How is bulimia nervosa diagnosed and treated?
Bulimia nervosa is an eating disorder characterized by episodes of binge eating. That is, a large amount of food is consumed in a short period of time and, usually, hidden from the people around them.
When bulimia nervosa appears, there are a series of criteria that health professionals take into account when making a diagnosis :
- Recurrent episodes of binge eating. A binge is characterized by the ingestion of food in a short space of time (for example, in a 2-hour period) and in an amount much greater than what most people ingest in a similar period of time and under the same circumstances.
- Feeling of loss of control over food intake (for example, feeling unable to stop eating or unable to control the type or amount of food being eaten).
- Inappropriate compensatory behaviors, repeatedly, with the aim of not gaining weight, such as self-induced vomiting, fasting, excessive exercise and excessive use of laxatives, diuretics, enemas or other drugs.
- Binge eating and inappropriate compensatory behaviors occur at least once a week for a period of 3 months.
- Self-evaluation is exaggeratedly influenced by body weight and shape.
Warning signs of bulimia nervosa
Regarding binge eating, it should be noted that, although the type of food consumed during these episodes varies, in most cases sweet foods, such as pastries, or salty foods are eaten.
Binge eating can occur at any time of the day, but is more common in the middle or late evening and is usually triggered by mood swings, anxiety, interpersonal difficulties, intense hunger, or feelings (discomfort) related to weight, body shape, or food. It occurs as an attempt to reduce discomfort, anxiety, or negative thoughts. It is accompanied by a feeling of lack of control and may temporarily reduce discomfort, but is always followed by feelings of guilt, self-loathing, or depressed mood.
Subsequent vomiting relieves the feeling of guilt for the high intake, the fear of weight gain/figure control, and a vicious circle is created that is difficult to stop. Frequent and repeated vomiting can easily cause lesions in the oral cavity, erosion of tooth enamel, sore throat and, in general, after binge eating and vomiting, the person is left exhausted with generalized pain. It is very common for a mood disorder to appear.
Differences between bulimia nervosa and binge eating disorder
Since the symptoms can be similar, it is important to differentiate bulimia nervosa from binge eating disorder. In the latter, there are no compensatory behaviors or body image distortion and, in a very early stage, there is no discomfort with the body/figure. With weight gain, this discomfort and negative self-evaluation do appear.
The main differences can be seen in the following table:
| Bulimia nervosa | Binge eating disorder |
|---|---|
| Binge eating and compensatory behaviors | Binge eating without compensatory behaviors Discomfort with body image and weight Self-evaluation extremely influenced by body image |
Discomfort with body image and weight Self-evaluation extremely influenced by body image | Ruminations about food and weight control |
| Oscillating weight | Overweight or obesity |
| Often increased physical activity | No physical activity Tendency towards a sedentary lifestyle |
| They tend to be more impulsive | Little impulsiveness |
As with all eating disorders, bulimia nervosa can have long-term physical health implications . The main resulting problems are the following:
- Physical complications mainly derived from purgative behaviors (vomiting, laxatives or diuretics), such as dehydration, which can lead to severe medical problems such as kidney failure.
- Heart problems, such as irregular heartbeats (arrhythmias) that can lead to serious situations as a result of hypokalemia and electrolyte disturbances secondary to vomiting.
- Gastroesophageal reflux, with the consequent dental caries, gum disease, dysphonia due to pharyngitis and laryngitis and other more serious digestive problems resulting from binge eating.
- Irregular periods or loss of menstruation (amenorrhea).
The treatment of bulimia nervosa
If there is any suspicion, you should go to the Primary Care Center where professionals can, if necessary, refer you to a child and adolescent mental health center or adult mental health center. The treatment provided in specialized centers is multidisciplinary and individualized according to the case. Professionals from the fields of psychology, psychiatry, nutrition and nursing are involved. Depending on the case and needs, a social worker or an occupational therapist may also be involved.
Treatment can be outpatient or, if required in extreme cases, inpatient (basically day hospital). At a psychological level, individual and group sessions are usually carried out. Pharmacological treatment will be indicated if it is considered necessary in order to facilitate the psychotherapeutic intervention.
The goals of treatment are:
- Find out the reasons why symptoms appear, what function they have, and work to acquire strategies to deal with stressful situations in a careful and respectful way towards oneself.
- Reduce and eliminate binge eating.
- Reduce and eliminate vomiting and the use of laxatives.
- Normalize physical exercise.
- Normalize eating habits.
- Normalize weight (if applicable).
- Normalize biological parameters (analytical).
How to prevent relapses in eating disorders?
Relapses are part of the recovery process . For this reason, it is important to stay calm and not blame yourself. You should not experience it as a failure but as a learning opportunity that is part of the recovery process. These relapses can occur when the person experiences a negative emotional moment, such as a breakup, a loss or a stressful situation, and conveys the discomfort through the relationship with food. In any case, we recommend not living in a constant state of alert and fear or shame in the face of a possible relapse. It is important to remember that one of the goals of treatment is the prevention of relapses.
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