Why is it important to treat bulimia and how to do it correctly

What is bulimia, how does it limit a person’s life and what is included in the modern understanding of its treatment - says clinical psychologist Yulia Khvorova.

Bulimia nervosa, or simply bulimia, is a mental illness that is classified as an eating disorder (ED) and is characterized by excessive preoccupation with body weight, binge eating, and regular attempts to purge food from the body.

How to suspect bulimia

Bulimia can be suspected based on the following signs:

1 Preoccupation with one’s weight, perception of oneself as too fat a person, obsessive fear of gaining weight.

2 Severe hunger is an obsessive, uncontrollable desire to eat.

3 Regular episodes of overeating. Overeating can be objective and subjective. With objective overeating, a person consumes a daily calorie intake or more in one meal. In the subjective case, he eats a small amount of food at a time, but he himself regards this as overeating. The frequency of episodes is at least twice a week for three months. These episodes evoke extremely strong negative emotions - guilt, anger, despair.

4 Practice cleansing techniques - getting rid of food and counteracting weight gain. This includes inducing vomiting, taking laxatives and appetite suppressants, and periods of fasting. Such techniques cause a feeling of shame and are hidden from others.

One or two symptoms may not indicate a disease; with bulimia, all four signs must be observed. The diagnosis can only be made by a psychiatrist after examining the patient and having a detailed conversation with him and his relatives.

The diagnosis can only be made by a psychiatrist after examining the patient and having a detailed conversation with him and his relatives.

Bulimia nervosa is also accompanied by self-criticism, feelings of helplessness and loneliness, low mood and depression. Due to loneliness and rejection, a person with bulimia finds thematic communities about bulimia and anorexia on the Internet.

Advanced bulimia leads to somatic diseases (diseases of internal organs and metabolic disorders).

Causes

For bulimia to develop, there can be a variety of reasons. The main reasons for the development of pathology are:

• hereditary predisposition;
• constant food restrictions and strict diets, which resulted in nutritional deficiencies;
• disruption of metabolic processes in the body;
• damage to the food center in the brain;
• psychological problems;
• hormonal imbalances;
• intense regular negative emotions.

One cause is sufficient for the occurrence of pathology, although in most cases there is a combination of causes.

What kind of people develop bulimia?

Bulimia nervosa develops from a combination of biological, social and psychological factors.

Biological factors:

• female gender - women are more susceptible to bulimia nervosa and anorexia than men;
• heredity - having relatives with eating disorders increases the risk of bulimia in a person;
• hunger or overfeeding during early development.

Sociocultural factors: The risk increases in countries and families that place particular importance on appearance and conformity to ideals and standards of beauty.

Psychological factors: perfectionism, low self-esteem, impulsiveness, increased emotional sensitivity.

All of these factors increase a person's susceptibility to developing an eating disorder.

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How bulimia limits a person's life if left untreated

Bulimia is a very expensive disease in every sense. Let's look at the price you have to pay for it.

1 Time consuming. A person spends several hours a day studying the energy value of foods, preparing diets, and carefully choosing products in the store. When eating, it lasts longer, taking into account the attack of overeating and subsequent cleansing techniques. Time is spent on thematic groups on social networks - communication, sharing experiences, searching for new ways of cleansing and motivating illustrations, slogans, stories.

We calculated with one client how much time she spent on the tasks described above - it turned out to be an average of 27 hours per week.

2 Spoils relationships with people. A person loses or spoils relationships with relatives, friends and acquaintances. The secrecy and preoccupation with the topic of food and cleansing rituals makes communication on other topics problematic. Depressed mood reduces the desire to communicate and meet people. Due to the fear of “breakdowns” and the need to perform cleansing procedures after eating, a person begins to avoid public eating places.

From a client’s story: “If my friends order pizza, I might lose my temper. I hung out with my classmates a few times, but they started making fun of me for not eating with them. I don't want to answer stupid questions about food, and vomiting in public is problematic."

3 Deteriorates physical health. The longer a person suffers from bulimia, the more damage it causes to health. The harm depends on how long a person has bulimia and what purging techniques they use.

