Bulimia nervosa refers to recurrent overeating, which results in self-induced vomiting. This eating disorder is one of the most acute medical and social problems of our time. Patients with bulimic symptoms suffer from an uncontrollable urge to consume a large quantity of food. Immoderate food intake leads to vomiting and excessive use of laxatives (Rushing et al., 2003). Heavy bulimia stage leads to sharp fluctuations in weight, namely 5 to 10 kg up and down, parotid gland swelling, chronic throat irritation, chronic fatigue, muscle pain and even loss of teeth.
The destructive eating behaviour can be viewed from emotional, cognitive and psychological perspective (Harrison, et al. 2010). A tendency to take mental stress with food, the dominance of the primary needs and the lack of responsibility for the food choices are rather conspicuous. Family food traditions, dissatisfaction with their own bodies and impaired relationships with peers are deemed to be the apparent causes of bulimia. However, this disorder is a complex combination of biological, psychogenic social and psychological factors.
Interestingly, in the struggle between heart and head, the one who eventually wins is stomach. The attack begins with gluttony and feeling of unbearable tension. One feels irritation, being remote from real life and powerless to suppress a passionate desire to eat forbidden foods. Preference is given to soft, sweet and fatty foods that do not require a long time to chew, such as cream, butter, cheese, chocolate, cakes or sandwiches. Eventually a person realizes that he cannot stop. The attack of overeating is followed by vomiting, but then come the fear of being caught along with the fear of weight gain, depression, acute dissatisfaction and self-blame.
Stereotype gluttony vomiting can acquire the character of obsession, with the process of the greedy, unscrupulous food intake gives a sensual pleasure, and vomiting becomes involuntary, conditional reflex. The usual amount of food does not bring the feeling of fullness in the stomach and satiety. Frequent and sharp increase in intra-abdominal pressure during vomiting leads to the typical swelling of the face.
Engel et al. (2009) determined the leading factors of formation of eating disorders, developed on the basis of the levels of psychotherapeutic influence. Bulimia usually develops due to interpersonal conflicts in the family, sexual or professional field, thus maladjustment often occurs in all spheres of life.Bulimic females tend to experience feelings of abandonment, loneliness, emptiness, frustration, boredom, sadness and depression. Usually teenage girls gain weight and then trying to control it, bulimic symptoms develop. The disease is formed by cycles of binge eating and fasting, gradually absorbing the psychic life of the patients. The system of values begins to be dominated by food, since a day is planned taking into account where and what can be eaten. Eventually, the remaining interests fade, due to which life seems grey. Escape from the unbearable boredom is quenched by a number of unusual and excessive amount of food products, such as pickles and jam or cakes with mustard.
Bulimia is rather prevalent in either underweight or overweight females. The disorder is characterized by a constant and an irresistible craving for food, combined with an obsessive fear of obesity. There several types of bulimia, including an attack of a ravenous hunger and satisfaction of fullness, constant need to chew something, an insatiable appetite that comes only while eating and night gluttony combined with day fasting. Pathological gluttons are divided into two groups. The first group includes vulnerable, anxious girls with low self-esteem, ashamed of their figure. Usually they have difficulties in communication and interaction with peers. The second group includes self-confident females who want to suppress others, by demonstrating an ideal appearance. Excessive weight is prone to cause shortness of breath, fatigue, abnormal joints, high blood pressure, heart attacks, and a number of other diseases, including diabetes (Rushing et al., 2003).
Repeatedly recurring bouts of binge eating is characterized by consumption over a certain period of time by the amount of food that is much greater than the amount eaten by most people. The patient has a feeling of loss of control over eating behaviour, for a person is not able to control the type and amount of consumes food.
Moreover, regular adoption of inadequate measures to combat weight gain is a common symptom. Thus, it embraces spontaneous vomiting, abuse of enemas, laxatives, diuretics or other drugs, as well as limiting a diet or exercise. Gluttony attacks and inadequate methods of compensation occur, on average, twice a week (Wilson & Sysko, 2009). The loss of control over eating behaviour, binge eating till the uncomfortable feeling of satiety and the absorption of large amounts of food without feeling hungry makes bulimic people uncontrollable. Therefore, embarrassment, or shame makes them eat alone, and ultimately they experience a sense of self-disgust, remorse or depression (Berg et al., 2013).
The history often marked episodes of anorexia nervosa with remissions from several months to several years. It has a latent form with a moderate weight reduction. The patients go to the doctor complaining about weakness, exhaustion and apathy, not to mention bulimia, which they have long suffered. A patient usually has a puffy face and swollen glands, while fingers and palate can contain scrapes and scars as a result of vomiting. Depression, anxiety, fears, impulsivity and social introversion are particularly conspicuous. Besides, preoccupation with thoughts about food, along with isolation from others make bulimic people neglect their duties, family and friends. In recent years, there has been emerging evidence of a genetic predisposition to the disease. It is assumed that the receptors in the brain that respond to leptin, a hormone protein and peptide in patients with bulimia are defective. Greedy fat intake may be caused by an increase in the number of fat cells, which may be due to genetic predisposition or overfeeding in early childhood.
