Bulimia (bulimia nervosa; eating-crushing addiction)

Bulimia (bulimia nervosa) - An often unrecognized but momentous eating disorder

Bulimia nervosa is a psychosomatic eating disorder. The disease is characterized mainly by repeated, uncontrolled food cravings or bingeing, which are usually followed by self-induced vomiting or abuse of laxatives and emetics. From this also derives the well-known name "Ess-Brechsucht". Bulimia, along with anorexia nervosa and binge eating disorder, are among the most common and common forms of severe eating disorders. But a bulimia is often not recognized early, since the patients are often of normal weight and thus the disease hardly appears externally. Despite a high level of suffering, many sufferers hide their disturbed eating habits and serious health problems arise as a result of bulimia nervosa. The possible causes of this mental illness are manifold.

contents

• Bulimia (bulimia nervosa) - An often unrecognized but momentous eating disorder
• Definition of the Ess-Brechsucht
• symptoms
• Causes - An interaction of many factors
• diagnosis
• treatment
• Naturopathic treatment
• Current state of research

Definition of the Ess-Brechsucht

The term bulimia derives from the Greek words "bous" and "limos" and is often translated as "ox hunger". For a long time, the so-called Ess-Brechsucht was considered a variant of anorexia until the bulimia was defined and recognized as an independent disease in the 1980s. In contrast to other mental eating disorders, which are usually associated with underweight or obesity, bulimia nervosa is a disease that is hardly visible to outsiders, especially at an early stage. Those affected are usually of normal weight and often appear self-confident to others and usually show a controlled or normal eating behavior in public. The disease takes place in stealth.

Typical hallmarks of bulimia are secretive and uncontrolled binge eating, usually with subsequent vomiting. (Image: Photographee.eu/fotolia.com)

A vicious circle of binge eating and its compensation

The bulimia-characterizing, uncontrolled binge eating episodes ("bingeing attacks") occur repeatedly but with varying degrees of frequency and vary from several times a day to several times a week. The calorie intake in a single binge can be up to 10,000 calories. Basically, two different types of bulimia are distinguished. If the patients vomit after the food cravings or are discharged, this is called the "purging type". Since this is the most common variant, the term Ess-Brechsucht is generally used. The "non-purging type" is a bulimic eating disorder that lacks vomiting and leads to weight control such as starvation or excessive exercise.

Bulimia is often preceded by anorexia

Many features of bulimia nervosa are similar to those of anorexia nervosa, including the underlying body disorder and thus a false perception of the body and an exaggerated concern about body shape and weight. It is not uncommon to find that an anorexia already existed before the diagnosis of bulimia. If there are some key diagnostic criteria in the clinical picture, such as a body disorder or if it has only insignificant effects on body weight, it is called an atypical bulimia nervosa.

symptoms

The central features of bulimia are repeated and uncontrolled binge eating, which in a mostly short period of time consumes an unusually large amount of food, mostly high in fat and carbohydrates, compared to most people. Those affected can not stop eating in such a food cravings and sweets in particular have a triggering function. After these "eating attacks", the affected feel a great fear or are ashamed of their own loss of control, so that the need arises to undo the intake of food and calorie intake. The self-esteem of those affected is very dependent on body weight or body shape. Compensation for the binging is then tried over self-induced vomiting, the use of laxative and drainage medications, fasting periods or excessive sports. These symptoms describe the typical vicious circle of bulimia nervosa.

Severe weight changes in a short period of time can be typical signs of bulimia, but most sufferers have normal weight or a slight underweight and are more likely to suffer from the symptoms of malnutrition with impaired vitamin and electrolyte balance. Calluses on the fingers (Russell sign) are considered an early warning signal. These are the result of frequent self-induced vomiting through the contact of knuckles and incisors.

In a single binge, the calorie intake can be up to 10,000 calories. In particular, sweets and high-fat foods are consumed in such a seizure in large quantities within a very short time. (Image: beats_ / fotolia.com)

In addition to the typical body disorder, which is associated with a self-esteem problem (despite normal weight, people with bulimia nervosa feel too thick), the Ess-Brechsucht also often accompanied by other mental disorders such as fears or constraints. Some of those affected suffer from listlessness, depression or self-hatred and think of suicide.

