Bulimia: How to recognize the disease and treat it?

Bulimia appears mainly in adolescence, but also in early adulthood. Insidious, the repercussions of the disease are serious: the consequences of bulimia are psychic, somatic and social.

In extreme cases, hospitalization is necessary. That is why it is imperative to quickly identify the first signs of the disease, because it is quite possible to cure bulimia and get out of it permanently.

Are you wondering how to get out of bulimia? Thanks to this article, you will learn to recognize bulimia nervosa as well as the methods that exist to treat it. Feel free to share this article with a loved one if you think they are suffering from this eating disorder.

What is vomiting bulimia?

Bulimia is an eating disorder (ED). The person with the disease will eat and vomit. Bulimia, sometimes called bulimia nervosa, is characterized by binge eating (or hyperphagia): this is a frenzied period during which the person ingests large quantities of food without being able to control themselves.

Attacks are systematically followed by compensatory behavior that is harmful to health: these are generally vomiting (hence the term bulimia vomitive) but taking diuretics, intense physical activity or even fasting are also possible.

As a result, the body mass index (BMI) remains normal most of the time and it is often difficult to realize this disorder in the individual, the somatic consequences not necessarily being visible at first sight.

Self-esteem and image are greatly impacted by the appearance of the body and there is a very entrenched physical dissatisfaction.

Confusing vomiting bulimia with binge eating is common: unlike bulimia, individuals enduring binge eating do not compensate, it is non-vomiting bulimia. This may explain why they sometimes suffer from overweight or even obesity. As with bulimia, the distress induced by overeating is very intense.

Bulimia is not a pathology that is obvious and it is important to know how to spot the clinical signs.

Good to know: The prevalence of bulimia would be 1.5% among young girls who are between 11 and 20 years old. It usually begins in adolescence, but later than anorexia nervosa , with a peak in very young adults, at the age of 19/20. Early onsets (before puberty) or after age 40 are very rare. Men are less affected: about one in four cases. But it is understood that these figures are underestimated, because people in the grip of bulimia do not systematically consult.

What are the symptoms of bulimia?

Insidious, the symptoms of bulimia set in gradually over a period of time, while remaining difficult to spot:

1. The bulimia crisis: the food impulses are irrepressible, and are sometimes triggered following an event experienced in a stressful way or because of an unwelcome negative emotion.
2. The feeling of loss of control is present with each bout of bulimia: the person can no longer stop eating. Craving is a symptom that is commonly found in other addictions, but which also takes hold of the bulimic person during binges.
   During the crisis, large portions of food are ingested very quickly, without being able to stop. These bouts of gluttony rarely occur during meals and take place in secret. Generally, what is ingested is neither prepared nor cooked, it is consumed as it is, even raw. These foods are sweet, fatty and rich.
3. A need to fill up : it's not about eating for pleasure, quantity is more important than quality.
4. A feeling of shame and guilt: Negative emotions then take hold of the person. Beyond the digestive discomfort (abdominal distension) caused by gluttony, it is guilt, shame, self-loathing and remorse that manifest themselves.
5. Compensatory attitudes: in addition to eliminating and making the crisis disappear, recurrent recourse to purgative behaviors is used to prevent weight gain. In order to reduce the tension in the stomach, the person will make themselves vomit, which leads to a form of relief and appeasement.
6. The fear of getting fat is very marked: Generally the consumption is restrictive and the diet severe. The use of laxatives and diuretics is possible, as is fasting or skipping meals. Physical activity is also practiced excessively in order to limit weight gain. Even if the weight varies a little from one week to another, the bulimic person is rarely overweight, his BMI remains within the norms.
7. Crises and offsets have been happening at least once a week for the past three months.

The diagnosis of bulimia is based on these compulsive binges and the urge to get rid of them, but other symptoms can also help identify the development of the eating disorder.

• Irregular (dysmenorrhea) or interrupted (amenorrhea) periods;
• Dental lesions, linked to recurrent vomiting (loss of enamel, polycaries, etc.);
• Calluses or scars on the back of the hands in case of manual simulation of the gag reflex to vomit (because the hands rub against the teeth);
• Petechiae (small spots) on the face or conjunctival hemorrhages, also caused by vomiting;
• Functional intestinal and digestive disorders (pain, constipation, bloating, etc.);
• Metabolic alkalosis or water and electrolyte disturbances (such as hypokalaemia), caused by vomiting;
• Metabolic acidosis, induced by diarrhea caused by laxatives;
• Cardiac arrhythmias, gastric ruptures and esophageal tears;
• Deficiencies in vitamins and bone mineralization (osteoporosis) caused by malnutrition;
• Anxiety disorders or depressive disorders;
• Addiction disorders;
• Sexual disorders;
• Fertility disorders.

