Bulimia Nervosa is a Mental Disorder
It is based on a constant concern over food (frequent conversations about weight, calories and diets), and fear of getting fat. Bulimia is considered to be a mental illness; its nature remains poorly understood as well as the nature of other mental illnesses. Bulimia is difficult to treat and the rate of those suffering from it is constantly growing. About 2 to 5 percent of teens and young women suffer from bulimia, but there are almost no lethal cases. Women with abnormal eating habits may suffer from a variety of disorders, ranging from cardiac disorders up to amenorrhea, which terminate a menstruation. Such disorders may also include osteoporosis, which usually develops in women after menopause and is characterized by a decrease in bone density.
Women get sick more often than men; male to female ratio is 1:10, although the cases among men have recently increased. Doctors claim that general number of patients has increased in recent decades – they call it “bulimic explosion in the population”. Bulimia is accompanied by uncontrolled, long defoliation; sometimes people artificially cause vomiting and use laxatives or enemas. Thus, bulimia is a disorder which is characterized by binge eating, followed by cleansing of the stomach. Bulimia and anorexia are a result of compliance with the strict diet, and can last for several years.
Description of the Disease
Bulimia is more common than anorexia. However, it is much harder to recognize. If people with anorexia are often so thin that they cannot hide their illness from others, the majority people with bulimia have normal body and normal weight. Thus, they can keep their illness in secret for many years, not telling anyone about it, perhaps only to one or two family members or very close and trusted friends. This is another tragedy of this debilitating disorder (Bauer, Anderson and Hyatt 15).
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Young women between 13 and 35 years are the group at risk. The highest peak of development and clinical manifestations of the disease accounts for 15-16 years, 22-25 years, and 27-28 years. Besides the fact that number of people of both sexes with various mild forms of the disorder is increasing, they are also on dangerous border of development of clinically significant bulimia nervosa. Most people with bulimia cannot break the cycle of overeating and release from eating. Bulimia is very painful. Feeling of fullness disappears, as well as control over the amount of food eaten – having started, people cannot stop eating. Often, a person ingests a huge number of products at a furious pace (Hall and Cohn 21).
However, regardless of the amount of food eaten, a person with bulimia reproaches himself that he or she was not supposed to do that. Realizing that something is going wrong, bulimia sick person, while absorbing another portion, consoles himself with the fact that he or she will certainly start a new life “from Monday”. However, this Monday never comes. The result is a feeling of inability to control oneself. Such a person gives a preference to sweets and other high-calorie foods that are (as generally considered) leading to fullness. Often, the desire to eat is a response to depression, self-blame, assiduous adherence to diet or simply boredom (Stavrou 23).
Such actions lead to desperate attempts to get rid of the eaten food and prevent weight gain. People with bulimia use various purification procedures in order to rid the body of unwanted food. Most often it is artificial inducing of vomiting or resorting to laxatives and diuretics, enemas. However, few people know that cleaning procedures usually are not reliable means of reducing or maintaining weight. Weight reduction, for example, after receiving laxatives, occurs mainly due to liquids loss, but not a fat loss. This fact negatively affects the operation of the whole organism. Other cleaning procedures are also not safe and can lead to serious health issues and even death (Stavrou 24).
There are two types of bulimia: heavy and nervous. Heavy bulimia requires urgent hospital treatment. Nervous bulimia (or bulimia nervosa) is an eating disorder, characterized by a sharp increase in appetite, usually coming in the form of attack and accompanied by painful feeling of hunger, general weakness, and pain in the epigastric region. Bulimia nervosa occurs in certain diseases of the central nervous system, endocrine system, and mental disorders. Bulimia nervosa might lead to obesity.
The main symptoms of severe bulimia:
- Strong fluctuations in body weight (10-15 kg);
- Increased soreness and muscle fatigue;
- Inflammation of the parotid glands;
- Throat irritation;
- Gum disease.
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Severe bulimia is characterized by:
- Chronic irritation of the throat;
- Fatigue and muscle pain;
- Swelling of the parotid gland (Bauer, Anderson and Hyatt 23).
