What is bulimia?
Bulimia addiction or ox or bull called hunger, belongs together with anorexia, binge eating disorder and bulimia of the eating disorders.
Epidemiology
From the bulimia nervosa predominantly (90-95%) are affected women. In young women in adolescence and young adulthood, the prevalence is 1-3%. Occupational groups in which low body weight for practicing the profession required or advantageous (for example, fashion model, dancer, ski jumpers) are particularly susceptible to this disease.
Characteristics and symptoms of bulimia
Bulimia sufferers are usually normal weight, but can also be under- or overweight. The typical feature are food cravings by which so-called counter-regulatory measures are taken to avoid weight gain: These include self-induced vomiting, fasting, extreme dieting, excessive sports, the abuse of laxatives (laxatives) and emetics.
The binges occur with varying frequency, the frequency of disturbance in the course vary can- several weeks can be between two bulimia attacks, the food and subsequent vomiting may also take place several times a day. The trigger for the cravings, emotional factors, psychological stress, dissatisfaction with one's own person, strong feelings of abandonment apply. Later, the cravings on the energy deficit caused by the counter-regulatory measures such as starvation and vomiting, with raised and strengthened. During the binge eating subjects have the feeling of losing control of himself and the amount of food that they eat. The binge eating can also take place planned.
Reasons for the subsequent regurgitation is mainly the fear of a possible weight gain and shame about their own loss of control / own failure. The amount of food can cause an uncomfortable feeling of fullness in the stomach also and pain, so that subsequent regurgitation acts relief. Through this exchange between hunger and eating followed by vomiting, purging or detraining bulimia also has the name bulimia addiction.
The dining nervosa often begins in a little higher than the age anorexia nervosa, with about 17 or 18 years. In the history of the person concerned may anorexia exist. The transition can take place at a time when the anorexia was achieved based on the weight and eating habits, a remission of the symptoms that the patient has begun again, therefore, more or to eat more frequently. The victims usually suffer from an impaired self-awareness and / or body image disorder. In contrast to anorexia nervosa, the weight limit self-imposed located in the region of the lower normal or slightly underweight. Sufferers often feel just at normal weight as "too fat". It is characterized by the excessive fear of weight gain, even at smaller weight fluctuations.
The causes of bulimia are similar to those of anorexia. Not infrequently, the bulimic anorectic a phase precedes or alternates with periods of anorexia from.
The most common psychiatric comorbidities and social problems:
-Abuse of alcohol or drugs, nicotine
-Auto aggressive behavior
-Uncontrolled fashion and consumer behavior, excessive spending of money, called frustration purchases, Shopaholic and shoplifting
-Extreme behaviors such as social isolation, or overfitting to group, family, power constraint, career urge (young, dynamic and successful)
-Depression, feelings of inferiority, dissatisfaction with oneself, of one's own gender role, as the repudiation of femininity and sexuality in general
As a result of bulimia can cause a range of organic damage. The increased gastric acid supply in the mouth damage during prolonged symptoms teeth (especially erosion of tooth enamel and loss of tooth substance) and the salivary glands (swelling, inflammation, resulting in an increase of the enzyme amylase). A bulimia can then be acutely life-threatening if by repeated vomiting or Laxantienmissbrauch a massive disturbance of electrolyte balance (especially potassium deficiency) occurs, which can lead to life-threatening heart rhythm disorders and kidney damage. More serious consequences in the long term are pancreatitis and gastrointestinal disorders (eg. As acute flaccid stomach extensions, gastric rupture, inflammation or rupture of the esophagus). In 10-30% of patients there is dry skin (probably related to a disturbed thyroid hormone levels), and about 50% morphological changes in the brain ("Pseudoatrophie"). The long-term risk of developing osteoporosis is probably not increased in bulimia patients (as opposed to anorexia nervosa).
Sufferers who suffer from bulimia usually try to hide their illness. Often it is only several years after it began, recognized / acknowledged and treated. The prognosis depends on the duration of the disease.
Bulimia definition
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
Criteria of the DSM-IV (American Psychiatric Association) for bulimia nervosa:
-Recurrent episodes of binge eating from. An episode is characterized by:
-Food intake in a short period of time (up to 2 hours), the amount of food is definitely larger than most people would eat in a similar time in similar circumstances.
-(Do not stop eating or not being able to control what or how much is eaten) a feeling of loss of control during the Essanfalles.
Recurring, inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting, abuse (abuse) of laxatives, diuretics, enemas, or other medications, fasting or excessive athletic exercises.
-Binge eating and inappropriate compensatory mechanisms occur on average at least twice weekly for three months.
-The self-perception is inappropriate strongly influenced by the figure and weight.
The disturbance does not occur exclusively during episodes of Anorexia Nervosa on (in the case is it about Anorexia Nervosa: bulimic type).
Here is a distinction between the purging-type (abuse of laxatives, vomiting, etc.) and the non-purging-type (Excessive Sport and fasting as countermeasures to binge eating).
International Statistical Classification of Diseases and Related Health Problems (ICD-10)
Criteria of ICD-10, F 50.2 Bulimia Nervosa:
-Persistent preoccupation with food, irresistible craving for food.
-Binge eating, which in a short time very large quantities are consumed in food.
-Attempt to counteract the fattening effect of food by various compensatory behaviors: self-induced vomiting, laxative abuse, intermittent periods of hunger, appetite suppressant drug, thyroid preparations or diuretics. In diabetic patients may lead to the neglect of insulin treatment.
-Morbid fear of being fat and a sharply defined weight limit which is medically considered "healthy" well below the premorbid.
-Common history of an episode of anorexia nervosa with an interval of several months to several years. This episode may have been fully developed or a disguised form of moderate weight loss and / or a temporary amenorrhea.
Bulimia treatment
One of the goals of psychotherapy of bulimia include the normalization of eating behavior, reducing countermeasures such as vomiting, normalization of attitude to the food, so as not to further evaluate this only in terms of their calorie and distorted beliefs about their to examine "fattening" effect, improving personal attitude towards oneself and one's own body, to build a stable, independent of external factors largely self-esteem and the (re) construction of social contacts. Prognosis depends on various factors, which include, among others, the disease duration are up to the beginning of psychotherapy and other mental disorders (comorbidity). Studies indicate that the treatment of bulimia can assist by certain antidepressants. An isolated treatment with antidepressants but rarely leads to a reduction of more than superficial symptoms, craving and negative mood, and does not address the underlying causes that have contributed to the emergence of mental disorder. Furthermore, the long-term outcome after discontinuation of medication is very inconvenient because of the risk of recurrence or the manifestation of other mental symptoms there.
Classification of eating disorders bulimia in the field
The group of eating disorders including anorexia (anorexia nervosa), bulimia (binge eating), which may be associated with obesity. The boundaries between the disorders are fluid. Not infrequently, is a form of the disease in this group over another. The psychological background problem, which leads to an eating disorder, is not significantly different between the different clinical pictures. Common to all eating disorders is low self-esteem, insecurity in self-image and self-awareness and a resulting increased adaptation to the expectations and desires of others. These features are made against the disease and often deteriorate in the course. When people with eating disorders, there is a much greater focus on the figure, although this does not apply solely to trigger an eating disorder. Another common feature is a difficult and troubled for various reasons, family interaction that exists long before the onset of the disorder. The knowledge of background problems shows that it is psychological and not organically-mediated diseases.