What is bulimia? Everything you need to know about this disease.
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What is bulimia? Everything you need to know about this disease.

Do you suffer from bulimia, this eating disorder? Are you looking to treat yourself or help a loved one?

Discover all the information available here.

Bulimia: what is it?

Bulimia nervosa is part of eating disorders (ED) just like anorexia nervosa and binge eating.

Bulimia is characterized by the occurrence of binge eating or overeating during which the person swallows huge amounts of food without being able to stop. Some studies suggest an absorption ranging from 2000 to 3000 kcal per seizure.

People with bulimia feel like they lose control completely during seizures and feel ashamed and guilty after them. After an attack occurs, people implement inappropriate compensatory behaviors in an attempt to eliminate calories and avoid gaining weight.

People with bulimia often resort to vomiting, the misuse of medications (laxatives, purgatives, enemas, diuretics), intensive physical exercise, or fasting.

Unlike anorexic people who are underweight, bulimic person usually has a normal weight.

In summary, bulimia is a disease that is characterized by the occurrence of seizures during which the person feels like he is losing all control over his behavior which leads him to quickly absorb a huge amount of food. This results in the implementation of inappropriate compensatory behaviors to avoid weight gain.

Binge eating disorder

Binge eating disorder is another eating disorder. It is very close to bulimia. We observe the presence of overeating crises but there are no compensatory behaviors to avoid weight gain. People with binge eating disorders are often overweight.

Anorexia with binge eating

Some people experience both the symptoms of anorexia nervosa and bulimia. In this case, we are not talking about bulimia but anorexia with binge eating.

Disorders associated with bulimia

There are mainly psychopathological disorders associated with bulimia. However, it is difficult to know if it is the appearance of bulimia that will lead to these disorders or if the presence of these disorders will lead the person to become bulimic.

The main psychological disorders associated are:

  • depression, 50% of bulimic people would develop a major depressive episode during their lifetime;
  • anxiety disorders, which are thought to be present in 34% of bulimics;
  • risky behavior, such as substance abuse (alcohol, drugs) which affects 41% of people with bulima4 ;
  • low self-esteem making bulimic people more sensitive to criticism and especially self-esteem excessively related to body image;
  • a personality disorder, which affects 30% of people with bulimia.

Extreme periods of fasting and compensatory behaviors (purging, use of laxatives, etc.) lead to complications that can cause serious kidney, cardiac, gastrointestinal, and dental problems.

Bulimia: who is affected?

Bulimia as a behavior has been known since ancient times. Literature informs us about Greek and Roman orgies, “meetings” during which guests indulged in all kinds of excesses including overeating going so far as to make themselves sick and vomit.

Bulimia as a disorder has been described since the 1970s. Depending on the studies and diagnostic criteria (broad or restrictive) used, there is a prevalence ranging from 1% to 5.4% of young girls concerned in Western societies.

This prevalence makes it an even more prevalent disease than anorexia nervosa, especially as the number of people affected continues to increase. Finally, it would affect 1 man for every 19 women concerned.

Bulimia: how to diagnose the disease?

Although the signs of bulimia often appear in late adolescence, the diagnosis is not made on average until 6 years later. Indeed, this eating disorder strongly associated with shame does not easily lead the bulimic person to consult.

The earlier the pathology is identified, the earlier therapeutic intervention can begin and the chances of recovery are thus increased.

Bulimia: what are the causes?

Bulimia is an eating disorder highlighted since the 70s. Since then, many studies have been conducted on bulimia but the exact causes behind the appearance of this disorder are still unknown.

However, hypotheses, still under study, try to explain the occurrence of bulimia.

Researchers agree that many factors are at the origin of bulimia including genetic, neuroendocrine, psychological, family, and social factors.

Although no gene has been clearly identified, studies point to familial risk. If a member of a family suffers from bulimia, it is more likely that another person in that family will have this disorder than in a “healthy” family.

Another study conducted on identical twins (monozygotic) shows that if one of the twins is affected by bulimia, there is a 23% chance that her twin will also be affected. This probability increases to 9% if they are different twins (dizygotic). It would therefore seem those genetic elements play a role in the appearance of bulimia.

Endocrine factors such as hormonal deficiency appear to be at play in this disease. The decrease in a hormone (LHRH) involved in the regulation of ovarian function is highlighted. However, this deficit is observed when there is weight loss and observations return to a normal LHRH level with weight regain.

