Bulimia: what it is, symptoms, treatment for this eating disorder 1

Bulimia: what it is, symptoms, treatment for this eating disorder

Bulimia: what it is, symptoms, treatment for this eating disorder

Bulimia: what it is, symptoms, treatment for this eating disorder

Bulimia is a disorder of eating behavior
. The disease, called DAP – Psychogenic Food Disorder or MIA, is characterized by frequent bingeing without inhibitory brakes. The consequences of greed, especially on weight, the bulimic remedies with drastic means, such as vomiting or excessive exercise . Moreover, it cannot resist the urgent need to gulp down food can no longer and secretly. He then feels a sense of guilt for the loss of control. In order not to put on weight, it expels the food, even with laxatives, or eliminates the calories introduced, with fasting or diet. In addition it has a false perception of its body, which it would like more slender, according to the modern ideal of thinness synonymous with beauty.

    Bulimia nervosa is caused by several factors, mostly psychological, such as low self-esteem, that interact with each other. Women, especially adolescents, are the most affected by the disease because they are obsessed with weight.

    Bulimia: what it is

    The word “bulimia” must be accompanied by “nervosa” to distinguish the disease from occasional episodes of excessive hunger, without other manifestations.

    The true pathological condition is a serious eating behavior disorder . In summary, the bulimic is subject to recurrent compulsive binge eating , done secretly and even at night. At the great ingestion of food, always make up for compensatory behavior, such as self-induced vomiting . Repair tactics are adopted to “get rid” of food and its unwanted effects on weight.

    Not only that, it proves an irresistible impulse to quickly stuff itself with large quantities of food , without inhibitors and until it “bursts”.

    The crisis of ” ravenous voracity” does not bring pleasure to the palate but serves to calm the mind. However the wild feast causes the person concerned a sense of guilt for having succumbed to the temptation.

    Bulimia and food obsession

    The assault on the refrigerator or the pantry can make the subject swallow from 5,000 to 20,000 calories in an hour , at a speed of 81.5 calories per minute.

    As a result, the devourer worries about his weight and immediately tries to empty his stomach or reduce his caloric impact . To this end, it implements eliminative compensatory strategies, including the abuse of laxatives and diuretics, and non-eliminatory ones, such as intense exercise .

    Whoever suffers from bulimia enters a vicious circle , because he alternates eating them with anomalous behaviors to fight them, like fasting. In bulimia nervosa, also called DAP-Psychogenic Food Disorder, the patient feels a physical emptiness within himself, which is actually affective. As a result, the anxiety he felt led him to fill the “bottomless pit” with food. The imperious and unstoppable thrust of the binge arrives automatically, without the subject being able to block it.

    It often also consumes raw or frozen products and mixes ingredients and flavors, sometimes in a disgusting way.

    The resulting guilt leads to insane decisions , such as a restrictive diet. In fact, he accuses himself of not being able to resist the seduction of food and is afraid of harming his line.

    The pathology is formidable as it is connected to numerous disorders, such as the erosion of tooth enamel due to the acidity of vomit. Bulimia nervosa is also a source of some diseases, from gastritis to cardiovascular dysfunction.

    As in anorexia, the patient gives too high a value to thinness. So to get it, after the ravenous sagging, try to exercise self-control over weight with drastic methods. The disorder, typical of women, particularly adolescents, is mainly caused by psychological and environmental factors.


    In recent years, cases of bulimia nervosa are expanding . Especially in the Western world, cases increase in every social class, without distinction of class. The recognition of the disease occurred in ’79 , when the English psychiatrist Gerald Russell described it for the first time. Compared to then its incidence has grown, starting from the 90s.

    According to studies, the disease affects most women. The young bulimics are 1%.

    Instead, there are no certain data on men but it is believed that today many of them also fall victim to MIA. Probably in the strong sex, bulimia nervosa is triggered by the almost maniacal male attention to the “sculptural” and dry aspect imposed by modern culture. Consequently, to achieve the ideal physical form, some men do not hesitate to control weight with the unorthodox methods typical of the disease.

    Bulimia and adolescence

    From research conducted on high school and university students, it seems that bulimic males fall between 0.1% and 1.4%. In practice, out of every 1,000 men around 14 would be bulimics .

