Bulimia

Causes

The causes of the bulimia are complex and multiple and result from a combination of factors emotion nels, Comportement with, psychological and social. These factors are probably (and paradoxically) the same ones as those of the Anorexia nervosa, the two diseases being frequently dependant. The same patient can suffer from a combination of the two diseases, or from an alternation of Anorexie and bulimia .

The bulimia can be isolated as a symptom. But it can also meet with others turbid: depressive syndromes, anxious disorders, of the personality, the addictives conduits (Comorbidité).

It should be noted that 30 to 60% of the people who suffer from food disorder suffer from a personality disorder of the type Borderline. The bulimia is then a symptom

The touched people often use the Nourriture and controls it on the Nourriture in order to find a means of compensation for emotion S and Sentiment S which seem untameable or insurmountable.

For some, Fast R, to introduce food in an excessive way and to be made vomit can be like a way of overcoming these difficult emotions and to have the impression to control its life.

Finally, these behaviors will harm the Santé physical and psychic.

Sexual abuse and bulimia

Waller showed that 40 women compulsive eaters having undergone a sexual violence in their childhood have behaviors of Vomissement and crises of pang of hunger more important than the others, especially if the sexual abuse were intrafamily, violent and early (before 14 years). One observes in these cases a compulsive, frantic and self-destroying devoration.

(Waller, Sexual deceives and the severity off bulimic symptoms, Brit.J.Psychiatry, 1992,161: 90-93)

Diagnosis

; Which is touched? : The bulimia is more frequent than the anorexia, and it is often associated for him. It touches more readily the women than the men (9/10), in particular the young woman, often beginning at the end of the Adolescence (18-19 years), and concerns in France 3% of the teenagers.

However, these figures can be distorted with the fall because of difficulty of detecting the “bulimia with purging” (vomiting, rectal injection,…) who does not show the marks usual of obesity or morbid thinness.

One notes a correlation between Trouble of the Food behavior (Bulimia and Anorexia) and Sexual problem. An abnormally high proportion of case of sexual abuse at the time of childhood and adolescence was underlined by several epidemiological studies.

A psychiatric interpretation sees the bulimia like a defense reaction against the seduction and the sex act by the deformation of the body (obesity in particular); contrary to the anorexia which would have the same aims while bringing back the body to the state prépubère (amenorrhoea in particular). ; Does Comment appear the disease? : The bulimia involves behaviors compulsifs of consumption of food, in great quantity, on a short amount of time. The selected food is stereotyped enough: very heating, readily sweetened food (cakes, creams, ices,…) sometimes salted (pork-butchery, cheeses,…). The course of the crisis is marked by a brutal beginning, with feeling of faintness, vacuum, large Anxiété, that the patient feels like particularly painful, and that the massive and brutal ingestion of food will be able to calm. This anxious paroxysm is thus balanced by the crisis compulsive eater itself, with food excess, often accompanied by Culpabilité, loss of control, and feeling of distress vis-a-vis the disorder and to shame to have yielded to the impulse. The crisis can last until the patient feels of violent abdominal pains, sign that the Estomac is filled, and often signing the end of the crisis. The patient is then often in catch with a physical faintness (partner with the mental pain, culpability, shame) which is often solved by voluntary vomiting. These food catches are often associated with a maintenance of the weight, because of the tactics of control of the weight: vomiting, catch of Laxative S, physical exercise, crisis of anorexia, Diurétique S, rectal injections, drugs cut-hunger.

Is Which the criteria to retain this diagnosis?

Occurred regular of crises compulsive eaters, as described above.
Strategies of maintenance of weight.
the crises occur at least twice per week, for at least 3 months.
the regard of oneself is particularly influenced by the weight and the body form (i.e. the patient has excessive concerns for his weight, its forms, food, etc)
the disorder does not occur exclusively for periods of bulimia. (if not, one speaks about anorexia associated with crises compulsive eaters)

Complications

Sometimes serious complications were noted: Oesophagite (related to the repeated vomiting), rupture oesophagienne or gastric (by massive absorption of food), of the ionic disorders (in connection with the use of diuretic or laxatives) being able to go until cardiac arrhythmias and dental complications.

Evolutions of the disease

spontaneous Disappearance with time, generally, but not without suffering which must justify a specialized consultation.
Passage to chronicity: the bulimia perdure, with frequent relapses, and serious health risks
Appearance of a depression, addictives conduits (Drug S, alcohol)
Main door towards the anorexia
school, emotional, social Disability.

Treatment

The psychological assistances best evaluated are the cognitivo-behavioral psychotherapies. The results are still discussed. But they seem more effective than medicamentous treatments such as the Fluoxétine.
D' other psychotherapies are used, but their comparative evaluation are even poorer: psychoanalytical Psychotherapy or of psychoanalytical inspiration, family systemic Therapies, psychotherapy interpersonnelle.
On associates a nutritional therapy with it. But very often the results obtained by this one do not last pas.
Une therapy which more particularly aims the personality disorder subjacent with the bulimia will give more result. This therapy can be done into individual, but (like in the case of the alcoholic personalities or drug addicts) it is more powerful when it is about a group therapy. There exist also groups of support, on the model of the Alcoholics anonymouses: the Outremangeurs Anonymities. The assumption of responsibility must also support the social, family, school integration. Seldom, of the Antidépresseur S will be prescribed, to overcome a particularly painful course.

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