Bulimia - Causes, symptoms and treatment. MF.

Bulimia is an eating disorder consisting of a series of gluttony and episodes of vomiting, the use of laxatives, etc. Uncontrolled attitudes toward food, increase and weight loss are only visible symptoms of the disease. In fact, this is the result of serious violations in the mental sphere.
Bulimia is considered a relatively young disease and has been relatively recently attributed to mental disorders. This is perhaps the main reason why this disease is still poorly understood.

Modern bulimia has different forms. For example: the use of laxatives, diuretics, debilitating exercises, an intensive diet or fasting between the bouts of gluttony. More details about the causes of the disease and differences from conventional gluttony in the article "Uncontrolled binge eating, insatiable hunger" & gt; & gt;

To understand the causes of the disease better, one should remember the story. Bulimia is a term borrowed from the Greek and means pathological gluttony.

In ancient Rome, a relatively common phenomenon was "vomitoria" - artificially induced vomiting, after a feast. Supporters of this procedure were the emperors Claudius and Vitellius. In the ancient Egyptian culture, the body was cleaned monthly by diarrhea. There was an opinion that diseases "come from food".Therefore, medieval doctors considered these purifications as one of the methods of treatment.

The complete refusal of food in the 1970s began to be treated separately as anorexia. She had nothing to do with the modern tendency to lose weight. For our ancestors leanness was repulsive. In the 1980s, epidemiological studies showed that bulimia is much more common than anorexia.

Symptoms and Diagnosis of Bulimia

First, we'll figure out whether bulimia is an independent disease.
It is believed that bulimia usually begins with discontent with its appearance. Consequence - unsuccessful, leading to gluttony, attempts to lose weight. Fear to grow fat replaces the sense of guilt from the reception of a large amount of food and the condition is temporarily relieved by vomiting, a "vicious circle" is obtained.

Sometimes, to justify their condition, patients come up with various explanations for their actions. For example, the ideology of recognizing bulimia( and other eating disorders) as a way of life, not a disease. These ideas have found their application in online communities, forums, blogs. Basically these topics are developed by teenage girls, obsessed with losing weight.

Girls describe themselves as "pro - mia" - striving for leanness, inventing diets and starvation, from time to time allowing themselves to violate strict rules of nutrition. In order not to spoil the diet, immediately after gluttony, completely get rid of the eaten, provoking vomiting. Overeating is usually spontaneous, when hunger becomes unbearable, but can be planned( special purchase of sweets, during the holiday).

Another direction "pro-ana", believe that vomiting is dirty, offensive, and attacks of gluttony are a sign of weakness and imperfection, lack of willpower. Girls discuss their way of life, share advice, publish pictures of thin models and celebrities, advise how to whiten teeth, increase hair volume, cleanse the skin, "cleanse the body"( enemas, starvation).

Diagnostic signs of bulimia:

- Repeated episodes of overeating( at least 2 times a week for 3 months), a large amount of food is consumed in a short period of time.
- The patient is focused on eating or feeling hungry.
- Confronting "weight gain" in one of such ways: vomiting, fasting, diets, excessive physical activity. Used drugs that reduce appetite, thyroid hormones, diuretics, enemas or laxatives.
- Low level of self-esteem due to changes in body mass and shape.

It is worth noting that currently the classifications are updated. Planned changes will include situations such as:

- possession of a healthy diet( orthorhysis), a 'healthy lifestyle';
- eternal life on a diet,
- constant loss in weight due to the established limit on food,
- the food ceases to be tasty and for the patient it is only a means for satisfying the body's need;
- the patient has more dietary kits, vitamins, weight loss products, in the alternative to "normal eating";
- most of the patient's thoughts about what he eats or will eat;
- disregard for food;
- there is no accidental overeating, the patient "does not remember how it was before" and does not allow the thought of "returning to normal food".

Distinctive features in the diagnosis of bulimia

The bulk of information about bulimia is based on American studies. There are important features of the disease that distinguish bulimia from other eating disorders.
- women are more prone to bulimia than anorexia, due to hormonal changes during the menstrual cycle;
- uncontrolled binge eating differs from anorexia. Despite significant fluctuations in body weight, with bulimia the weight of the patient more often remains normal;
- overeating - compensatory behavior, less persistent than anorexia( about 2 times a week);
- Vomiting or spitting out a large amount of food is regularly used without swallowing.