However, despite this set of symptoms and clinical signs , it is sometimes difficult to distinguish whether the disorder is bulimia or anorexia.

What are the differences between bulimia and anorexia?

In many ways, bulimia and anorexia are similar. Some bulimic patients have previously gone through a phase of anorexia nervosa . There is also a form of anorexia called "anorexia-bulimia", which presents purgative behavior.

However, here are the differences that can be seen between anorexia and bulimia:

1. Weight: Underweight is rare in individuals plagued by bulimia. Unlike anorexic patients, who are generally extremely thin, people maintain a normal BMI, although at the margin they can also be thin, they are rarely cachectic.
2. Control: in anorexia, patients remain in very strong hypercontrol, whereas in the case of bulimia, loss of control is frequent and hyperphagic attacks therefore occur more often.
3. Crises: more common among bulimic people, they are also objective about what they swallow, that is to say they are aware that the quantities ingested are excessive. Conversely, people with anorexia who are in crisis believe they eat a lot, while their portions are normal, even small.
4. Addiction: the natural reward circuit is altered in bulimia, and food is a form of drug, providing relief and appeasement; while in anorexia it is the restrictive behaviors that are reinforced by the reward circuitry.
5. Denial: very important in cases of anorexia, it is less present in bulimia, that is to say that suffering individuals are more often aware of their disorder and try to find solutions to cure it.
6. Somatic consequences: in anorexia, malnutrition impacts bone density, the immune system, muscles and hormones, whereas in vomiting bulimia, the repercussions are mainly metabolic, digestive and dental.

Good to know: Sometimes, we meet bulimic individuals who are extremely thin due to vomiting, and hospitalization is then necessary, because the vital prognosis is engaged. Conversely, we also find anorexic-bulimic patients , undergoing compulsions for whole weeks, and who will again not eat for months. The anorexic thought (that is to say the fact of doing everything possible to stay thin, to be very afraid of gaining weight and to be constantly the victim of body dissatisfaction) animates both bulimic and anorexic people. Lack of self-esteem, perfectionist traits, certain comorbidities, menstrual disturbances… are common points between these two disorders. Both sides of the same coin, anorexia and bulimia can be cured with appropriate care , and for this it is necessary to approach competent professionals.

Psychiatrist or psychologist: who to consult to treat the disease?

Since bulimia is an illness with physical, psychological and social consequences, it is essential to start treatment as soon as possible in order to avoid the risk of becoming chronic.

Thus, to treat alimentary bulimia, it is important to be followed by both a psychiatrist and a psychologist. If a little deliver a drug treatment, psychological support is essential, in order to have a better understanding of the appearance of the disorder and to highlight the behavioral reflexes which are associated, in order to stop them.

In another time, the therapy with a psychologist will also make it possible to carry out a work of restoration of the self-esteem and the self-love which can be at the same time a cause and a consequence of the disease.

Consulting a psychiatrist to treat bulimia , as a first step, allows you to obtain a diagnosis of your illness. It also eliminates all possibilities of physical pathologies that cause it. He can then indicate a treatment and psychotherapy to follow, for which he has the choice to refer to a clinical psychologist, who will intervene on this specific point.

Similarly, he can put you in contact with nutrition specialists such as dieticians specializing in TCA, for example, or with other experts (sophrologists, hypnotherapists, etc.). It guarantees overall support and ensures that it runs smoothly.

The psychiatrist provides coordination on three levels: psychotherapeutic, biological and social. Indeed, the interpersonal approach is sometimes necessary and must be done jointly with the family, social services or even the hospital. In addition, the psychiatrist takes into account the risk factors that are sometimes associated with the disorder: in the case of bulimia, it may be, for example, alcohol addiction.

Once the diagnosis has been established, beyond the choice of therapy, it is the therapeutic alliance which takes precedence and which accelerates the progress towards healing. It is essential that the sick person be ready to get involved in the medical process, just as it is equally important that the specialists selected be trained in eating disorders.

The clinical psychologist is also, like the psychiatrist. But the psychiatrist has the skills to make a medical diagnosis of bulimic disorder and, if necessary, prescribe drug treatment. He will provide psychotherapeutic support for people in psychological distress, whether in an office or in the hospital, following one or more approaches that he deems necessary to cure bulimic disorder: analytical, cognitive, systemic, etc.

Read also: Psychologist or psychiatrist, what are the differences and similarities?

