Bulimia: Symptoms and Treatment
Bulimia (bulimia nervosa) is a kind of eating disorder, in which patients have a sharp increase in appetite, and it manifests itself in the form of an attack, accompanied by painful hunger, soreness «under the stomach» and weakness. Bulimia, the symptoms of which can also accompany a number of diseases of the endocrine system, the central nervous system, is manifested, in addition, with mental disorders, and also in frequent cases becomes the cause of obesity.
As a basis of bulimia is considered a neuropsychic disorder, it manifests itself in the loss of control over consumed food, as well as in the concentration of the patient on calories, weight and, in fact, on food. This disorder is combined with the appearance of severe attacks of hunger, the use of laxatives and drugs for weight loss, in addition, patients also, in addition to this, provoke a vomiting. Distinctive features of bulimics are their understated self-esteem, excessive self-criticism, a constant sense of guilt. The idea of their own weight in these patients is distorted. The severe stage of bulimia is accompanied by sharp fluctuations in the mass of the patients.
From the Greek, the literal translation of the term «bulimia» in its constituent parts means «bullish hunger», in addition, the disease can also be referred to as «kinorexia.» Pathological increase of hunger in some cases can be accompanied by abdominal pain and weakness, eating does not reach the saturation stage, which leads to overeating (it is defined as the corresponding term — polyphagia).
As already indicated, bulimia can act as a satellite of the actual central nervous system (CNS) disorders in the functional or organic part (epilepsy, craniocerebral trauma, tumors, etc.), and as a companion of mental pathologies (obsessive-compulsive syndrome States, psychopathy, schizophrenia, etc.). In addition, bulimia can also be triggered by high blood levels in the patient’s insulin.
In recent years, the incidence of bulimia, diagnosed mainly among women, has increased and, unfortunately, there are no positive changes in terms of reducing its growth at the moment. It is accepted to distinguish the relationship of bulimia with certain ethnic and social prerequisites predisposing to the development of this disorder.
In general, you can also indicate that bulimia is one of the variants of obsessions, directly related to food. Anorexia is another variant of this type of disorder.
Predominantly bulimia, not caused by exposure in the form of any organic factor, has a psychological nature that determines the intake of food by a sick person as a way to correct the general emotional state in which it currently resides. At the subconscious level, the patient, through overeating, makes attempts to escape from an objectively existing reality.
Thus, the outbreak of negative emotions (insecurity, anger, fear, anger, etc.) is the reason for resorting to food, which is supposed to result in positive emotions. In other words, the arising troubles «get stuck», food helps to supplant such emotions to the subconscious. Considering the fact that at the physiological level, the ingestion of food in reality allows one to achieve at the expense of pleasant taste sensations the production of the hormone of happiness (endorphin), a kind of fixation is formed that is related to the corresponding situation, it looks simple: eating, the person receives positive emotions and, accordingly, pleasure.
As a result of such a binding, food is increasingly used as a way of avoiding emerging problems, regardless of their scale. Subsequently, the prolongation of pleasant sensations is achieved by increasing the time taken for food intake while simultaneously concentrating the patient on the fullness of the stomach and on the volumes consumed by it. Even later, those taste sensations with which food intake is associated are lost, the concentration, again, concerns the fullness of the stomach and the consumed volumes. At the physiological level, the concentration of blood supply focuses on the organs of the digestive system, the functions of the nervous system are impaired, the psychological state of patients is reduced to concentrating interests solely on nutritional needs.
The considered option of avoiding problems existing in the reality of patients, has some attraction, which determines the main danger of falling into the vicious circle associated with this disease. The principle of such attractiveness is extremely simple, it consists in the fact that «tasty» is always available, everywhere and to everyone, that is, in fact, the food is available to all. And if the person itself is predisposed to finding simple ways to avoid psychological problems, then the food, due to which, to some extent, it becomes possible, becomes almost a natural option in their choice.
Based on these aspects, it can be added that bulimia is a psychophysical dependence for the simple reason that it has not only a specific psychological background, but also specifically the existing instinct associated with the need to satisfy hunger. The development of biological dependence occurs in those cases in which regular overeating leads to a violation of the mechanism, through which the regulation of appetite is provided.