The most common physical health problems in people with bulimia are:

• digestive disorders - constipation, gastritis, ulcers, colon prolapse;
• destruction of tooth enamel and deterioration of the condition of teeth, inflammation of the oral mucosa and skin in the corners of the mouth due to the acid contained in the vomit;
• heart and kidney failure, which develop due to disturbances in electrolyte metabolism - useful minerals are lost with vomiting; typical problems - swelling, weakness, heart rhythm disturbances, difficulty breathing;
• nails crumble and peel, hair becomes thinner and falls out due to a lack of microelements;
• decreased cognitive abilities, memory, concentration.

4 Takes money. All of the above requires additional financial costs. Here are my client's rough estimates for the week:

• 4000 rubles - additional food that could have been done without;
• 200 rubles - laxatives, drugs to cleanse the body;
• 1500 rubles – medications that help reduce appetite

Even such an incomplete list of the consequences of bulimia shows how significantly it affects a person’s life, changes his physical and psychological state, and reduces social functioning.

Patients with bulimia themselves may not be aware of the consequences of the disease and their severity, which is also a manifestation of the disease.

Stages of pathology

Psychologists distinguish 3 stages of the disease:

• an unconscious stage in which the patient may eat food at night, as a result of which he experiences a feeling of guilt. There are no serious deviations, so it is difficult to diagnose the problem;
• the stage of awareness at which overeating becomes persistent, which causes constant feelings of guilt, phobias, fears, and depression. The patient cannot control the process of eating, and emptying the stomach becomes necessary, including due to pain, dizziness, and stomach discomfort;
• the action stage in which people with bulimia begin to understand that there is a problem.

The success of treating the disease depends on the timeliness of seeking medical help.

How to treat bulimia

Treatment of bulimia requires an interdisciplinary approach - involving several specialists from various fields of medicine. The team of specialists includes: a general practitioner, a psychiatrist, a psychotherapist. According to indications, a cardiologist, nephrologist, endocrinologist, and gynecologist may be included. Ideally, all team members should have specific knowledge, skills and experience in the area of ​​eating disorders and be in the same location to be connected and work in a consistent manner. Therefore, there are special clinics and departments for the treatment of eating disorders.

Treatment consists of three components - restoration of physical health, drug treatment of bulimia and psychotherapy.

Restoring physical health. Restoration of physical condition can be carried out on an outpatient basis or in a hospital, depending on the severity of the manifestations. This stage of treatment is mandatory, since while the body is exhausted, psychotherapy will not have an effect.

Cognitive behavioral therapy (CBT) has proven effectiveness in treating bulimia.

Drug treatment. During or after restoring the body’s strength, a psychiatrist can prescribe medications that normalize the exchange of neurotransmitters in the central nervous system and thereby improve mood, reduce stress, and make a person’s behavior more flexible and adequate. In many cases, drug therapy is not necessary; psychotherapy alone may be sufficient for treatment.

Psychotherapy. Cognitive behavioral therapy (CBT) has proven effectiveness in treating bulimia. A special method has been developed for the treatment of eating disorders - CBT-E (CBT-E, enhanced cognitive behavioral therapy for bulimia).

CBT-E occurs in four stages over about twenty weeks:

1 Therapy begins with psychoeducation and informed consent for therapy.

2 Then begins the stage of articulating the processes that maintain the disorder and the problems that should be targeted in therapy. In parallel, BMI and behavior are monitored.

3 The next stage is a personalized program of changes in the underlying mechanisms that support the disorder.

4 The final stage (lessons 18–20, weeks 15–20) is relapse management, which ensures the maintenance of improvements achieved during therapy and the prevention of relapses.

The effectiveness of cognitive behavioral therapy for bulimia:

• 45% experience complete remission - the symptoms of the disorder disappear and do not return if the doctor’s recommendations are followed;
• 27% experience significant improvement and a decrease in the impact of the disease on functioning;
• 23% have a chronic type of course and no effect of therapy.

The decision about treatment always remains with the patient (after 18 years), but the support of family and friends plays an important role at any age.

When to see a doctor

The effectiveness of treatment for this disease depends on how promptly the patient consults doctors. The disease is treated by a psychotherapist who can refer the patient for consultation with a psychiatrist and nutritionist.

