Health. Bulimia: How to detect it early?

Bulimia nervosa, along with binge eating disorder and anorexia nervosa, is one of the eating disorders. Eating disorders are characterized by a disrupted relationship with food, which significantly and lastingly impairs physical and mental health.

Anorexia nervosa involves strict and voluntary food deprivation for several months or even years. Bulimia nervosa is characterized by episodes during which the person compulsively consumes large quantities of food – cravings – in a short period of time, day or night.

These attacks, associated with a feeling of loss of control, are followed by inappropriate compensatory behaviors (vomiting, laxatives, fasting, excessive physical exercise, etc.). "People suffering from bulimia generally have a normal BMI due to compensatory behaviors," notes the HAS.

Binge eating disorder is characterized by episodes of binge eating, but these episodes are not followed by compensatory behaviors. "People with binge eating disorder are generally overweight or obese," the health authority adds.

“People suffering from bulimia rarely seek help”

These disorders are common, with bulimia affecting approximately 1.5% of 11- to 20-year-olds and affecting approximately three girls for every boy. It generally occurs later than anorexia (peaks between 13-14 and 16-17 years), around 19-20 years. Binge eating disorder is more common and affects between 3 and 5% of the population. Men are affected almost as much as women. Ameli.fr adds that these figures are probably underestimated, "people suffering from bulimia rarely seek medical help, and people suffering from binge eating disorder seek medical help for being overweight without mentioning their eating disorder."

In 2020, Inserm recalled the close links between bulimia and anorexia (0.9 to 1.5% of women and 0.2 to 0.3% of men). "20 to 50% of subjects suffering from anorexia nervosa have bulimia attacks and 27% of subjects suffering from bulimia nervosa have a history of anorexia nervosa. (…) The reasons for this development are not known. And the prognosis for recovery is equivalent in young women suffering from purely restrictive anorexia or anorexia-bulimia."

• an overwhelming, compulsive, uncontrollable need to eat (“craving”);
• the crisis takes place outside of meals and in secret;
• the bulimic person eats large quantities of food quickly, without being able to stop (all that which is within reach);
• These foods are generally neither cooked nor prepared and are most often high in calories (fat and sugar). The goal is not to indulge yourself by eating what you like, but really to fill yourself up.

On this subject, actress Karine Viard, who suffered from bulimia for several years, described this need to fill herself up on the Canal + show "En Aparté." "I've often noticed that when you eat too much, when you eat frantically, it's because there's something between you and yourself that isn't expressed. You have to be able to express something or to cover up your emotions. You fill yourself up, you fill a void."

Multifactorial diseases

Bulimia, binge eating disorder, or anorexia nervosa are multifactorial eating disorders. In addition to genetic and biological factors, there are psychological vulnerability factors.

Thus, according to Ameli.fr, depressive disorders or bipolar disorders, personality disorders, attention deficit hyperactivity disorder, low self-esteem, perfectionism are more often present in people with eating disorders.

Life events (mental stress factors, abuse, loss of a loved one, sexual trauma, etc.), the implementation of a restrictive diet or the occurrence of vomiting during an illness also constitute risk factors.

The importance of early care

People with bulimia often go untreated. The shame of talking about it and a generally normal body mass index make this eating disorder difficult to spot. In the case of binge eating disorder, people are often overweight. Also, according to Ameli.fr, the presence of binge eating disorder should be investigated in anyone who is overweight.

Treatment for bulimia and binge eating disorder relies on a multidisciplinary medical team, including psychiatric, nutritional, somatic, and social services. According to Ameli.fr, "the goal of treatment is to help people overcome their compulsive desire to eat as early as possible by relearning how to eat in a balanced way and regaining their body image and self-esteem." Early treatment is a key factor in recovery, just as the role of the family is central to recovery.

Source: Ameli.fr, Inserm, HAS