Bulimia (bulimia nervosa) is a binge eating disorder and thus belongs to the eating disorders. Unlike anorexia nervosa, bulimia nervosa sufferers can hardly be seen to be suffering from an eating disorder, as they are usually of normal weight. Typical signs include high-calorie eating, vomiting, tooth decay and a lack of self-esteem.
What is bulimia nervosa?
Bulimia (bulimia nervosa) is derived from the Greek and actually means “ox hunger.” However, in psychological and common usage, bulimia is synonymous with binge eating. In this case, excessive amounts of food are eaten (cravings), but for fear of gaining weight, are regurgitated. In advanced cases, bulimics continue to eat after vomiting and the cycle begins again. Meanwhile, however, there are also subtypes of bulimia in which there is no vomiting, but too much exercise is to train away what has been eaten (sports bulimia) or is purged with various means.
Causes
The causes of the craving attacks of bulimia have depth psychological reasons, while the vomiting in bulimia can be fixed in relation to the ideal of beauty. Possible reasons for bulimia may be trauma experiences that the affected person has not been able to deal with psychologically. These include fear of loss, abuse, rape, neglect and/or other physical and psychological violence. Co-dependency often accompanies bulimia. This is also known as relationship addiction and involves unconditionally caring for a close person in the environment. For example, alcoholic or drug-addicted parents, siblings or closest friends. In addition, there is a fear of gaining weight, which may be due to the ideal of beauty in the media and the general public. However, many people suffering from bulimia also work in professions where a good figure is important (e.g. modeling industry). However, bulimia is not to be fixed at the occupation.
Symptoms, complaints, and signs
People affected by bulimia are mostly of normal weight. Sometimes they are – in accordance with the healthy normal population – also overweight or underweight. In this respect, bulimia is not expressed in the outward appearance of affected individuals. Rather, the disease is characterized by more or less regular eating attacks that can occur several times a day, or even only every few days. In the process, the perceived control over eating behavior declines. Large amounts of food and a fast eating pace play a role in the eating attacks. The clinical picture of bulimia is defined by the fact that the person affected tries to compensate for his or her eating behavior. Self-induced vomiting is particularly common for this. But also doing a lot of sports, starting extreme diets and using laxatives and emetics seem to be good measures for the person concerned. Combinations of these measures also occur. During the course of the disease, ravenous hunger is further promoted by the fact that the countermeasures taken against food put a strain on the body’s energy balance. In this respect, a vicious circle of eating attacks and depleting countermeasures is initiated. Possible late effects affect the teeth and esophagus (due to stomach acid), the stomach, metabolism and intestines (due to laxatives) and much more. Headaches, neck pain and back pain are particularly common and non-specific symptoms that are frequently experienced by bulimia sufferers. The illness often appears at around 17 or 18 years of age and is occasionally linked to a history of anorexia. The list of possible psychological comorbidities is long and includes, for example, substance abuse, feelings of inferiority, and impulse control disorders.
Complications
Bulimia is a serious illness that absolutely must be treated by a physician or by a psychologist. It is not uncommon for patients to also need to be admitted to a clinic for treatment so that they can no longer harm themselves. If bulimia is not treated properly, it can leave very severe health damage to the body and, in the worst case, lead to death. Various symptoms and complications usually occur with bulimia. The affected person often shows aggressive behavior and social isolation. In addition, there is depression and feelings of inferiority, which are not further aggravated by social exclusion.Not infrequently, bulimia also occurs with the abuse of alcohol and other drugs and leads to the use of medications that cause vomiting. These drugs are harmful to the body in high amounts and cause problems with the stomach. Due to the rising stomach acid, the teeth are permanently damaged and must be replaced with crowns. Treatment takes place primarily on the psychological level. In addition, there is the treatment of the physical symptoms, as the body has to get used to an ordinary food intake again. As a rule, the treatment of bulimia is successful, but does not exclude the possibility that the affected person will develop the disease again.
When should one go to the doctor?
In the case of bulimia, medical treatment is definitely necessary. In the worst case, the disease can lead to death. In severe cases, sufferers must be treated in a closed clinic. In most cases, the patients themselves do not admit to the disease, so that it is mainly parents and friends who have to initiate the treatment and diagnosis. A doctor must be consulted if the affected person loses a lot of weight in a short time. Persistent vomiting or lowered self-esteem may also indicate the disease. Likewise, patients often suffer from tooth decay and eat high-calorie foods. In addition, a doctor should be consulted if bulimia leads to psychological and social discomfort. In acute emergencies, an emergency physician must be called. Comprehensive treatment of bulimia should be carried out in a clinic. For this, however, those affected must admit to the illness. Treatment in self-help groups is also possible.
