Bulimia nervosa: binge eating and vomiting disorder

The bulimia nervosa It is an eating and psychological disorder with severe consequences on the physical integrity and mental health of the people who develop it. As such, it is a psychopathology that should be treated as soon as possible by mental health professionals.

In this article we will see what are its main characteristics, symptoms and treatment of this alteration.

• Related article: "Major Eating Disorders: Anorexia and Bulimia"

What is bulimia?

Bulimia nervosa is a psychological disorder characterized by a tendency to binge on food practically uncontrolled, and shortly after feeling the need to eliminate the ingested foods from the body. In addition, it is associated with purging behaviors or aimed at compensating for the acquisition of calories (inducing vomiting, starting to exercise intense, etc.) that appear right after these binges, and that are associated with feelings of guilt and worry about having been eating without need.

Consequently, it is an eating disorder, since it is based on a pathological dynamic of relationship with food through food. Also, by affecting something as important as food intake and the functioning of the digestive system,

seriously compromises health not only because of malnutrition problems, but also because purging behaviors can lead to infections and very serious injuries.

Diagnosis

The bulimic syndrome is an eating disorder characterized by abnormal eating patterns, with episodes of massive food intake followed by maneuvers that seek to eliminate those calories. After these episodes, it is usual for the subject to feel sad, in a bad mood and have feelings of self pity.

This disorder has a higher incidence rate among Western women ages 18-25, from any sociocultural stratum.

Despite the fact that bulimia nervosa encounters certain diagnostic difficulties, the criteria provided by the DSM-IV and the ICD-10 are very useful. According to DSM-IV, these are the diagnostic criteria:

• Binge eating, characterized by the ingestion of a food in a short space of time, and the feeling of loss of control over its intake.
• Compensatory behaviors inappropriate and repeated that seek not to increase body weight. These behaviors include inducing 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 it is notably influenced by body weight and silhouette.

On the other hand, it is necessary to distinguish bulimia nervosa from binge eating disorder, a very similar psychopathology but in which there are no behaviors to compensate for food intake.

Types of Bulimia nervosa

These are the main types of bulimia nervosa.

Purgative type

During the bulimia nervosa episode, the subject vomiting is regularly induced or use laxatives, diuretics, or enemas. In this way, the body itself is intervened once food has been ingested.

Non-purging type

During the bulimic episode, the individual uses other inappropriate compensatory behaviors, such as fast or the excessive exercise, but does not resort to purgative methods. In this way, an attempt is made to prevent the ingestion of food (at least in the short term) or it is ensured that the effects of this ingestion are not reflected too much in the body. through an obsessive tendency to exercise.

Clinical picture of bulimia

These are the aspects that characterize the development of this psychopathology.

Behavioral disturbances

The person affected by bulimic disorder generally presents disorganized behavior, at first only linked to eating, but later also in other facets of her life. The behavioral pattern associated with eating is disorganized and unpredictable, unlike in the case of Anorexy.

Binge eating can vary in frequency depending on mood and availability. Purging behaviors are not regular, and fear of gaining weight is dependent on mood or other circumstances.

Purge behaviors

After episodes of large food intake, bulimia sufferers become aware that the food they eat will make them gain weight; this possibility terrifies them, creates them anxiety and they resolve these thoughts by eliminating what is ingested through provoked vomiting, the abuse of laxatives, diuretics or intense physical exercise.

The most common behavior is the induction of vomiting, and the least common, the consumption of diuretics. Also, vomiting and laxatives are often linked methods.

Alterations in cognition

The bulimic patient, like the anorexic, presents altered thoughts about food, body weight and figure. Both pathologies show a great rejection of the possibility of being overweight or obese.

Some bulimic patients come from anorexia nervosa when, when said disorder becomes chronic, it evolves into bulimia. At that time, they go from strict control of their diet to intermittent control, appearing binge-eating and purgative behaviors.

Psychopathologies associated with Bulimia nervosa

People who develop an eating disorder of the bulimic type show, for the most part, extensive associated psychopathology. The depression It is the disorder most frequently related to bulimia, although it has also been detected that bulimic patients score high on the scales of anxiety.

It is also very common for patients with this psychological alteration to present typical characteristics of Body Dysmorphic DisorderAlthough it does not focus solely on weight or fat accumulation, it generates an obsession with one's own appearance. This last psychological disorder is characterized by non-conformity with one's appearance, usually focused on very specific physical features.

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 symptom it is nonspecific and generally does not allow the disorder to be identified from these data. Apathy, fatigue, sleep disturbances and irritability can accompany loss of academic or work performance and neglect of personal care.

In the examination of the patients in the first stages of the disease, slight distensions can already be seen abdominals with constipation, hypertrophy of the parotid glands, wear on tooth enamel and abrasions on the back of hands.

Complications in the Cardiovascular system include the 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.

Regarding the endocrine system, bulimia patients may have a normal menstrual cycle, but it is not uncommon for them to have irregularities or even amenorrhea, with low levels of estradiol and progesterone.

Treatment of bulimia nervosa

Especially in summary, these are the main therapeutic targets for bulimia nervosa:

• Restoring healthy nutritional guidelines.
• Recovery of physical state: stabilization of body weight, rehydration, correction of physical defects.
• Normalization of the mental state: mood improvement, treatment for possible personality disorders, avoid substance abuse, correct cognitive dysfunctional style.
• Reestablishment of family relationships: increase participation, communication and reestablish guidelines and functional roles.
• Correction of social interaction patterns: accept the disorder, face failures, accept responsibility, reject degrading social frameworks.

Bibliographic references:

• Cash, T.F.; Deagle, E.A. (1997). The nature and extent of body ‐ image disturbances in anorexia nervosa and bulimia nervosa: A meta ‐ analysis. International Journal of Eating Disorders. 22 (2): pp. 107 - 126.
• Cooper, P.J.; Fairburn, C.G. (1993). Confusion over the core psychopathology of bulimia nervosa. The International Journal of Eating Disorders, 13 (4): 385-389.
• Fisher, M.M.; Rosen, D.S., Ornstein, R.M.; Mammel, K.A.; Katzman, D.K.; Rome, E.S.; et al. (2014). Characteristics of avoidant / restrictive food intake disorder in children and adolescents: a "new disorder" in DSM-5. The Journal of Adolescent Health. 55 (1): 49–52.
• Jarne, A. and Talarn, A. (2011). Manual of clinical psychopathology. Madrid: Herder.
• Palmer, R. (2004). Bulimia nervosa: 25 years on. The British Journal of Psychiatry: the Journal of Mental Science 185 (6): 447-448.
• Sarason, I.G. and Sarason, B.R. (2006). Psychopathology. Pearson Prentice Hall.