Thus, the basis for regulating the feeling of hunger is no longer reduced to normal biological factors (such as the fullness of the stomach or the carbohydrate content in the blood), but to the subjective principle of its activation. That is, the feeling of hunger in such cases does not arise from, again, the normal principle that a person really needs to eat, but in other situations, under the influence of factors, the pathological feeling of hunger is causing what becomes possible even after eating. Thus, if a patient with bulimia initially consumed food only under conditions in which he did not feel hunger as such, the progression of this disease leads to the fact that hunger becomes his constant companion, that is, an insurmountable feeling of hunger will be constant for the patient.
Nutritional behavior may be violated in accordance with one of the following:
- the absorption of food occurs paroxysmally and in huge quantities, that is, a sudden appearance of appetite occurs
- a constant intake of food for the sick, that is, as is understandable, feeds the patient all the time;
- night food consumption, accompanied by a night feeling of hunger
The classification of bulimia is reduced to its compliance with the following options:
- primary bulimia — a feeling of constant hunger, coupled with an uncontrolled desire to «eat, eat and eat»;
- bulimia, which is the result of anorexia — with anorexia, binge eating attacks that can not be controlled are also allowed, after which the same feeling of guilt occurs in bullies, attempts are made to purify in one form or another.
The course of bulimia can also be determined by one of the following patterns of patient behavior:
- binge eating is accompanied by the subsequent implementation of measures to cleanse the body of food from vomiting, enema or laxative
- there is no cleansing from the consumed food, attempts are being made to control their own weight through diets, which is associated with periodic disruptions to overeating, which is followed by measures to aggravate dietary restrictions on nutrition.
The causes of bulimia are closely related to the symptomatology, therefore the allocation of this section is rather symbolic, due to which, however, we can determine for the reader some principles of the cause-and-effect factor of the development of this disease. Considering the fact that the problem of bulimia is strictly individual, although it has some similar features in different cases, part of the causes of this disease can be picked up and directly from the section describing the manifestations of bulimia, that is, from the section on symptoms.
Let’s start with the fact that bulimia in accordance with the causes provoking it can have a physiological or psychological nature.
The physiological nature implies under itself already isolated organic brain lesions, as well as lesions that affect the metabolic processes and hormonal disorders. As to the psychological nature of the occurrence, it occurs in the vast majority of cases of diagnosing bulimia.
In particular, for example, it can be noted that often bulimia is a disease that develops in people from wealthy families, which is due to the ambitiousness and general pretentiousness of the existing facilities within their framework. Quite often, children from such families are identified with an inferiority complex, combined with the fear of failing their family, not justifying the expectations (or hopes imagined), disgracing, etc.
Initially, patients with bulimia have nothing special «out of the crowd», although it may be evident that they have exaggerated claims against themselves, susceptibility to depressive conditions and being alone. Over time, their life is completely concentrated on food and only on it, in this connection, communication and society as such are already in the background. Because of this situation, patients with bulimia begin to finally become isolated in themselves, in one way or another finding reasons for avoiding any communication.
One of the problems with bulimia is that in this disease, unlike anorexia, for example, which can be found in people who have apparently been depleted, the weight of the bulemics persists over a long period of time within the normal range, sometimes only reaching some moderate Fluctuations in the big party. This is explained by the fact that bulimia is accompanied by the patient’s need to get rid of food through vomiting, which, despite a considerable appetite, excludes the fact of excessive caloric intake. Meanwhile, this is not a final statement, because about half of what is eaten does take time to assimilate. Thus, patients can practically not stand out, about their mania basically they are silent, admitting to her only very close people.
Basically, bulimia nervosa, as already indicated, is diagnosed in the female part of the population, from the age of 13 years and older. The critical age at the peak of the manifestation of bulimia symptomatology is defined in the range from 15 to 16, from 22 to 25 and from 27 to 28 years, although this disease can be diagnosed in older patients, at this point we will stop in detail regarding the symptoms of the disease. Bulimia in mild form is often diagnosed in both sexes. It also happens that this disease can result from a previous long-term diet. In other words, with prolonged restriction of oneself in receiving the desired food, a person «breaks down» at one time, starting up, so to speak, «all the hard» in this direction.
What is noteworthy, the bulemics themselves often distinguish such a side of the problem that provokes this disease, as a lack of appropriate volitional qualities. That is, in accordance with this principle, the patient precisely because of this can not refuse at the expense of certain volitional efforts from consumption of food under the given scenario, adhering simultaneously to this diet regime without any deviations. Allocation of this party in the problem is wrong.
