Water is essential for the body and for being healthy . It has usually been said that we should stay hydrated all day long to make our body’s work easier and to prevent problems such as constipation.

So, does that mean that it is healthy to drink large amounts of water every day? Where is the line between healthy and problematic? Do those who do not separate themselves from the water bottle have a problem? Can water be harmful to our organism?

In general terms, it has always been recommended to ingest between 1 and 2 litres of water per day for the correct functioning of the organism, although this statement is subject to multiple factors that can vary the amount of desirable intake: the metabolism, the amount of sport done, the time of year, the vital stage, the amount of vegetables and fruit ingested… In this article we are going to talk about potomania (also known as psychogenic polydipsia), what are its causes and its treatment.

What is potomania?

Potomania, also known as psychogenic polydipsia , is the desire to drink large amounts of fluid, usually water, as a result of a mental or organic disorder.

It is a disorder that takes the form of compulsive acts, and is not governed by the physical sensation of thirst , that is, the person with this syndrome will drink large amounts of water without being thirsty.

On a nosological level, potomania is not included in any classification system of psychiatric disorders , but due to its characteristics it could be included under the heading of DSM 5 “Unspecified eating or eating disorder” (APA, 2013). Other professionals advocate including it within impulse control disorders.

Symptoms

Potomania is characterized by the compulsive intake of liquid , which generates in the person a feeling of relief and pleasure.

Symptoms characteristic of food intake that cause clinically significant discomfort or impairment in social, occupational, or other important areas of a person’s functioning predominate. For example, feel clinically significant anxiety if they cannot quickly access the fluid they wish to drink. The desire for fluid governs the person, who cannot lead a normal life.

In the most serious cases, 8 to 15 litres of water can be drunk per day. When a person consumes more than 6 liters of water per day, he or she should consult a doctor immediately, even if no other symptoms seem to be present.

There is a high anxiety when they do not have access to the liquid they want to ingest, sleep problems, panic attacks and headaches .

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On the other hand, potomania is often confused with dipsomania . The latter is the irresistible tendency to abuse alcoholic drinks. It refers to an impulsive form of intake, related to external stressors, which generates very unadaptive behaviours.

Negative consequences of potomania on the body

What can happen to our organism if we exceed our water intake systematically and over time? It is known that drinking more than 3 litres of water a day is no longer beneficial for the body, because it can alter the balance between fluids and electrolytes .

Some symptoms that indicate that our body is hyperhydrated are

  • Muscle cramps, feeling of fatigue and tiredness (consequence of the dilution of potassium and sodium in the blood).
  • Nausea and headache .
  • Reduced concentration and loss of mental agility (low blood sodium affects brain function).
  • Drowsiness and body paralysis .
  • In very extreme cases, coma and death.

Psychological and organic causes

We must highlight the hypothalamus as the main organic cause. One of the functions of this region of the brain is to warn of the lack of liquid in the organism through the signal of thirst. An alteration in this brain structure could generate episodes of potomania. Another possible organic cause to be considered is diabetes mellitus .

However, experts say the origins of this syndrome are mostly due to certain mental illnesses, delusions and eating disorders. Among the causes, the following stand out :

Psychotic disorders and dementias

Diseases such as schizophrenia, bipolar disorders, or Alzheimer’s can influence their occurrence.

2. Anorexia

In these cases, the person drinks large amounts of fluids in order to satisfy themselves without taking in calories , or to gain weight before passing a medical check-up.

3. Vigorexia and orthorexia

Their motivation would lie in distorted beliefs about the benefits of drinking certain fluids.

4. Medications

The use of certain medications, such as some anti-inflammatory drugs, diuretics and lithium , which interfere with kidney function, should also be highlighted as causes.

Treatment

In this section we will explain the psychological treatment of this syndrome. It should be noted that in severe cases psychological treatment should be accompanied by medical and/or pharmacological treatment to control the hypnoatremia (low sodium level).

One of the great challenges for psychologists when treating this syndrome is that the person is not able to control the intense desire to drink water, so it is difficult to follow the guidelines and recommendations given to reduce fluid intake. In extreme cases, the clinician may be forced to reduce the patient’s mobility to a particular area lacking sources of fluid.

Basically, treatment of psychogenic polydipsia will be based on therapist-accompanied fluid restriction (the patient should ingest between 1L-1.5L of water every 24 hours) together with cognitive-behavioral techniques. Some of them are:

  • Techniques for reducing anxiety : muscle relaxation, controlled breathing, deep breathing, self-instruction…
  • Techniques to reduce water intake gradually: drinking a limited amount of water a day in small sips, paying full attention to each sip of water…
  • Techniques aimed at redirecting the patient’s attention when he feels the desire to drink water .
  • Token economy: in some cases this system can be implemented to reinforce self-control behaviour, for example in people with schizophrenia.
  • Cognitive restructuring in cases where there are distorted beliefs regarding water intake (e.g., existing myths about the benefits of drinking large amounts of water)