced to induce vomiting several times during the evening, and for this they even had peacock feathers prepared in advance.
According to statistics, bulimia occurs 2 times more often than anorexia. First of all, it is detected in women . But don’t think that it bypasses men. They are also susceptible to this scourge.
There is a certain risk group whose members are prone to developing the disease. This is the category of people whose line of work requires a beautiful, physically harmonious body. This includes athletes, dancers, actors, models, and public figures.
As already mentioned, the disease is accompanied by bouts of gluttony. During such an attack, a person is able to eat up to 2 kg of food, consume 5–6 thousand kcal at a time (while the average norm is 2 thousand per day).
Such “binges” are repeated on average up to 10 times a week. In some cases, their frequency is two per week or can reach up to five attacks per day.
How to recognize bulimia?
Bulimia, the symptoms and signs of which are rather vague in the first stage, are easily diagnosed in the second stage, because become characteristic of this eating disorder.
The development of the process may be indicated by the following signs of bulimia: • Continuing to eat even after a feeling of complete satiety appears. • Inability to satisfy hunger while eating. • Concern about weight gain and searching for a way to lose it. • Excessive self-criticism towards your body. • The occurrence of digestive problems - increased salivation, enlarged salivary glands, inflammation of the esophagus, intestinal disorders, impaired liver function, etc. • Inflammation of the gums and throat due to constant trauma by nails and acidic stomach contents during vomiting. • Decay and loss of teeth. • Skin problems – decreased skin turgor and the appearance of dermatitis. • Menstrual irregularities. • Convulsions due to imbalance of water-salt metabolism. • Renal dysfunction, especially when taking diuretics. • General physical weakness and loss of strength.
Separately, it must be said that although bulimia is not considered a fatal disease, if prolonged and untreated, it can lead to a decrease in quality of life and a number of quite dangerous complications, namely: • Hypotension (low blood pressure) and quite frequent fainting caused by it. • Development of drug or alcohol addiction. • Chronic cardiovascular failure. • Neurasthenia. • Hypocalcemia (lack of calcium), leading to such dangerous conditions as arrhythmias, lethargic stupor, renal failure and confusion. • Edema of the extremities due to impaired renal function. • Spontaneous abortion.
It should be noted that despite the progressive development of signs of bulimia, a significant decrease in body weight usually does not occur, which makes it easy to differentiate it from anorexia, accompanied by severe exhaustion. Relative weight constancy along with binge eating episodes are the two main criteria that distinguish bulimia from anorexia.
Male variant of the disease
Despite the fact that 90% of cases occur in the female population, 10% also affect men.
But the causes of bulimia in men are somewhat different than in women. Sexuality plays a special role here. It was found that about 30% of men who were sexually assaulted suffered from a similar disorder.
Sexuality also matters. Bulimia more often accompanies men with homosexual or bisexual orientation, as well as transgender people.
For heterosexual patients, as it turned out, the topic of sexuality in the family was taboo. They either had no relationships with women or were unsuccessful.
Male bulimia most often strikes its victim between the ages of 15 and 25, while the female form makes its debut somewhat earlier, at about 11 years. The disease is more difficult to diagnose in men than in women. As a rule, they are more masterful at hiding its symptoms, and when hinted they react aggressively.
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.
Prevention of food addiction
Prevention of food addiction consists of following three simple rules:
- You should not reward yourself with food for achieving any goals, this can develop a conditioned reflex, it is best to use other measures - a pleasant purchase, relaxation or spa;
- You should not force feed your children; if the child is hungry, he will take the spoon on his own; do not force him to eat every last drop if he is already full;
- Eat food only in a specially designated place.
Prevention of food addiction is the best option for maintaining a healthy lifestyle and eliminating the risk of obesity. Follow certain rules, adjust your motivation, change your lifestyle, thinking, learn to enjoy other things and you will get rid of food addiction forever.
When to contact specialists
You should contact a psychologist at the first symptoms. Even if the problem seems minor and looks like a mild addiction. It exists and must be addressed immediately. There are serious reasons behind “eating” stress or refusing food, which only a psychologist can understand.
Do not delay solving the problem, leave a request on our website and we will provide a psychologist at any time, the service is open 24 hours. The consultation can take place in any convenient format: online chat with a psychologist, audio session or video consultation.
Let's sum it up
“Moderation is the best feast” G. Derzhavin
The main idea of combating food addiction is to teach a person to deal with stress using constructive methods. This is a long and labor-intensive process that requires the sensitive control of a specialist and the full dedication of the client. An important stage is reconciliation with one’s own “I,” the correct interpretation and expression of one’s feelings, and the mobilization of hidden reserves. Only a highly qualified psychologist can make this path correct and less painful. Under the strict guidance of a professional, achieving success will be much easier.