    The bulimics, in the study, are between 0.3% and 9.4%. In conclusion, of every 1,000 women a minimum of 3 and a maximum of 94 are carriers of the disorder. Therefore bulimia nervosa seems to be a prerogative of the female population, with about 94% of cases.

    In “pink” sex, bulimia generally affects women between the ages of 16 and 40, predominantly in adolescence.

    Currently the age of onset of female bulimia nervosa is lowering, with cases in prepubing age.

    Usually the onset occurs between 12 and 25 years , with a peak around 17 years.

    The data on bulimia nervosa are probably underestimated. In fact, the numerous subjects who, feeling ashamed, hide MIA for years cannot be counted.

    Bulimia: a brief history

    The term bulimia embodies the meaning of the disorder as it derives from the Greek “boulimía”, or ” ox hunger “. Once the disease was also classified as “cinoressia”, that is ” dog hunger “.

    The pathological craving for food already existed in antiquity, as evidenced by texts of ages before Christ. However, in the past excessive hunger was not followed by vomiting or other compensatory practices of bulimia nervosa.

    More noteworthy is the fact that, at one time, during the banquet it was vomiting to make room in the stomach and start eating again. Still in remote periods, gastric emptying, done several times a month, was considered a healthy therapy, especially for the obese. Instead, in the Middle Ages, the rich displayed excessive food intake. On the other hand, ascetics and saints practiced vomiting as an antidote to the devil’s temptations and self-punishment for repairing sins.

    Actual bulimia nervosa has been witnessed since the 20th century , but as a symptom and not as a disease in itself. But since the 1930s, many patients have been reported to have bulimic problems. However, only in 1952 , the disease was discovered and included in the DSM-Diagnostic and Statistical Manual of Mental Disorders.

    In 1979, Gerald Russell framed the syndrome as we know it today. The British psychiatrist has defined the disease as a ” disturbing variant of anorexia “.

    Bulimia nervosa has in common with anorexia the cult of the slender body and its attainment at all costs.

    The phenomenon is due to the propaganda of thinness as a synonym of beauty. Above all, social media, fashion and media promote a distorted vision of the body that enchants many people.

    Bulimia: causes

    Bulimia nervosa is a complex pathology and is established by an interaction of different factors. First of all, the genetic component plays a dominant role , around 28-38%. The onset of the disease is four times more frequent in those with bulimic relatives. Family factors that predispose to the pathology are obesity and alcoholism of the parents . Also inherited character traits, such as the tendency to depression or obsessive perfectionism, affect the onset of the disorder.

    Even traumatic experiences with relatives affect the disease:

    sexual abuse or childhood violence
    stressful events, such as the separation of parents.
    Bulimia nervosa can be conditioned by the environment in which one lives.

    Social causes

    The desire for a lean body or being a victim of bullying are conditions that favor the disease.

    Some professions, such as the mannequin , and certain sports, which force us to be thin, like dance, are at risk of disturbance. The obsession with weight control, in the name of extreme thinness, is also and especially enhanced by social media. Most noteworthy is Instagram , because it shows threadlike figures, often false, as an example to follow.

    Dangerous sites are dedicated to MIA that praise the sick behavior of the disorder , such as vomiting, to get thinness. Many young women fall into deception and practice nefarious advice to the worst consequences or death .

    Diets too severe

    A diet that is too restrictive can pave the way for bulimia nervosa. The phenomenon was confirmed by an experiment conducted on 15-year-old female students in London. After a year of severe diet, the girls showed an eight times greater risk of incurring the disease.

    Even a long period of abstention from food , prolonged fasting or, on the contrary, obesity can be the cause of MIA .

    Those with type 1 diabetes, juvenile, can sometimes give in to the desire to eat a lot. To prevent insulin injection and keep the blood sugar level low, the patient vomits. In the long run, this misconduct results in overt bulimia nervosa.

    Bulimia: symptoms

    Psychological symptoms

    On the psychological side , the bulimic future is dominated by:

    • anxiety
    • bad stress management
    • low self-esteem
    • difficulty tolerating emotions.

    First of all it presents an altered perception of oneself and one’s body , always considering itself too fat.