Treatment and therapy
Bulimia is a disease that can be treated only with the help of a doctor who specializes in bulimia. This doctor is usually a therapist or psychologist. Treatment for bulimia can usually only begin once the person realizes they need help. After that, a weeks-long psychosomatic cure is the best foundation stone to find back to a healthy life. In this therapy, an attempt is made to find out the causes of bulimia in order to then work them up. A person suffering from bulimia must learn to use alternative methods instead of overeating. A person suffering from bulimia will have to watch his or her eating behavior for the rest of his or her life, just as a dry alcoholic has to be careful not to drink any more alcohol. However, the bulimic has the disadvantage here that he must eat to survive and cannot live abstinently. Dealing with food properly is as important a point in bulimia therapy as different methods of dealing with the causes. After intensive therapy, outpatient, regular talk therapy must be continued in order to be able to cope in everyday life and to learn to deal with relapses without falling back into bulimia.
Outlook and prognosis
The eating disorder can be cured with the right therapy and substantial cooperation from the patient. Approximately half of all patients achieve freedom from symptoms after a course of several years. In about 30%, only partial improvement of the clinical picture is observed, and 20% of all patients show no cure of the existing symptoms. The earlier the disease is diagnosed, the better the chances of recovery. At the same time, the age of the patient at the onset of treatment plays a significant role in the prognosis. Younger patients in their teens have a significantly better chance of recovery than adults. With the use of therapy, the chances of recovery improve significantly than without the help of a doctor or therapist. Despite medical care, many patients often suffer one or more relapses within the recovery process. Young patients are particularly affected by this. In addition, there is a risk that the disease will turn into a chronic course and persist for many years. At the same time, this increases the likelihood of the onset of a secondary illness. Patients with bulimia often suffer from depression, obsessive-compulsive disorder, addiction or impulse control disorder. Patients who also suffer from a borderline disorder have a significantly worse prognosis. They have a significantly higher suicide rate and are more likely to abuse alcohol.
Prevention
Preventing bulimia is very difficult because the causes of bulimia mostly settle subconsciously. Before the affected person realizes that he is stuck in a bulimic thought spiral, he is usually no longer even capable of recognizing for himself that he needs help. It is important to have good self-reflection and a healthy self-esteem in order to be able to approximately prevent bulimia. Bulimia, like all addictions, is the expression of mental suffering that has not been worked through. Therefore, anyone who has experienced bad things should always seek therapeutic help, even if they think they don’t need it. Awareness of this is vital to survival, because bulimia, like other addictions, can be fatal.
Aftercare
As a rule, intensive aftercare is necessary for bulimia nervosa. Especially after inpatient therapy, it is recommended to see an outpatient psychotherapist and continue treatment. This can help those affected to find their way back into everyday life and prevent any relapses. In addition, attending self-help groups can be helpful in most cases. In most clinics, individual aftercare plans are agreed upon in consultation with the treating physicians prior to discharge. It is essential that patients adhere to such instructions. In individual serious cases, those affected can move into special supervised residential groups for former bulimia patients for the period of aftercare following inpatient therapy. In addition, many medical facilities offer the possibility of online-supported aftercare for patients with eating disorders. Outpatient psychotherapy is also particularly recommended for those affected who have not previously been treated in a clinic. This should be continued in any case, even if the affected person notices a clear improvement of the disease. Family members and relatives should be involved in the process throughout the entire period of aftercare. If a relapse occurs, patients should always consult a physician.
Here’s what you can do yourself
Bulimia is a serious eating disorder that can result in considerable physical and psychological damage if it is not recognized in time and treated professionally. It is therefore essential to refrain from self-therapy. However, those affected can help to support the recovery process. The earlier the disease is detected, the lower the risk that sufferers will suffer long-term damage. Therefore, a doctor should be consulted at the first signs of binge eating. In addition to drug treatment, patients should definitely take advantage of accompanying psychotherapy. If the treating physician does not suggest this on his or her own initiative, the therapy must be actively requested by those affected. Cognitive behavioral therapies in particular are very often successful in bulimia nervosa. It is also important that those affected are not ashamed of their condition and at least inform their close social circle, such as parents, roommates and, if necessary, colleagues or superiors about their illness. Many patients are also helped by joining a self-help group or exchanging information with other sufferers in online forums for bulimics. In addition, a bulimia diary is recommended. Such records can help keep track of eating behavior and identify the triggers of the disease. Bingeing attacks, which occur primarily at night, can also be controlled by consumption patterns. Instead of stockpiling food for the entire week, only daily needs should be purchased.
