What is a bulimia crisis? What to do ?

Bulimia is characterized by “crises”. It touches approximately 1.5% of 11–20 year olds and concerns three girls for one boy, according to the French National Authority for Health (HAS). It’s a eating disorder (TCA) where the impulsive and repetitive character of the food consumption predominates. Contrary to popular belief, the bulimic rarely feels pleasure when he eats: he seems rather to obey an injunction to absorb the maximum quantity, even if it means making himself sick.

Bulimia is characterized by “crises” associated withabsorption of a large amount of food in a short time with a feeling of loss of control. She fills up without thinking. This is followed by compensatory behaviors such as induced vomiting, I’use of laxatives, diuretics or other medications; the fasting and excessive physical exercise. People with bulimia usually have a Normal BMI due to compensatory behaviors. “Bulimia is decked out in various adjectives but in realityshe is always mental. The seizures can occur at specific times and can also be nocturnal, indicates Valérie Sengler, psychoanalyst in Paris and Saint-Mandé.

Bulimia is distinct from binge eating which is characterized by recurrent episodes of binge eating, but without resorting to compensatory behaviors (make yourself vomit, take laxatives, etc.). These people are usually overweight or obese. Binge eating disorder involves 3 to 5% of the population (more than bulimia). It affects men almost as much as women and it is more often diagnosed in adulthood. This does not prevent the earlier forms which are often more severe.

“There is actually three types of bulimia : the one that supposes theuse of laxatives, vomitingthe one where we are going start fasting or exercise excessively without making himself vomit or anything. The third bulimia is the one where we eat a lot compulsively and where we will do nothing”, details the psychoanalyst. “Anorexia bulimia does not exist. Anorexia consists of not eating while bulimia consists of gorging on food”, nuances the specialist.

“Anorexia bulimia does not exist”

To characterize bulimia, it takes an episode of abnormal absorption of food over a short time (less than two hours in general) accompanied by a lack of control. Those seizures occur one to several times a week at least, over several months. “These disorders are difficult to spot because patients speak little about them, often feeling guilt and shame” remind her HAS. Certain situations favor the occurrence of bulimia. For example: a history of eating disorders (anorexia…), psychological manifestations (suicide attempts, self-mutilation, addiction, anxiety and mood disorders (depression, bipolarity)…

• Request for weight-loss diet or even bariatric surgery
• Restrictive eating habits, food exclusions, inappropriate use of products or methods known as “for slimming, draining, purifying, detoxifying”, inappropriate use of laxatives, diuretics, food supplements.
• Worry of those around you (parents, spouse, siblings) about eating behavior.
• Excessive physical exercise.
• Excessive concern about weight or build, especially with normal or low BMI (bulimia).
• Swollen submandibular angle (parotidomegaly); indirect sign of vomiting (bulimia).
• tooth erosion,
• hand abrasion related to vomiting (Russell’s signs)
• fertility disorders,
• hypokalemia

• Young people, especially adolescent girls and young women.
• Occupational or leisure activities at risk (for bulimia): models, sports disciplines with a weight category or requiring weight control (gymnastics, dance, in particular classical, athletics, synchronized swimming, bodybuilding, horse racing [jockey]etc.) in particular the level of competition.
• Family history of eating disorder(s) (ED).

The diagnosis of bulimia is based on the frequency of the disorder.

Like anorexia, bulimia has a hereditary basis. Studies on twins allow its heritability to be estimated at 0.4-0.5. Some of the genes studied by the researchers are also those of anorexia. Food intake, moderate in normal subjects, would be disturbed in opposite excesses in anorexics and bulimics. But it may be that the environment plays a major role in triggering a poor self-image at the end of childhood. Bulimia is more common in children whose parents are absent or in constant conflict.

The diagnosis of bulimia is based on the frequency of the disorder (at least twice a week and at least for six months) and weight control trials (evidenced by lower than normal weight). The questioning of the doctor will aim to rule out other disorders related to bulimia (differential diagnosis) such as anorexic nervosa, hyperphagia or compulsive consumption of drinks (eg potomania). In adolescents and young adults it is recommended to make a consultation in several times, allowing them to be seen with and without the parents.

The earlier the treatment, the better the prognosis. It is multidisciplinary: psychotherapies (individual, family, group) cognitive and behavioral therapies and a nutritional support and dietetics (adapted diet, production and maintenance of a food diary). L’hospitalization can intervene in the event of a significant depressive state, recurrences of bulimic attacks, or in the presence of significant metabolic disorders. The patient is then referred to a nutrition service.

Bulimia can have harmful physiological, medical, social, educational and professional consequences. It is therefore necessary to help the bulimic person to get out of it, especially if he is a teenager as is mostly the case for the first attacks. The family must be involved from the start of care. A early management promote faster healing, and avoid chronicity.

• Role of parents

The bulimia most often appears in early adolescence. This is a period when it is advisable to be particularly attentive to the behavior of your child. Do not reason as if the child was doing it on purpose. “Bulimia is obviously compulsive because we can’t fight it is the characteristic of each compulsion, explains the psychoanalyst. Even if it is difficult, the parents must maintain the dialogue with their bulimic child, and try to understand his discomfort, to possibly hear his reproaches. They should also talk about it with siblings, who may be worried about this new behavior, especially if they are younger. If the crisis lasts, the parents must convince the child to consult the doctor and the psychologist. There are associations bringing together people with bulimia and their families: they are useful for getting through the crisis and finding practical advice.

Having suffered from bulimia carries the risk of recurrence during life.

• Psychotherapies

Psychotherapy is a solution of choice to overcome bulimia. If the problem is strongly associated with troubles in the family, a family analysis can help find the solutions. Cognitive and behavioral therapy (CBT) is the one that gives the best results for bulimia. CBT lasts at least several months. The therapist helps the bulimic person to see clearly in the cognitive schemas guiding his representation of the body and of food, and to measure their inappropriateness. The behaviors characteristic of the bulimic are isolated and slowly combated, in order to return to normal food intake.

• Medications

There are no drugs specifically dedicated to bulimia. When the patient has symptoms of depression or anxiety, antidepressant or anxiolytic treatment can have positive effects.

Bulimia can lead to menstrual cycle disorders, sleep disturbances, onset of diabetes, dehydrationa esophagitis and dental complications serious (related to vomiting). Psychologically, bulimia is frequently associated with depression, anxiety disorders, addiction, personality and an increased risk of suicidal gesture. Having suffered from an eating disorder puts you at risk of suffering a recurrence or another form of eating disorder during your lifetime.

Thanks to Valérie Sengler, psychoanalyst in Paris and Saint-Mandé.