bulimia

Classification according to ICD-10
F50.2	Bulimia nervosa
F50.3	atypical bulimia nervosa
F50.4	Binge eating in other mental disorders
F50.5	Vomiting in other mental disorders
ICD-10 online (WHO version 2019)

The Bulimia or bulimia nervosa (also bulimia addiction and Bulimarexie called) is a part through more than increased appetite and excessive food intake indicated disease , linked to the anorexia , the binge eating disorder and food addiction to eating disorders .

"Bulimia" comes over neulateinisch bulimia of ancient Greek βουλιμία boulimía , cravings , literally ox hunger or bull hunger , from βοῦς, "ox, bull, cow, ox" and λιμός, "Hunger" and refers only strictly seen only the symptom of hot hunger and then also called hyperorexia (from ancient Greek ὑπέρ- hypér, "over-" and ὄρεξις órexis, "appetite").

Epidemiology

Bulimia nervosa mainly affects women (90–95%). In young women in adolescence and young adulthood , the prevalence is 1–3%. Occupational groups for whom low body weight is required or advantageous for practicing the profession ( e.g. photo model , dancer , ski jumpers ) are particularly susceptible to this disease.

Characteristics and symptoms

Bulimia sufferers are usually of normal weight , but can also be underweight or overweight. A typical feature are binge eating, after which so-called counter-regulatory measures are taken to avoid weight gain: These include self-induced vomiting , starvation , extreme diets , excessive exercise , the abuse of laxatives ( laxatives ) and emetics .

The binge eating occurs at different rates, although the frequency can also vary in the course of the disorder - there can be several days between two binge eating, eating and subsequent vomiting can also occur several times a day. In particular, emotional factors, psychological stress, dissatisfaction with oneself or strong feelings of abandonment are considered triggers for binge eating. Later, cravings are triggered and further intensified through the energy deficit that results from counter-regulatory measures such as starvation and vomiting.

During the binge eating, people feel like they are losing control of themselves and the amount of food they eat. The binge eating can also take place in a planned manner.

Bulimia nervosa often begins at a slightly older age than the anorexia nervosa associated with it , around 17 or 18 years of age. Anorexia may exist in the history of those affected. The transition can take place at a point in time when remission of the symptoms of anorexia has been achieved based on weight and eating behavior and the person concerned has accordingly started to eat more or more regularly. Those affected mostly suffer from impaired self-perception and / or a body schema disorder ( dysmorphophobia ). Those affected often feel that they are "too fat" even at normal weight. It is characterized by the excessive fear of gaining weight, even with minor weight fluctuations.

The most common psychiatric comorbidities and social problems include:

• Abuse of alcohol , drugs , medication, nicotine
• auto-aggressive behavior
• Impulse control weakness : uncontrolled fashion and consumption behavior, excessive spending, so-called frustration purchases, shopping addiction and shoplifting
• extreme behaviors, such as social isolation or overadaptation to a group or family, compulsion to perform, career urge (young, dynamic and successful)
• poor social skills
• Depression , feelings of inferiority , dissatisfaction with oneself or with one's own gender role , for example the rejection of femininity and sexuality in general
• Panic attacks , anxiety disorders, and obsessive-compulsive disorder
• AD (H) S

Pronounced tooth defects in the lower jaw due to stomach acid. The upper jaw has already been restored with dental crowns.

A variety of organic damage can occur as a result of bulimia. If the symptoms persist, the increased supply of gastric acid in the mouth damages the teeth (especially erosion of the tooth enamel and loss of hard tooth substance) and the salivary glands (swelling, inflammation, which leads to an increase in the enzyme amylase ). Bulimia can become acutely life-threatening if repeated vomiting or the abuse of laxatives cause a massive disturbance of the electrolyte balance (especially potassium deficiency ), which can lead to life-threatening cardiac arrhythmias and kidney damage . Other serious long-term consequences are pancreatitis and gastrointestinal disorders (e.g. acute atonic stomach enlargement, gastric rupture, inflammation or rupture of the esophagus). Dry skin is found in 10–30% of those affected (presumably in connection with an impaired thyroid hormone balance), and in around 50% morphological changes in the brain (“pseudoatrophy”). Common general symptoms include headache, neck pain, back pain, and menstrual cramps in women and girls. The long-term risk of developing osteoporosis is probably not increased in bulimic patients (in contrast to anorexia nervosa).