The fact is that bulimia has common aspects with drug abuse, except that food, as we have already noted, is even more accessible and, in fact, for this reason it is seen as a drug — through direct comparison of impact, behavior and other moments . Similarly, with the depth of the problem of drug addiction, you can also consider the problem of bulimia, because in this disease, the patient also can not get rid of the addictive craving for food, that is, the way out of the vicious circle is an option impossible. Considering the fact that with the passage of time with bulimia the feeling of satiety does not come, the «dose» of consumed food has to be increased, meals are needed even more often, snacks become almost constant phenomenon, then, as the reader can see, parallels with drug addiction are undeniable.
The peculiarity of bulimia is that the main preferences in the food of patients are given to the flour and sweet. The reasons for this choice, in general, are clear: this food is more conducive to the emergence of pleasure from it, thereby increasing the production of the endorphin by the body, and, of course, this food has a higher calorie content, because of which sugar in the blood grows, and With it, respectively, the saturation also grows.
There is another side in this love for food, it consists that patients, using it in too large quantities, begin to experience a sense of guilt because of the eaten. The sense of guilt, as you understand, refers to negative feelings, that is, to «seized» feelings, which, accordingly, leads to the fact that with the appearance of the next bouts of hunger, which, of course, again closes the vicious circle. Attacks of binge eating in many cases are accompanied by a sense of guilt to get rid of what was eaten, which can also be done under the influence of fear for excess weight due to the abundance of eaten. The simplest way is to induce vomiting for such patients, although they «do not disdain» them with enemas, laxatives. In addition to this regulation, the weight of the bulemics is sought through certain restrictions in food and through dieting.
Thus, the development of bulimia is similar to the cycle in which overeating is first observed, self-purification attempts (vomiting, enemas, laxatives), and after diet , all this until the next breakdown, which is in any case in this cycle.
For the most part, seldom does anyone in the bulimics have an idea of what constitutes digestion, how it happens. Because of this ignorance, respectively, unknown to them remains the fact that vomiting, artificially induced by them after eating, does not completely give the food just eaten off the stomach, moreover, almost half of what was eaten, everything also remains In it after vomiting. Further, this food is sent, as it should, to the intestines, after which it naturally leaves the body in the appropriate form. As for the use of laxative, it, in fact, causes loss of fluid, but in no way becomes a means to reduce the digestibility of calories consumed.
In addition, an important point is the practical danger of cleaning procedures due to the methods noted and used by the bulemics. It consists in the fact that the water-salt balance in the body is subject to disturbance, and the pharyngeal mucosa and esophagus are irritated. Thus, patients who regularly use «enemas» for «cleansing purposes» often come across a variety of proctological disorders. And this — not to mention the fact that severe dehydration, again, achieved through the use of certain drugs and against the background of the overall picture of the disease, can cause death.
Given the peculiarities of bulimia, it should be noted that the treatment of this disease requires not only the implementation of measures for the direction of gastroenterology, but also the measures of psychotherapy, moreover, it is psychotherapy that is the main and primary direction of influence on the patient to achieve relevant results. Absence of those in the treatment of measures to correct psychological problems reduces to zero the probability of recovery from bulimia, which is important to remember.
The basics associated with the disease, as well as its main manifestations, we have considered a little bit more briefly, now we will try to understand the essence of manifestations of the symptomatology and their nature in more detail.
At the heart of the disease, for example, may be the following scheme. For example, a child in childhood missed tenderness, affection, warmth, etc., in addition, he also fell under certain restrictions on the part of contact with other children, due to which he could receive a share of pleasure, joy and positive emotions corresponding to such communication, but as Clearly, did not receive them. That is, the child grew in severity, in «snake mittens». As a result of this way of life is that he, without having other sources of joy and positive emotions at his disposal, finds them, figuratively speaking, in food.
As a result, the main influx of such emotions comes through eating, but the parents, having no possibility or desire to give it more (in an emotional, again, plan), indulge in increased appetite compensating for the lack of such needs. This, in turn, leads to the fact that the child begins to overeat, which affects his weight. In a team, for example, in a school, for this reason, he encounters with self-disapproval of others, with ridicule, lack of popularity and various antics of peers due to overweight. The child begins to understand that the reason for all this can be fullness, because of what he gradually begins to hate his own preferences in food, his own body. As a destructive measure to combat weight, there are various methods of affecting the body, such as hunger strikes, and induced vomiting, etc. In some cases, children reach a state of exhaustion, in addition, they lose interest in everything that is not related to the topic of weight loss.