What treatments exist to overcome bulimia?

This eating disorder can be treated using different approaches, natural or not, the combination of practices will allow the person to get out of it.

1. Medical treatments

For eating disorders, there are prescription medications that can help with recovery. However, it is an additional aid that cannot be substituted for medical and psychological follow-up taking place in parallel. It is a tool in the therapeutic management, but it is the whole of the accompaniment put in place which contributes to remission.

The objective of this type of medication is to reduce the appearance of symptoms and therefore the occurrence of attacks. Often, this also makes it possible to treat disorders present in parallel with bulimia: depression or anxiety.

Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, are generally recommended in the treatment of bulimia.

It's an antidepressant. It increases the amount of serotonin, a neurotransmitter, facilitating the flow of nerve information. SSRIs reduce the frequency of seizures and in this case, vomiting, but also act on anxiety and depression.

Treatment with fluoxetine is widely supported by research, but it must always be taken in a multimodal support process and therefore with psychological support.

2. Natural treatments

Natural treatments for bulimia are also used. However, they should not be combined with therapy based on psychotropic drugs, in order to avoid interactions or overdoses.

Naturopathy

Naturopathy encourages reclaiming one's body through diet, relaxation and physical activity. It is an unconventional medicine, but recognized by the WHO. It takes into account the individual as a whole, including his environment. Its purpose is to strengthen the body and its defenses with natural and preferably biological methods. Phytology (plants), aromatology (essential oils) as well as relaxation and breathing techniques are the tools.

In no case will naturopathy treat a bulimic individual, but it will be complementary to the care, if the person is receptive to it.

Phytotherapy

By their soothing properties, some plants have a relaxing and anti-stress effect. These natural anxiolytics reduce anxiety and help, in particular, to sleep better. As such, valerian and passionflower are effective. Rhodiola is also interesting for managing stressful situations. They are found in dietary supplements. Linden and lemon balm herbal teas are also appreciable at bedtime.

Essential oils have lifesaving qualities right from their bottle: by breathing in the fragrances, certain sensors in the nose activate the emotional seat present in the brain, which makes the oils more effective than taken orally. There are many essential oils that facilitate relaxation and it is possible to combine them to promote synergy: fine lavender, bitter orange petitgrain or marjoram with shells.

Diluting them in a vegetable oil to relax, by massaging the solar plexus or the wrists, provides a feeling of well-being. Some essential oils are used to reduce compulsions: cinnamon has an appetite suppressant effect and ginger, as well as peppermint, help reduce nausea.

Some plants, taken in the form of capsules, will slow down food consumption by their satiating effect. Nopal, for example, provides a feeling of satiety . Fucus and konjac also have this effect, as they gel and then swell in the stomach.

Homeopathy

Homeopathy could help reduce food compulsions and better control the feeling of hunger. In any case, it is strongly recommended to approach a naturopath before using these natural treatments, especially in the case of essential oils which, if used incorrectly, can become toxic.

Acupuncture

Some complementary approaches are also possible in parallel with psychotherapy. Acupuncture is one of them. It aims to stabilize the poorly distributed energy in the body. In the case of eating disorders, it is the spleen and the heart that are affected.

Acupuncture therefore seeks to act on these specific points, facilitating the rebalancing and normal activity of these organs. The results are generally rapid, always in addition to medical and psychological monitoring.

Learning to relax and unwind can be a keystone of treatment, as bulimia is usually fraught with anxiety and negative emotions act as precursors to seizures. Cardiac coherence is a simple breathing exercise that lowers levels of the stress hormone cortisol. In five minutes the effects are felt.

Meditation

Finally, the practice of meditation , strongly associated with states of mindfulness, completes this search for self-knowledge and relaxation. Yoga, combining a gentle physical approach and breathing techniques, provides the body with hormonal secretions promoting well-being and strengthening self-esteem and image.

Mindful states promote the creation of links between actions and thoughts in order to live the present moment fully, without rejecting what is experienced.

During compulsions, the loss of control is such that people with bulimia do not have the ability to reflect on their actions, the only objective being to “fill themselves”. The mindfulness technique allows you to reconnect and become aware of what is at stake: eating while taking the time to listen to your senses (the color of the dishes, the texture of the food, the smell food, the noise of the dishes in the mouth, the flavor of the aromas…) but also of his feelings and his emotions.

However, all of its treatments, whether natural or medicinal, will have no effect without the implementation of appropriate psychotherapy.

Which therapy is the most effective for treating bulimia?

Cognitive and behavioral therapies (CBT) are recommended as first-line treatment for bulimia. Treating bulimia with CBTs offers the best results in reducing seizures and compulsions as well as healing in general.