    Binge eating would serve to divert attention from intolerable emotional states or to escape from situations that threaten a positive self-assessment.

    Compensatory techniques, such as vomiting, would restore the bulimic’s self-confidence and self-esteem, which exercises weight control.

    Bulimia nervosa can also be understood as a biological rebellion of the organism towards excessive dietary restrictions. As a result the disease would be nothing but the other side of anorexia. However, despite the expedients, the bulimics manage to eliminate only half of the swallowed food, so often their weight is not reduced.

    Probably those suffering from bulimia fills the absence of affections with food or pays for frustrating work and disappointed expectations. But then, with repentance and the fear of extra pounds, he goes on to neutralize the feast with unhealthy systems.

    Emotions in bulimia

    A similar management of emotions does not eliminate the underlying problems, rather it creates new ones. The subject falls into a spiral that leads to other binges and negative feelings. Often what is eaten is precisely what is ‘ forbidden’ by dietary rules . This is also why the person experiences discomfort and a feeling of loss of control. As a result, he can judge his diet irreparably ruined and feel intensely distressed and demoralized.
    With guilt, the bulimic judges himself as lacking in willpower. He also immediately examines his body in search of the consequences of food transgression.
    To cancel the eating, go to the stratagems of the disease, called ” bulimic bleeding” , that is:

    • He retched
    • diet
    • fasting
    • all-out exercise
    • laxatives
    • diuretics
    • enemas
    • weight loss drugs, such as thyroid hormones.
    After the psychological suffering, there are no obvious physical and social consequences . The person concerned may have work problems and in common everyday activities. To avoid food temptations, the bulimic locks himself in the house and uses defensive subterfuges to avoid being discovered.
    At the extreme, all aspects of life are affected. Sometimes the patient goes into self-harm and substance abuse, alcohol and drugs.

    Physical symptoms of the bulimic

    On an organic level, initially there are trivial symptoms:

    • inflammation of the throat
    • enlargement of the salivary glands
    • dental caries and erosion
    • dry and yellowish skin
    • hair loss and constipation.
    The most complex disorders are:

    • fainting
    • numbness
    • gastric dilation
    • dehydration
    • abdominal pain and swelling
    • long and laborious digestion
    • fatigue and weakness due to malnutrition and electrolyte imbalance, following vomiting.
    The women can suffer from sexual dysfunction and an altered menstrual cycle, or even amenorrhea. Men reveal erection disorders .
    Repercussions occur at renal, intestinal and bone level, affected by osteoporosis. Most damaged by MIA is the cardiovascular system , with problems such as heart failure.
    Related to the possible and rare excess weight of the bulimic, diabetes and hypertension may occur. In contrast, bulimic people appear in majority in normal weight and only occasionally in slight underweight.


    Those suffering from bulimia experience disgust, depression, self-depreciation and introversion, thus denying symptoms and keeping manifestations of the disease hidden.
    Often, for this reason, it is not easy to diagnose the disorder , which can remain hidden for years.

    The role of family members

    However everyone can help discover the disease:
    family and friends observing strange attitudes, including running in the bathroom after meals and a disproportionate physical activity;
    dentist noticing erosion of dental enamel;
    general practitioner believing that some complaints complained of by the subject, such as swelling of the face and parotids, are suspected as a result of vomiting.
    The diagnosis is still up to the specialist . The nutritionist doctor or psychotherapist has the skills to pick up on the signs of bulimia nervosa.
    The sooner you recognize the disease, the sooner you can intervene to treat it. More years pass from its onset and the more it becomes ingrained, putting the patient in danger of life , even by suicide.
    The certainty of the diagnosis is when the patient has two characteristics:
    food greed
    feeling of loss of control, at least once a week for three months in a row.
    Sometimes, once shame is over , those suffering from bulimia go spontaneously to the doctor. The health care professional can confirm the diagnosis through obvious symptoms, such as frequent “purification” moments.

