What is the nervous bulimia?
Bulimia is a disorder of eating behavior characterized by repeated episodes of overfeeding or excessive food intake and an exaggerated concern about weight control. This leads the patient to take extreme measures to counteract the weight gain produced by the overfeeding. Therefore, episodes of “binge”, in which compulsively eat large amount of food in a short time. These episodes often suffer in secret. After binge eating, the patient often feels guilty about it and uses a number of inappropriate compensatory methods to avoid weight gain.
Despite being recognized in ancient Greece, it was only identified and described as a disease with its own characteristics in 1979 by the English psychiatrist Gerald Russell. It is estimated that approximately 1% of the population suffers from this disease, although this figure may be a lower estimate of reality. In fact, there are studies that show that up to 7% of young women who see their GP have symptoms of bulimia nervosa. It is much less common in males.
What are the symptoms of bulimia nervosa?
According to the World Health Organization, the diagnostic criteria for bulimia nervosa are as follows:
The majority of patients with bulimia nervosa have a weight within normal, although some may be above or below.
Persistent preoccupation with food along with an irresistible desire or a craving for food. Episodes of overeating in which large amounts of food are consumed in short periods of time.
The patient attempts to counteract the impact of binge eating on weight by one or more of the following means: excessive exercise, self-induced vomiting after ingestion, prolonged periods of fasting or use of drugs such as laxatives, diuretics, or appetite suppressants.
Excessive or morbid fear of obesity. This is also seen in anorexia nervosa. In fact, bulimic patients have often had previous episodes of anorexia nervosa.
Several research studies have associated bulimia nervosa with alterations in various brain neurotransmitters (they are the messenger substances neurons use to communicate with one another) such as noradrenalin, serotonin or endorphins. Genetic vulnerability has also been described.
During adolescence, patients with bulimia nervosa often have behavioral disturbances, so they may have other impulsivity problems (such as problems with alcohol or other drugs), sexual disinhibition, high irritability or emotional lability. These patients often have low self-esteem; In fact, bulimia nervosa appears more frequently in people with depressive disorders. There are also a number of personality disorders, especially borderline disorders.
As with anorexia nervosa, patients with bulimia nervosa often have high school performance. Also, social and cultural pressures are important to maintain a thin figure, although, as has been indicated, most bulimic patients maintain a weight within normal limits. It is also worth mentioning that bulimic patients frequently perceive their parents as negligent and feel rejected by them.
What are the causes of bulimia nervosa?
The cause of bulimia nervosa is unknown, usually being a combination of biological, psychological and social factors:
- Denture Damage to Stomach Acids
- Thickening of the salivary gland
- Esophagitis (inflammation of the esophagus) and esophageal ulcers
- Injuries to the stomach and intestine
Cardiovascular and Metabolic Alterations
- Cardiac arrhythmias
- Alterations in blood ions
- Edema (fluid retention) in the legs
- Renal disorders
- Urinary infections
Neurological and muscular problems
- Muscle contractures and paralysis
- Epileptic seizures
- Endocrine Disorders
- Decreases in female hormones
- Ovarian atrophy
- Ovarian cysts
What is the evolution and prognosis of the disease?
While some cases of bulimia nervosa are brief, symptoms usually occur a few months or years before the patient seeks help. As might be expected, those patients who are capable of engaging in a treatment are the ones with a better outcome. Approximately one-third of patients may experience a chronicity of some of the symptoms.
The prognosis of bulimia nervosa will depend greatly on sequelae. It should be noted that binge eating, but above all compensatory behaviors such as self-induced vomiting or abuse of laxatives or diuretics can lead to serious physical complications:
What is the treatment of bulimia nervosa?
Treatment should be focused on both the symptoms of bulimia nervosa and the associated physical and psychological disorders. Specific treatments for bulimia nervosa include both psychological therapies and pharmacological treatments. However, as with most psychiatric disorders, it is the combination of both strategies that achieves a better response.
In general, the treatment of patients with bulimia nervosa should be done on an outpatient basis. Hospital admission, preferably in specialized units, is advised only when there have been repeated failures through outpatient treatment and physical or psychological problems that require a more intensive treatment
Several psychological interventions have been used in the treatment of this type of eating disorder:
Also, self-help groups are useful to some.
Cognitive behavioral therapy is the most frequently used form of psychological treatment for bulimia nervosa. This modality of treatment has been elaborated from the cognitive therapies previously developed for the depression and other psychiatric pathologies.
- Motivational Therapy
- Interpersonal Therapy
- Cognitive Analytic Therapy: It is a short-term therapeutic modality, usually between 16 and 20 sessions, combining elements of cognitive therapy and psychodynamic-oriented psychotherapies.
- Rational Emotive Therapy
- Family therapy: This is a fundamental element of treatment in a significant number of cases.
- Group therapy for relapse prevention
- Other group therapies
Antidepressant drugs: in part because of the high frequency of depressive symptoms in bulimic patients, antidepressants – given alone or in combination with some form of psychotherapy – are the drugs most used in this disease. Although multiple antidepressants that have been used, such as amitriptyline, imipramine, desipramine, trazodone or phenelzine, are the serotonin reuptake inhibitors such as fluoxetine, fluvoxamine, paroxetine, sertraline, or citalopram Which have shown greater effectiveness.
Opioid antagonists: Naltrexone is an opioid antagonist commonly used for the treatment of heroin and alcohol addiction, which has also shown some efficacy in the treatment of bulimia nervosa.
Other drugs: such as fenfluramine, lithium, acamprosate, or gabapentin may be useful in certain subgroups of patients.