Although the most well-known eating disorder (ED) is anorexia, bulimia nervosa also has a significant prevalence. According to the study Characterization, epidemiology and trends in eating disorders.published in 2022, stands at between 0.37 and 2.98% in Europe.
To better understand the processes behind this disorder, we have turned to Xandra Romero, a dietician-nutritionist specializing in the treatment of eating disorders and coordinator of the Nutrition Specialization Group in Eating Disorders (GE-NuTCA) of the Spanish Academy of Nutrition and Dietetics. Romero has participated in the drafting of the document. Something’s wrong with hima useful, free downloadable guide to spotting the warning signs after an eating disorder developed by GE-NuTCA.
What is bulimia nervosa?
It is an eating disorder characterized by recurrent episodes of binge eatingthat is, the ingestion, in a given period of time, of a quantity of food clearly greater than what most people would ingest in a similar period under similar circumstances. It is accompanied by feeling of lack of control on what is ingested.
In order to diagnose bulimia, other circumstances must also be present. “It is appreciated recurrent inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting, incorrect use of laxatives, diuretics or other medications, fasting or excessive exercise,» says the expert.
As with other eating disorders, it mainly affects women (90-95% of patients) and quite young women. The age of onset of this disorder is usually between 18 and 20 years, according to data from the Spanish Federation of Associations for the Support and Fight against Anorexia and Bulimia Nervosa. Anorexia and bulimia are not, as some would have us believe, two sides of the same coin, but they do have many similarities and interrelations, with patients experiencing both disorders over time.
Many patients end up with bulimia after poorly cured anorexia. The statistics are especially worrying among elite female athletesespecially in sports with a high level of discipline linked to weight or physical spectrum, such as rhythmic gymnastics, athletics or synchronized swimming.
Are there different types of bulimia?
Not really. Previously, the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) distinguished between purging bulimia (with vomiting, laxatives, enemas, or diuretics) and non-purging bulimia (with fasting or exercise). But in the latest version, the DSM-V, this distinction is no longer made. Today, “the main change in the diagnostic criteria for bulimia nervosa is to reduce the amount of food consumed, and to reduce the amount of alcohol … binge eating frequency threshold from twice a week in DSM-IV to once a week in DSM-V,” notes the TCA specialist.
Causes of bulimia
Although the exact causes of this eating disorder are unknown, Romero appeals to:
- Biological factors. Among them, a greater behavioral susceptibility to the deregulation of appetite.
- Psychological factorsHighlights one body image changes and difficulty delaying reward.
- Psychosocial factors. As in the case of anorexia nervosa, eating problems in the family environment, being exposed to constant comments from friends, family and authority figures, about weight and image.
- Behavioral factors. Above all, weight control behaviors (fasting, food restriction, etc.), excessive concern about body mass index, social isolation, etc.
How to know if someone close to you suffers from bulimia
Unlike people who suffer from anorexia nervosa, the symptoms of bulimia can go unnoticed by those around them since The emaciated or extremely thin state does not have to be visible“A patient with bulimia can appear in a wide spectrum of weights and body shapes, which often makes suspicion difficult,” says Romero. That’s why you should be alert to these other signs:
- Eating in secret
- Make frequent visits to the bathroom after eating.
- Disappearance of large quantities of food.
- Finding hidden food or laxative wrappers.
- Alteration of tooth enamel due to recurrent vomiting
- Small eye discharges due to the effort of purging.
- Calluses on the knuckles of the hands, called Russell’s sign
- Parotid hypertrophy, seen as a widening of the cheeks or jaw.
- Frequent mood swings
Mental and physical consequences of bulimia
Most of the psychological consequences of bulimia nervosa are similar to those of other eating disorders. European studies report major depression in 33% of cases, anxiety in 31% and certain specific phobias in 17%, with no significant differences between genders.
As for the physical consequences of bulimia, many are also shared with other eating disorders, such as gastrointestinal, cardiac, pulmonary, hematological, endocrine, neurological and dermatological disorders. “In bulimia, in addition, the following are added: Problems inherent to purge compensatory mechanismswhich can result in severe edema, arrhythmias and heart failure, electrolyte disturbances with very serious consequences, gastric and duodenal ulcers and perforations.”
Bulimia and depression, a close relationship
As we have just seen, psychiatric comorbidity is high in patients with eating disorders. The most frequent psychiatric diagnoses are mood disorders, substance use disorders and anxiety disorders. “Within the affective disorders, the most frequent is the Major depressive disorder and dysthymia They are among the most frequent comorbid disorders in people with bulimia nervosa and anorexia nervosa, with prevalence rates ranging from 20% to 83%.”
How bulimia is treated from a nutritional point of view
Although one of the essential keys to treating this mental health problem has to do with psychotherapy, dietary-nutritional treatment is also essential. In this sense, Xandra Romero states that «it is necessary, as with the rest of TCA, work on food education so that the patient can incorporate a variety and quantity of foods sufficient to cover their needs.»
As food is incorporated, hunger and satiety signals will be recovered. “And we work to reduce the magnitude of the binges or make those intakes Increasingly awareso that they are reduced both in frequency and magnitude,» concludes the expert.
Given the multiple implications of this type of disorder, a multifactorial approach is essential, with the presence of psychologists, dieticians-nutritionists and, in many cases, a qualified trainer in physical activity and sports sciences who provide guidelines for approaching physical exercise in a non-pathological manner.
The ALDI Council
Comments about other people’s bodies can be hurtful. In fact, one of the risk factors for eating disorders is dealing with derogatory comments about size. Avoid doing this.
Xandra Romero. Graduate in Human Nutrition and Dietetics from the University of Paris and PhD from the University of Barcelona. Member of the Academy, coordinator of the Nutrition Specialization Group in Eating Disorders (GE-NuTCA) of the Spanish Academy of Nutrition and Dietetics, and member of the Scientific Advisory Committee of the Academy. She is a clinical dietician-nutritionist specialized in the approach to Eating Disorders (ED) and in charge of the Day Hospital for Child and Adolescent ED at IMQ-AMSA.
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