This disorder would therefore seem to be a consequence of bulimia rather than a cause.

At the neurological level, many studies link serotonergic dysfunction with a disorder of the feeling of satiety often observed in bulimics. Serotonin is a substance that ensures the passage of the nerve message between neurons (at synapses).

It is particularly involved in stimulating the satiety center (the area of the brain that regulates appetite). For many reasons that are still unknown, there is a decrease in the amount of serotonin in people with bulimia and a tendency to increase this neurotransmitter after recovery.

Psychologically, many studies have linked the onset of bulimia to the presence of low self-esteem based largely on body image. Hypotheses and analytical studies find certain constants in the personality and feelings experienced by bulimic adolescent girls.

Bulimia often affects young people who have difficulty expressing what they are feeling and who often even have difficulty understanding their own bodily sensations (feelings of hunger and satiety). Psychoanalytic writings often evoke a rejection of the body as a sexual object.

These teenagers would subconsciously wish to remain little girls. The disorders caused by eating disorders undermine the body which “regresses” (absence of menstruation, loss of forms with weight loss, etc …).

Finally, studies conducted on the personality of people affected by bulimia, find some common personality traits such as conformism, lack of initiative, lack of spontaneity, inhibition of behavior and emotions, etc …

At the cognitive level, studies highlight negative automatic thoughts leading to false beliefs often present in bulimics such as “thinness is a guarantee of happiness” or “any fat gain is bad”.

Finally, bulimia is a pathology that affects the population of industrialized countries. Socio-cultural factors, therefore, play an important role in the development of bulimia.

Images of the “perfect woman” working, raising her children, and controlling her weight are widely conveyed by the media. These representations can be taken with distance by adults who feel good about themselves, but they can have devastating effects on teenagers in need of bearings.

Bulimia: people at risk and risk factors

Bulimia nervosa would begin in late adolescence. It affects girls more frequently than boys (1 boy affected for every 19 girls). Bulimia, like other eating disorders, affects populations in industrialized countries more.

Finally, some professions (athlete, actor, model, dancer) for which it is important to have some control of one’s weight and body image, would have more people suffering from eating disorders than other trades.

Bulimia would start 5 times out of 10 during a weight loss diet. For 3 out of 10 people, bulimia nervosa was preceded by anorexia nervosa. Finally, 2 times out of 10, it was depression that inaugurated the onset of bulimia.

Bulimia: how to prevent it?

Although there is no safe way to prevent the onset of this disorder, there may be ways to detect its onset earlier and contain its progression.

For example, the pediatrician and/or general practitioner may play an important role in identifying early indicators that may suggest an eating disorder.

During a medical visit, do not hesitate to share your concerns about your child’s or teen’s eating behavior. Thus warned, he will be able to ask him questions about his eating habits and the satisfaction or not he feels about his body appearance.

In addition, parents can cultivate and strengthen a healthy body image for their children, regardless of their size, shape, and appearance. It is important to be careful to avoid any negative jokes about it.

The symptoms of bulimia are as follows: phases of overeating, phases of fasting …

To discover the complete list, consult the article below.

Bulimia: the symptoms

This eating disorder is linked to a real compulsive crisis as well as a loss of control of the mind over the body, which is why daily activities such as eating meals in society can be a real challenge for bulimic people.

  • Overeating phases during which the person will eat until reaching the point of discomfort or pain. Food intake will be much higher than that taken during a normal meal or snack;
  • fasting phases thinking that they will be able to restore weight gain;
  • vomiting caused after eating;
  • taking diuretics, laxatives,, or enemas;
  • intensive sports practice;
  • isolation;
  • mood swings, irritability, sadness, guilt, shame;
  • Abnormal concerns about body shape and weight result in a negatively distorted view of body image.

The course of a binge eating disorder

Pre-crisis

The perfectionism that guides the bulimic person creates inner tensions as well as a feeling of lack, anxiety, and irritability.

The crisis

A loss of control and the need to satisfy an impulse can then invade the bulimic person. The beginning of the crisis corresponds to the moment when the will yield to this impulse that becomes unbearable and when the bulimic person will try to compensate for what is most often felt as an inner emptiness.

To do this, she will ingest a significant amount of food in a very short time, to the detriment of the notion of pleasure. Foods are chosen and are preferably sweet and high in calories.

A feeling of guilt will surpass the satisfaction of seeing the urge satisfied and will lead to the vomiting phase. This is a real purge, supposed to bring some relief.