The body responds appropriately to the child’s attempts to combat excess weight, as a protest from his side there are bouts of hunger, to control them with each manifestation is more and more difficult.
It is also possible that bulimia develops in people whose weight can be called normal, but the essence of the disease lies in the fact that it develops as a result of frequent attacks on a child in childhood. In such cases, it often happens that for the parents the child is «not good enough», regardless of what this statement concerns — in the course is the comparison with peers in particular. Similarly, the reproaches are used in regard to the awkwardness of the child, his awkwardness or, which, unfortunately, is not uncommon, regarding ugliness, it is also issued «on the top» in the form of appropriate reproaches. The situation is aggravated by the fact that the girls (namely, they mostly have to deal with such attacks) take all possible and sometimes impossible attempts to «prove to everyone» what they can achieve (in terms of beauty, demand and fashion) , Reaching the standard samples of «supermodels». Their body, similarly to the reproach of parents and environment, is perceived «not so» before any results are achieved, after which radical measures are taken to combat it, and this is a scheme of such alternately repeating components as «hunger — excessive appetite — Called vomiting — overeating. «
Bulimia can also appear sporadically, which is accompanied by the appearance of bouts of hunger in people who are apparently healthy and healthy, at first glance. Basically, the manifestations of bulimia here consist in trying to «seize» a problem that has arisen, a problem that a person does not want to deal with. It can touch anything, for example, problems arising in family life or in work — that is, in any situation and sphere in which a person refuses to perceive them as they should. Because of anxiety, prerequisites arise on the need for a decision. As a result, the consciousness refuses to accept the problem, while the body, figuratively speaking, finds a problem for its «solution», through the subconsciousness, compensating for the growing anxiety with the growth of appetite. Even such a simple, as it seems, example, requires the provision of qualified assistance.
So, now back to anorexia and bulimia, which, by and large, are two sides in one common problem. Anorexia itself is the result of uncontrolled measures, realized in attempts to lose weight in combination with fear of «grow» with extra kilograms. That is, anorexia is accompanied by a loss of appetite, and the development of depressed states in patients. In this case, if anorexic force is forcibly forced to eat, then it will develop a «protective reaction», accompanied by vomiting with convulsions. About 5% of American women in the «business» area suffer from anorexia, while housewives account for about 2%.
As for the Russian Federation, this disease accounts for an average of 0.5% of the female population in the age range of 25-55 years. Predominantly for this disease women fall into the «public» sphere of activity (show business, TV, etc.), as well as the elite. On average, the death rate from anorexia is about 11.5%, which in particular occurs due to insufficient intake of food in the body, various vitamins and trace elements that it needs. If to speak about more exact figures, on the average perishes about 2500 patients (within the limits of consideration of the annual statistics on the given disease). In addition, one out of ten cases accounts for a case of exhaustion, a heart attack or suicide.
As a practical antipode anorexia, we are considering the disease of interest, in fact, bulimia. Bulimia, as the reader has already been able to understand, consists in part of its manifestations in uncontrolled overeating. The result of this disease at certain stages are convulsions, gastric lavage in a hospital and subsequent treatment in a number of ways. In addition to bulimia, pathologies of one or another scale that affect the gastrointestinal tract (GIT) also join. Basically, as already we also found out, women are sick, it is possible to determine approximately the territorial predisposition. For example, only adult Americans account for 1.5% of the population, of which 10 cases are 9 women, 1, respectively, men. According to European countries, the statistics are approximately the same. But in Japan bulimia is somewhat rare, here the prevalence of the disease is only about 0.25%. Regardless of the location, bulimia is a purely «female» disease.
Situations that provoke overeating, there may be a mass. This can be a process of divorce, relevant for women, and a session for the student, and parents’ misunderstandings or «unrequited love» for adolescents, etc. What is noteworthy, in Russia, statistics not only differ from other countries in this disease, but also deviate somewhat from the standards assigned to it. The fact is that the current incidence is about 34% of cases of diagnosing bulimia in men, and about 22% of cases diagnosed in children.