    The role of the specialist

    The specialist examines the subject’s diet , weight and other physical details, from muscle tone to the condition of skin and hair.
    Important psychological criteria are also the psychological aspects of the patient, such as his constant concern for weight .
    The patient undergoes laboratory tests , including blood counts , and instrumental tests, such as heart tests, to assess his state of health.
    With the BMI-Body Mass Index, above 18.5, it is established if you are in the presence of bulimia and not anorexia.
    The expert’s diagnosis is based on the specific characteristics of bulimia nervosa described in the DSM- Diagnostic and Statistical Manual of Mental Disorders . The treaty for specialists considers above all the psychological aspects of the patient. To be judged as bulimic, a subject must show the telltale signs of the disease, in particular repeated binges and loss of control .

    How to cure bulimia nervosa

    According to authoritative British guidelines of 2017, the most effective intervention for bulimia nervosa is cognitive-behavioral therapy.
    It appears that with 20 sessions of this treatment in 20 weeks , we can achieve remission of the disease. In comparison, 100 psychoanalytic sessions in two years would not have given the same result.
    The treatment is multidisciplinary because it involves more professional figures, such as the dietician.
    The therapeutic pathway is usually outpatient and rarely, in the most serious cases, requires hospitalization .
    Therapy can be individual or group . When dealing with other bulimics, the patient may feel understood and comfortable. All together, the sick manage to confide , to share the same problems and to socialize.
    The bulimic who does not go to the doctor can undergo the same treatment thanks to self-help manuals or digital therapy , proposed by special sites.

    Cognitive behavioral therapy: how it works

     Therapy involves a first phase to change the patient’s attitude towards nutrition.
    The subject is encouraged to have a healthy and regular diet , overcoming his bad relationship with food. For him, controlling the right weight must be a goal and not the only factor in estimating his own value. The specialist teaches when to eat , with a separation between meals of no more than 3-4 hours, and what to assume, with a personalized regime.
    A food diary can help you understand the eating habits to be corrected and the nutritional deficiencies to be solved.
    The patient is then guided to recognize and overcome the symptoms of bulimia nervosa, especially compensatory behaviors. Against intolerance to negative emotions, the bulimic is advised to seek positive emotions , striving to escape marginalized life.
    Even the familiar and relational therapy are critical. The two treatments are used to discover and resolve the patient’s difficult relationships with relatives and societies, which have weighed on the development of the disease.
    Linked to the disorder, low self-esteem and anxiety are due to a bad self-concept and negative confrontation with others. On the contrary, well-established and serene external relations are a support for the subject. Even the conscious and available attitudes of family members towards the relative’s illness offer relief.


    Bulimia nervosa can be tackled with antidepressant drugs , which improve mood and reduce eating disorders. However, these medicines work after a long administration and are not without side effects.These substances should not be prescribed for more than 15 days , in a dose of three tablets a day. 
    According to the psychotherapist, drugs are a passive treatment method , which does not commit the patient to change. Furthermore, antidepressants do not work on bad habits, such as restrictive diet.
    The effect of medicines is limited in time and lower than that of cognitive-behavioral therapy, which is an active method.

    Diet for bulimia 

    The diet should be customized , tailored to the specialist.
    In the case of normal weight , the calories to be taken can be 2000 per day.
    In the underweight , the increase in daily calories should reach at least 3,000 calories a day .
    Instead, in the face of being overweight , calories should be raised to around 1200 a day .
    For all those who suffer from bulimia, food should be taken as if it were a medicine: at least four “tablets” a day. The four ‘meals’, breakfast, lunch, dinner and a snack, bring the body back to the feeding marked by signs of hunger and satiety .
    In general, all patients should adopt the Mediterranean Diet , that is, based on healthy foods, cooked in a healthy way because they contribute to the well-being of an organism tried by MIA.
    The balanced diet of the patient follows the LARN – Levels of Reference Intake of Nutrients and energy 
    The protein requirement , divided into 2/3 vegetables and 1/3 of animal origin, is equal to 10-15% of the total daily calories. While fat at 10-35% of daily calories and carbohydrates at 45-60% of total calories in a day.
    Furthermore, the distribution of daily calories at meals includes: breakfast 20%, snack 5%, lunch 40%, snack 5%, dinner 30%.