Possible Causes of Bulimia
The main reasons for the increased appetite:
- Psychogenic (psychological);
Organic causes of bulimia:
- Diabetes mellitus. Increased appetite is often a symptom of untreated diabetes mellitus or is associated with low blood sugar levels as a harbinger of complications of the disease (insulin shock);
- Inflammation of the brain stem. Residual phenomenon of encephalitis. Bulimia is often combined with dementia or diabetes insipidus;
- Toxic lesions of the brain;
- Genetic disease with lesions of the brain structures. Increased appetite is regarded as bulimia with the defeat of the central nervous system;
- Side effects of adrenal hormones (prednisone, dexamethasone, etc.) – Cushing’s syndrome. Along with increased appetite, there are other signs of excessive hormone activity (increased blood pressure, stretch marks on the abdomen and thighs, changes in blood sugar levels, etc);
- Increased activity of the thyroid hormone (hyperthyroidism) (Hall and Cohn 29).
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Psychogenic causes of bulimia:
- Violation of intrafamily relations. Development of binge eating in children may contribute to the conflict between mother and child. Often, children are beginning to eat an inordinate amount of food if they consider themselves abandoned, deprived of affection, compared to other brothers and sisters;
- Emotional isolation. For example, changes in appetite may occur when placing a child in a boarding school. For a child, food is a source of positive emotions and “acquisitions”, a defense mechanism against depression, a cure from fear (Bauer, Anderson and Hyatt 60).
Treatment of Bulimia
It should first be understood that the earlier the treatment is, the higher the efficiency and lower the cost will be (one can use only qualified psychotherapy). The best results are a combination of psychotherapy (individual and family), dietary therapy and drug treatment. Treatment of bulimia ideally should be done in a hospital. Within explanatory psychotherapy, physician explains the need for treatment, discusses relevant activities and food ration with patient. Efforts to meet the requirements are accompanied by a variety of promotions (Hall and Cohn 56).
Cognitive-behavioral therapy includes standard elements of behaviorist therapy, but the focus is concentrated on identifying and changing faulty thinking patterns, beliefs and attitudes, which can cause and exacerbate binge eating attacks or other extremes – a complete rejection of food. Monitoring of food consumption is a key element of therapy, as well as the definition of stimulants and their removal or development of alternative responses to such stimulation. Interpersonal psychotherapy focuses on the problems of interpersonal relationships, self-esteem, self-confidence, social skills and communication strategies to address these problems. The task of family therapy is to help family members change the factors that could affect the development of certain pathologies of bulimic patient thinking. The patient is not the only one who should carry the blame for this disease (Stavrou 45).
When a patient is recovering from bulimia, group therapy is very effective. Communication in the group allows participants to share experiences, talk about how to overcome the disease and learn about the experiences of others. In addition, helping others helps improve self-esteem of the individual. Group should be led by an experienced and specially trained leader. Many bulimic patients suffer from depression, symptoms of which disappear under the influence of antidepressants. To date, only fluoxetine Prozac is approved for treatment of bulimia by U.S. Food and Drug Administration (FDA). This antidepressant reduces seizure frequency of binge eating and the desire to release the stomach by vomiting in patients with moderate to severe bulimia (Stavrou 48).
Some patients may require hospitalization, while others may be on outpatient care. Stabilization of the patient is the main goal, if a person is in a life-threatening condition. The primary goals of treatment are aimed at the physical and psychological needs of the patient to regain physical health and normal food intake. The patient should identify inner feelings that led to the violations. Appropriate treatment should be directed to the fact that the person controlled arising problems, self-perceptions. Designated education can help patient to control weight. Advice of a doctor or a support group can help the patient in the recovery process (Bauer, Anderson and Hyatt 58).
The ultimate goal for the patient is to accept oneself the way he/ she is, and to be physically and emotionally healthy. A physical and mental health is likely to take some time, and the results will be gradual. Patience is an important part of the recovery process. Positive attitude with great effort of the patient is another integral component of a successful recovery.
There are also other methods of bulimia treatment:
- Laser therapy
By intravenous laser irradiation of blood, doctors seek for increasing the sensitivity of the patient to psychotropic and neurological drugs that allows assigning them (drugs) in minimal doses, and, therefore, significantly reduce the likelihood of side effects.
- Magnetic therapy
Magnetic field effect on the nervous system is characterized by changes in the conditioned reflex activity. This is due to stimulation of inhibitory processes that contribute to the overall calm and reduce emotional stress. Influencing the peripheral receptors of sensitivity, magnetic therapy anaesthetizes and improves the conduction of nerve impulses, thereby restoring the function of injured peripheral nerves by improving the growth of nerve cells. It is proved that the use of magnetic therapy in complex rehabilitation therapy promotes more rapid normalization of mental status of patients: increased intellectual productivity, reduction of vegetative disorders, normalization of nocturnal sleep (Stavrou 72).