Now let’s move on to the peculiarities of clinical manifestations associated with bulimia. In particular, patients may have a certain swelling of the glands in the neck and face, the enamel of the teeth from their back surface is subject to the development of erosive processes, the person may have hemorrhages, the salivary glands may also swell (which gives the patients a characteristic appearance in which they are compared with Chipmunk). In the throat there is a constant soreness, the esophagus is inflamed, which is accompanied by heartburn. All this symptomatology is manifested as a result of the effect induced by artificially induced sick vomiting. Bulimic episodes of «food-vomiting» are also accompanied by impulsive actions performed against the background of emotional overstrain, actions of this nature are performed in conditions of patients’ stay alone. Eating is associated with the need for significant efforts to neutralize the harm that overeating carries with it, which is also directly related to the need to get rid of the calories absorbed from the food itself.
Bulimia patients also implement the appropriate behavior in humans, which makes it difficult to «suspect a suspicion». So, because of the shame associated with uncontrolled behavior caused by excessive appetite, bulimics attempt to hide the real state of things. Often secretly sick enough to eat, then, as a standard for themselves, cause vomiting to get rid of the eaten. In public, they eat in moderation, if not limited. If the process of eating in the daily routine is prevented or if someone finds bulimics behind a «hungry meal», the actions are accordingly shamefaced and quickly concealed and interrupted / terminated. Absorption of food in frequent cases involves preparing for a «ritual,» which is accompanied by preliminary bulk purchases and preparations. To implement a plan for such a «ritual,» the patient can even go to steal food.
The listed episodes and the line of behavior, true inherent in bulimics, can hide for a long period of time, until, respectively, they are detected.
Progression of bulimia gradually leads to the fact that the thoughts of a sick person are reduced only to satisfying hunger, as a result of which any type of problem (interpersonal, family, professional, etc.) recede into the background. Outwardly, as already noted, most patients with bulimia look normal, creating the impression of healthy people, although their propensity to loneliness, exertion (first of all, to oneself), depressiveness of moods can be singled out. Standards they overestimate, while self-esteem, on the contrary, is subject to understatement. Again, as we have already pointed out, life is fully focused on food, features of the figure, and also on the fact that one has to hide one’s own preferences from the environment.
As another, no less specific sign of bulimia, the feeling of bulimic loss of control over oneself is highlighted, which is actual in particular for the period of manifestation of a binge attack. This concerns, for example, the feeling that it is impossible to control the amount of food eaten, or that it is basically impossible to refrain from eating. There is also fear of the patient before that he will not manage to stop eating since the beginning of his binge eating, and this fear can reach serious panic conditions. It is at the expense of such fears and a sense of lack of control that compensatory actions are performed, that is, these are already considered attempts to induce vomiting, use enema, laxatives, fasting and diet. This, according to the patients, allows to counteract both overeating and weight, which due to this can increase.
Bulimia is accompanied by, among other things, also the emergence of anxiety in patients regarding their own weight and overall shape. This explains the seriousness of the relationship and the corresponding approach to caring for the figure and weight, including systematic diet compliance. If we look at specific areas through which self-esteem is formed, then bulimics concentrate on weight and figure, often on the first place in the distribution of topical priorities for them. Moreover, it is precisely the peculiarities of the state in these areas that determine the corresponding «mood» for them in assessing themselves, in relation to themselves.
Next, we should also highlight another characteristic characteristic of patients with bulimia, and it consists in their emotional fragility, which is also supplemented by difficulties in controlling their own emotions. Figuratively speaking, it can be identified that fat is a kind of protection for bulimics, allowing to be shielded from the fact that in general a person can be injured, it concerns in particular relations with the opposite sex and general emotions that could lead to a similar result. Food, in turn, is seen as a substitute for any pleasures that exist in life.
In patients with bulimia, two main trends prevail in life, these are attacks of constant and uncontrollable appetite / absorption of food and fear associated with loss of control over emotions. The fear of losing control over them is gradually transformed into a kind of attitude towards food. It is, roughly speaking, manifested in the fact that it is easy to «blossom out» and «afford everything», which is not to say about emotions in life that can be dangerous and can be «wounded» by their manifestation, that is, the food serves as The counterweight to the rest of life, outside which bulimics, in fact, are.
Basically, patients try to cope with the problem at the expense of dietary restrictions, but the more they restrict the restrictions for themselves and the more they try not to eat, the more their desire for unrestrained absorption of food increases.
