Bulimia nervosa: the disorder of binge eating and vomiting

the bulimia nervosa it is an eating and psychological disorder with serious consequences on the physical integrity and mental health of the people who develop it. As such, it is a psychopathology that should be treated as soon as possible by mental health professionals.

In this article, we will see what are its main characteristic symptoms and the treatment of this disorder.

    What is bulimia?

    Bulimia nervosa is a psychological disorder characterized by a tendency to overeat in an almost uncontrolled manner, and soon after feeling the need to eliminate these ingested foods from the body. In addition, it is associated with behaviors of purging or aimed at compensating for the acquisition of calories (inducing vomiting, starting to exercise, etc.) which appear immediately after these binge eating attacks, and which are associated with feelings of guilt and fear of having been eating unnecessarily.

    It is therefore an eating disorder, because it is based on a pathological dynamic of relationship to food through food. Additionally, by affecting something as important as food intake and the functioning of the digestive system, it seriously compromises health not only to produce malnutrition problems, but also because the purging behaviors can lead to very serious infections and injuries.

    diagnostic

    the bulimic syndrome is an eating disorder characterized by abnormal eating habits, with episodes of massive food intake followed by maneuvers to eliminate those calories. After these episodes, it is common for the subject to feel sad, cranky, and self-pity.

    This disorder has a higher incidence rate between western women aged 18 to 25, Of any socio-cultural stratum.

    Although bulimia nervosa encounters certain diagnostic difficulties, the criteria provided by DSM-IV and CIE-10 are very useful. According to the DSM-IV, these are the diagnostic criteria:

    • Presence of binge eating, Characterized by the ingestion of a food in a short time, and the feeling of loss of control over its intake.
    • compensatory behavior inappropriate and repeated that seek not to increase body weight. These behaviors include inducing vomiting, the use of laxatives, diuretics, enemas, fasting, and inappropriate exercise.
    • Seizures and excessive behavior are seen at least twice a week for a period of three months.
    • self evaluation he is remarkably influenced by body weight and figure.

    On the other hand, a distinction must be made between bulimia nervosa and binge eating disorder, a very similar psychopathology but in which no compensatory behavior of food intake appears.

    Types of bulimia nervosa

    These are the main types of bulimia nervosa.

    purgative type

    During the episode of bulimia nervosa, the subject vomiting is regularly provoked or use laxatives, diuretics, or enemas. In this way, it intervenes on the body itself once the food has been ingested.

    Non-purgative type

    During the bulimic episode, the individual uses other inappropriate compensatory behaviors, such as bulimia young where he excessive exercise, But do not resort to purgative methods. In this way, an attempt is made to prevent the ingestion of food (at least in the short term) or to ensure that the effects of this ingestion are not too pronounced in the body. by an obsessive tendency to exercise.

    Clinical picture of bulimia

    These are the aspects that characterize the development of this psychopathology.

    Behavior changes

    The person with bulimic disorder usually exhibits disorganized behavior, initially only related to diet, but later in other areas of their life as well. The pattern of behavior associated with food is disorganized and unpredictable, unlike the case of Anorexia.

    Overeating can vary in frequency depending on mood and availability. Bleeding behaviors are inconsistent and fear of gaining weight depends on mood or other circumstances.

    Purge ducts

    After episodes of high food intake, people suffering from bulimia realize that the food ingested will make them gain weight; this possibility terrifies them, creates anxiety and resolves these thoughts by eliminating ingestion through induced vomiting, overuse of laxatives, diuretics or intense physical exercise.

    The most common behavior is to induce vomiting and the least common is the use of diuretics. In addition, vomiting and laxatives are often related methods.

    Cognition alterations

    The bulimic patient, like the anorexic, presents altered thoughts about food, body weight and figure. Both pathologies show a great rejection of the possibility of being overweight or obese.

    Some bulimic patients come from nervous anorexia when, as a chronic complement to this disorder, it progresses to bulimia. At this point, they switch from tight control over their eating to intermittent control, appearing as binge eating and purgative behaviors.

    Psychopathologies associated with bulimia nervosa

    People who develop a bulimic-like eating disorder, for the most part, have extensive associated psychopathology. Depression is the disorder most commonly associated with bulimia, although bulimic patients were also found to have a high score on the anxiety scales.

    It is also very common for patients with this psychological disorder to have Typical features of body dysmorphic disorder, Which, while not all about weight or fat accumulation, generates an obsession with one’s own appearance. The latter psychological disorder is characterized by a nonconformity with one’s own appearance, usually centered on very specific physical traits.

    Medical complications associated with bulimia nervosa

    There is a general symptom that is likely to show up in most people with bulimia nervosa. This set of symptoms it is not specific and generally does not identify the disorder from this data. Apathy, fatigue, sleep disturbances and irritability can accompany the loss of academic or professional performance and the abandonment of personal care.

    On examination of patients in the early stages of the disease, slight abdominal distension with constipation, enlarged parotid glands, wear of tooth enamel and abrasions on the back of the hands can already be observed.

    Complications in the cardiovascular system include hypokalaemia, which can cause severe changes in the ECG, with dire consequences. This high risk factor is due to the loss of potassium in the blood caused by regular purges.

    Regarding the Endocrine systemBulimic patients may have a normal menstrual cycle, but it is not uncommon for them to have irregularities or even amenorrhea, With low levels of estradiol and progesterone.

    Treatment of bulimia nervosa

    Especially briefly, here are the main therapeutic goals of bulimia nervosa:

    • Restoration of healthy nutritional recommendations.
    • Recovery of physical condition: Stabilization of body weight, rehydration, correction of physical defects.
    • Normalization of mental state: Improved mood, treatment of possible personality disorders, drug prevention, correction of dysfunctional cognitive style.
    • Restoration of family relationships: Increase participation, communication and restore functional guidelines and roles.
    • Correction of guidelines for social interaction: Accept disorder, fight against setbacks, accept responsibility, reject degrading social frameworks.

    Bibliographic references:

    • Cash, TF; Deagle, EA (1997). The nature and extent of body image alterations in anorexia nervosa and bulimia nervosa: a meta-analysis. International Journal of Eating Disorders. 22 (2): pages 107 to 126.
    • Cooper, PJ; Fairburn, CG (1993). Confusion over the basic psychopathology of bulimia nervosa. International Journal of Eating Disorders, 13 (4): 385-389.
    • Fisher, MM; Rosen, DS, Ornstein, RM; Mammel, KA; Katzman, DK; Rome, ES; et al. (2014). Characteristics of food intake avoidance / restriction disorder in children and adolescents: a “new disorder” in DSM-5. The Journal of Adolescent Health. 55 (1): 49-52.
    • Jarne, A. and Talarn, A. (2011). Manual of clinical psychopathology. Madrid: Herder.
    • Palmer, R. (2004). Bulimia nervosa: 25 years later. The British Journal of Psychiatry: Journal of Mental Science 185 (6): 447 – 448.
    • Sarason, IG and Sarason, BR (2006). Psychopathology. Pearson Prentice Hall.

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