Bulimia nervosa

From a nutritional point of view, bulimia nervosa is an eating behavior that deviates from the normal way of eating and from the guidelines of healthy eating. From a psychological point of view, bulimia nervosa is a need that the individual has to eat in an excessive and compulsive way because this produces a significant effect of satisfaction followed by compensatory behaviors of the "binge" by having a distorted image of their own body.

Bulimia nervosa preferentially affects young women, usually after adolescence.

There is no single cause that produces the disease, and we can find personality factors that predispose to its appearance, social or cultural factors and even genetic factors that are not well known. Thus, in individuals with bulimia nervosa there is usually a prevalence of obesity in childhood and obesity in their parents that is higher than expected. The rarity of bulimia nervosa in underdeveloped countries suggests that cultural factors are important. Finally, biological alterations are described in these individuals related to the regulation of eating behavior and the mechanisms of satiety.

Bulimia nervosa is characterized by repeated episodes of binge eating ("binge eating") that is followed by abnormal compensatory behaviors, such as self-induced vomiting or taking weight loss drugs such as laxatives and diuretics. Sometimes they also practice certain sports such as ballet or gymnastics in order not to gain weight. The weight of patients with bulimia nervosa as a consequence of this behavior is usually within normal limits or only slightly exceeds them.

In this alteration of eating behavior, it is possible that there is a personality alteration, with hypersensitivity to failures of any kind, which would lead to states of anxiety and depression, which would be stopped by the "binge." This positive effect of the "binge" would predominate over the long-term rejection consequences of obesity (social criticism and negative effects on health). To this would be added the great importance that body image would have for these people, which would force them to provoke vomiting and taking substances to lose the weight gained during binge eating.

There is no test that diagnoses a person as bulimic. The diagnosis of bulimia nervosa is made based on criteria of medical consensus, such as the criteria established by the American Psychiatric Association or the criteria of the World Health Organization. The key to the diagnosis of bulimia nervosa according to these criteria are the strong desire to eat ("binges"), the intense fear of gaining weight, the use of compensatory techniques to avoid gaining weight (vomiting, drugs) and the disorder in perception of one's own body image.

Generally, the serious medical complications associated with bulimia nervosa do not exist because of the "binge." The medical problem of bulimia nervosa is derived from complications associated with compensatory behaviors that follow the "binge", that is, vomiting and taking laxatives and diuretics. Thus, in the blood analysis potassium and chlorine alterations appear and the acidity of the blood decreases, which clinically translate into fatigue, muscle weakness and constipation. Cardiac arrhythmias may also appear. Sometimes kidney function can be altered. Vomiting can also damage the digestive tract, mouth, and teeth.

The treatment of bulimia nervosa is multidisciplinary, where psychologists, psychiatrists and nutritionists will participate, and will have the support of the primary care physician.

Treatment will include pharmacological, psychological and nutritional measures. Since there is generally no severe malnutrition, treatment and monitoring are done on an outpatient basis.

With regard to pharmacological treatment, antidepressants are very useful, regardless of the existence of depression in the individual; these drugs block the urge to binge. In addition, we can use anxiolytic drugs such as fluoxetine to correct the stress associated with bulimic behavior in these people.

Regarding psychological treatment, this will be aimed at reducing the frequency of "binges", as well as avoiding the adverse situations that trigger them. Psychological intervention can be carried out individually or in a group, and joint intervention with the family is always recommended. In this therapy, patients are taught to monitor behaviors, situations, or thoughts that may be linked to binge-eating episodes, eat regularly, and change the relationship they have established between weight and improved fitness. self esteem. Psychological treatment can achieve remission of symptoms in up to 25-50% of patients, although it must be complemented with pharmacological treatment.

The nutritional treatment approach is also aimed at modifying the eating pattern that these individuals have. The first point to achieve this is to make a nutritional assessment of the individual through a food survey. In this way we will be able to evaluate the lack of some type of food, if they follow an adequate meal schedule, if they eat with the rest of the family, know the circumstances in which binges take place, as well as the compensation methods they use or foods that they consider "dangerous."

Secondly, we must act by giving certain information to the patient: what is their clinical situation, what are the consequences of binge eating and the complications of compensatory behaviors (vomiting, use of laxatives), and what a balanced diet should consist of.

The third point will consist of preparing the food plan based on the information obtained in the food survey. To do this, a regular and orderly meal schedule will be established, with three main meals and two or three intermediate intakes between the main meals. This will avoid long periods of fasting that increase the risk of binge eating.

Regarding caloric intake, the use of restrictive eating guidelines is discouraged, even in cases where there is overweight, as this will favor compulsive eating. In this sense, an alternative is to increase the consumption of foods rich in fiber in these patients in order to produce a feeling of satiety. In addition, the indicated diet should be varied, limiting or excluding at first the foods that may cause "fear" or anxiety in the patient; however, these foods should be gradually introduced until they become a regular part of their intake.

Meals should be done with company (family, friends).

Fourth and last, once the patient has started the change in his eating pattern, we must follow his behavior in the long term to avoid relapses. It is useful in these circumstances for the patient to make a record of what he eats; With this, we will be able to assess the consolidation of our recommendations and we will be able to detect the points that need to be reinforced. Weight control can be done, although sporadically and always in the doctor's office.

The evolution of bulimia nervosa and the prognosis is highly variable. We must bear in mind that the follow-up will be long, of years, since relapses are frequent. Mortality from this disorder is very low, and approximately half of patients make a full recovery within a few years.

There is no measure to prevent the appearance of bulimic behavior. But yes in the early detection of it. Signs of alarm and suspicion are the young woman with any of the following features: restrictive diets, sports or dance practice, family history of eating disorders, stressful life situations, family or school conflict, depression, low self-esteem, alcoholism. One reason for consulting a doctor that can alert us to the presence of the disease is the demand for a "diet to lose weight" due to being slightly overweight (or even within normal weight ranges).