    Diet for bulimics in normal weight  

    The fractionated diet suitable for normal weight bulimics satisfies and makes one synchronize with the rhythm of “real”, metabolic hunger. Once the mental path has been prepared, the subject must find the time and tranquility necessary for each meal, interrupting other activities.
    The feeding program must be pre-established, deciding in advance what to eat so as not to fail. To stop the hunger crisis, you need chews for a long time, such as firm and compact fruit.
    On the contrary, liquid foods such as ice cream, juices and smoothies should be limited , which “betray” immediately causing a sense of emptiness. Instead, as a snack, toast with cooked ham, bresaola, yogurt or candy bars are fine.
    By breaking down and adjusting meals, self-esteem is improved and the metabolism is re-balanced .

    Diet for overweight bulimics

    The integral hypocaloric diet , for overweight bulimics, is prescribed by Arianna Banderali. According to the expert, the impulsive and compulsive desire for food is not uncontrollable, but it can be dominated by training to tolerate hunger.
    In order not to succumb to voracity, nutrition must be based on foods rich in fiber , such as whole grains, seeds, legumes and vegetables, which swell and deceive the stomach and brain . Furthermore, as you turn off appetite, hot herbal teas are useful, which also have a relaxing effect.
    By minimizing the dressing of minestrone, whole wheat pasta, salads and other “compliant” dishes, do not exceed 1,200 calories per day.

    Diet food for bulimics in underweight

    The underweight diet serves the lean bulimics to raise their BMI above 18.5. However, they should not consume too many fatty foods but rather the protein foods that increase lean mass and not fat. In essence, they should favor:

    • chicken
    • turkey
    • fish
    • eggs
    • bresaola
    • beans
    • rice
    • wheat sprouts.
    Furthermore, they are important concentrated and minimum volume foods and small and frequent meals For example, a semolina with egg yolks and parmesan is more suitable than elaborate pastas or sweets, difficult to digest. Even yogurt and dairy products are useful for young underweight bulimics who have to stock up on calcium to avoid osteoporosis in adulthood .
    In severe cases , the diet should include 300 g of carbohydrates and 100 g of protein per day, for about 2500-3000 calories.
    In addition to diet, movement is necessary to stimulate the muscles and calm anxiety . Above all, walking tones the thigh muscles and manages to lift the buttocks
    Finally, “comforting” techniques are recommended , in place of food. In particular, massages and yoga relax and stimulate self-esteem .

    Bulimia and physical activity

    Even physical activity, such as diet, can be regulated. Without overdoing it, for the patient’s well-being, a brisk walk for half an hour, five times a week , would suffice .
    For the harmony of the psyche and the whole body, it should preferably practice group sports . In fact, volleyball and other collective activities facilitate social inclusion and stimulate mental faculties.

    How to prevent this eating disorder

    People at risk of bulimia nervosa, because they have sick relatives or because they are obese or anorexic, should be kept under strict control. The signs of illness, mental illness and eating disorders must be readily understood even in those who are not at risk.
    Family members, friends and anyone close to the subject, such as teachers or work colleagues , must understand the alarm bells of the disease. All the more reason, health and teaching staff must be prepared to identify bulimia nervosa.
    To this end, in Italy, training courses are scheduled, as in Milan, where prevention is taught in schools. Especially teenagers who show symptoms of eating disorders should be helped to overcome their problems, particularly psychological ones. Children need to be directed towards more realistic ideals of weight and healthier dietary habits.

    The importance of the community

    The family has the main role in preventing the disease . A serene environment, devoid of conflict, and the example of healthy eating are decisive in the growth of young people. The support and understanding of parents make children more confident and trusting in themselves and in life. Even the true and positive values ​​transmitted by adults to the new generations are a protective shield against bulimia nervosa.
    Authentic ideals are opposed to false ones, such as idolizing thinness and pro-MIA techniques, heralded by an altered society.
    In conclusion, it is possible to prevent bulimia nervosa by knowing it and recognizing it. Information to the public is therefore the most powerful weapon, which enables people to cope with the disorder. Only by speaking clearly and widely about the disease can many citizens be sensitized.
    Before the disease occurs, existential problems and wrong beliefs , which afflict adolescents the most , must be taken into consideration .
    At the first symptoms of the disease, a prompt and targeted intervention is necessary to eliminate them.
    In the case of bulimia nervosa, the patient must be firmly initiated to the most appropriate treatment , which also avoids possible relapses.

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