This eating disorder is linked to a real crise compulsive as well as a loss of control of the mind over the body, that’s why daily activities like eating meals in society can be a real challenge for people with bulimia.

• Phases of overeating during which the person will eat until they reach the point of discomfort or pain. Food intake will be much higher than that taken during a normal meal or snack;
• Fasting phases thinking that they will be able to restore weight gain;
• vomiting caused after eating;
• Making diuretics, laxatives ou enemas ;
• Intensive sports practice ;
• Isolation ; 
• Mood swings, irritability, sadness, guilt, shame ;
• Abnormal concerns about body shape and weight resulting in a negative distorted view of body image.

Course of a bulimia attack

The pre-crisis

Le perfectionism which guides the bulimic person creates internal tensions as well as a feeling of lack, anxiety and irritability.

Crisis

A loss of control and  need to satisfy an impulse can then invade the bulimic person. The onset of the crisis corresponds to the moment when the will gives way to this drive which becomes unbearable and when the bulimic person will try to compensate for what is most often felt as an interior emptiness.

To do so, she goes ingest a large amount of food in a very short period of time, to the detriment of the notion of pleasure. Foods are chosen and are preferably sweet and high in calories.

A feeling of guilt will surpass the satisfaction of seeing the impulse satisfied and will lead to the vomiting phase. It’s about a real purge, supposed to bring a certain relief. In some cases, vomiting may also be accompanied by laxatives, diuretics or even enemas.

After the crisis

Shame and guilt then give way to a feeling of disgust, which will lead to a desire to regain control over oneself and not to do it again. But these crises are part of a vicious circle which is difficult to get out of just willpower because, more than just a habit, binge eating is part of a ritual.

Psychopathological assessment

To establish a diagnosis of bulimia, various factors must be observed in the behavior of the person.

In North America, the usual screening tool is the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) published by the American Psychiatric Association. In Europe and elsewhere in the world, healthcare professionals generally use the International Classification of Diseases (ICD-10).

In summary, to evoke a bulimic disorder, it is necessary to note the presence of binge eating during which the person has the impression that totally loses control of his behavior which will lead her to swallow in a limited period of time a quantity of food much greater than normal. Finally, the presence of compensatory behaviors is necessary to talk about bulimia knowing that the crises and the compensatory behaviors must occur on average 2 times a week for 3 consecutive months. Finally, the doctor will assess theself esteem of the person in order to see if this one is excessively influenced by the weight and the silhouette as is the case in bulimic people.

Somatic assessment

In addition to thepsychopathological assessment, a complete physical examination is often necessary in order to assess the consequences of the purges and other compensatory behaviors on the patient’s health.

The exam will look for problems:

• heart such as heart rhythm disturbances;
• dental including erosion of tooth enamel;
• gastrointestinal such as bowel mobility disorders;
• bony, especially a decrease in bone mineral density;
• kidney ;
• dermatological.

EAT-26 screening test

The EAT-26 test can screen people who may be suffering from eating disorders. This is a 26-item questionnaire that the patient fills in alone and then gives it to a professional who analyzes it. The questions will allow us to question the presence and frequency of diets, compensatory behaviors and the control that the person exercises over his eating behavior.

Source: For the French version of the EAT-26 screening test, Leichner et al. 1994⁹

Complications of bulimia

The main complications of bulimia are the more or less serious physiological disorders induced by compensatory bleeding behaviors.

The vomiting repeated illnesses can cause various ailments such as: erosion of tooth enamel, inflammation of the esophagus, swelling of the salivary glands and a drop in potassium levels which can cause rhythm disturbances or even heart failure.

La taking laxatives it also causes many disorders among which one can observe intestinal atony (lack of tone of the digestive tract) causing constipation, dehydration, edema and even a drop in sodium level which can lead to kidney failure.

About the dietary restrictions, these can induce anemia, amenorrhea (cessation of menstruation), hypotension, cardiac slowdown and a drop in calcium levels which can cause osteoporosis.

Finally, substance abuse (drugs and alcohol), often present in people with bulimia, can lead to other somatic disorders. In addition, the use of these substances can also lead the person to adopt risky behaviors because of the disinhibition (unprotected sex, etc.).