What is bulimia nervosa?
Bulimia is an eating behavior disorder characterized by repeated
episodes of overeating or overeating and an excessive preoccupation with
weight control. This leads the patient to take extreme measures to counteract weight gain produced by overeating. Therefore, episodes of "binge" occurs, in which compulsively large amount of food ingested in a short time. These episodes often suffer in secret.
After binge eating, the patient often feels guilty about it and uses a
series of inappropriate compensatory methods to prevent weight gain.
Despite being already known 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 about 1% of the population suffers from this
disease, although this figure may be an estimate below the reality. In fact, studies show that up to 7% of young women who consult their GP with symptoms of bulimia nervosa. It is much less common in men.
What are the symptoms of bulimia nervosa?
According to the World Health Organization, the diagnostic criteria for bulimia nervosa are:
Most patients with bulimia nervosa have a weight within the normal range, although some may be above or below.
- Persistent preoccupation with food with an irresistible desire or compulsive overeating.
- 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 in weight by one or more of the following means: excessive exercise, self-induced vomiting after ingestion, prolonged periods of fasting or consumption of drugs such as laxatives, diuretics or appetite suppressants.
- Excessive or morbid fear to obesity . This is also observed in anorexia nervosa. Indeed, bulimic patients often have had previous episodes of anorexia nervosa.
Several research studies have bulimia nervosa associated with
alterations in several brain neurotransmitters (messenger substances are
neurons use to communicate with each other) such as norepinephrine,
serotonin and endorphins. It has also been described a genetic vulnerability.
Psychological factors
During the adolescent bulimia nervosa patients often exhibit behavioral changes, so may be other problems of impulsivity (such as problems with alcohol, or other drugs ) sexual disinhibition, irritability or emotional lability high. Often these patients have low self-esteem associated; in fact, bulimia nervosa occurs more often in people with disorders depressive . It also presents more frequently various personality disorders, particularly borderline personality disorder.
Social factors
As occurs in anorexia nervosa , bulimia nervosa patients often have strong academic performance.
Equally important are the social and cultural pressures around to
maintain a slim figure, although, as noted, most bulimic patients
maintain a weight within normal limits. Also worth mentioning that bulimic patients often they perceive their parents as neglectful and feel rejected by them.
What are the causes of bulimia nervosa?
The cause of bulimia nervosa is unknown, being generally a combination of biological, psychological and social factors:
Gastrointestinal problems - Damage to the teeth by stomach acid
- Thickening of the salivary glands
- Esophagitis (inflammation of the esophagus) and esophageal ulcers
- Lesions in the stomach and intestine
- Cardiac arrhythmias
- Alterations in blood ions
- Edema (fluid retention) in the legs
- Renal impairment
- Urinary infections
- Contractures and muscle paralysis
- Epileptic seizures
- Endocrine disorders
- Decreases in female hormones
- Ovarian atrophy
- Ovarian cysts
- Infertility
While some cases of bulimia nervosa are short, usually symptoms occur months or years before the patient seek help. As expected, patients who are able to engage in treatment are those with a better outcome. Approximately one third of patients can occur chronicity of any symptoms.
The prognosis for bulimia nervosa will depend largely on the aftermath.
Keep in mind that binging, but above all compensatory behaviors such as
self-induced vomiting or misuse of laxatives or diuretics can have
serious physical complications:
What is the treatment of bulimia nervosa?
Treatment should be focused both to the symptoms of bulimia nervosa as to the associated physical and psychological disorders. Specific treatments for bulimia nervosa include both psychological therapies as drug treatments. However, as with most psychiatric disorders, it is the combination of both strategies that achieved a better response.
Usually, the treatment of bulimia nervosa patients must be performed on an outpatient basis.
Admission, preferably in dedicated units is recommended only when they
have been repeated failures by outpatient treatment and coexist physical
or psychological problems that a more intensive treatment may require
Psychological treatments
Several psychological interventions are being used in the treatment of this disorder of eating behavior:
Also, self-help groups are useful for some.
- Cognitive behavioral therapy: the mode most commonly used psychological treatment for bulimia nervosa. This treatment modality has been made from previously developed cognitive therapy for depression and other psychiatric disorders.
- Motivational therapy
- Interpersonal therapy
- Cognitive analytic therapy: is a therapeutic modality of short duration, usually between 16 and 20 sessions, which combines elements of cognitive therapy and psychodynamic psychotherapy orientation.
- Rational Emotive Therapy
- Family therapy: This is a fundamental element of treatment in a significant number of cases.
- Group therapy relapse prevention
- Other group therapy
- Antidepressants: in part due to the high frequency of depressive symptoms in bulimic patients are observed, antidepressants Well administered alone or in combination with some form of psychotherapy are the drugs used in this disease. If multiple antidepressants are well have been employed, such as amitriptyline, imipramine, desipramine, trazodone or phenelzine, are inhibitors of serotonin reuptake as fluoxetine, fluvoxamine, paroxetine, sertraline or citalopram who has shown greater efficiency.
- Opioid antagonists: Naltrexone is an opioid antagonist which is commonly used to treat heroin addiction and alcohol also has shown some efficacy in the treatment of bulimia nervosa.
- Other drugs: such as fenfluramine, lithium, acamprosate or gabapentin can be useful in certain subgroups of patients.
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