Health consequences

The multiple physical consequences of bulimia nervosa are similar to those of anorexia nervosa, but especially bulimia-typical vomiting and previous binge eating can cause serious damage. Repeated vomiting and the associated excessive presence of gastric acid in the oral cavity lead to tooth damage, such as the loss of enamel and tooth substance or tooth decay. Salivary glands also swell frequently and become inflamed. In some patients, the swellings of the salivary glands are externally visible by so-called "hamster baking". Also noticeable may be a soft tissue thickening of finger and toe end members (so-called drumstick fingers).

Also, hoarseness, sore throat, and esophagitis, pancreas, and gastritis are common sequelae. The intake of enormous amounts of food within a very short time can lead to an acute gastric dilatation and sometimes even to gastric tears.

Inadequate nutrition, like anorexia nervosa, can lead to hormonal changes that can cause menstrual disorders in many affected women and may result in infertility. It is also often reported in connection with an altered thyroid hormone balance of dry skin and hair loss. Persistent abuse of laxatives often causes edema as well as diarrhea. If the symptoms of the disease lead to a massive disturbance of the electrolyte balance and in particular to potassium deficiency (hypokalaemia), bulimia can be life-threatening due to cardiac arrhythmias and kidney damage.

In about half of those affected morphological changes of the brain were observed (brain atrophy or pseudoatrophy). The increased risk of osteoporosis after a prolonged illness is probably not present in Bulimia nervosa, in contrast to anorexia nervosa.

Not infrequently problems in the family and social environment play a role in the expropriation of bulimia. Especially girls and young women in puberty are prone to it. (Image: Viacheslav Iakobchuk / fotolia.com)

Causes - An interaction of many factors

Like the symptoms, the causes of bulimia are similar in many ways to those of anorexia. Frequently phases of anorexia and bulimia alternate, or the disease of bulimia nervosa was preceded by anorexia nervosa.

Different and individually different factors play a role in the development of the disease, which makes it difficult to clearly identify the respective causes. Mostly it is an interaction of personal and psychological factors together with social and biological components.

Typical and common personal components include disturbed body awareness and self-esteem issues. Sick people make themselves and their self-esteem dependent on the body weight and the figure. Being slim is the top priority in order to feel good, with the personal perception of your own body shape being distorted.

What role do family and society play??

Sometimes an eating disorder is preceded by a stressful event, such as personal and family tragedies. Abuse and mistreatment can also play a role. In addition to problems in the social and family environment (for example, conflicts, pressure to perform), social constraints and expectations are often decisive. Common reasons include bullying and the general thinness of the Western world. Especially girls and young women in puberty are often unsure about their body and, in combination with certain personality traits (e.g., high stamina) are very vulnerable in this regard.

In many cases, in addition to the eating disorder also an abuse of psychoactive substances, which occurs in bulimia particularly often as alcohol problem. Likewise, in the family of those affected a substance dependence is more often observed. Various studies have found familial accumulations of eating and obsessive-compulsive disorder as well as depression. Thus, bulimia is also associated with a certain genetic predisposition.

diagnosis

The described signs of bulimia often remain hidden. Unlike anorexia, the bulimic disorder is not associated with continuous weight loss, but overweight and underweight alternate (in anorectic episodes). Patients usually keep their eating disorder secret or deny it vehemently, because they are ashamed and suffer from great feelings of guilt. The disease therefore typically goes unnoticed for a long time.

In the case of bulimia nervosa, those affected often compensate for their loss of control and the shame and anger over it by self-induced vomiting. (Image: FollowTheFlow / fotolia.com)

Eating disorders are complex and not always obvious?

If one suspects an eating disorder, it is not so easy to differentiate the respective forms and to make a clear diagnosis by the manifold and similar symptoms and causes. In addition, mixed forms can always occur. Bulimia nervosa is particularly difficult to distinguish from the so-called "binge eating" eating disorder, which is also characterized by episodes of binge eating with loss of control. However, there is no compensation for vomiting or further measures, and therefore more obesity occurs.

Evidence of a bulimic behavior, for example, the (sudden) regular course to the toilet shortly after eating and injuries with bite marks on the fingers and back of the hand. Main diagnostic criteria are the following:

• Continuing occupation with food and a recurring craving for food intake that leads to typical binge eating (at least two a week over three months or more),
• Attempt to reverse uncontrolled food intake, usually by self-induced vomiting,
• Morbid anxiety to get fat and a distorted perception of your own body weight.

