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Autor: dr Ana Đorđević   


People suffering from bulimia constantly think about food. What to eat? When to eat? How many calories did I take? I'll stop eating from this moment. I'll eat less starting from tomorrow. Change the word "eat" with the word "drink" and you get an alcoholic! People suffering from bulimia are similar to other addicts in many things. Many expert teams have been trying for a long time, using different methods, to put the food obsession under control.

Bulimia, damage vital urge

Taking food is the instinctive and vital urge, i.e. it is an urge to self-preservation. The quantitative disorder of this urge can cause its reduction and complete loss of the urge, on one hand, or decrease and sick voracity, on the other. The reduction of the feeding urge is called starvation. It can be intentional, with the aim to lose weight, to protest (hunger strike) or it can be caused by lunatic ideas, such as an idea that the food is poisonous or in the cases of schizophrenia, when imperative hallucinations forbid taking food. A special syndrome in clinical practice is mental anorexia, the disorder which occurs mostly in young women after the puberty, and it is characterized by drastic reduction of complete cessation of taking food, weight loss, lack of menstruation (amenorrhea), and special mental state. This disorder causes progressive weight loss, complete physical exhaustion (cachexia), and it results in death in 10% of the cases.

Phenomenon "animal hunger"

The increase of the urge for feeding, in the sense of sick voracity, can be seen in the cases of some disorders such as progressive paralysis, encephalitis, some brain tumors, and idiocy. This disorder can be seen in some epileptic patients, as the sign of the illness (aura), when a patient directly before the seizure, can eat an enormous amount of food, up to 10 kg during one meal. This phenomenon is called "animal hunger"

Sick voracity

The increased need for food, in the sense of sick voracity – BULIMIA – can be also an obsessive-compulsive disorder. In this case, food releases stress, tension and fear. According to behavioral theory, this disorder – sick overeating – can occur when stress is of small or moderate intensity. In the cases when stress or fear are extremely strong we cannot eat at all.

Bulimia is characterized by sporadic overeating urge, as well as expressed concern about one's own appearance and weight. It is usually women who suffer from this disorder. Many famous personalities from the fashion, film and music world admit that they had or still have this problem. Even the British princess Diana publicly admitted that she had suffered from bulimia for a long time. Between two overeating urge a person usually lives ascetic lifestyle, strictly obeying rules, and resisting even the most delicious food, when it carries a lot of calories. However, sometime these people completely lose control over their appetite and throw themselves on enormous amounts of "forbidden" caloric food. This is called the overeating attack. To prevent gaining weight, these people use many different tricks: they vomit on purpose, take laxatives (purgatives), they do sports or exercise till exhaustion, or they completely stop eating – punishing themselves by starving for some time.

Bulimia, the modern addiction

Bulimia has many similarities to other addictions. Patients are in both cases preoccupied with the substances that they are addicted to, they feel unclassifiable need to it and lose their control when consuming it, and significant percent of them experience recidivism after treatment.

The classical Pavlov's learning theory is the basic for the treatment in which a subject is exposed to a stimulus. we know for a long time that fear is a phenomenon that is controlled by stimuli. The exposure of the subject to stimuli that cause fear appears to be effective way in treating fear. This approach is used in treating patients with bulimia. As in the cases of fear, it is believed that exposure to the stimuli that provoke appetite can reduce the overeating urge, which refers to uncontrollable need to consume a certain substance. Just like the fear, it is a learned reaction which can be provoked by different stimuli. Generally, the addicts are used to consume the substance they are addicted to, when they get a certain stimulus for that, for example, a local cafe, people with whom they usually drink or take drugs, a bottle, needle, etc. If a jar of jam on the kitchen counter provokes the urge to eat, in time, the very look at the jar will cause hunger. Due to certain reaction in the organism, the look at he jar will be enough for an uncontrollable need for food to occur.

Numerous experiments have proven that stimuli provoke certain psychological reactions in addicts. In alcoholics the need is provoked even if they pass by a cafe. After alcohol is consumed the body temperature decreases. The stimuli which come before the consuming produce a "preparing" increase of the body temperature in alcoholics, even if there is no alcohol in the surrounding. This anticipating compensating reaction is experienced as lust – uncontrollable need. There is similar combination of specific stimuli and overeating urge in bulimia. For example, the fatty food or emotional confusion, bad mood, boredom or loneliness, even for just several days. This stimuli also conditions the preparing reactions in the organism of a person suffering from bulimia, such as the increased values of insulin, and the decrease of the sugar in blood. This is recognized as the uncontrollable need for food, i.e. the overeating urge occurs.

The therapy is progressive

The aim of the therapy is for these so called preparing reactions to lose their meaning and importance. The recent therapy model, based on behavioral procedures, is to expose the subject to the stimuli while, at the same time, to prevent the responses, i.e. the reactions to the stimuli. In bulimia therapy this means progressive, more frequent and longer exposure to the stimuli, while they are not allowed to eat. This is directly opposite to the important component of traditional (classical) bulimia therapy, which means that the "dangerous" food is being hidden from a patient, and even not brought into the house. During the exposure to the stimuli, under the doctor's supervision, a patient performs the full ritual of the overeating urge, same as it happens at home. The delicious food is brought before the patient, which they smell intensively during one hour. After awhile it is allowed for the patient to taste a bit of the food from a table. The therapeutist stimulates the patient to take some food. However, as the time goes by, this need is being reduced. Due to the fact that the patient really does not consume the food this need fades. After one hour the need for food is drastically decreased, and after 10 therapies the need disappears. The stimuli lose their predictive value.

Ana Djordjevic, MD

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