People who suffer from bulimia usually try to hide their illness. Often it is only recognized / admitted and treated several years after it has started. The prognosis depends on the duration of the illness.

causes

The causes of bulimia are similar to those of anorexia . Bulimia is often preceded by an anorectic phase or alternates with phases of anorexia.

The main reasons for vomiting are the fear of possible weight gain and shame about losing control / failure. The amount of food in the stomach can also cause an uncomfortable feeling of fullness and pain, so that the subsequent vomiting has a relieving effect.

Classic conditioning

Jansen (1994, 1998) assumes that classic conditioning can trigger previously neutral sensory stimuli, reflex-like physical reactions such as salivation, insulin release, mobilization of free fatty acids or excitement, which are normally only associated with food intake. It is believed that this conditioned response can induce cravings to eat. The conditioned stimulus could be an external one (e.g. television) as well as an internal one (e.g. boredom). The tendency to react to corresponding cues with desire is called cue-responsiveness. Following this hypothesis, an attempt can be made to erase this knee-jerk reaction by means of exposure therapy with reaction prevention (cue exposure, food exposure).

Operant conditioning

A trigger could, for example, be that someone does not have the sufficient social skills to express their own anger in conflict situations. If the emotional tension is reduced relatively quickly (contingently) after eating and vomiting, this behavior is intensified.

Definitions

Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

DSM-5 ( American Psychiatric Association ) criteria for Bulimia Nervosa:

1. Recurring episodes of binge eating. An eating attack is characterized by the following two features:
   • Eating a large amount of food in a period of time (e.g. 2 hours) that is significantly greater than what most people would eat under comparable conditions
   • Feeling of losing control of eating behavior during the episode
2. Repeated use of inadequate compensatory measures to counter weight gain (e.g., fasting, vomiting, abuse of laxatives or diuretics, excessive exercise)
3. Binge eating and inappropriate compensatory measures occur on average at least once a week for three months.
4. Self-perception is inappropriately influenced by figure and weight.
5. The disorder does not occur exclusively during episodes of anorexia nervosa (in which case it is anorexia nervosa: bulimic type).

International Statistical Classification of Diseases and Related Health Problems (ICD-10)

ICD-10 criteria , F 50.2 Bulimia Nervosa:

1. Constant preoccupation with food, irresistible greed for food.
2. Binge eating, in which large amounts of food are consumed in a short period of time.
3. Attempt to counteract the fattening effect of food through various compensatory behaviors: self-induced vomiting, abuse of laxatives, intermittent periods of starvation, use of appetite suppressants, thyroid preparations or diuretics . Insulin treatment can be neglected in diabetics.
4. Morbid fear of becoming fat, as well as a sharply defined weight limit, which is far below the premorbid, medically considered "healthy" condition.
5. Common history of anorexia nervosa episode with an interval of a few months to several years. This episode may have been full-blown or a covert form with moderate weight loss and / or transient amenorrhea .

therapy

The goals of psychotherapy for bulimia include, among other things, the normalization of eating behavior, the reduction of countermeasures such as vomiting, a normalization of attitudes towards foods so that they are no longer valued in terms of their calorie content, and distorted beliefs with regard to food to examine their “fattening” effect, the improvement of the personal attitude towards oneself and one's own body, the development of a stable self-esteem that is largely independent of external factors and the (re) establishment of social contacts. The prognosis depends on various factors, including the duration of illness until the start of psychotherapy and other mental illnesses ( comorbidity ). Studies indicate that the therapy of bulimia can be supported by certain antidepressants . However, treatment with antidepressants in isolation seldom leads to more than a reduction in ostensible symptoms, cravings, and negative mood, and does not change the underlying causes that contributed to the development of the mental disorder. Furthermore, the long-term course after discontinuation of the medication is very unfavorable, since there is a risk of relapse or the manifestation of other psychological symptoms.

