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Bulimia
Bulimia is a disorder of the food pipeline, which is characterized by a pathological report to food manifested by excessive intakes of food, repeatedly and sustainable. To compensate for excess calories ingested, or in order to relieve feelings such as anger, disgust, pressure at school, etc. ... the person eating uses one or more of the following acts:
* Provocation of vomiting
* Inappropriate use of laxatives and / or diuretics
* Exercise excessive
* Imposition of restrictions on food type anorexic in order to "rebalance the scales."
Causes
The causes of bulimia are complex and multifaceted and are derived from a combination of factors emotional, behavioral, psychological and social. These factors are, paradoxically, the same as those of anorexia nervosa, the two diseases are often linked. A single patient may suffer from a combination of the two diseases, or an alternation of anorexia and bulimia.
Bulimia can be isolated as a symptom. But it can also meet with other troubles: syndromes depression, anxiety disorders of the personality, addiction (comorbidity).
It should be noted that 30 to 60% of people who suffer from eating disorders suffer from a personality disorder type borderline. Bulimia is then a symptom.
Those affected often use food and control over food in order to find a way to compensate for emotions and feelings that seem Indomitable or insurmountable.
For some, fasting, ingestion of food in a manner to be excessive and may be vomiting as a way to overcome these difficult emotions and feeling of control over their lives.
Finally, these behaviors will affect the physical and mental health.
Sexual abuse and bulimia
Waller showed that 40 bulimic women who have suffered sexual violence in their childhood behaviour vomiting and crises craving more important than others, especially if was intrafamilial sexual abuse, violence and early (before 14 years ). There is in these cases a dévoration compulsive, frenetic and self.
Diagnosis
Who is affected?
Bulimia is more common than anorexia, and she is often associated. It affects women more likely than men (9 / 10), particularly young women, often starting in late adolescence (18-19 years) and concerns in France 3% of adolescents.
However, these figures may be distorted by the decline because of the difficulty to detect "with bulimia purge" (vomiting, enema ,...) which does not show the usual stigma of obesity or wasting disease.
There is a correlation between Trouble Behavior of Food (Bulimia and Anorexia) and Trouble of sexuality. An abnormally high proportion of cases of sexual abuse during childhood and adolescence was stressed by several epidemiological studies.
A psychiatric interpretation sees bulimia as a defensive reaction against seduction and sexual intercourse by the deformation of the body (including obesity); unlike anorexia who seek the same objectives in bringing the body to the state prepubescent ( amenorrhea particular).
How to manifest the disease?
The bulimia causes compulsive behaviors consumption of food in large quantity, on a short period of time. The foods chosen are fairly stereotypical: very calorie foods, sweet happy (cakes, creams, sometimes salted ice ,...) (meats, cheeses ,...). The unfolding of the crisis is marked by a brutal beginning, with feeling sick, empty, high anxiety, that the patient feels particularly painful, and that the massive and brutal ingestion of food will calm down. The climax therefore anxious to balance the crisis by eating itself, with excess food, often accompanied by guilt, loss of control, and sense of distress facing trouble and the shame of having succumbed to the impulse. The crisis could last until the patient feels severe abdominal pain, a sign that the stomach is full, and often signing the crisis ends. The patient is then often taken a physical discomfort (pain associated with morality, guilt, shame), which solves often vomiting volunteers. These are often taken food associated with maintaining weight, because of the tactics of weight control: vomiting, taking laxatives, exercise, anorexia crisis, diuretics, enemas, drugs-cutting hunger.
What are the criteria to retain this diagnosis?
* Survenue regular crises eaters, as described above.
* Strategies for sustaining weight.
* The crises occur at least twice a week for at least 3 months.
* Self-esteem is particularly influenced by the weight and body shape (ie that the patient has concerns for his excessive weight, its forms, food, etc.).
* The disorder does not occur exclusively during periods of bulimia. (otherwise, there is talk of anorexia associated with crises eaters)
Complications
Sometimes serious complications were noted: esophagitis (linked to repeated vomiting), esophageal or gastric rupture (a massive absorption of food), ionic unrest (in connection with the use of laxatives or diuretics) up cardiac arrhythmias and dental complications. These complications can raise awareness about the risks involved: for example vomit blood can be a shock to the / bulimic and reduce its crises. But it is possible then he / she will turn to other addictions to fill its need to control both her body and her life and simultaneously destroy them.
Evolution of the disease
* Death with time poorly explained, most often, but not without suffering that must justify a specialized consultation.
* Switch chronicity: bulimia continues, with frequent relapses, and serious risks to health. This could show the determination of the matter on one or more unresolved events in his life.
* Existence of a depression, addiction (drugs, alcohol): moving the symptom of bulimia to other modes of expression of suffering.
* Gateway to anorexia: reversal of the impulse on the person and own reversal in the opposite. (Pulsions and destiny impulses, Metapsychology, Freud, 1915).
* Disability academic, emotional, social displacement of emptiness felt in other areas.
Treatment
The best psychological aid are evaluated cognitive-behavioral psychotherapy. The results are still controversial. But they seem to be more effective than drug treatments such as fluoxetine.
Other psychotherapy are used, but their benchmarks are even poorer: psychoanalytic psychotherapy or inspiration psychoanalytic systemic family therapy, interpersonal psychotherapy.
It combines a nutritional therapy. But very often the results obtained by it do not last, proving that bulimia is a symptom.
A therapy aimed specifically personality disorder underlies bulimia give more results. This therapy can be done individually, but (as in the case of personalities alcoholics or drug addicts) it is more efficient when it comes to group therapy. There are also support groups, modelled on Alcoholics Anonymous: Outremangeurs Anonymous. The care must also foster social, family, school. Rarely, antidepressants may be prescribed to overcome a particularly difficult course.
Read also www.womenshealth.gov
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