- Light therapy
Most experts are associating a positive effect of light therapy with enhanced regulatory function of the cerebral cortex, as well as the normalization of activity of the autonomic system. The method has been also successfully used in the treatment of depression.
- Massage and Hydrotherapy
Massage, soothing pine baths, an activating power shower, pool and sauna – all this strengthens the body, gives strength and a positive effect on mood.
- Rehabilitation programs
Individual rehabilitation program is constructed for each patient and includes the consistent expansion of the regime and the gradual increase in psychophysical actions. Diverse and thoughtful physical exercises and classes in the pool promote the restoration of the blood flow, oxygen saturation of red blood cells and accelerating metabolism. All of the above is beneficial to the patient’s body – it increases the degree of assimilation of medicines and their side-effects decrease. Particular attention is paid to social adaptation. Psychologists and nurses help patients resume the lost skills (communication and interaction with others, personal care, laundry, cooking, etc.), as well as training new (drawing, playing musical instruments, pottery, etc) (Hall and Cohn 63).
Diagnostics of Nervous Eating Disorders
Correct diagnosis should be put before the emergence of the disease. The doctor is obliged to respond to any abnormalities associated with weight control: an obsessive desire to lose weight, exhausting workouts, painful perception of the body. It is not necessary to wait for the more serious symptoms of drastic weight loss, cessation of menstruation, exhaustion, severe and chronic fatigue, stop or slow sexual development, increased risk of osteoporosis (Hall and Cohn 90).
Aside from the obvious symptoms, there are also such symptoms that are nearly impossible to diagnose before the appearance of the following features: lack of vitamins, minerals, protein and calorie, balance of which determines the development of a young body. An objective examination is rarely possible to detect any obvious abnormalities. Patients with bulimia nervosa tend to have no violations of nutritional status, they have a healthy appearance, and other people who are familiar with the patients, even members of their families may sometimes not know anything about their condition. An objective examination of patients with recurrent vomiting reveals a similar offense, as in patients with anorexia nervosa (Bauer, Anderson and Hyatt 93).
Main features of bulimia nervosa are desire to be thin, fear of gaining weight, a biased attitude to food, cognitive disorders, psychological problems and health problems, including a lack of menstrual cycles. Progress of this disease began in the XX century. A large role in this was played by the media, which promoted thin woman as an ideal of beauty. Women, especially young ones, did and do sacrifice in order to adhere to these imaginary standards, which are undermining their health. There are certain professions where food taboos and diet are part of a profession that is inevitably a threat to the psyche.
There is a set of materials about bulimia in the media. One of the reasons for the growth of the public interest is the tragic outcome that may have these diseases. In 1982, the nation was shocked by the death Karen Carpenter, a popular singer and host of a TV show. The prevalence of these problems among adolescent girls and young women also cause serious concerns. The number of people exposed to growing bulimia rates: thinness becomes obsessive national idea. People tend to lose as much pounds as possible and reach a dangerous brink as a result. Knowledge of the dangers of this disease should be spread everywhere everyone knew about the dangers this disease carries.
Bauer, Barbara G., Anderson, Wayne P. and Robert W. Hyatt. Bulimia. New York: Routledge, 2013. Print.
This book is the authors’ investigation of case records. The authors are trying to take of another look on casual factors and methods of bulimia treatment. The book covers all stages of the disease, its technical aspects, possible causes, and the disastrous consequences. The authors focus attention on the importance of group and family therapy and significance of a high self-esteem.
Hall, Lindsey and Leigh Cohn. Bulimia: A Guide to Recovery. New York: Grze Books, 2010. Print.
Lindsey Hall and Leigh Cohn provide a detailed tutorial on how to struggle with bulimia. In particular, the authors analyze the diagnostic of the disease, the things to do instead of bingeing, self-esteem tools for recovery; they remind about the importance of group therapy and professional treatment.
Stavrou, Maria. Bulimics on Bulimia. London: Jessica Kingsley Publishers, 2008. Print.
In this book, Maria Stavrou provides different stories about bulimia, thereby trying to find the root causes of the disease. Also, Maria examines the history and origin of the disease, its diagnostics and possible causes.