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Please note that health information can only support the conversation with a psychotherapist or physician: It should never be a substitute for it!

What is bulimia?

Typical signs of bulimia (full medical term: bulimia nervosa) are frequently occurring binges. People who suffer from bulimia consume huge portions of food in a short amount of time. They are unable to control these cravings and to determine what and how much they consume. Due to feelings of shame, binge-eating is often tried to be kept secret.

To avoid gaining weight, sufferers often steer against a feared weight gain following binge eating: they vomit, take laxatives, diuretics or other medications. Excessive exercising, enemas or strict fasting are also used to maintain weight.

People with bulimia are constantly preoccupied with their body weight. Their confidence is dependent on their weight, so they are scared of becoming fat, even though most of them are of normal weight.

How frequently does bulimia occur?

Approximately one to two of 100 people (1,5%) fall ill from bulimia in the course of their lives. Individual symptoms (signs of illness) of bulimia, however, are more frequent and occur in around 5 out of 100 people.

Primarily, women and young girls are affected. 90 out of 100 persons affected are girls and women. However, recently, an increasing number of young men have been reporting that they are scared of getting fat and are controlling their eating behaviour by binge-eating, vomiting, doing more sports or using laxatives to maintain their weight.

5 out of 100 people suffer from individual symptoms of bulimia in the course of their lives

Are there different forms and progressions of bulimia?

Bulimia often begins in young adulthood. Sufferers go on a lot of diets in order to feel happy with their bodies, and at the same time have cravings and binges which become ever stronger. Not infrequently, bulimia is also preceded by anorexia. Although the symptoms of anorexia are decreasing, meaning that the body weight is normalising, binges set in, which are in turn counteracted through vomiting, laxatives or similar. Phases with normal eating behaviour and phases with bulimic eating behaviour therefore frequently alternate.

Bulimia is a well treatable mental illness. Around a third of sufferers achieve completely normal eating behaviour through psychotherapy. For a further proportion of sufferers, at least an improvement of symptoms can be achieved.

How does bulimia emerge?

Various factors and conditions interact in bulimia. Societal factors can play a role. These include, for instance, the Western beauty ideal of being very slim and the constant availability of calorie-rich food. Societal factors interact with the biological (e.g. heredity), personal (e.g. low self-esteem) and life history characteristics (e.g. loss of an attachment figure) of the individual person, which can trigger or foster the emergence and maintenance of bulimia.
"It is the expression of a mental tension, like despair, not being able to stand anything anymore and even vomiting normal portions."
Person with experience of bulimia.

"It is the expression of a mental tension, like despair, not being able to stand anything anymore and even vomiting normal portions."

Person with experience of bulimia

Who is particularly at risk?

Young women aged between 18 and 24 years are seen as being particularly at risk of developing bulimia. People who have little self-confidence define themselves strongly according to their figure and weight, frequently diet and have only little support from their social milieu are equally subject to an increased risk.

Moreover, in jobs which place particular demands on weight and figure (e.g. modelling, dancing, competitive sport) more people also suffer from bulimia.
A further influencing factor is the family situation. Critical remarks from parents and siblings on weight and figure, a family climate with little support, as well as high expectations and demands can facilitate bulimia.

Genetic factors equally appear to play a role: Sisters, mothers or daughters of bulimia sufferers have a three to four-fold higher risk of suffering from bulimia themselves.

How do you find out whether you have bulimia?

Bulimia does not emerge overnight. It is very important that sufferers seek help early because the outcome of the illness depends to a considerable extent on a quick onset of treatment.

Indications of the onset of an eating disorder can be:

  • Dissatisfaction with one's eating behaviour
  • Worries about one's weight and eating habits
  • Worries about one's figure
  • Secret eating
  • Vomiting or binges

Often, the GP is the first choice to contact. To find out if you are suffering from an eating disorder, however, a thorough diagnosis by a specialised physician or psychotherapist is necessary. This includes a detailed physical examination and an in-depth conversation about eating behaviour and counter-measures. Based on the results of the examination, it is decided which form of treatment is recommendable.

As a general rule: The earlier bulimia is detected, the greater the chances of successfully treating it.

How is bulimia treated?

Psychotherapy according to the cognitive-behavioural therapy approach has proved to be particularly effective. If no behavioural therapy is possible, a treatment following the psychodynamic approach can also be considered. Approximately one third of diseased persons can be cured in the long term by psychotherapy. It is important that the therapists providing treatment have specialist knowledge and well grounded experiences in the area of eating disorders. For minors, upon agreement with the patient, the family members are often included in the therapy from time to time.
With outpatient psychotherapy, the patient generally has weekly sessions. Upon consultation with the physician providing treatment, in some cases supplementary medication can also be useful.

If outpatient treatment alone is not sufficient, a hospital stay in a specialised constitution is recommendable. In Hamburg, there are several clinics for psychosomatic medicine and psychotherapy. A complete list of clinics for psychosomatic medicine and psychotherapy in Hamburg and the surrounding area can be found on essstoerungen.psychenet.de (German version) and in the Therapy Guide for the City of Hamburg from page 139 (German version). A list of clinics for child and adolescent psychiatry, psychotherapy and psychosomatic medicine can also be found on essstoerungen.psychenet.de (German version) and in the Therapy Guide for the City of Hamburg from page 193 (German version).

However, if making contact with a psychotherapist or clinic is an effort too big, sufferers can turn to a specialised advice centre. The employees of the advice centres provide information about the illness, the different treatment possibilities and pass on suitable addresses. A list of specialist advice centres for sufferers of eating disorders can be found in the Therapy Guide for the City of Hamburg from page 167 (german version).

What can friends and family do?

If signs of bulimia are discernible, this should be addressed directly but cautiously. It might happen that the sufferer initially denies everything and is not ready to talk. Nevertheless, it is recommended to continue to address the topic. In this respect, it is even more necessary to avoid impatience and strong emotions and to face the person with bulimia in a supportive manner.

As a partner, parent or friend of a sufferer, you have certain demands placed on you. Nevertheless, it is important not to push the person concerned too much. Family members can also go to advice centres for eating disorders, to GPs and specialised physicians as well as to psychotherapists.

Helpful information and links:

http://www.nationaleatingdisorders.org

Sources:

Backmund, H. & Gerlinghoff, M. (2005). Ess-Störungen, ein Ratgeber für Angehörige. Deutscher Taschenbuch Verlag: München.

Bryant-Waugh, R. & Lask, B. (2008). Essstörungen bei Kindern und Jugendlichen. Rat und Hilfe für Eltern. Huber Verlag: Mannheim.

Bundeszentrale gesundheitliche Aufklärung zum Thema Essstörungen. Verfügbar unter http://www.bzga-essstoerungen.de/ [Stand: 25.8.2011]

Written by: 

Katarina Rafailovic (Psychologist), Prof. Dr. Bernd Löwe (Specialist physician for psychotherapeutic medicine, Specialist physician for internal medicine, Psychological psychotherapist)

Date of creation: 17.08.2011
Date of last editing of content: 05.10.2015
Date of next editing of content: 05.10.2016

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Deutsche Gesellschaft für Psychosomatische Medizin und Psychotherapie (DGPM), Deutsches Kollegium für Psychosomatische Medizin (DKPM) (2010). Diagnostik und Therapie von Ess-Störungen. Verfügbar unter http://www.awmf.org/leitlinien/detail/ll/051-026.html [Stand: 25.8.2011]