You should seek medical help as soon as possible if:

• there is no feeling of satiety;
• periodically there are attacks of overeating, which the patient does not control;
• there is a fear of gaining excess weight;
• the patient is dissatisfied with the appearance;
• Eating alone is preferable;
• the patient is afraid to start eating because he will not be able to stop;
• after eating, a feeling of irritation and anger appears;
• behavior becomes impulsive.

JSC "Medicine" (academician Roitberg's clinic) in Moscow offers the services of qualified psychotherapists and psychiatrists in the field of treatment of bulimia. The clinic is located at the address: 2nd Tverskoy-Yamskaya lane, building 10, a 5-minute walk from the Moskovskaya metro station. Highly qualified psychotherapists and the use of modern treatment methods allow patients to be confident in the success of therapy.

Consequences for ENT organs

With bulimia, the throat often suffers. On the one hand, the cause is the same vomiting, which irritates the tissues. On the other hand, microtraumas have an effect - by pressing on the root of the tongue, a person often injures the mucous membrane. Against this background, a set of unpleasant symptoms appears:

• pain or soreness;
• constant desire to cough and clear your throat;
• inflammatory diseases due to wound infection.

It is not difficult to get an infection. If a patient does not control hunger, he is unlikely to think about keeping his hands clean. And vomit contains a lot of bacteria. Sometimes stomach contents end up in the nose. This often causes inflammation of the mucous membrane or sinuses.

Many patients have a chronic runny nose (although weakened immunity also affects this). But there is a more serious complication. Getting vomit into the nose is dangerous due to aspiration of the respiratory tract. It provokes, at a minimum, pneumonia, and at maximum, suffocation.

Literature:

• Gurova O.Yu. Metabolic and mental characteristics of obese patients: Author's abstract. dis. ...cand. honey. Sci. M., 2010..
• Fedorova I.I. Clinical, dynamic and psychotherapeutic aspects of eating disorders: Dis. Ph.D. honey. Sci. Tomsk, 2007.
• Dorozhevets A. N. Distortion of the image of the physical self in patients with obesity and anorexia nervosa: dissertation. - Moscow State University, 1986.
• Clinical Guide to Mental Disorders / Ed. D. Barlow. Translation from English, ed. Professor E.G. Eidemiller. — 3rd ed. - St. Petersburg: Peter, 2008. - 912 p. — ISBN 978-5-94723-046-8.

Effects on the digestive system

Since with bulimia a person interferes with the normal functioning of the gastrointestinal tract, numerous disorders are observed in this area:

• Esophagitis. The most common symptom of this disease. The esophagus becomes inflamed under the influence of hydrochloric acid.
• Gastritis. It is directly caused by a violation of the diet.
• Stomach ulcer. Since a person hides a mental disorder, gastritis does not receive proper treatment.
• Constipation, flatulence, bloating. These are the consequences of poor eating behavior.
• Disorder of intestinal motility. Occurs with laxative abuse.

One of the dangerous consequences of bulimia is gastrointestinal cancer. They are caused by chronic injuries to the mucous membranes, which disrupt the normal process of cell division.

Consequences for the oral cavity

A common symptom of bulimia is erosive destruction of tooth enamel. The reason for this is frequent episodes of vomiting. Along with food, the stomach also expels a small amount of juice. It contains hydrochloric acid, which corrodes enamel. The more often a person vomits, the stronger the acid attack on the teeth. In addition to caries, the following are observed in the patient’s mouth:

• unpleasant odor due to constantly introduced bacteria;
• salivary glands enlarged due to inflammation;
• ulcers on the mucous membrane (injuries are usually caused by nails when inducing vomiting).

The patient’s teeth often turn yellow, become sensitive, and react to cold and hot foods. The gums become inflamed, which, if left untreated, can lead to periodontal disease. Without timely treatment, this threatens tooth loss.

Consequences for the endocrine system

The endocrine system suffers due to poor nutrition and human interference in the process of food absorption. Bulimia can cause diseases:

• thyroid gland (usually hypothyroidism);
• parathyroid gland (due to calcium deficiency);
• adrenal glands (due to increased production of the stress hormone cortisol);
• ovaries (up to anovulation).

Even women who have recovered from bulimia often face reproductive problems in the future. Since obstacles arise that prevent the body from absorbing nutrients from food, metabolism is disrupted. This is dangerous due to a deficiency of vital elements and diseases: diabetes, anemia, atherosclerosis, gout.