Bulimia nervosa: the disorder of binge eating and vomiting
Bulimia nervosa is an eating and psychological disorder.
1. Diagnosis of Bulimia nervosa
bulimic syndrome is an eating disorder characterized by abnormal eating patterns, with episodes of massive food intake followed by maneuvers to eliminate those calories. Following these episodes, the subject usually feels sad, moody, and has feelings of self-pity.
This disorder presents a higher incidence rate among western women between 18 and 25 years old , coming from any sociocultural stratum.
Although bulimia nervosa encounters certain diagnostic difficulties, the criteria provided by the DSM-IV and the ICD-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 period of time, and the feeling of loss of control over its intake.
- Inappropriate and repeated compensatory behaviors that aim at not increasing body weight. These behaviors include provocation of vomiting, use of laxatives, diuretics, enemas, fasting, and inappropriate exercise.
- Binge eating and compensatory behaviors are observed at least twice a week for a period of three months.
- Self-assessment is significantly influenced by body weight and shape.
1.1. Types of Bulimia nervosa
During the bulimia nervosa episode, the subject regularly makes himself vomit or uses laxatives, diuretics or enemas. In this way, the subject intervenes on his or her own body once food has been eaten.
During the bulimic episode, the individual uses other inappropriate compensatory behaviors, such as fasting or excessive exercise , but does not resort to purgative methods. In this way, the aim is to prevent the ingestion of food (at least in the short term) or to ensure that the effects of this ingestion do not become too apparent in the body. through an obsessive tendency to exercise.
2. Bulimia Nervosa Clinic
2.1. Behavioural alterations
The person affected by bulimic disorder generally exhibits disorganized behavior, initially only related to eating, but later in other facets of his life as well. The behavioral pattern associated with eating is disorganized and unpredictable, unlike in the case of Anorexia .
Bingeing can vary in frequency depending on mood and availability. Purging behaviors are not regular and the fear of weight gain is contingent on mood or other circumstances.
2.2. Purging behaviour
After episodes of heavy eating, those with bulimia become aware that the food they eat will cause them to gain weight; this possibility terrifies them, creates anxiety, and they resolve these thoughts by eliminating the food they eat through provoked vomiting, laxative abuse, diuretics, or intense physical exercise.
The most common behavior is the provocation of vomiting, and the least common, the consumption of diuretics.In addition, vomiting and laxatives are often linked methods.
2.3. Alterations in cognition
The bulimic patient, like the anorexic, has altered thoughts about food, body weight, and shape. Both pathologies show a great rejection to the possibility of being overweight or obese.
Some bulimic patients come from anorexia nervosa when, as the disorder becomes chronic, it progresses to bulimia. At this point, they go from strict control of their diet to intermittent control, with the appearance of binge eating and purging behaviors.
3. Psychopathologies associated with Bulimia nervosa
Most people who develop a bulimic-type eating disorder show extensive associated psychopathology. Depression is the disorder most frequently associated with bulimia, although bulimic patients have also been found to score high on anxiety scales.
It is also very common for patients with this psychological disorder to present typical characteristics of Body Dysmorphic Disorder , which, although it does not focus solely on weight or fat accumulation, generates an obsession with one’s own appearance.
4. Medical complications associated with bulimia nervosa
There is a general symptomatology that is likely to occur in most people affected by bulimia nervosa. This set of symptoms is nonspecific and generally does not allow the disorder to be identified from these data. Apathy, fatigue, sleep disturbance, and irritability may accompany loss of academic or work performance and neglect of personal care.
In the exploration of the patients in the first stages of the disease, slight abdominal distensions with constipation, hypertrophy of the parotid glands, wear on the dental enamel and abrasions on the back of the hands can already be seen.
Complications in the cardiovascular system include hypokalemia, which can produce severe alterations in the ECG, with dire consequences. This high risk factor is due to the loss of potassium in the blood caused by regular purging.
As for the endocrine system , patients with bulimia may have a normal menstrual cycle, but it is not uncommon for them to have irregularities or even amenorrhea , with low rates of estradiol and progesterone.
5. Treatment of Bulimia nervosa: objectives
In a particularly summary fashion, these are the main therapeutic goals for bulimia nervosa:
- Restoring healthy nutritional guidelines .
- Recovery of physical condition : stabilization of body weight, rehydration, correction of physical defects.
- Normalization of psychic state : improvement of mood, treatment for possible personality disorders, avoidance of substance abuse, correction of dysfunctional cognitive style.
- Restoring family relationships : increasing participation, communication and restoring functional patterns and roles.
- Correction of the patterns of social interaction : accepting the disorder, facing the failures, accepting the responsibility, rejecting denigrating social frameworks.
- Jarne, A. and Talarn, A. (2011). Manual of clinical psychopathology . Madrid: Herder
- Sarason, I.G. and Sarason, B.R. (2006). Psychopathology . Pearson Prentice Hall.