Bulimia. Causes, symptoms, diagnosis and treatment of the disease. Bulimia Symptoms and signs of bulimia

Most girls and women are captive of stereotypes and, in pursuit of an ideal appearance and figure, are constantly trying to change themselves. This struggle does not always end in victory; often the consequence of such a war is; the disease is insidious, which, in turn, leads to irreversible health consequences.

People communicate less and less in reality; communication has been replaced by fashionable gadgets. No one discusses problems in private with each other, no one shares news, but life is “boiling” online. Here people fall in love, meet and even have affairs. People are exchanging real life for a ghostly virtual space.

Julia, 22 years old, says:

“I have few friends, and I don’t meet them often. But online I feel great. I come home from college and start surfing - wandering aimlessly through websites and social network pages. Sometimes I read some materials. I don't communicate much on forums; I mostly read other people's posts. One secret warms my soul: no one knows that I have been suffering from bulimia for 5 years. Do you know what this is? This is when you buy food for a week and eat it all at once. And then you need to vomit the food in order to understand that you have not harmed your body. No, I’m causing harm, otherwise why in the morning I look like I’ve been drinking water or something stronger all night - my face and eyes are swollen, I’m swelling all over. But my weight is normal.

Only this is not the norm that it was at 15-16 years old, when my weight was ideal. And then, by the age of 17, with a height of 170 centimeters, I began to weigh 65 kilograms and panicked.

Yes, I started eating right, going to the gym, tightening my figure, but then I gave up everything, and the weight began to grow rapidly again.

And then I discovered this wonderful remedy. It’s probably not normal that I drink laxatives and diuretics by the handful, as well as tranquilizers and antidepressants, and sometimes such melancholy attacks me, even if I cry. My teeth are crumbling, colds don’t go away, sometimes I have cramps, but I can’t help it. My main activity is inducing vomiting, and so on from morning to evening.

I promise myself to improve my eating behavior starting tomorrow, but the next day nothing happens. I feel lonely and sad again, and only food becomes a source of pleasure for me, and even communication on the Internet.

I have lost my interests and friends, but I understand that I no longer want to live like this. There is information about bulimia on the Internet, but there is not very much of it. I'm starting to write a blog where I will tell people about how I became bulimic and what consequences it led to. I hope my advice will help someone."

What do you know about bulimia?

Most often, those who want to lose weight by restricting their eating habits suffer from bulimia. Sometimes bulimia is caused by failure, stress, feelings of loneliness and lack of positive emotions.

A person constantly worries due to real or imaginary reasons, and eventually begins to consume food in huge quantities. He swallows it quickly, most often without even chewing it.

Then the patient experiences burning shame, he begins to reproach himself and his body. He is afraid that he will get better, a desire appears at any cost to get rid of the food he has consumed, and he immediately fulfills this desire. The patient induces vomiting artificially, then begins to take laxatives and diuretics. To this, almost all bulimics add increased physical activity.

In this struggle, the body becomes a victim and hostage of the disease. The patient does not realize that the consequences of bulimia can be irreversible - up to the failure of some organs and his death.

Consequences of bulimia:

What happens to the body of a bulimic? The work of all internal organs is disrupted.

Let's name the main health consequences of bulimia.

• 1

  Chronic dehydration (occurs due to constant artificial vomiting and prolonged use of diuretics) leads to an imbalance in water and electrolyte balance. This means that the body experiences a severe deficiency of calcium salts, sodium chlorine, and potassium, which can impair muscle contractility, including the heart muscle. Those who suffer from bulimia, due to disruption of the heart and kidneys, experience numerous edemas. They experience tachycardia, enlarged lymph nodes, shortness of breath and weakness.

• 2

  Metabolism is disrupted, the endocrine system “fails.” Thyroid and parathyroid levels drop while levels of the stress hormone cortisol rise. The production of female hormones also decreases, which can lead to menstrual irregularities in women.

• 3

  The digestive system begins to work incorrectly: gastritis and ulcers of the stomach and duodenum occur. Most of the beneficial enzymes that are necessary for the normal functioning of the body are excreted before they have time to be absorbed. The mucous membrane of the mouth and esophagus is constantly inflamed. The condition of tooth enamel deteriorates, up to complete tooth destruction. Ulcers form in the esophagus, which are difficult to treat and can lead to serious problems, including cancer.

• 4

  The condition of hair and nails deteriorates significantly, hair falls out, thins, becomes dry, brittle and lifeless. Without timely treatment, bone and muscle tissue weakens.

• 5

  The functioning of the nervous and cardiovascular systems is disrupted. Patients constantly feel anxious and cannot sleep. The biological rhythms of the body change.

The head of the Clinic for Eating Disorders, Anna Vladimirovna Nazarenko, considers the main cause of bulimia to be breakdowns that result from many years of “dieting.” All women want to be thin and slender, but when a woman constantly limits herself, she craves delicious (and forbidden) food. She begins to eat everything, becomes horrified at what she has done, and begins to vomit this food. This is how the disease mechanism starts.

Bulimics keep their illness a secret...

It is difficult to recognize patients with bulimia: they are no different from those around them, and they keep their disease a secret, and can only tell their closest friend about it (and more often than not, they do not trust this secret to anyone).

