How do I get bulimic
- Description: Common eating disorder with alternation from strictly controlled eating habits and food cravings
- Main symptoms: "Seizures" with subsequent vomiting, excessive sport, fasting
- Possible consequences:Malnutrition, tooth damage, gastritis, inflamed esophagus, cardiac arrhythmias, kidney damage, osteoporosis
- Causes: weak self-esteem, striving for recognition, adaptation to the prevailing ideal of beauty, familial influence on eating behavior and self-acceptance, genetic causes, biological triggers
- Diagnosis: standardized questionnaires and interviews on symptoms and causes
- Therapy: cognitive behavioral therapy, relearning healthy eating habits, individual and group therapy, antidepressants, mostly inpatient treatment
Bulimia (bulimia nervosa) is one of the eating disorders. Colloquially it is also referred to as eating-vomiting addiction. Typical bulimia symptoms are food cravings, in which those affected devour large amounts of food in an uncontrolled manner. In order not to gain weight, they then take drastic countermeasures.
Eating Disorders - What Now?
Correct handlingSevere weight loss, secret vomiting - an eating disorder triggers fears and insecurity in relatives. How do I deal with someone who is sick? What can i do to help him? The most important strategies for living with bulimia and anorexia.
The secret illnessEating disorders are a secret disease. Those affected are ashamed and try everything to hide their condition. They feel dizzy for fear of being forced to eat or prevented from vomiting. This is not a sign of bad character, but part of the disease.
Care for loved onesWhen children, partners or friends develop an eating disorder, the relatives are very worried and insecure. Speak up anyway, what you are observing, express your fears and offer help - for example in looking for a therapist.
Just eat again?The request “just eat something” seems easy to fulfill - but it is not. Anorectic people are terrified of losing control of their eating habits once they start eating more. Another reason: The eating disorder expresses a deeper emotional problem. Just eating again doesn't solve it.
Avoid assigning blameIn the past, parents, especially the mother, were often blamed for the occurrence of an eating disorder. But it's not that simple. The triggers can be very different. And several factors always come together. Avoid blaming yourself.
Don't broach the subject while eatingDo not discuss eating disorders while you are eating - there is too much potential for conflict. Such a delicate conversation works better in another situation.
Time out from illnessPeople with an eating disorder are more than just their disease - and want to be perceived in their healthy parts. Even if it's difficult, the problem shouldn't always be the focus of attention. Do something together and also address positive things - this strengthens self-confidence and thus helps to face the disease.
The relatives suffer tooWatching a loved one fade away is very painful. Look for relatives support - in a self-help group or as part of short-term therapy.
Only the person concerned can become activeNormalizing one's eating habits is frightening for the patient and requires a lot of strength, courage and motivation. The decision to get help can therefore only come from the patient. You can encourage them to do so and offer help - but putting pressure on them is of little use.
Getting well takes patienceEating disorders are serious illnesses, and recovery is a long process, with progression as well as regression. Longer therapeutic care is necessary even after a stay in hospital. But the good news is - it's worth the effort.
People with bulimia strive for a figure that corresponds to the prevailing, overly slim ideal of beauty. This way they hope for recognition and affection. It seems threatening to them to gain weight because they fear exclusion. Often, a diet is the beginning of the vomiting addiction.
Bulimia is not as easy to recognize for outsiders as anorexia, for example. People who suffer from eating-vomiting addiction are usually normal or only slightly underweight. Some are even overweight. The eating-vomiting attacks usually take place in secret, so that no one notices anything for a long time.
Most of the time, bulimics have a strong control over their eating habits. You are on a diet and skip meals. But then they keep getting hunger pangs.
Bulimia: "Offer Help"
Three questions toDr. med Robert Doerr,
Specialist in psychiatry, psychotherapy
Who is particularly affected by eating disorders?
Women in particular are significantly more likely to develop eating disorders. Likewise, low self-esteem, excessive performance demands and problematic family behavior patterns contribute to the development. However, the trigger is rarely a single factor; rather, various factors work together, and there is often a one-off triggering event, such as a diet.
What is the best way to address a suspicion of bulimia?
Preferably very directly. Say you are worried. Avoid eating criticism and allegations. Speak in the first-person form and do not apply pressure. Instead, signal that the person means a lot to you and that you want to help. Getting help is not a sign of weakness, but the first important step towards change.
Can people with bulimia get completely well again?
Relapses can occur especially at the beginning and in the first year after the end of treatment, the probability is around 30 percent. It is helpful to develop an understanding of the risk situations. And to develop concrete, well-functioning coping strategies. Also, don't evaluate a relapse as a complete failure, but as an incident from which you can learn something for the future.
- Dr. med Robert Doerr,
Specialist in psychiatry, psychotherapy
Dr. med. Robert Doerr is chief physician at the Schön Klinik Berchtesgadener Land in the field of psychosomatic medicine.
