Bulimia is a disease that has nothing to do with a whim. Patients usually have low self-esteem, difficulty in interpersonal relationships, mood instability, trauma, emotional dysregulation, and a feeling of emptiness. This discomfort makes them look for their identity in thinness, and in this way, the clinical picture arises.
Thus, although society presents thinness as a business card for success, this psychological discomfort makes patients want to be thin. “Society is not the only culprit. In other times, the discomfort was translated into other behaviours. But today, with this social message, the discomfort of these girls leads them to have these disorders.”
In this way, biological, psychological and social factors intervene in the origin of this disease that distorts the patient’s vision of himself.
The limitation of food imposed by the patient himself leads to a strong state of anxiety and the pathological need to eat large amounts of food.
Until now, the biological vulnerability involved in the development of the disease is unknown, and some triggering factors related to the social environment, diets and the fear of physical teasing are better known. Many factors coincide with anorexia, such as affective disorders arising in the family, drug abuse, obesity, diabetes mellitus, certain personality traits, and distorted ideas of one’s body.
It is important to clarify that eating behaviour disorders do not usually appear when one of these factors is manifested. Still, rather it is the confluence of several that can lead to the appearance of bulimia.
Two subtypes can be distinguished in this disease:
During the episode of bulimia nervosa, the patient resorts to vomiting or other purgative methods, such as laxatives and diuretics, to avoid weight gain.
In this case, the person with bulimia uses other compensatory behaviours such as fasting or compulsive physical exercise but does not resort to vomiting, diuretics or laxatives to avoid gaining weight.
According to Díaz Marsá, early intervention is essential for remission to occur and to do so as soon as possible. It is a disease of psychiatric and psychotherapeutic treatment. Below is discomfort that must be identified in each patient individually to address it. Lack of control with food is a way of covering up what is happening to them/the discomfort underneath.
From Primary Care, doctors may suspect the appearance of a picture of bulimia nervosa if a person is too worried about increasing their weight and presents large fluctuations, especially if there are obvious signs of excessive use of laxatives.
Other clues include:
- Swelling of the salivary glands in the cheeks.
- The presence of scars on the knuckles from using the fingers to induce vomiting.
- Erosion of tooth enamel due to stomach acid.
- Low blood potassium.
However, the diagnosis is complicated since episodes of greed and vomiting are easily hidden. In addition, some symptoms can be confused with those of other pathologies.
For an adequate diagnosis, a psychiatric interview is necessary to reveal the patient’s perception of his body and the relationship he maintains with food. Likewise, a complete physical examination is necessary to detect disorders resulting from his eating behaviour.
In the treatment of bulimia, the first step is the evaluation of the patient by the psychiatrist. After it, there are two approaches: pharmacological and psychotherapy, although the ideal is that the treatment combines both.
The use of drugs allows “improving binge eating, impulsivity, purging behaviours. In addition, they allow psychotherapy to be carried out and to be effective. Through this psychological approach, patients are provided with tools to control impulsivity and emotionally unstable and improve their self-esteem and interpersonal relationships.
Another part of the treatment should focus on the nutritional approach, working closely with endocrinologists and nutritionists to guarantee the physical and organic health of the patients. In short, it is about establishing healthy lifestyle habits and self-care so that patients can take control of their health. “Many times, patients associate the treatment with gaining weight, making it difficult to adhere to it. We have to make them understand that nobody wants them to gain weight, but rather that they are healthy within the weight canons and that the objective is that stop suffering.”
How can people close to the patient act?
The best way to help a bulimic person is to be aware that they have an eating disorder. Some recommendations that your environment can follow are:
- Avoid critical comments about weight, food, etc.
- Understand that bulimia is a serious problem, not the nonsense of the person who suffers from it.
- Try not to control the patient all the time and talk only about the problem. In this way, they will prevent him from feeling overwhelmed and will encourage him to have the perception of support and understanding.
- Put aside blackmail such as “if you eat, I will buy you something you want”. Unfortunately, these formulas are useless and make the situation worse.