There are different types of bulimia for certain categories of patients, due to which there is a difference in terms of psychological characteristics, which requires, respectively, a difference in the therapeutic measures being implemented. So, for some patients the problem of excess weight is actual, they can not follow any diet, therefore bulimia treatment for them is mostly medicamentous. In most cases, such patients come to an awareness of the essence of the problem, that is, that once they have passed a certain experience, as a result of which a fear arose about the further inability to correct and control the impulses that arise. This is accompanied by an awareness of the fact that the existing attitude to food is protective, and that they would also like to implement unrestrained impulses in other spheres, leaving behind such impulses only in relation to consumed food.
More rarely, in practice, specialists have to deal with those patients who do not recognize the protection factor as an actual problem in their own disorder. Because of this, the attitude towards food on their part can be compared with the perception of it as a demon in them. Communication of the rampant about food and its own inability to control itself in other life spheres such patients can not realize and accept. Often such an attitude on the part of a part of the patients is associated with an increased sense of guilt and with moralism about their own debauchery, as well as with its complete denial. In general, the part of patients under consideration faces significant difficulties related to relations with the opposite sex.
What is noteworthy, in some patients the symptoms of bulimia develop by that time in life when children grow up, more precisely — when they leave their parents’ home. Here, as is clear, we are talking about older women, whom we initially identified in the general examination of the disease. The problems that arise in the relations of the spouses in this case take more obvious contours, which is explained by the fact that the husband, as before, is engaged in professional activity, and the spouse, having remained «out of work», having exhausted the basic role, that is, the role of the mother, Faces a certain depressive background. Under such conditions, due to the unrestrained absorption of food, attempts are made to compensate for one’s own state due to pleasant emotions obtained with food, which also gives the opportunity to fill the days with a meaning.
There is another type of patient. Here, with bulimia, it is possible for a certain period to withstand the diet-induced restrictions and conditions that occur against this background, but afterwards there is a loss of control and a breakdown. As a result, the weight is in constant fluctuations between the optimal index and between that figure which exceeds 5-6 kg. In this case, there is an alternation of control periods in patients with periods of loss of control. They are in a constant struggle with diets, although they never achieve excessive weight.
In this case, patients, reaching a weight norm through weight loss, realize their own attractiveness, but internal fear leads to the fact that they again begin to eat excessively, which is done in order to have a certain layer of fat, which provides the possibility of fencing And protection from the people around them. The peculiarity of such patients is also their increased resistance in relation to the therapeutic measures implemented in their address. To solve the problem, they tend to try to turn to specialized assistance from nutritionists and other doctors, missing the need for psychocorrection, due to which disappointment and lack of effect from other measures leads to the fact that further therapy is simply ignored.
An extremely relevant aspect for patients with bulimia is the dependence on positive evaluation by the people around them. Stabilization of their self-esteem, in other words, is achieved due to the certainty that there is approval from the environment. Because of this, bulimics often try to behave in such a way that their behavior and actions correspond to the expectations that exist on their part of the environment, which, however, leads to the suppression of their own desires, which, of course, are in the background.
Patients with bulimia in this case tend to make others happy, adhering to the idea that in order to be loved, it is necessary to achieve perfection. This behavior, as well as thinness — the criteria of conformity and excellence, and the achievement of love and recognition of others, in their opinion. Accepting themselves in a different way than expected is difficult for them, because of this there are difficulties with self-perception, and difficulties in relationships.
Given that bulimics tend to be liked by those around them, as one of the measures that allow this to happen, it becomes a cover up of their true emotions, because if, for example, anger is shown, then the person addressed to it , Will be offended, which means that he will not be able to like either. In the end, a lot of actions are performed by the bulemics, which one does not want to do, which, in turn, is accompanied by a low degree of self-expression. The origins of this behavior, as well as the problem of bulimia, can go back to early childhood with their roots. Add to this can also be the fact that as a condition that also originates from such a trait as «like others», one can also consider such a characteristic feature of bulimics as the desire for perfectionism, based on dependence on the approval of people around them. The desire to achieve perfection in this case has a slightly different form, if associated with food. Weight correction by diet in most cases becomes ineffective, because it is not possible to stick to a diet for a long time, because of a malfunction, discomfort and guilt increase, the elimination of them becomes possible only at the expense of food, which leads to the re-formation of a closed circle according to the scheme «food — a sense of guilt — food. «
By itself, food in any case becomes a means to relieve stress only for a while. In this case, the longer the overeating manifests itself (actually bulimia as a determining condition), the less prolonged are the periods of «calm» following the ingestion of food. As a result, food also acts as a regulator of mood for patients. Based on these points, it is necessary to emphasize how important is the treatment of bulimia in the early stages, and the treatment is not only medicated, but also psychotherapeutic, and not only treatment specifically for the patient with this disease, but also work with his family (in particular, , A method of psychocorrection).
