Bulimia nervosa: The psychological dilemma behind delicious food

Author: Chen Han, Chief Physician, Shanghai Mental Health Center

Reviewer: Chen Jue, Chief Physician, Shanghai Mental Health Center

Xiaoyu, a girl with a bright appearance, beautiful figure and cheerful personality, was suffering and in pain in private. At first, Xiaoyu just wanted to lose weight like many girls and become "more beautiful". But soon after losing weight, Xiaoyu felt that her appetite was out of control. At first, she would occasionally overeat because of stress or bad mood, but gradually, this behavior became frequent and difficult to control. She would eat a lot in a short period of time until her stomach was uncomfortable, and then she would take extreme measures such as vomiting and taking laxatives to eliminate the guilt because of the fear of weight gain. This repetitive behavior seriously affected her quality of life and mental and physical health.

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Xiaoyu's symptoms are typical manifestations of bulimia nervosa. Bulimia nervosa, also known as bulimia, is a type of eating disorder that often occurs in young women and has multiple causes.

1. Psychological factors: Patients often have personality traits such as low self-esteem, high neuroticism, emotional instability and impulsivity. They may over-diet in pursuit of a perfect body shape, which can easily lead to loss of appetite control. Once out of control, they will fall into a vicious cycle of binge eating and vomiting. In addition, stressful events in life, such as tense interpersonal relationships, high pressure from study and work, etc., may also be the cause of bulimia nervosa.

2. Genetic factors: Studies have shown that bulimia nervosa has a certain tendency to cluster in families, and the incidence rate is significantly higher among direct relatives of the disease, which suggests that genetic factors play an important role in the onset of the disease.

3. Biochemical factors: Central neurotransmitters such as serotonin and dopamine are believed to be related to the onset of bulimia nervosa. In particular, serotonin deficiency is most closely related to bulimia nervosa.

4. Social factors: The prevailing aesthetic concept of “thinness is beauty” in today’s society, especially the influence of some media and social software in recent years, has caused many women to pay excessive attention to their body shape and make subjective evaluations, thus inducing bulimia nervosa.

5. Family factors: Family is often considered to be a factor in the generation and maintenance of eating disorders. The family relationships of these patients are often characterized by entanglement, overprotection, and rigidity.

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The clinical manifestations of bulimia nervosa are complex and diverse, mainly including the following aspects.

1. Binge eating behavior: Patients will have repeated episodes of binge eating, eating much more than normal needs, and eating very quickly. The types of food are mostly high-calorie foods, such as snacks, candies, etc.

2. Purging behavior: After binge eating, patients will take various measures to eliminate the effects of food, such as vomiting, excessive exercise, abuse of laxatives or diuretics, etc.

3. Distorted concept of weight: Patients often have a distorted understanding of weight and body shape. Even if they are very thin, they still think they are too fat and have a very determined pursuit of thinness.

4. Emotional symptoms: Patients often suffer from emotional disorders such as anxiety, depression, and irritability. Excessive attention to weight and body shape also exacerbates these negative emotions.

5. Physiological symptoms: Long-term binge eating and purging behavior can lead to a series of physiological problems, such as gastrointestinal discomfort, water and electrolyte imbalance, tooth enamel wear, salivary gland swelling, etc. In severe cases, acute pancreatitis and digestive tract rupture may occur.

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The diagnosis of bulimia nervosa requires a combination of the patient's clinical manifestations, psychological assessment, and necessary physical examination. The doctor will make a diagnosis by taking a detailed medical history, observing eating behavior, and assessing the psychological state.

The treatment of bulimia nervosa mainly includes nutritional therapy, drug therapy and psychotherapy.

1. Nutritional therapy: Help patients establish a standardized diet plan to reduce behaviors such as binge eating and vomiting caused by dieting, including reasonable nutritional meal planning, eating-related behavior management, exercise management, etc., to repair various physical damages.

2. Drug treatment: The antidepressant fluoxetine is the only drug that has been approved for the treatment of bulimia nervosa. It can be used to alleviate symptoms such as binge eating and vomiting. It can also be used for symptomatic treatment of patients with emotional disorders such as depression and anxiety.

3. Psychological treatment: Cognitive behavioral therapy (CBT) is the first-line treatment for bulimia nervosa. CBT aims to help patients establish healthy eating rules, correct cognitive biases about body shape, weight, and self-control, and rebuild cognitive systems. In addition, interpersonal therapy, dialectical behavioral therapy, psychodynamic therapy, etc. have also achieved good therapeutic effects.

4. Self-regulation: It also has a certain effect. Patients can improve symptoms through daily conditioning, such as maintaining a regular lifestyle, adequate sleep, and appropriate social activities. At the same time, learning effective ways to express emotions and reducing self-suppression and denial are also important aspects of self-regulation.

Xiaoyu's story shows us the great physical and mental damage that bulimia nervosa causes to patients. In the face of this disease, society needs more understanding, care and support. Through scientific treatment and active self-adjustment, patients are fully capable of getting out of trouble and regaining health and happiness. At the same time, we should also reflect on the deviation of social aesthetic concepts, advocate healthy and diversified beauty, and let everyone embrace their own bodies with confidence.

References

[1] Wang Xiangqun, Wang Gaohua. Guidelines for the prevention and treatment of eating disorders in China[M]. Chinese Medical Electronic Audio-visual Publishing House, 2015.12.

[2] Chen Jue. Eating disorders[M]. People's Medical Publishing House, 2013.