Bulimia is a disease which is based on neuro-psychiatric disorder, manifested in uncontrolled food consumption, concentration on food, calories, weight. This is general wide-known bulimia definition. Also, a patient suffers from attacks of insatiable hunger, uses means for weight loss, takes laxatives, causes vomiting. Bulimics differ in low self-esteem, sense of guilt, excessive self-criticism, have distorted view of their own weight. At severe stages, bulimia leads to sharp weight variations (5 to 10 kg up and down), swelling of the parotid gland, chronic throat irritation, chronic fatigue and pain in muscles, loss of teeth.
Term «bulimia» is derived from Greek roots «bovus» (bull) and «limos» (hunger). Literally – «bull hunger». Also, this disease is called kynorexia. Bulimia is characterized by pathologically enhanced feeling of hunger (sometimes accompanied by weakness and pain in abdomen), which is accompanied by lack of satiety when eating (polyphagia – gluttony). Bulimia is a result of organic or functional disorders of the central nervous system (hypothalamic-pituitary disorders, epilepsy, tumors, traumatic brain injury) or mental illness (schizophrenia, psychopathy, obsessive-compulsive disorder). Also, bulimia may develop as a result of high blood insulin.
As food disorder bulimia was considered only in the twentieth century. In recent years, an incidence of bulimia, in the vast majority of cases – among women, continues to grow. It is believed that incidence of this disorder has social and ethnic roots.
Bulimia is a form of addiction (obsession) in the relation to food. Another extreme form of an obsessive-compulsive disorder related to food is anorexia.
Most often, bulimia is not associated with organic disorders, has psychological character, arises when eating food becomes a factor of emotional state correction. Thus unconsciously patient tries changing consciousness by means of overeating to get away from objective reality in subjectively assessed, unpleasant for him really. During the flash of negative emotions (anger, rage, irritation, fear, uncertainty and others), a man turns to food as a way to get positive emotions, eat for comfort, displace negative emotions into the subconscious. Since physiologically eating is really connected with receiving positive taste sensations, as well as endorphins production (hormones of happiness), there is a situational fixation: ate – enjoyed. A man more and more often resorts to this method of avoiding problems in future, he is trying to prolong pleasant sensations, increasing the time of food intake and amount of consumed food. Over time, a person loses the sense of taste when eating and concentrates on food volume, a fullness of the stomach. Physiologically, blood flow is concentrated in digestive organs and nervous activity deteriorates, psychologically – interests and attention are shifted towards food needs.
This way of psychological avoidance of real problems is dangerously attractive for its simplicity and accessibility. After all, it is always possible to eat tasty things, irrespective of personal qualities, appearance, standards of living – food is available. For individuals who are prone to finding easy ways to solve psychological problems, dependence on food becomes a natural choice. Bulimia is a psychophysical addiction because it has not only psychological background, but it also contains biological instinct of satisfying hunger.
Biological dependence develops when as a result of a regular overeating delicate appetite control mechanism is impaired. Regulation of hunger is no longer based on biological factors (content of carbohydrates in blood, stomach fullness) and becomes subjective. Hunger does not appear when a person needs food, but sometimes immediately after a meal. Thus, if originally person suffering from bulimia ate when he did not feel hungry, then in the course of the disease, he begins to feel an irresistible desire to eat all the time – there is a biological dependence on food.
Classification of bulimia
- primary bulimia, an uncontrollable urge to eat, constant hunger;
- bulimia, as a consequence of anorexia – anorexics may experience attacks of uncontrollable eating followed by a sense of guilt and vomiting, as well as other attempts to purification.
Furthermore, bulimia can occur in two ways:
- after binge eating episodes methods of purification are used- vomiting, laxative, enema;
- patients are not engaged in the cleansing stomach from eating food, but try to control their weight with diets, regularly breaking down into gluttony, after which only aggravate conditions of a limited diet.
Causes of bulimia are divided into physiological and psychological.
Physiological causes are associated with organic lesions of food center of the cerebral cortex, metabolic disorders (insulin resistance, metabolic syndrome), hormonal disorders (hypothalamic-pituitary insufficiency).
In the vast majority of cases in clinical practice, we have to deal with bulimia, which has psychological causes.
Specialists noted that bulimia often develops at persons belonging to affluent families, with a tendency to pretension and ambition of family settings. In such family, children often obtain inferiority complex, fear of falling short of expectations, to bring down, to disgrace the family.
Initially, people suffering from bulimia appear normal but are prone to increased demands to themselves, loneliness, depressive states. Over time, their life begins to center around food, society goes into the background and bulimics withdraw into themselves even more by avoiding communication.
If anorexia is quite easy to identify at objectively depleted people, bulimics are often quite long retain normal weight or are prone to its moderate increase. Bulimia with the need to get rid of eaten by vomiting often doesn’t cause an excessive increase in calory intake (although almost half of the consumed food has time to digest) and a sick person practically doesn’t attract attention. Bulimics tend to keep their obsession a secret, only very close people can be aware of it.