Repeated episodes of binge eating
Bulimic people lose control during food cravings. They gobble up large amounts of very high calorie foods in a short amount of time. The loss of control can be so severe that they are initially unaware of their actions. Bulimics sometimes consume up to 10,000 calories in about one to two hours. That is more than four times what a healthy person needs in a full day. Women have a requirement of around 1900 kilocalories per day.
The feeding attacks are often triggered by stress and last until an uncomfortable feeling of fullness arises. While devouring the food, some sufferers feel a brief relaxation. After the binge eating, however, they are usually ashamed of their behavior, feel disgusted or reproach themselves.
Measures against weight gain
In order not to gain weight, people with bulimia try to get the food out of the body as undigested as possible or to take other countermeasures. There are two types of bulimics:
Countermeasure vomiting (purging type): About 70 to 90 percent of bulimics belong to the "purging type". In most cases you will vomit up what you have eaten immediately. To do this, they provoke nausea with their fingers. Some patients also use aids, such as wooden spoons, the handles of which they stick into their necks. Some instead (or in addition) try to maintain their weight through fasting, laxatives, or extreme exercise.
To check whether they have vomited all of their food, many bulimic patients eat a colored food such as tomatoes at the beginning of the binge eating.
Some purging-type bulimics also use laxatives or make enemas.
Countermeasure fasting and exercise (non-purging type): Patients of the "non-purging type" do not lose weight by vomiting, but rather by strict fasting and excessive physical activity. However, this type is rarer than the purging type.
Pay attention to your figure and weight
Similar to anorexics, people with bulimia are very careful about their weight and are very afraid of gaining weight. Outward appearance is crucial to their self-esteem. They only find slim bodies beautiful. The exaggerated fixation on figure and nutrition is often the first symptom that strangers to outsiders notice.
Differences Between Bulimia and Anorexia
Bulimia and anorexia nervosa are not always easy to distinguish. In fact, bulimia often begins with a period of severe weight loss before the onset of binge eating and vomiting. However, the psychological backgrounds of the illnesses are fundamentally different.
Pronounced bulimia causes great damage in the body.
- Malnutrition: The repeated diets, the constant vomiting, but also the use of laxatives can disrupt the electrolyte balance and cause malnutrition.
- Heart failure: Too low a potassium level in the blood and cells can result in an irregular heartbeat and heart failure.
- Osteoporosis: Calcium deficiency makes bones fragile.
- Kidney damage: The lack of electrolytes can cause life-threatening kidney damage.
- Abdominal pain and stomach tear: Overeating causes the stomach to bloat. This causes a lot of pain. In the worst case, a life-threatening tear in the stomach (gastric rupture) can occur.
- Constipation: Vomiting slows down the transport of food in the body. Blockages occur.
- Tooth damage: The consequences of bulimia are often felt in the teeth. The stomach acid first destroys the tooth enamel and then the dentin. As a result, the teeth can initially become painful and temperature-sensitive and then damaged.
- Esophagitis: The rising stomach acid causes inflammation of the lining of the esophagus (esophagitis). In extreme cases, if gastric juice gets into the airways, there is a risk of suffocation or pneumonia.
- Gastritis: In addition, vomiting irritates the stomach and can also become inflamed (gastritis). Constant vomiting then often leads to further injuries up to painful bleeding, scarring and organ ruptures.
- Pancreatitis: The binge eating can lead to inflammation of the pancreas. It manifests itself in severe abdominal pain, fever and an increased heart rate.
- Menstrual Disorders and Infertility: Often times, menstrual periods become irregular or absent in women with bulimia. Fertility also decreases.
- Skin changes: In 10 to 30 percent of bulimic patients, dry skin and brittle hair with hair loss are further consequences. Frequent vomiting causes the salivary glands to swell and the corners of the mouth to become sore.
- Mental changes: Bulimia affects mood and concentration. In half of those affected, the shape of the brain also changes (pseudo-atrophy). However, the causes and effects of this phenomenon are not clear.
- Risks in pregnancy: Due to malnutrition, unborn children of a bulimic mother often do not develop properly. The child can suffer permanent damage.
Bulimia: causes and risk factors
Why a person gets bulimia is not yet fully understood. When the disease breaks out, several factors often come together. Risk factors include:
- genetic predisposition
- biological components
- lack of self-esteem
- problematic family influences
- high performance standards
- western ideal of beauty
- negative self-image
People with bulimia often have a negative self-image. There is a deep gap between the claim "how I want to be" and the perception of "how I really am". This is especially true for your own body. Self-esteem depends heavily on the figure. Bulimics usually strive for an extremely slim ideal, which they can only achieve by massive restriction in eating - or by vomiting.
