Bulimia: what is it?

Bulimia is part of eating disorders or eating disorders (ADD) just like anorexia nervosa andhyperphagie.

Bulimia is characterized by the occurrence of binge eating ou overeating during which the person swallows huge amounts of food without being able to stop. Some studies suggest an absorption that can range from 2000 to 3000 kcal per crisis¹. Bulimic people have the impression of totally lose control during crises and feel shameful et guilty after these. After the onset of a seizure, people engage in inappropriate compensatory behaviors in an attempt to eliminate ingested calories andavoid gaining weight. People with bulimia often resort to vomiting, the excessive use of drugs (laxatives, purgatives, enemas, diuretics), the intensive practice of physical exercises or fasting.

Unlike people with anorexia who are underweight, the bulimic person has usually normal weight.

In summary, bulimia is a disease characterized by the occurrence of crises during which the person has the impression of losing all control over his behavior which leads him to absorb quickly a huge amount of food. It follows the establishment of inappropriate compensatory behaviors to avoid weight gain.

Binge eating disorder

L’hyperphagie bulimic is another eating disorder. He is very close to bulimia. We observe the presence of overeating crises but there is no compensatory behavior to prevent weight gain. People with binge eating disorder are often overweight.

Anorexia with binge eating

Some people have symptoms of both anorexia nervosa and bulimia. In this case, we speak not of bulimia but ofAnorexia with binge eating.

Prevalence

Bulimia as a behavior has been known since ancient times. Literature provides us with information on Greek and Roman orgies, “meetings” during which the guests indulged in all kinds of excess, including excess food that went so far as to make themselves sick and make themselves vomit.

Bulimia as a disorder has been described since the 1970s. Depending on the studies and diagnostic criteria (broad or restrictive) used, there is a prevalence ranging from 1% to 5,4% of Girls concerned in western societies⁶. This prevalence makes it an even more widespread disease than anorexia nervosa, especially as the number of people affected continues to increase.⁷. Finally, it would affect 1 man for 19 women concerned.

Diagnostic

Although the signs of bulimia often appear in late adolescence, the diagnosis is not made, on average, until 6 years later. Indeed, this eating disorder strongly associated with shame does not easily lead the bulimic person to consult. The earlier the pathology is identified, the earlier the therapeutic intervention can begin and the chances of recovery are thus increased.

The causes of bulimia?

Bulimia is an eating disorder identified since the 70s. Since then, many studies have been carried out on bulimia, but the exact causes behind the appearance of this disorder are still unknown. However, hypotheses, still under study, attempt to explain the occurrence of bulimia.

Researchers agree that many factors are at the origin of bulimia, including genetic factors, neuroendocriniens, psychological, family et social.

Althoughno gene has been clearly identified, studies highlight a family risk. If a family member suffers from bulimia, there is a greater chance that another person in that family will have this disorder than in a “healthy” family. Another study conducted on identical twins (monozygotes) shows that if one of the two twins is affected by bulimia, there is a 23% chance that her twin will also be affected. This probability increases to 9% if they are different twins (dizygotes)2. It would therefore seem that genetic elements play a role in the onset of bulimia.

benefits endocrine factors such as hormonal deficiency seem to be at play in this disease. The drop in a hormone (LH-RH) involved in the regulation of ovarian function is highlighted. However, this deficit is observed when there is a loss of weight and the observations return to a normal level of LH-RH with the regaining of weight. This disorder would therefore seem to be a consequence of bulimia rather than a cause.

Au neurological level, many researches link a serotonergic dysfunction with a disorder of the feeling of satiety often observed in bulimics. Serotonin is a substance which ensures the passage of the nervous message between neurons (at the level of synapses). It is particularly involved in stimulating the satiety center (area of ​​the brain that regulates appetite). For many reasons still unknown, there is a decrease in the amount of serotonin in people with bulimia and a tendency to increase this neurotransmitter after recovery.3.

On the psychological level, many studies have linked the onset of bulimia with the presence of low self-esteem based largely on body image. Hypotheses and analytical studies find some constants in the personality and feelings experienced by bulimic adolescent girls. Bulimia often affects young people who have difficulty expressing what they are feeling and who often even have trouble understanding their own. bodily sensations (feelings of hunger and satiety). Psychoanalytic writings often evoke a body rejection as a sexual object. These teenage girls would subconsciously wish to remain little girls. The disorders caused by eating disorders harm the body which “regresses” (absence of menstruation, loss of shape with weight loss, etc.). Finally, studies conducted on the personality of people affected by bulimia, find certain common personality traits such as: conformism,  lack of initiatives,  lack of spontaneity, the behavior inhibition and emotionsEtc. …

Au cognitive level, studies highlight negative automatic thoughts leading to false beliefs often present in bulimics such as “thinness is a guarantee of happiness” or “all fat gain is bad”.

Finally, bulimia is a pathology that affects the population of industrialized countries more. The socio-cultural factors therefore play an important place in the development of bulimia. Images of the “perfect woman” who works, raises her children and controls her weight are widely conveyed by the media. These representations can be taken with a distance by adults who feel good about themselves, but they can have devastating effects on teenagers lacking in reference points.

Associated disorders

We mainly find psychopathological disorders associated with bulimia. However, it is difficult to know if it is the onset of bulimia that will cause these disorders or if the presence of these disorders will lead the person to become bulimic.

The main associated psychological disorders are:

• depression, 50% of people with bulimia would develop a major depressive episode during their lifetime;
• anxiety disorders, which are believed to be present in 34% of bulimics4 ;
• the risky behavior, such as substance abuse (alcohol, drugs) that would affect 41% of people with bulimia4 ;
• a low self-esteem making bulimic people more sensitive to criticism and especially a self-esteem excessively linked to body image;
• un personality trouble, which would affect 30% of people with bulimia5.

Extreme fasting periods and compensatory behaviors (purges, use of laxatives, etc.) lead to complications that can cause serious kidney, heart, gastrointestinal and dental problems.

People at risk and risk factors

Bulimia would start around late adolescence. It would more frequently affect girls than boys (1 boy reached for 19 girls). Bulimia, like other eating disorders, affects the populations of industrialized countries. Finally, certain professions (athlete, actor, model, dancer) for which it is important to have a certain weight control and its body image, have more people suffering from eating disorders than other trades.

Bulimia would start 5 times out of 10 during a weight loss diet. For 3 in 10 people, bulimia was preceded by anorexia nervosa. Finally, 2 times out of 10, it is a depression which inaugurated the onset of bulimia.

Prevention