Most often, bulimia develops in young women (since 13 years). Peak symptoms severity are observed in the age group of 15 – 16 years, 22 – 25 years and about 27 – 28 years. In addition, more and more often mild forms of the disease are revealed at people of both sexes. Often, bulimia can be a consequence of long-lasting diet. Man, limiting himself to delicious favorite food for a long time, breaks down and go on a blind.
Among bulimics and their relatives often there is an opinion that the problem of overeating is a problem of lack of willpower that patient must simply stop eating by force of will and stick to a strict diet. However, it is not true.
Bulimia is similar to drug addiction, only drug here is food. Independently patient cannot break out of a vicious circle, with time he loses a feeling of satiety, and he has to increase dosage – increase amount of food, meals are becoming more frequent, it comes to the fact that patient always eats something.
People with bulimia often prefer sweet and starchy foods. First, this food causes most pleasure from eating and contributes to the greater production of endorphins, and secondly, it is high in calories and contributes to a significant increase in blood sugar levels that somehow sates bulimic.
However, a patient is often aware that he is eating too much, often feels guilty for his gluttony. New negative emotions cause hunger attacks – a vicious circle. After gluttony attack, the majority of bulimia patients have a desire to get rid of consumed food, not to gain weight. The easiest way to cause vomiting, also they resort to laxatives, enemas. As a rule, there are attempts to regulate weight through diets, food restrictions.
As a result, bulimia acquires cyclic form: overeating, self-cleaning by means of vomiting, laxatives and enemas, followed by a period of strict diet and a new breakdown.
Generally, few bulimics know how digestion occurs and do not know that vomiting after a meal does not lead to a complete return of consumed food, almost half of the eaten remains in the body and goes into the intestine, and laxatives lead to fluid loss, but not to the decreased digestibility of calories.
Moreover, regular cleaning procedures are not safe, are likely to disrupt water and salt balance, lead to irritation of mucous membranes of the esophagus, pharynx. People regularly practicing enema, a risk to earn proctology disorders. Severe dehydration can result in death.
Bulimia requires an integrated approach – patients not only need treatment by a gastroenterologist but also qualified psychotherapeutic help. Without correction of mental health problems that led to the disease, recovery is not possible.
Behavioral signs of bulimia:
- eating large quantities of food, poor chewing, haste in eating;
- bulimic after taking food can cause vomiting;
- sequestered life, secrecy, signs of psychological illness.
Physiological signs of bulimia:
- frequent weight variations – patient gains weight, then sharply loses it;
- weakness, low energy, general illness;
- a tendency to throat and pharynx inflammation (tonsillitis, pharyngitis);
- digestive diseases, metabolic disorders;
- dental diseases as a consequence of regular vomiting;
- increased salivation, salivary glands hypertrophy;
- dermatitis, skin laxity, signs of dehydration.
Almost always, patients refuse to notice bulimic symptoms and signs in their believe that nutrition problems may be solved with the help of willpower.
Bulimia Effects on the Body and Complications
- complications from oral cavity: tooth decay, periodontal disease and periodontitis, destruction of tooth enamel; hoarseness due to regular vomiting, mucosal injury of upper respiratory and digestive tract;
- parotitis may develop;
- gynecological disorders: cycle disorders up to amenorrhea;
- digestive disorders: chronic gastritis, enteritis, intestinal motility disorders, inflammation of esophagus mucosa, colon diseases, constipation, flatulence, disorders of pancreas and liver;
- endocrine diseases: diabetes, hypothyroidism, adrenal insufficiency; metabolic syndrome, the disorder of water and electrolyte balance.
Treatment for bulimia always involves elimination of its causes. At organic forms of bulimia primary pathology is treated, at bulimia nervosa, pathogenetic therapy is carried out as correction of psychological disorders. (Bulimia nervosa is characterized by bingeing and compensatory behaviors such as self-induced vomiting intended to undo or compensate effects of binge eating.)
Bulimia nervosa treatment combines both individual and group therapy. Often, patients suffering from depression are recommended antidepressants. To patients who have such complications as metabolic and digestive disorders special diet and correcting drug therapy in accordance with existing pathology are indicated.
Usually, only psychotherapy course is not enough to recover, long-term therapy is required with regular monitoring by a psychotherapist to avoid relapses.
Currently, researches are constantly carried out in the treatment of eating disorders, new techniques are being developed, increases the efficiency of medical care for patients with bulimia.
Prognosis for Bulimia
Prognosis of binge eating disorder is associated with a psychological condition of patient and treatment efficiency. In case of treatment ineffectiveness and its withdrawal prognosis is unfavorable – complications develop, the cardiovascular system is affected. Death can occur from cardiac insufficiency, stomach rupture, internal hemorrhages, as well as mental depression, may push patient to commit suicide.
With regular therapy and detection of psychological disorders, the prognosis is favorable. According to Canadian Pharmacy statistics, there are possible spontaneous recoveries through strong, positive emotional events.