It is very important to distinguish between ordinary overeating and uncontrolled overeating( compulsive overeating).In itself, overeating is not a disease. Here is a brief description of these concepts, with an emphasis on the differences between them.

Common between painful overeating and overeating:

- eat a lot;
- trapeznichayut faster and negligently than usual;
- attacks occur mainly on "their" territory, away from strangers;
- after overeating people feel shy and embarrassed;
- both disorders can lead to overweight and obesity;
- both disorders depend on the emotional sphere;
- are associated with other eating disorders;

Features of Bulimia:

- seizures depend on stress, boredom, sadness, sadness and are a type of
reaction to various feelings and emotions;
- overeating is planned and organized;
- the patient has a negative attitude towards food;
- people eat in isolation, are ashamed of the act of eating;
- suffering from bulimia, are excluded from society as they eat alone;
- there is compensation for another form of behavior( exercise, vomiting, use of laxatives)
- women overeat twice as often as men;
-the variety and aesthetic appearance of food consumed during a meal, does not matter much.

Treatment of bulimia

When self-treatment of bulimia at home is usually very high risk of failure. For effective treatment, several conditions are necessary. The most important of them is the patient's motivation( attitude) and the doctor's experience in the treatment of this disease. Professional treatment of bulimia should include psychotherapy( cognitive-behavioral or family therapy) and medication.

Drug medication for bulimia

The generally accepted standards of bulimia treatment suggest that drug therapy should be the only or dominant form of treatment. Many studies show that in patients the key disorder is a deficiency of the neurotransmitter serotonin. Serotonin plays an important role in the regulation of mood, its deficiency is expressed in the form of affective mood disorders, which most often cause eating disorders. The logical conclusion is that antidepressants are the most effective in treating bulimia. Treatment is carried out strictly under the supervision of a psychiatrist.

Antidepressants of the modern class have proven effective in the treatment of bulimia, and new generations of drugs in this group are characterized by fewer side effects.

Selective serotonin reuptake inhibitors( SSRIs) are the best. In addition to the antidepressant effect, they reduce appetite - the effect is permanent, but it is very important at the initial stages of treatment. Preparations of this group: Citalopram( Celexa), Escitalopram( Lexapro), Fluoxetine( Prozac, Sarafem), Fluvoxamine, Paroxetine( Paxil), Sertraline( Zoloft), Venlafaxine -( Velaxin, Velafax, Efevelon, Venlaksor).

Other antidepressants that can be used in the treatment of bulimia:

Tricyclic. Amitriptyline( Elavil), Clomipramine( Anafranil), Desipramine( Norpramin, Pertofrane), Imipramine( Janimine, Tofranil), Nortriptyline( Aventyl, Pamelor)

Monoamine oxidase inhibitors. Consonar, Isocarboxazide( Benazide), Moclobemide( Manerix), Phenelzine( Nardil), Tranylcipromine( Parnate), Tetracyclics, Mianserin( Bolvidon), Mirtazapine( Remeron)

Tetracyclic or other groups of antidepressants. Trazodone( Desyrel), Aminoketonea, Bupropion( Zyban)

Inhibitor of reuptake of serotonin and norepinephrine. Venlafaxine( Effexor)

Serotonin and norepinephrine reuptake inhibitor. Duloxetine( Cymbalta)

There are reports of the effectiveness of other preparations, for example Topiramate( Maxitopyr, Topreal, Topamax, Topsaver) - drugs for the treatment of convulsive disorders. With bulimia helps to normalize the mood and reduce uncontrolled urge to absorb food.

Remedies for the treatment of addictions ( alcohol, drugs) - Naltrexone( Nalorex, Vivitrol) reduces the risk of dependence on bulimia.

Antiemetic - ondansetron( Zofran)( used to give a feeling of fullness and fullness.)

Others. Lithium carbonate( Carbolith, Cibalith-S, Duralith, Eskalith, Lithane, Lithizine, Lithobide, Lithonate, Lithotabs)

Bulimia therapy

There are many types of psychotherapy, each physician sees in his own way the personality, emotions and problems of the patient. Different doctors have different methods of treatment. It is impossible to unequivocally determine which method is the best and most effective. Different approaches, depending on the nature of the problem, will be more or less effective.