In some cases, vomiting can also be accompanied by laxatives, diuretics or even enemas.

Post-crisis

Shame and guilt then give way to a feeling of disgust, which will lead to a desire to regain control over oneself and not do it again. But these crises are part of a vicious circle from which it is difficult to get out solely thanks to willpower, because, more than just a habit, binge eating is part of a ritual.

Bulimia: psychopathological assessment

To make a diagnosis of bulimia, various factors must be observed in the person’s behavior.

In North America, the usual screening tool is the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) published by the American Psychiatric Association. In Europe and elsewhere in the world, health professionals generally use the International Classification of Diseases (ICD-10).

In summary, to evoke a bulimic disorder, it is necessary to note the presence of binge eating during which the person has the impression that he totally loses control of his behavior which will lead him to swallow in a limited period of time a quantity of food much higher than normal.

The presence of compensatory behaviors is necessary to talk about bulimia knowing that seizures and compensatory behaviors must occur on average 2 times a week for 3 consecutive months.

Finally, the doctor will assess the person’s self-esteem to see if it is excessively influenced by weight and silhouette as is the case in bulimic people.

Somatic evaluation

In addition to psychopathological assessment, a complete physical examination is often required to assess the consequences of purging and other compensatory behaviors on the patient’s health.

The review will look for problems:

  • cardiac such as heart rhythm disorders;
  • dental including erosion of tooth enamel;
  • gastrointestinal such as impaired intestinal mobility;
  • bone, including decreased bone mineral density;
  • Kidney stones;
  • Dermatological.

EAT-26 Screening Test

The EAT-26 test screens people who may be suffering from eating disorders. It is a 26-item questionnaire that the patient completes alone and then gives to a professional who analyzes it. The questions will make it possible to question the presence and frequency of diets, compensatory behaviors, and the control that the person exerts on his eating behavior.

Complications of bulimia

The main complications of bulimia are the more or less serious physiological disorders induced by compensatory purging behaviors.

Repeated vomiting can lead to various ailments such as erosion of tooth enamel, inflammation of the esophagus, swelling of the salivary glands, and a drop in potassium levels that can cause rhythm disorders or even heart failure.

Taking laxatives also causes many disorders among which we can observe intestinal atony (lack of tone of the digestive tract) causing constipation, dehydration, edema, and even a drop in sodium levels that can lead to kidney failure.

Regarding dietary restrictions, these can induce anemia, amenorrhea (cessation of menstruation), hypotension, slow heart, and low calcium levels that can cause osteoporosis.

Finally, substance abuse (drugs and alcohol), often present in people with bulimia, can lead to other somatic disorders. In addition, the use of these substances can also lead the person to adopt risky behaviors because of disinhibition (unprotected sex, etc.).

It is difficult to get out of bulimia without accompaniment.

Discover below all the treatments in detail to overcome this disease.

Bulimia: how to treat it?

It is difficult to get out of bulimia without accompaniment. The prescription of medication and the proposal to undertake psychotherapy can then be considered to treat bulimia. Sometimes specialized hospitalization may be necessary.

Drug management

Medications may be prescribed to reduce the symptoms of bulimia (decrease in the number of attacks) but also to treat associated disorders such as anxiety and depression.

Finally, after a medical evaluation of the physiological consequences of purge behaviors (digestive, kidney, cardiac, endocrine disorders, etc …) the doctor may prescribe examinations (blood tests) and medications to treat these disorders.

Antidepressants can help reduce the symptoms of bulimia. The Food and Drug Administration recommends the preferential prescription of fluoxetine (Prozac) as part of bulimia. This antidepressant is part of the class of antidepressants whose operation is to inhibit the reuptake of serotonin (SSRIs).

This medication works by increasing the amount of the neurotransmitter serotonin in synapses (junctions between two neurons). The increased presence of serotonin facilitates the passage of nerve information.

However, depending on the disorders presented by his patient (other associated psychopathological disorders), the doctor may prescribe other antidepressants or medications (including some anxiolytics) to treat bulimia.

Psychotherapeutic accompaniment

Psychotherapies are offered for the most part, individually or in groups, but all have the objectives: to improve the perception and self-esteem of the bulimic person and to work on certain conflicts.

Behavioral and cognitive therapies (CBT)

They are very effective in treating the symptoms of bulimia since it is a question of getting the patient to observe his pathological behaviors (here, it will be seizures but also purging behaviors) and then modify them.

