Bulimia is medically a form of eating disorder and is called bulimia nervosa. And bulimia nervosa is defined as such: it refers to uncontrollable food and binge eating.
Bulimia is a disorder of eating behavior disorder. Patients are terrified of obesity, and their self-esteem is often affected by the body and weight changes. Usually in late night, solitude or boredom, frustration, and anger, he suddenly caused gluttony, and he couldn’t stop himself until the discomfort of abdominal distension before he could rest.
Although he was satisfied temporarily after the gluttony, the guilt, self-blame and The uncontrollable anxiety has prompted them to use inappropriate methods (such as vomiting, abusing laxatives, diuretics, dieting, or excessively strenuous exercise) to clear food that has been eaten.
1) There is a predominant concept of persistent uncontrollable eating and craving for food, and the patient succumbs to bulimia episodes that consume large amounts of food in a short period.
2) At least use one of the following methods to offset the weight gain of foods:
3) There is a history of anorexia nervosa, with the interval between months and years.
4) The Onset of binge eating at least twice a week for 3 months.
5) Exclusion of overheating caused by organic diseases of the nervous system and gluttony secondary to mental disorders such as epilepsy and schizophrenia.
2. In the early stages, patients were shy about their gluttony behavior, often in secret.
At the beginning of the disease, the patient’s ability to control eating behavior became weaker, and the self-control ability of the disease was destroyed at the later stage of the disease.
3. The most common way to control weight is to induce vomiting. You can use the hand or another device to stimulate the throat, and also use emetic to induce vomiting. After a period, you do not need to evoke it. The patient thinks that vomiting can cause vomiting, even if only a small amount of food is available.
4. About one-third of patients use a laxative to lose weight, and very few patients even use an enema.
5. Patients are too concerned about their body shape and often feel unsatisfied.
6. May be accompanied by depression or anxiety symptoms, most of which are related to body weight or body shape.
7. In severe cases, water electrolysis and metabolic disorders may occur, manifesting as hypokalemia, hyponatremia and so on. Vomiting leads to a decrease in stomach acid and metabolic alkalosis, and catharsis can lead to metabolic acidosis.
8. In the later stage of the disease, there is a fatal danger due to complications such as an esophagus, gastrointestinal tract, and heart.
Psychological factors: Most patients have emotional problems and emotional instability, and they are forced to avoid suffering by eating. Some studies have pointed out that this habit of using chewing foods to relieve psychological stress may be related to the abnormal parenting style of mothers at the young age.
Anorexia Circulatory Symptoms: People with anorexia often limit the amount of food they eat, but sometimes suffer from hunger. They have mental and operational urges to eat large amounts of food.
1) The onset of irresistible desire or behavior of feeding can enter a lot of food at one time. At least 2 episodes per week for at least 3 months.
2) There is a fear of gaining weight.
3) often use spitting, catharsis, increase the amount of exercise and other methods to eliminate obesity caused by overeating.
4) It is not an overheating caused by a systemic organ lesion of the nervous system, nor a secondary
1. Regular gluttony (eat a lot of food in the short term).
2. Periodic vomiting and diarrhea (self-vomiting, taking laxatives, strict diet or excessive exercise).
3. Despite regular exercise and dieting, maintain or restore the original weight.
4. Although you do not gain weight, you can eat a lot of food at one time.
5. Stay in the bathroom for a long time to induce vomiting.
6. Frequent abuse of drugs, alcohol, or theft.
7. I feel depressed for a long time.
8. The menstrual cycle is irregular.
Proper treatment of bulimia nervosa patients requires close cooperation among multidisciplinary professionals, and individualization of treatment plans is essential. Also, a complete treatment plan should also consider merging mental disorders such as depression, personality disorders, and drug abuse.
The goal of treatment is to relieve symptoms and prevent recurrence. When the patient’s psychiatric symptoms or physical conditions pose a threat to life, and the patient refuses hospitalization, compulsory treatment must first be considered, such as suicidal ideation and suicidal behavior, electrolyte imbalance, and arrhythmia.
The study of drug treatment of bulimia nervosa progressed faster than anorexia nervosa. Commonly used drugs include antidepressants and anticonvulsants. The former is the mainstay. The widely used safe antidepressants are selective 5-HT reuptake inhibitors, and the anticonvulsants phenytoin and carbamazepine have a slight antibulk effect.
Most psychotherapy studies have found that psychological interventions are effective for bulimia nervosa, which can reduce the number of bulimic episodes and improve symptoms.
1) CBT The goal of CBT therapy is to break binge eating – clear the vicious circle, control bulimia nervosa symptoms, and prevent relapse.
The CBT method considers regular eating to be essential and adopts behavioral techniques to reduce gluttony behaviors, including avoiding situations where binge eating occurs, changing the way of thinking about problems, teaching patients to prevent relapses, and using self-monitoring methods to record in detail. Your diet.
2) Interpersonal psychotherapy (IPT) Unlike the CBT approach, IPT does not focus directly on the symptoms of BN, but focuses on and corrects “problematic interpersonal relationships.” By changing the way of an interpersonal relationship among BN patients, the purpose of controlling and relieving symptoms is achieved. Therefore, IPT is slow and takes a long time.
A series of comparative studies found that CBT was markedly effective, while IPT was dramatically slower, and CBT was superior to IPT at the beginning of treatment, and then symptoms of BN patients continued to improve after IPT; although the onset time of CBT and IPT was different, the two treatments had comparable efficacy.
3) Behavioural Therapy (BT) There are many ways to treat BT. It is reported that exposure and response prevention (ERP) treatment is ideal for bulimia nervosa, and ERP treatment is derived from the mode of reducing anxiety in the treatment of obsessive-compulsive disorder. In patients with bulimia nervosa who received ERP treatment, most of the symptoms improved and even improved significantly. A long-term follow-up study found that CBT and IPT were superior to BT. Compared with the former two methods, BT patients were prone to recurrence.
4) Home treatment In the treatment of bulimia nervosa, family intervention in the form of support, education, and possibly family therapy is also needed. Since bulimia nervosa is often a part of maintaining family balance, family therapy or family intervention combined with individual treatments is often necessary.
5) Group psychotherapy Group psychotherapy based on psychoanalysis is also an effective adjuvant therapy.
To obtain the best effect in clinical work, more extensive treatment measures of psychotherapy and drug treatment are adopted. The therapeutic effect of CBT alone or in combination with drugs was superior to that of drug therapy alone.
Also, some patients still need to support the body to provide treatment, the provisions of the patient’s eating time and food intake, to minimize or stop vomiting, to disable the use of cathartic drugs; the water and electrolyte metabolism is symptomatic treatment.