Summing up, I would like to dwell on the fact that bulimics in the overwhelming majority of cases are inclined to categorically deny the existence of the problem in the form of the disease we are considering. Given this, the main signs of bulimia can be detected by relatives and close people of the alleged patients, because, in fact, we distinguish them separately:
- Behavioral signs of bulimia
- eating a large amount of food, ingesting large chunks, with bad chewing, eating is absorbed hastily
- eating, bulimics rush to leave the table to the toilet, which they urgently need to call for vomiting;
- patients with bulimia are living in a closed way of life, non-standard signs of behavior may appear that indicate some mental health disorders, and they are also secretive
- excessive dietary craving, persistent counting of calories consumed with food
- presence of «diarrheal» patient diuretic, emetic, laxatives
- imparting yourself to exhaustion through physical exercise;
- Physiological signs of bulimia
- weakness, general health problems, low energy levels throughout the day
- susceptibility to inflammatory diseases of the pharynx and throat (they appear in the form of pharyngitis, angina, etc.)
- menstrual irregularities, amenorrhea (absence of menstruation)
- Frequent fluctuations in weight in the greater or lesser direction
- metabolic disorders, diseases of the digestive system
- hypertrophy of the salivary glands, increased salivation
- presence of dental diseases acting in this case as a result of regular vomiting calls
- signs of dehydration, flabbiness of skin, dermatitis, changes in general condition of hair, nails and skin
Complications of bulimia
Because of the systematic overeating, supplemented by the challenge of vomiting, a number of serious health problems can develop, they are as follows:
- the development of diseases in the oral cavity, in particular it is periodontitis, periodontitis and caries, tooth enamel is also destroyed
- because of vomiting, the voice becomes constantly hoarse
- parotitis may develop;
- violations of the cycle develop, which, as already highlighted, can reach amenorrhea;
- pregnancy becomes a separate problem direction, as for the changes associated with it, as well as the actual fact of its occurrence (that is, problems with conception are considered)
- disorders of the digestive system (chronic forms of enteritis, gastritis, inflammation of the esophagus mucosa, disorders of intestinal peristalsis, flatulence, constipation, violations of the liver, pancreas, etc.)
- development of endocrine diseases (hypothyroidism, diabetes)
- violations in the work of the cardiovascular system, which is accompanied by a violation of the heart rhythm, dizziness, loss of consciousness; In rare but not excluded variants of the course of the bulimia disease against the background of loss of trace elements (magnesium and potassium), accompanying the appearance of the listed problems, can cause heart failure;
- gastric rupture (this complication is rare, but it is also not excluded that it is caused by an excess of food in the stomach)
- propensity to alcoholism on the basis of depressive states, provoked by constant concern about their own weight and combined with a sense of guilt arising from overeating.
Diagnosis and treatment
As the main areas on which diagnosis of bulimia is based, you can determine the questioning of the patient, in some cases — talk only with people from close associates or with relatives, that is, with the exception of communication with the patient due to certain circumstances, this is not Admitting. The main circumstances concerning the development of the disease, the symptomatology and peculiarities of the state of health, appearance of the patient are elucidated. Additionally, the results of tests may be required, on the basis of which it is possible to identify specific changes associated with bulimia. The diagnosis of «bulimia nervosa» can be diagnosed by a specialist based on a pattern in which overeating combined with «cleansing» is performed at least twice a week for three months or more.
With regard to such an issue as the treatment of bulimia, then, as already indicated, it is based on the implementation of a set of measures for drug therapy and behavioral psychotherapy measures. Due to behavioral psychotherapy, it is possible to «reach out» to the patient in terms of understanding the existing problem, and then decide how to deal with it in a specific case. The duration of such therapy is about 5 months, due to the appropriate impact, the reduction is subject to the number of episodes associated with overeating, which in turn makes it possible later to relieve the patient of the dependence that has arisen. Treatment of medicamentous, primarily, to restore the lost trace elements (magnesium, potassium), as well as to treat complications provoked by bulimia. Additionally, antidepressants are prescribed, which supplement behavioral psychotherapy, thereby contributing to better treatment outcomes.
For treatment of bulimia, if symptoms appear, you need to consult a therapist, in addition treatment may require consultation of a gastroenterologist.