For a thorough diagnosis, it is important that sufferers seek special medical and psychotherapeutic advice. In addition to an in-depth physical examination, detailed and structured discussions in particular provide decisive information on the present form of an eating disorder and its treatment options. Frequently, the interviews consist of pre-defined interview questionnaires. When making the diagnosis, it is important that, in addition to the eating disorder, possible accompanying mental disorders or illnesses are also recognized and can thus be taken into account in a treatment plan. Since sufferers often find it difficult to admit their illness, it is often close family and circle of friends who first see evidence of an eating disorder. These individuals are encouraged to engage in conversation with those affected and seek professional help as sensitively as possible.

About one to two out of every 100 people get bulimia during their lifetime. Individual symptoms, however, occur much more frequently and one assumes a high number of unreported cases. About 90% of women and young girls are affected, with increasing incidence of eating disorders in young men.

People who suffer from bulimia often show normal weight or weight fluctuations, because the high calorie intake in food cravings is reversed by the fear of becoming fat. (Image: satura_ / fotolia.com)

treatment

As with all eating disorders, the basic requirement for successful treatment is the personal attitude of those affected. In addition to recognizing and accepting one's own illness, there must also be the will and the motivation to overcome it. If this is the case and there is a clear diagnosis, an outpatient therapy usually takes place. In the case of conspicuously severe symptoms with physical consequences or self-harming behavior, it may also be necessary to stay in hospital for the patients. In addition, successful treatment often consists of a combination of different therapeutic approaches. The aim of the treatment is to break the vicious circle of food cravings and vomiting and to achieve a normalization of eating behavior. Basically, different approaches from a physical rehabilitation and nutritional counseling as well as an individually adapted psychotherapy (among other things with the inclusion of the family) are combined.

Although sufferers typically deal with the topic of food much and deeply, there is little sound knowledge about a healthy diet. Education and advice on a balanced and healthy diet can already lead to a significant improvement in the pathological behaviors. Often help a meal plan and offering previously avoided foods to regulate the disturbed eating behavior again.

Family and other affected people can help

In psychotherapeutic treatment, different concepts apply. Common forms of therapy are, for example, cognitive behavioral therapy, interpersonal therapy or even psychodynamic approaches. Among other things, these treatments are designed to increase self-esteem and help patients to deal with their eating disorders in order to change their behavior. Especially with adolescents, family involvement can be very important. It is mainly about giving the family a significant role in overcoming the eating disorder. Group therapies and self-help groups also show success in the treatment of bulimia.

Antidepressants are usually only integrated into the treatment if there is also a depressive mood or psychotherapy does not bring about the desired improvement. Regardless of depression, therapy with selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, can help those affected. If those affected already suffer from physical secondary symptoms, such as underweight or malnutrition, it is also a primary goal in addition to the psychotherapeutic treatment to treat them and to prevent further physical damage.

The chances of success of a treatment depend in particular on the severity and duration of the disease. In general, however, the chances of a cure for bulimia are better than for anorexia and the risk of death is lower. Statistically, 50 to 75 percent of the patients are cured of bulimia, but a shift in symptoms or the relapse rate are not taken into account.

In order to overcome a bulimia, the involvement of family or the exchange with other stakeholders can play an important role. (Image: Photographee.eu/fotolia.com)

Naturopathic treatment

In case of a severe eating disorder, such as the eating-breakage, it is absolutely necessary to have a medical and psychotherapeutic treatment. However, naturopathy can accompany and support conventional medicine treatment of bulimia nervosa. Most naturopathic measures are, however, only used in the early stages or with a rather mild symptomatology. Homeopathic therapies and acupuncture are most commonly used as adjunctive measures. In the early phase of a bulimia, an attempt is sometimes made, with the help of Schuessler salts, to compensate for psychological causes.

Current state of research

Eating disorders such as bulimia nervosa are serious and lethal diseases that often begin during or even before puberty and often affect those affected for a very long time. However, a recent long-term study published in the journal "Journal of Clinical Psychiatry" seems more likely than previously to suggest that adults are cured in adulthood and recover from their eating disorder. This should encourage all concerned and motivate them to fight their illness. (jvs, cs; Updated on 07/11/2018)

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