The goal of CBT is not to find the causes or origin of the disorder but to act on it.

The psychotherapist intervenes in the mental processes (thought patterns) and emotions that regulate the patient’s behaviors and encourage him to reassess the choices that prompted him to give in to a crisis.

The patient is very active in CBT, he will have to fill out many grids and questionnaires. In the context of bulimia, generally, about twenty sessions are necessary to question and modify the dysfunctional thoughts of the patient in relation to diet, weight and body image, self-esteem, etc …

Family systemic therapy

This therapy is called “systemic” because it considers the family group as a system and a set of interdependent elements. In this case, the family would not consist of independent elements (parents/children), but of entities that influence each other.

Family systemic therapy studies modes of communication and different interactions within the family in an attempt to improve internal relationships.

When one family member is affected by a disease such as bulimia, the other members will be affected. For example, meal times can be particularly complicated for the family to manage. The actions and words of each other can be helpful or on the contrary harmful to the patient.

It is not a question of making each other feel guilty, nor of making them guilty of bulimia, but of taking into consideration their suffering and of making everyone move in the right direction for them and also for the patient.

Psychodynamic psychotherapy

This psychotherapy is inspired by psychoanalysis. It is widely used to accompany the patient in the search for conflicts (personal, interpersonal, conscious and unconscious, etc.) that may be at the origin of the appearance of eating disorders.

Interpersonal psychotherapy

This short therapy, mainly used to treat depression, has been proven to support people suffering from eating disorders.

During interpersonal psychotherapy, the subject will not be a diet but the patient’s current interpersonal difficulties that necessarily have consequences on his eating behavior.

Nutritional therapy

This psycho-educational therapy is very important and effective in addition to psychotherapy. Indeed, the benefits it can bring do not last if it is performed alone, bulimia is often only a symptom that reflects a deeper evil.

It is used with people who also suffer from other eating disorders.

Nutritional therapy will allow the patient to learn to eat again: resume a balanced diet, apprehend taboo foods (especially sweet, which allowed vomiting), eat slow sugars again to avoid crises, and get used to meals sitting at the table, 4 a day, in reasonable quantities.

Information related to weight and diet will be provided and explained such as the theory of natural weight. With this therapy, we try to change the relationship that the patient has with food.

Finally, this method also looks at the compensatory purging behaviors that the patient used to use. It therefore also aims to allow him to lose the habit of using methods such as laxatives if this were the case in

Canada’s Food Guide (CFG)

This guide is a very good tool to relearn how to eat well as is often the case when you suffer from eating disorders.

It divides foods into 5 categories: grain products, vegetables and fruits, dairy products, meat and alternatives, and other foods, i.e. pleasure foods that do not belong to the other groups.

This last category, which is rarely found in guides, is very interesting for people suffering from anorexia or bulimia because this category meets the psychological needs more than the nutritional needs of the person.

Each meal must contain at least 4 groups out of 5. Each group provides unique nutrients.

Hospitalization

Sometimes, specialized hospitalization may be necessary to increase the patient’s chances of recovery, after the failure of outpatient treatment and when significant health problems are detected.

Depending on the institution, may be proposed a specialized conventional hospitalization or hospitalization in a day hospital. For the latter, the person will go to the hospital every day of the week for care and return home in the evening.

In a department specializing in the management of eating disorders, the patient receives care provided by a multidisciplinary team (doctor, nutritionist, psychologist, etc.).

Treatment often includes nutritional rehabilitation, psycho-educational support, and psychotherapy follow-up.

As part of its quality approach, Passeportsanté.net invites you to discover the opinion of a health professional.

Bulimia: what our doctor thinks

“I can only encourage people who suffer from bulimia to talk about it. I know how difficult it can be and that the shame that gnaws at these people often prevents them from taking the first step.

The professionals who accompany these people toward recovery will not make any judgment against them. On the contrary, they will encourage them to express all the pain they experience living with this disease on a daily basis.

Curing bulimia is possible. The path is not simple, it is sometimes fraught with pitfalls but there is a possible future without eating disorders.

It is important to enhance the self-esteem of bulimic people but also to teach them to manage their impulsivity and communication. Psychoeducational support based on diet combined with psychotherapy significantly increases the chances of recovery.

Finally, associations of patients and families defend beautiful projects and are a very important place of exchange and support.”

Image Credit: Image by lookstudio on Freepik

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