Overfeeding is associated with family tradition and excessive power, one-sided use of food with the aim to deliver the child to enjoy the tranquility. Often, parents offer the child a meal, instead of meeting its current needs and refer to it only when he eats well. As a result, the child grows up without being aware of their emotional needs and not knowing when he is hungry and when full. Do not rely on your feelings, such a child is focused on parents who do not feel the master of his own body, not control their own behavior, needs and impulses. Children who are overweight are three times less mobile than their peers, they are not able to endure severe physical and emotional pain. For the timid child physical volume of the body symbolizes security and protection from the outside world and the associated liability.
Overeating is often marked with family conflicts, insensitive attitude of parents to the child or neglect of his personality. The family is usually dominated by a mother, which establishes a symbiotic relationship with a child, holds the development and readiness for social contacts, keeping it in a passive receptive position. As a result, in the future of patients develop alertness, the apathetic gloomy despair, the desire to escape into solitude, pretentious aggressive guilt. Increased anxiety, impulsivity, low self-esteem, extroversion, communication disorders, a tendency to the formation of various dependencies are common as well. Irresistible attraction to food can be used for relief of neurotic symptoms.
Constant overeating may be an attempt to escape from reality. The act of absorption of food reduces situational anxiety and depression due to the shift of attention to the body weight is easier to control than the situation and their emotional state. In the future, the stereotype becomes a reaction to emotional frustration. Certain foods may have a particular symbolic significance. Milk causes the feeling of security, meat provides force, caviar is associated with prestige, coffee and alcohol with adulthood, while sweets with awards.
Bulimia is a result of organic or functional disorders of the central nervous system. Also bulimia may develop as a result of higher concentrations of insulin in the blood. During the outbreak of negative emotions, such as anger, rage, fear, or uncertainty, a person turns to food as a way to get positive emotions, trying to seize troubles. As physiological eating is effectively connected with a pleasant taste, as well as the production of endorphins, namely hormones of happiness. A bulimic person is increasingly resorting to this method to hide from problems and to further extend the pleasant feeling of meal by increasing its quantity. Over time, people lose the taste and concentrate merely on volume, filling the stomach. Bulimia is similar to drug addiction, however in this case food serves as a drug. It is worth noting that sufferers from bulimia prefer sweet and starchy foods. However, often a patient is aware of the fact that he eats too much, and for this reason the feeling of guilt overwhelms. A negative emotions cause a new attack of hunger, that eventually become a vicious circle.
McElroy et al. (2012) provide an integrated approach of rehabilitation and prevention of bulimic symptoms along with the use of psychotherapy. A comprehensive rehabilitation model of eating disorders shows that teenagers want to get rid of food dependence and ready for an active volitional effort to achieve a positive result. The prerequisites for psychology of eating behavior include development of motivation to healthy eating, a clear statement of the formation and weight loss programs and visualization and specification, particularly keeping a food diary. Development of self-confidence as well as the formation of psychological defense in a situation of food temptation is of paramount importance a well.
Apparently, treatment of bulimia should involve the elimination of its causes. Usually a course of psychotherapeutic treatment is not enough, since prolonged therapy requires regular supervision of the therapist to exclude relapse of attacks.
Berg, K. C. , Crosby, R. D., Cao L., Peterson, C. B., Engel, S. G., Mitchell, J. E., & Wonderlich, S. A. (2013). Facets of negative affect prior to and following binge-only, purge-only, and binge/purge events in women with bulimia nervosa. Journal of Abnormal Psychology 122, 111–118.
Bohon, C., & Stice, E. Reward abnormalities among women with full and subthreshold bulimia nervosa: A functional magnetic resonance imaging study. International Journal of Eating Disorders 44(7), 585–595.
Engel, S. G., Kahler, K. A., Lystad, C. M., Crosby, R. D., Simonich, H. K., & Wonderlich, S. A., Peterson, C. B., & Mitchell, J. E. (2009). Eating behavior in obese BED, obese non-BED, and non-obese control subjects: A naturalistic study. Behaviour Research and Therapy 47, 897–900.
Harrison, A., Sullivan, S., Tchanturia, K., & Treasure, J. (2010). Emotional functioning in eating disorders: Attentional bias, emotion recognition and emotion regulation. Psychological Medicine 40, 1887–1897.
Heatherton, T. F., & Baumeister, R. F. (1991). Binge eating as escape from self-awareness. Psychological Bulletin 110(1), 86 –108.
McElroy, S. L., Guerdjikova, A. I., Mori, N., & O’Melia, A. M. (2012). Pharmacological management of binge eating disorder: current and emerging treatment options. Therapeutics and Clinical Risk Management 8, 219–241.
Mond, J. M., Latner, J.E., Hay, P.J., Owen, C., Rodgers, B. (2010). Objective and subjective bulimic episodes in the classification of bulimic-type eating disorders: Another nail in the coffin of a problematic distinction. Behaviour Research and Therapy 48, 661-669.
Rushing, J. M., Jones L. E., Carney, C. P. (2003). Bulimia nervosa: A primary care review. The Primary Care Companion to the Journal of Clinical Psychiatry 5(5), 217–224.
Smyth, J. M., Wonderlich, S. A., Heron, K., Sliwinski, M., Crosby, R. D., Mitchell, J. E., & Engel, S. G. (2007). Daily and momentary mood and stress predict binge eating and vomiting in bulimia nervosa patients in the natural environment. Journal of Consulting and Clinical Psychology 75, 629 – 638.
Wilson, G. T. & Sysko, R. (2009). Frequency of binge eating episodes in bulimia nervosa and binge eating disorder: Diagnostic considerations. International Journal of Eating Disorders 42(7), 603-610.