Extreme performance demands
Patients' self-esteem depends heavily on their success in achieving lofty goals. At the same time, they are extremely self-critical, which leads to constant dissatisfaction with their own performance.
The conflict between excessive expectations of oneself and fear and feelings of failure creates strong states of tension. The binge eating can relieve this tension for a short time.
Problematic family behavior
How food is handled within the family can contribute to eating disorders. It is particularly critical when eating serves to distract, reward or relax.
Restrained eating behavior and frequent diets by mothers also seem to have a negative influence, as does a critical attitude towards one's own body within the family.
Often there are problems in dealing with each other among family members. According to some experts, bulimics more often come from families that are particularly ambitious and performance-oriented or who resolve their conflicts impulsively and violently.
Some experts also describe a lack of warmth, affection and appreciation in familiar relationships with one another.
All of this may or may not be the case. It is also unclear whether such family constellations actually contribute specifically to bulimia or generally promote emotional instability.
Western ideal of beauty
Bulimia is often fueled by a desire to conform to society's ideals of beauty. The current ideal is strongly towards underweight. It also motivates people of normal weight to go on a diet.
Often, patients with bulimia are slightly overweight before the onset of the eating-vomiting addiction. They then feel unattractive and find it difficult to accept their bodies. They try to get closer to the ideal of beauty through diets. Often this is the beginning of bulimia.
Constant starvation greatly fuels the need for food. Eventually, they can no longer withstand the pressure and the vicious circle of eating-vomiting addiction begins. The momentum of bulimia can then only be stopped with professional help.
Serotonin: This messenger substance creates feelings of happiness, but it also influences the feeling of satiety in the brain. It has been found that people with bulimia produce less serotonin.
Since the body needs carbohydrate-rich food for the formation of the messenger substance, this is a possible explanation for the binge eating: People with bulimia try to regulate negative feelings through the massive intake of carbohydrates. However, it is unclear whether the disturbance in the messenger system is actually the cause of bulimia or rather occurs in the course of bulimia and stabilizes it.
The body's own opioids: The body's own opioids also appear to play a role in bulimia. These are substances that reduce or suppress the sensation of pain and appetite.
It is believed that high opioid levels make fasting easier when you are hungry and at the same time lift your mood. Researchers have found very low levels of endogenous opioids in bulimics. This triggers cravings and thus also the binge eating. In this way, low opioid levels could contribute to bulimia.
There is also a hereditary predisposition to the eating disorder. This is particularly indicated by twin studies. If one twin falls ill, the other has a much higher risk of developing bulimia in identical twin pairs than in dizygotic twins.
How great the influence of the genes actually is, however, is not yet certain. Overall, however, it does not seem as great in bulimia as in anorexia (anorexia).
Bulimia: examinations and diagnosis
If bulimia is suspected, it makes sense to see your family doctor first.He can refer you to specialized doctors and psychologists.
The doctor can find out whether a patient suffers from bulimia during an anamnesis interview. The doctor could ask the patient the following questions if bulimia is suspected:
- Do you feel too fat?
- Are you happy with your body?
- Do you pay close attention to how much and what you eat?
- Do you have food cravings that make you feel like you can't stop eating?
- Does it happen that you vomit up the food you have eaten again? How common is that?
- Do you have physical complaints such as muscle weakness, constipation, severe bulging pain?
Most of those affected hide their eating and vomiting behavior. Many are not sure whether this is pathological at all. Others mistakenly believe that they can get a grip on the pathological behavior themselves. It is a great challenge for the patient and the doctor alike to build such trust that the person concerned can open up to the doctor and seek help.
If the family doctor determines bulimia, he will provide the person concerned with psychotherapeutic help. Since bulimia has predominantly psychological causes, treating the physical complaints is not sufficient.
The psychotherapist can use a clinical interview to record the specific psychological complaints. He can also determine whether the patient suffers from other disorders. People with bulimia often also have depression, anxiety disorders, or personality disorders.
Diagnostic criteria of bulimia
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the following characteristics are considered to be signs of bulimia.
- repeated episodes of binge eating
- repeated use of inappropriate countermeasures to counteract weight gain
- The feeding attacks and inappropriate compensatory behavior occur on average at least twice a week for at least three months.
- Figure and body weight have an undue influence on self-assessment.
- Symptoms are not solely associated with anorexia.
To record the diagnostic criteria, special questionnaires have been developed, which are supplemented by interviews. This includes the extensive structured clinical interview for DSM-IV (SKIB interview). In addition to the eating disorder, it also includes other mental illnesses.
The structured interview for anorexia and bulimia (SIAB) consists of a questionnaire for self-assessment as well as an interview part with 87 questions, which the doctor or psychologist goes through with the patient.
In addition to the psychological diagnosis, a physical examination is also necessary.
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