Classification of bulimia in the field of eating disorders

The group of eating disorders includes anorexia (anorexia nervosa), bulimia and overeating ( binge eating ), the overweight ( obesity may be associated). The boundaries between the disorders are fluid. It is not uncommon for one form of the disease to change from this group to another. The psychological background problem that leads to an eating disorder does not make a significant difference between the individual disorders. Common to all eating disorders are low self-esteem, insecurity in self-image and self-perception, and the resulting increased adaptation to the ideas and wishes of others. These characteristics exist prior to the disease and often worsen as it progresses. People with eating disorders have a significantly greater orientation towards their figure, although this is not only considered to be the trigger for an eating disorder. Another common characteristic is a family interaction that is difficult to dysfunctional for various reasons and that exists well before the disorder manifests itself. Knowledge of the background problems makes it clear that the illnesses are psychological and not organically triggered.

literature

• Reinhold G. Laessle, Harald Wurmser, Karl M. Pirke: Eating disorders. In: J. Margraf: Textbook of behavior therapy. Volume 2, 2nd edition. Springer, Berlin 2000, ISBN 3-540-66440-8 .
• Manfred M. Fichter: Anorexia and Bulimia. Courage for those affected, relatives and friends . Karger, Basel a. a. 2008, ISBN 978-3-8055-8208-7 .
• Peggy Claude-Pierre: The way back to life. Understand and cure anorexia and bulimia. From the American by Gabriele Herbst. 4th edition. Fischer, Frankfurt 2006, ISBN 3-596-14922-3 .
• C. Keppler: When food and body replace the mother: groundbreaking without talking to death ... Patmos, 2002.
• T. Legenbauer, S. Vocks: Whoever wants to be beautiful has to suffer? Ways out of the beauty mania - a guide. Hogrefe, 2005.
• Peter J. Cooper: Bulimia nervosa and binge eating. London 1995.

Web links

Wiktionary: bulimia  - explanations of meanings, word origins, synonyms, translations

• Link catalog on bulimia at curlie.org (formerly DMOZ )
• List of literature from the Federal Center for Health Education
• A few pounds of human. (PDF; 2.3 MB) Fluter, No. 33 - Topic: Nutrition, Federal Agency for Political Education
• Martina de Zwaan: What do anorexia and bulimia nervosa have to do with diet? Psychosomatic and Psychotherapeutic Department, University Hospital Erlangen , public lecture in Lecture2Go of the University of Hamburg

Individual evidence

1. ↑ Eating disorders . ( Memento of the original from June 19, 2009 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Health Directorate of the Canton of Zug; Retrieved April 14, 2009. 
2. ^ Dictionary.reference.com
3. ↑ ^{a b c d e f} Helga Simchen: Eating disorders and personality. Anorexia, bulimia and obesity - why eating and starving become an addiction . 1st edition. Kohlhammer, Stuttgart 2010, ISBN 978-3-17-020848-3 .
4. ↑ Laessle u. a., 2000.
5. ↑ Christina Siebrecht: Osteoporosis in patients with anorexia and bulimia nervosa: A longitudinal study. (PDF)
6. ↑ ^{a b} Brunna Tuschen-Caffier, Irmela Florin: Vicious circle of bulimia: A manual for psychological therapy . Hogrefe Verlag, 2012, ISBN 978-3-8409-2372-2 ( limited preview in Google book search).
7. ↑ ^{a b} Tanja Legenbauer, Silja Vocks: Manual of cognitive behavioral therapy for anorexia and bulimia . Springer-Verlag, 2014, ISBN 978-3-642-20385-5 , pp. 33 and 140 ( limited preview in Google Book search).
8. ↑ Michael Linden: Behavioral Therapy Manual . Springer Science & Business Media, 2008, ISBN 978-3-540-75739-9 , pp. 131 ( limited preview in Google Book search).
9. ↑ Rolf Meermann, Ernst-Jürgen Borgart: Eating disorders: anorexia and bulimia: a cognitive-behavioral guide for therapists . W. Kohlhammer Verlag, 2005, ISBN 3-17-018458-X , p. 70 ( limited preview in Google Book search).

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