Cognitive - Behavioral Therapy

It is based on the eradication of negative thoughts about yourself and your body, which are the main ones in the formation of the disease and the negative attitude towards food.
About 4-6 months, the patient learns to eat 3 times a day, including foods that have not previously been consumed.
During this period, the patient describes his daily diet, any cases of overeating and consumption of calories, as well as negative thoughts about eating, if any.
Over time, the patient will be able to detect a distorted and false view of his appearance.

Gradually, the type of food expands, and the patient begins to struggle with pathological reflexes and automatic behavior with the help of a therapist. Former beliefs are challenged, and conclusions based on reasonable and real expectations begin to dominate.

It is believed that interpersonal therapy is less effective in treating bulimia than cognitive-behavioral therapy. Of course, this type of therapy takes much longer!

Interpersonal Therapy

Interpersonal therapy is designed to combat depression and anxiety, which are central to the formation of an eating disorder. This type of therapy does not address the issues of weight, eating and body image. When the patient mentions this during the session, the therapist imperceptibly changes the direction of the conversation.
Objectives of interpersonal therapy:
- expression of feelings,
- to adapt the patient to uncertainty and changes in life,
- to create a sense of individuality and independence,
- to deal with all negative events of the past( sexual violence or other traumatic events that contributed toformation of an eating disorder).

Family therapy

This type of therapy is based on the assumption that the main role in the development of eating disorders is played by incorrect family relationships. Family therapy can be effective for both young people and older people.

Maudsley-based therapy

Involves parents' involvement in the treatment of adolescents in patients with bulimia. The treatment includes restoring the weight of the child under the control of the parents, solving the problems associated with the period of growing up and sexual identification, empowering the family. The approach is good because it stimulates parents to participate in the treatment process, prevents them from developing a "guilt complex" in front of the child.

Psychodynamic Therapy

In psychodynamic therapy an important role is played by a uniform view of the doctor and the patient on the psychotraumatic events from the past. The therapist explains the events and behavior of the patient. Under the guidance of a doctor, the patient begins to solve problems that reinforce his illness.
Due to the individual approach, it is very difficult to assess the real effectiveness of such therapy in the treatment of bulimia. If the patient himself is convinced that his illness is a reflection of internal problems and emotions, psychodynamic therapy will be extremely effective.

Integrated approach to

Some physicians individually approach each case and use a combination of several treatments. For example, keeping a journal of nutrition and emotions in combination with elements of psychodynamic therapy has a positive interaction in many manifestations of eating disorders, including bulimia.

Bulimia therapy

For the treatment of bulimia, a combination of sedative herbs, stimulants of nervous and cerebral activity and natural andédepressants is used.

Soothing: Ledum, hawthorn, valerian, mint, oregano, wormwood, motherwort, hops.
Stimulants of nervous activity: ayr marsh, scarlet, rhodiola pink, eleutherococcus.
Antidepressants: aralia, ginseng, St. John's wort, saffron, St. John's wort
Herbs normalizing metabolism and appetite: buckthorn bark, heather ordinary, sage, brown seaweed, bubbly fucus.

Below are the three best tested and reliable herbal mixtures. Do not use them for a long time, as the body can become addicted. You need to take a break in the treatment or change the prescription.

Recipe # 1:
1. rosehip - 100 grams of vitamins.
2. Chamomile flowers - 100 g - treatment of acute and chronic inflammation of the gastric mucosa.
3. Melissa leaves - 50 g
4. Yarrow grass - 50 g
5. Angelica root - 50 g - calms the nervous system.
6. St. John's wort 50 g
7. hop cones 7 - 20 g
8. valerian root 8 - 20 g
9. leaves of peppermint - 20 g

Recipe No.2.
1. yarrow herb - 50 g
2. angelica root - 50 g
3. valerian root - 50 g
4. rhizome of calamus - 50 g
5. hop cones - 50 g
6. flowers of lavender - 50 g-calms, improve cerebral circulation.
7. peppermint leaf - 50 g
8. Rosemary leaves - 50 g
9. Melissa leaves - 50 g
10. Thyme grass - 50 g

Mix all the herbs, 1 tablespoon of herbs with a glass of boiling water and cook on a water bathfor 20 minutes. Drink warm, filtered infusion twice a day for half a cup.

