Eating disorder - symptoms and treatment

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.

Is food addiction a psychological or physiological problem?

Food addiction is a mental pathology in which a person uses food as emotional reinforcement and a stimulant of physical pleasure. Eating becomes a super value, all other pleasures are pushed into the background. Problems get eaten up, when faced with troubles, a person does not try to solve them, he resorts to food, in an attempt to forget, like an alcoholic reaches for a bottle under any stress.

Important! Only 20% of people addicted to food can cope with this problem on their own. The rest cannot do without a nutritionist, psychologist, or even a psychotherapist.

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.

Food addiction test

Test yourself and answer a few questions to see if you have signs of addiction:

1. After losing weight, do you quickly gain back the lost pounds?
2. Do you often think about food?
3. Do you have an obsessive desire to count the calories of the foods you eat?
4. Are there any foods that make you want to eat more of them?
5. Do you weigh yourself often?
6. Can you consume a large amount of food in a short time?
7. Do you ever feel like after eating a small portion you lose control and start eating to excess?
8. Do you have problems with emotions and feelings that may be associated with eating or not eating?
9. Does the amount of food you eat depend on whether you are with a group or alone?
10. Do you often find yourself in situations where you reward yourself for success with certain products?
11. Do you feel guilty after eating food?

If your answer to the test results in more than 5 “yes” answers

, it’s time to talk about this with a specialist - a nutritionist or psychologist and start getting rid of food addiction.

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.

Consequences of food addiction

As with any addiction, for people suffering from food addiction, the manifestations of the disease and its consequences for physical and mental health can be serious and long-lasting:

• Diabetes;
• Obesity;
• Problems with the heart and blood vessels, strokes, heart attacks, hypertension, arrhythmias, etc.;
• Oncology: the risk of breast, uterine, and colon cancer increases;
• Gastrointestinal problems;
• Diseases of the spine, joints, musculoskeletal system, unable to withstand increased loads;
• Complications during childbirth;
• Difficulties with reproductive function;
• Poor drug tolerance;
• Thrombosis;
• Slow wound healing;
• Gangrene;
• Premature aging;
• Psychological problems: low self-esteem, social isolation, depression

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.