How does a vicious circle work?
It usually starts with a restrictive diet. Prolonged hunger and a ban on favorite food sooner or later break into an attack: in a short time a person eats a large amount of food and cannot stop. Next comes shame, fear of gaining weight and an attempt to “cancel” what you have eaten by vomiting, laxatives or fasting. Cleansing relieves anxiety, but increases hunger and triggers the next breakdown. The circle closes, and attacks become more and more frequent, and any strong emotions, not just hunger, become the reason for them.
- Severe food restrictions and forbidden foods
- An attack of uncontrollable overeating
- Guilt and fear of gaining weight
- Cleansing or strenuous exercise
- Short-term relief and a new round of restrictions
Signs that are noticeable from the outside
A person with bulimia usually does not appear exhausted, and this is the main reason for late diagnosis. Regular disappearances to the toilet immediately after meals, food supplies in the room, the disappearance of large volumes of food, and packages of laxatives should alert you. Over time, bodily traces of cleansing appear: swollen cheeks due to the salivary glands, destruction of enamel and increased sensitivity of the teeth, abrasions on the back of the fingers, hoarseness, frequent heartburn.
- Going to the toilet immediately after eating
- Swelling of the face in the area of the parotid glands
- Enamel destruction, caries, tooth sensitivity
- Heartburn, sore throat, hoarseness
- Weight fluctuations, leg swelling
- Secretiveness in food, refusal to eat in company
Why is bulimia dangerous?
The main threat is the loss of potassium and other electrolytes through vomiting and taking laxatives. Low potassium interferes with heart function and can cause dangerous arrhythmias and sometimes cardiac arrest. Stomach acid destroys teeth and damages the esophagus, even to the point of rupture of the mucous membrane with bleeding. Abuse of laxatives leads to chronic constipation and bowel dependence on drugs. In women, the menstrual cycle is often disrupted. Depression, anxiety and alcohol abuse are often associated.
- Hypokalemia and cardiac arrhythmias
- Enamel erosion and multiple caries
- Esophagitis, ruptures of the esophageal mucosa
- Chronic constipation after laxatives
- Menstrual irregularities
- Depression and anxiety disorders
Diagnostics
The diagnosis is made by a psychiatrist or psychotherapist based on a conversation: the frequency of attacks, the presence of compensatory behavior and the extent to which self-esteem is tied to weight are important. Additionally, the physical condition is assessed, because complications often occur hidden. The therapist prescribes a blood test with electrolytes, biochemistry to assess kidney and liver function, and an ECG. A dental examination can help identify characteristic enamel breakdown. According to indications, thyroid hormones are checked and gastroscopy is performed.
- Clinical interview and eating behavior questionnaires
- Potassium, sodium and other electrolytes
- Biochemical blood test
- General blood test
- ECG for rhythm assessment
- Examination of the dentist and, if indicated, gastroscopy
Treatment and recovery
The basis of treatment is psychotherapy, primarily cognitive-behavioral, adapted for eating disorders. It helps restore regular eating without forbidden foods, break the “emotion-attack” connection and change your attitude towards the body. At the same time, the therapist corrects electrolyte imbalances and treats complications, and the dentist takes care of the teeth. For depression and severe attacks, a psychiatrist may prescribe medications. Family support and avoidance of any new diets during treatment are essential.
- Regular meals 3 times a day plus snacks
- Cognitive behavioral therapy, for adolescents - family
- Refusal from dieting, weighing and calorie counting during treatment
- Potassium replenishment and treatment of complications
- Medicines prescribed by a psychiatrist
- Long-term observation to prevent breakdowns