Nervous bulimia

Nervous bulimia is observed within the framework of mental disorders and borderline personal pathology of almost all species.

Bulimia nervosa is a recurring episode of compulsive overeating accompanied by vomiting, using laxatives and diuretics, excessive physical exercise or fasting. Diagnosis is based on anamnestic information and survey data. Treatment consists in psychotherapy and the appointment of SSRIs, especially fluoxetine.

Nervous bulimia affects 1 -3% of adolescents and young women. At the same time, they are constantly and excessively concerned about the figure and body weight. Unlike patients with anorexia nervosa in patients with bulimia nervosa, usually the body weight is normal.

The syndrome of bulimia nervosa is divided into two types: the first type - without the previous picture of anorexia nervosa, the second type - with the previous picture of anorexia nervosa (in the latter case bulimia nervosa is considered as a special form of anorexia nervosa or as a stage of the disease). The greatest importance in the formation of the syndrome of bulimia nervosa is given to depression of a different nature. This combination with psychopathological disorders makes it necessary to consult patients with psychiatrists.

[1], [2], [3]

Causes and pathogenesis of bulimia nervosa

As the provoking factors of bulimic episodes, there are periods of prolonged abstinence from food with the formation of hypoglycemic conditions. A number of researchers have identified hypothalamic-pituitary dysfunctions, which are assessed ambiguously. It is assumed that hypothalamic-pituitary disorders can be a reaction to mental and physiological (vomiting) stress. However, the possibility of a primary pathology of the hypothalamic-pituitary system with initial neuroendocrinal and motivational disorders that participate in the formation of pathological eating behavior with bouts of bulimia is not excluded. With bulimia nervosa, serotonergic deficiency is defined. Violation of the synthesis and metabolism of serotonin is the basis of depression, which is given the primary role in the origin of bulimia nervosa.

[4], [5], [6],

Symptoms of bulimia nervosa

Symptoms of bulimia nervosa are characterized by repeated episodes of consumption of large amounts of high-calorie, easily assimilated, carbohydrate-rich foods at discrete periods of time. Usually these periods take less than 2 hours in duration. Similar episodes alternate with measures aimed at maintaining normal body weight (diet, intake of laxatives, diuretics). Bulimic episode, as a rule, ends with abdominal pain, self-induced vomiting, less often sleep. During the bulimic period and after it, patients realize that their eating behavior is abnormal, they are negative to him, they have a depressive mood, a self-protest against such food excesses. During the bulimic episode, there is often a fear of the inability to stop eating at will. As a rule, patients hide bulimic episodes from others. The body weight of patients is subject to frequent fluctuations within 5-6 kg. Alternation of bulimic episodes with periods of fasting allows to keep body weight within the limits of the norm. Often, patients with bulimia are amenorrhea or oligomenorrhea. Nervous bulimia can change the clinical picture of previous anorexia nervosa, but it can also start on its own. Characteristic combination with various personality disorders of almost all types.

Typical episodes of bulimia nervosa are also described with obesity, but constitute a small percentage. The hyperphagic response to stress observed in patients with obesity does not correspond completely to the clinical picture of bulimia nervosa. As a rule, with hyperphagic reaction to stress within the framework of obesity, bulimic episodes do not alternate with long posts, but are followed by periods of less pronounced permanent overeating. In addition, the bulimic episode usually does not end with self-induced vomiting. Hyperfagic reaction to stress can take the features of bulimia nervosa while the doctor prescribes a reduced diet. However, artificially induced vomiting is extremely rare in these cases.

Patients usually describe the behavior of overeating-cleansing. Bulimic episode includes fast food intake, especially high-calorie, for example ice cream and cakes. Episodes of overeating differ in the amount of food consumed, the calorie content of which sometimes reaches thousands of kilocalories. These episodes tend to recur, are often provoked by psychosocial stress, the frequency can reach several times a day, and they are kept secret.

Many symptoms and physical complications are the result of cleansing behavior. Vomiting leads to erosion of the enamel of the frontal teeth and an increase in salivary jeans. Sometimes severe violations of water-electrolyte balance occur, especially hypokalemia. Very rarely there are ruptures of the stomach or esophagus, which are life-threatening complications. Cardiomyopathy can develop as a result of prolonged use of syrup Ipecacuanas for inducing vomiting.

Patients with bulimia nervosa are more aware and tormented by remorse and guilt than patients with anorexia nervosa, more often recognize their problems when talking with a sympathetic doctor. They are also less introverted and more prone to impulsive behavior, alcohol and drug use, severe depression.

Diagnosis of bulimia nervosa

This disorder should be suspected if the patient exhibits significant concern about weight gain and there are large fluctuations in body weight, especially if excessive laxatives or unexplained hypokalemia are used. Although patients with bulimia express concern about becoming full and may have an overweight, most body weight fluctuates around normal. Enlarged parathyroid glands, scars in the area of the finger joints (due to vomiting), erosion of the teeth are dangerous signs. At the same time, the diagnosis depends on the description of the behavior of overeating - cleansing by the patient.

For the diagnosis (according to the Manual on Statistics and Diagnostics of Mental Disorders, fourth edition - DSM-IV), two bulimic episodes per week are necessary for at least 3 months, although an attentive doctor will not limit himself to these criteria.

[7], [8]

Differential diagnosis

First of all, it is necessary to exclude somatic diseases accompanied by vomiting (pathology of the gastrointestinal tract, kidneys). As a rule, a typical picture of bulimia nervosa is so characteristic that the presence of this syndrome is beyond doubt.

[9], [10], [11]

Treatment of bulimia nervosa

Treatment of bulimia nervosa includes psychotherapy and drug therapy. Psychotherapy, usually cognitive-behavioral, has both a short-term and a long-term effect. SSRIs have a certain degree of effectiveness in reducing overeating and vomiting, but they enhance their effect in combination with cognitive-behavioral therapy, and this combination is the treatment of choice.

Psychotropic therapy is needed, the nature of which is determined by the leading psychopathological syndrome. The drugs of choice for the treatment of bulimia nervosa are selective serotonergic antidepressants. The greatest effect is possessed by fluoxetine (Prozac), an inhibitor of serotonin reuptake in the tresynaptic membrane. He is prescribed in doses from 40 to 60 mg / day - for one dose, for 2-3 months. In addition, it is necessary to develop a new food stereotype with an explanation to the patient that periods of a rigid diet are provocateurs of bulimic episodes. Regular meals with a decrease in the diet of easily assimilated, carbohydrate-rich foods helps prevent episodes of bulimia. The existing amenorrhea does not require hormone replacement therapy, and the menstrual cycle, as a rule, normalizes with the disappearance of episodes of bulimia.

To improve the functioning of the cerebral systems of neuroendocrine and motivational regulation, nootropil, aminalon, vascular preparations, glutamic acid are used. When referring to the EEG for lowering the threshold of seizure readiness of the brain, it is possible to prescribe small doses of finlepsin (0.2 g 2 times a day).