It is a question of modifying the patient's attitude and behavior in relation to food: he observes his pathological acts (namely crises and purgative behavior) in order to then learn how to transform them.

CBTs act on the disorder itself. By identifying the factors responsible for the frenzies, the person implements new postures, replacing the problematic functionings.

The psychotherapist works with the patient on his thought patterns, his mental processes, but also on the emotions that intervene in the regulation of his behavior. The individual is therefore active in his therapy and his healing: exercises and instructions (for example, eating at fixed times) can be given.

In the context of bulimia, cognitive and behavioral therapies help to:

• Increase motivation for change;
• Replace dysfunctional dietary practices and attitudes ;
• Reduce unfounded beliefs and fears about shape and weight;
• Anticipate and prevent all relapses;
• Positively reinforce body image and self-esteem.

Other therapies remain possible, such as interpersonal therapies (working on the problems encountered in relationships and which actively maintain the disorder), psychoanalytic therapies or family therapies (especially in the event of conflicts with the family or suffering caused by bulimia within the entourage).

Hypnotherapy would make it possible to treat bulimia through hypnosis: by intervening on the unconscious, the practitioner and the patient go in search of the origin of the disorder, so as to ensure that food is no longer an obsession.

Thus, when the diagnosis of bulimia is made, the goal of psychotherapy is to support the change in dysfunctional thoughts related to the eating disorder. The choice of psychotherapy is made with the patient and sometimes with his entourage.

Generally, if the disease affects children, adolescents, or even young adults, management involves the family. Early care, adapted to the personal situation according to age and the severity of the disorders, is more effective.

The therapeutic management of bulimia responds to a multidisciplinary care plan because EDs impact the person on several levels: psychological, physical, nutritional, family and social.

All of its dimensions must therefore be included to promote the chances of recovery. The follow-up must be done over the long term and encourage coordination between the different specialists. Generally, it is an ambulatory accompaniment which takes place, hospitalization remains rare and is organized only in the event of serious somatic complications or emergencies (passage to the suicidal act).

The therapeutic alliance is favored by the establishment of a qualitative relationship between the professionals, the entourage and the patient. The accompaniment aims to treat psychic dysfunctions as well as emotional dysregulations, but also the associated psychological disorders and the impacts on the social level.

What role does nutrition education play in healing?

It is also important to bring in a nutrition professional, specializing in TCA, to learn how to find an appropriate nutritional balance behavior.

Nutrition education helps to modify the ideas held by the person around food and weight. The complication of the disease on the somatic level must also be supported (digestive, dental, metabolic, bone, gynecological and obstetrical consequences).

The objective here is to help the person affected by the disorder to understand the fundamentals of food by offering them to reconnect with food. For example, she will be able to learn to cook with raw ingredients, dishes with balanced proportions and contents for herself.

Learning is done through a rediscovery of the senses and in particular of touch, taste and sight which were no longer taken into account during compulsive food crises.

Nutrition education also allows the person to rediscover a feeling of hunger often lost. During binge eating, the person does not stop eating. Eventually, the person ends up not knowing when they are hungry and when they are not. Gluttony gives way to irrepressible crises which must be stopped by regularizing the appetite .

Finally, food education has a role of reconciliation between food and the person suffering from eating disorders. To be bulimic is also to maintain a relationship of dislike for food to the point of making oneself vomit. Thus, nutritional education will promote, through practice, the transformation of received ideas about food.

For example, eating starchy foods does not make you fat, as long as they are eaten in reasonable quantities and accompanied by fiber-rich vegetables. On the contrary, starches are even essential because being a source of carbohydrates, they give energy to the brain and the body to function.

Bottom line

People with bulimia question their behavior and find it easier to get out of the vicious circle that this disorder represents.

Even though bulimia is based on only two main symptoms, namely “filling up” and “emptying”, the consequences are not less. Somatic complications related to vomiting are, in some cases, fatal: hypokalaemia going so far as to cause cardiac arrest.

Also, the psychological repercussions sometimes lead to suicide attempts and significant psychiatric disorders, requiring hospitalization, although this remains rare.

Being aware of effective treatments and psychotherapies is essential as a patient, and it is also essential to be able to choose a practitioner with whom you can trust to freely discuss your disorder.

However, this is not always possible: surrounding yourself and being able to express yourself to a loved one is then a first step in asking for support. Also, self-help associations exist and can be contacted by telephone.

Even if the disease has been present for a long time, it is never too late to talk about it and begin the path to recovery. Overcoming bulimia is possible.

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