Recipe # 3.
1. Chamomile flowers - 50 g
2. Melissa leaves - 50 g
3. St. John's Wort - 50 g
4. Nettle - 50 g - a general strengthening, multivitamin property.
5. hop cones - 50 g
6. chicory root - 50 g
7. lover root - 50 g - antiemetics
8. valerian root 8 - 50 g
9. lavender flower - 50 g

All herbs thoroughly mix,if necessary, grind it. One tablespoon of the mixture pour a glass of boiling water. Leave to stand for three hours. Drink 2-3 times a day for half a cup before meals.

Bioenergetics in the treatment of bulimia

The most popular form of alternative medicine. This is one of the oldest ways to restore health. Therapy has been known since antiquity in China, India, Egypt, Mesopotamia. Most diseases in the human body begin with thoughts of the disease, and then the disease appears in the physical body. In the case of bulimia, the patient is constantly unhappy with the proportions of the body, he is concerned about increased appetite.

Bioenergetics activates the natural defenses of the body, inducing "order" in the patient's body. When the energy source of the problem is eliminated, the disease stops. This treatment option is very good if you can not defeat the disease in a classical way.

Illoreflexotherapy

Acupuncture is a treatment technique that has come from the ancient East. It is not used as an independent method of treatment, but only as a supplement to traditional medicine. Acupuncture points are stimulated with needles. For effective therapy, you need to know the exact location of these points. Acupuncture in the treatment of bulimia is a new direction.
Effects of therapy: normalizes the patient's appetite and energy metabolism. In addition, acupuncture relaxes and helps to get rid of stress.

Art therapy

Art therapy. For example, the patient depicts his fears and problems on the canvas.

Physiotherapy

Massage - Relaxes, relieves stress

Other

Meditation and yoga, help to master the techniques of relaxation.

Support for loved ones with bulimia

• Do not set a patient's recovery time. Each patient progresses at its own speed.
• Be patient and supportive during the entire treatment process.
• Family members should openly talk about their feelings and maintain open communication with a sick person.
• Do not try to establish control over the actions of bulimia.
• If a minor needs help and is not ready to share his problems with his relatives, he should be given the opportunity to talk with an adult whom the teenager trusts, for example, a school psychologist, a nurse, a teacher, a trainer, a priest.

Consequences of Bulimia

The most common complications of the disease:

- an electrolyte imbalance - especially hypokalemia, usually leads to a violation of cardiac activity( arrhythmias, cardiogenic shock, myocardial infarction), and weakness of the heart muscle.
- low level of free calcium ions( disorders of blood coagulability, weakening of bones and teeth, impaired passage of nerve impulses, increased risk of osteoporosis)
- lack of chlorine in the body causes dysfunction of digestion and dehydration.
- due to vomiting, under the influence of gastric juice, tooth enamel is significantly damaged.
- during vomiting infection is entered into the oral cavity. Consequence - irritation of the throat, swelling of the submaxillary salivary glands, ulcers in the tongue.
- During the enema installation, there may be damage to the esophagus and stomach, bleeding in the gastrointestinal tract, gastric perforation, stomach distension, constipation( depending on laxatives), pancreatitis, bowel and duodenal diseases.
- the wall of the rectum weakens and hemorrhoids develop.
- sometimes vomiting leads to rupture of the esophagus or stomach.
- the most fatal consequences - cancer of the larynx or esophagus.

Other( less common) effects of bulimia:

- zinc deficiency - decreased immunity, impaired taste and smell, hair loss.
- disorders of the menstrual cycle, until the disappearance of menstruation.
- general dehydration of the body, as a result, dryness of the skin and mucous membranes.
- arthralgia or joint pain without inflammatory processes.
- low levels of tryptophan and serotonin negatively affect mood, sleep and sexual needs.
- malnutrition and dehydration causes low blood pressure( dizziness, blurred vision, fainting, headache).
- deficiency of iron and vitamin B12 - consequence of this, anemia.
- those affected by bulimia often have sexual contact with casual partners( promiscuity) because of low self-esteem.
- there is a tendency to abuse alcohol and drugs.
- abstinence syndrome( like addiction) may occur if the patient is restricted in eating.

Prophylaxis of bulimia

Prevention is very difficult and is aimed at "catching" the eating disorder at the beginning of its development, until the beginning of therapy. Often, the disease disappears from others. Anybody from relatives does not suspect about presence of a pathology, it is impossible to interfere in time and to help the patient.
Further prevention is already aimed at preventing the development of a more severe form of the disease and causing harm to human health.

Doctor psychiatrist Kondratenko NA