Bulimia: how to recognize it and how to cure it
Bulimia nervosa falls under the category of eating disorders (DCA). The etymology of the word derives from the ancient Greek and means “hunger like an ox”, but the definition is much broader
What is bulimia?
It manifests itself through the search for and the spasmodic and uncontrolled intake of food followed by the implementation of compensatory behaviors such as for example the induction of vomiting or the use of laxatives due to an excessive concern for one’s physical fitness and the body weight.
The mechanism is cyclical and continues over time.
However, this condition underlies states of profound psychic malaise due to many aspects and it is essential to recognize the symptoms in order to be able to embark on a healing journey.
When do we talk about bulimia and how can we recognize it?
Bulimia nervosa can manifest itself in adolescence or early youth and is more frequent in women, it often coincides with very delicate life phases that involve a series of transformations both on a physical and biological level.
This condition is kept hidden, emotions of deep shame arise, self-esteem is damaged, mood is depressed, and social interactions are very limited.
The concern for food is constant and the hunger-satiety mechanism is compromised as the strict diet generates an increase in hunger and appetite, with the consequent modification of some neurotransmitters, including serotonin and electrolytes, for which the physiological repercussions become inevitable.
Bulimic subjects generally have a normal weight and know how to mask how long they live; this makes the disorder difficult to recognize.
Symptoms of bulimia nervosa
The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) classifies bulimia nervosa in the category of eating and eating disorders.
The characteristic symptoms are:
recurring episodes of binge eating that manifest themselves through two aspects:
- eating, in a given period of time (for example, a two-hour period) a significantly larger amount of food than most individuals would eat in the same time and under similar circumstances;
- Losing control during the episode (e.g. feeling like you can’t stop eating or control what and how much you are eating).
Recurring and inappropriate compensatory behaviors aimed at preventing any weight gain, such as self-induced vomiting, abuse of laxatives, diuretics or other drugs, fasting or excessive physical activity.
Self-esteem levels affected by body shape and weight.
On average, binge eating and inappropriate compensatory behaviors occur at least once a week for 3 months.
The severity of the disorder is based on the frequency of compensatory behaviors implemented during a week: mild (about 1-3 episodes); moderate (about 4-7 episodes); severe (8-13 episodes); extreme (about 14 or more episodes).
Bulimic crises occur in solitude and the episodes can be more or less planned
These behavior patterns may appear singly or in parallel with multiple addictions to alcohol, drugs, medications, or compulsive shopping, as well as self-harming behaviors.
Differences between bulimia and binge eating
It is important not to confuse Bulimia nervosa with Binge Eating Disorder as both fall under the nutrition and eating disorders described by the DSM-5 but with small differences.
Binge Eating Disorder is characterized by binge eating at least once a week for 3 months, but unlike bulimia nervosa, it does not present inappropriate compensatory behaviors.
Furthermore, the interest shown in weight control and body shape is less than in Bulimia.
What are the causes?
Scientific research agrees on a bio-psycho-social multifactorial model that identifies a set of factors whose diversified and varied interaction determines their appearance and perpetuation.
It is therefore necessary to distinguish predisposing factors, triggering factors and perpetuating factors.
Predisposing factors, i.e. biological and psychological vulnerabilities that may favour the onset of the disorder:
- the age of onset, which usually coincides with the adolescent period during which a series of rapid body transformations take place;
- the personality characteristics, i.e. low self-esteem, tendency to abrupt mood swings and intolerance to frustration, with a predisposition to perfectionism often linked to the dichotomous thought of ‘all or nothing’;
- the presence of possible slight overweight and/or obesity in childhood, associated with experiences of derision by peers;
- the idealisation of thinness due to aesthetic models and stereotypes that have a totally negative effect on self-esteem, inducing one to embark on a dietary regime;
- family heredity linked both to genetic characteristics and to a particular way of adapting to the environment.
Triggering factors indicating the transition to the disorder due to an event experienced as traumatic
- relationships with peers due to comparisons, devaluations and mockery of body image;
- the presence of a depressive state and low self-esteem linked to interpersonal relationships;
- separation from the family, break-up of a romantic relationship, change of home and school with the consequent loss of friendships;
- situations linked to difficult and painful moments such as the death of a significant person, an illness or a family crisis;
- events that tend to increase the subject’s difficulties in terms of their relational abilities and their autonomy and self-esteem.
Perpetuating factors that allow a vicious circle to develop that encourages and maintains the disorder:
- initial appreciation of physical appearance, special attention from family members;
- progressive impoverishment of emotional and social relationships.
What does bulimia lead to?
People with this disorder tend to judge themselves excessively and constantly by controlling their weight, body shape and diet according to very strict rules that require constancy and commitment.
Consequently, the appearance of so-called binges represents a momentary loss of control.
Initially, they may generate pleasure by relieving tension, but over time they lead to the onset of negative emotions such as fear of gaining weight, guilt, shame, disgust, which in turn may trigger new binges.
Compensatory behaviours such as vomiting and other techniques to avoid gaining weight are, on the other hand, ways of having the impression of keeping one’s life under control by temporarily alleviating the state of deep emotional malaise.
There is often a perfectionistic ideal and the fear of gaining weight manifests itself in an intense and pervasive form.
The evaluation of the self is mainly centred on body weight, body shape and one’s own ability to control these.
Thus, a cyclical mechanism is generated that keeps the symptoms alive.
Frequent recourse to such conduct generates various side effects in the body: electrolyte imbalances or dehydration, with major physiological problems, kidney imbalances due to diuretic abuse and manifest abrasions of the knuckles of the hands and dryness of the skin.
The use of laxatives can lead to cardiac dysfunction with loss of vital minerals such as potassium, magnesium and sodium.
Furthermore, in women, the menstrual cycle may stop, hair may fall out, sleep or concentration may be interrupted.
From a psychological point of view, the decrease in mood, resulting in a general malaise accompanied by feelings of shame, leads to denial of the existence of the problem.
The psycho-physical state of health is completely compromised and an adequate diagnostic framework for a course of treatment is complex.
How bulimia is treated
As with many diseases, the treatment of bulimia nervosa involves the integration of different interventions depending on the severity with which the disorder manifests itself.
Psychotherapy
Since this disorder is caused by multiple bio-psycho-social factors, psychotherapeutic treatment is certainly essential.
Through psychotherapy, it is in fact possible to address and unravel the deep-seated issues that link the person to the symptom and the states of malaise, so as to be able to break the mechanism.
In particular, mind-body approaches prove effective.
Pharmacological therapy
In severe cases, following a thorough medical consultation, antidepressant medication can be used to treat bulimia nervosa.
Bulimia nervosa is a multifaceted disorder, the psychological malaise that underlies the dysfunctional behaviour generates profound suffering, but it is possible to take the road to change through awareness and courage by relying on a professional.
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