Their life becomes a “running in a vicious circle”, where a diet is followed by a breakdown, then a cleansing, and again all over again. After cleansing, the patient immediately begins to feel hungry, which means that the state of “food binge” is close.

Because of this rhythm of life, he constantly experiences remorse, hence melancholy and depression. At the heart of bulimia are hidden deep psychological experiences. Trying to transfer all feelings to food is a unique way to find answers to vital questions, but food will not help you find a way out.

You need to understand that bulimia is not a simple eating disorder. This disease hides a whole complex of problems, and it is impossible to solve them with one effort of will.

How to help with bulimia

If you have discovered this disease in yourself or your loved ones, do not panic, but act. Just don’t sit on the forum for years and read the advice of others.

When you have a toothache, you go to the dentist. Why are you hoping for a miracle for the hundredth time and thinking that tomorrow morning you will wake up and start eating right?

If the problem is serious, and you understand that you cannot cope with it yourself, you should not go into a new “round of weight loss/eating/vomiting/exhausting workouts”, but look for a specialist who will help you cope with the disease.

Specialists at the Anna Nazarenko Eating Disorders Clinic have many years of successful experience in treating bulimia. You can schedule an initial consultation to determine the severity of your bulimia and receive recommendations for further treatment.

Bulimia (bulimia nervosa) is an eating disorder that is classified as a mental disorder. It manifests itself in attacks of overeating, during which a person absorbs a huge amount of food in 1-2 hours, sometimes up to 2.5 kg. At the same time, he does not feel its taste and does not experience a feeling of satiety. Following such an eating breakdown comes a feeling of remorse, and the bulimic tries to correct the situation. To do this, he induces vomiting, takes laxatives or diuretics, uses enemas, actively plays sports, or adheres to a strict diet. As a result, the body becomes depleted and a whole bunch of diseases develop, which can lead to death.

People find themselves in a vicious circle. Hunger strikes, chronic stress, and overwork place a heavy burden on our shoulders. When the stress becomes unbearable, a nervous breakdown occurs, which causes an attack of overeating. While eating, there is euphoria, a feeling of lightness and release. But after this there is a feeling of guilt, physical discomfort and a panicky fear of gaining weight. This causes a new wave of stress and an attempt to lose weight.

Like most other mental disorders, bulimia is not perceived by people as a serious problem. He does not seek help from a doctor or psychologist. The illusion is created that the attacks can be stopped at any time. Bulimia seems to be a shameful habit that brings a lot of inconvenience. Attacks of overeating and “purging” are carefully hidden, believing that people, even relatives, do not need to know about it.

According to statistics, 10-15% of women aged 15 to 40 years suffer from bulimia. After all, it is the fair sex who are constantly concerned about their appearance and excess weight. This problem is less common among men. They make up only 5% of the total number of bulimics.

Some professions are conducive to the development of bulimia. For example, it is very important for dancers, actors, models and track and field athletes not to be overweight. Therefore, among these people the disease occurs 8-10 times more often than among representatives of other professions.

Interestingly, this problem is most relevant in developed countries such as the USA, Great Britain, and Switzerland. But among people with low incomes, bulimia is rare.

Bulimia, like any other problem, rarely comes alone. It is accompanied by self-destructive sexual behavior, depression, suicide attempts, alcoholism and drug use.

Despite all the efforts of doctors, approximately 50% of patients manage to achieve complete recovery, 30% experience relapses of the disease after a few years, and in 20% of cases treatment does not have an effect. The success of the fight against bulimia largely depends on the willpower and life position of a person.

What shapes our appetite?

Appetite or the desire to eat is an emotion that arises when we feel hungry.

Appetite is a pleasant expectation, anticipation of pleasure from delicious food. Thanks to it, a person develops food-procuring behavior: buy food, cook, set the table, eat. The food center is responsible for this activity. It includes several areas located in the cerebral cortex, hypothalamus, and spinal cord. It contains sensitive cells that respond to the concentration of glucose and hormones of the digestive system in the blood. As soon as their level drops, a feeling of hunger arises, followed by an appetite.

Commands from the food center are transmitted along a chain of nerve cells to the digestive organs and they begin to work actively. Saliva, gastric juice, bile and pancreatic secretions are released. These fluids ensure digestion and good absorption of food. Intestinal peristalsis increases - its muscles contract to ensure the passage of food through the gastrointestinal tract. At this stage, the feeling of hunger intensifies even more.

When food enters the stomach, it irritates special receptors. They transmit this information to the food center and there a feeling of fullness and pleasure from eating arises. We understand that we have eaten enough and it’s time to stop.

If the functioning of the food center is disrupted, bulimia develops. Scientists put forward several hypotheses for the development of the disease:

• Receptors in the food center are too sensitive to low blood sugar levels - appetite appears too early.
• The impulse from the receptors in the stomach does not pass well through the chain of nerve cells due to problems at the point of their connection (synapse) - a feeling of satiety does not occur.
• The various structures of the food center do not work coherently.

There are 2 manifestations of appetite:

1. General appetite– you react positively to any food. It arises from the fact that “hungry” blood, which has few nutrients, washes sensitive nerve cells (receptors) in the brain in the hypothalamus region. Violations of this mechanism lead to the appearance of a form of bulimia, in which a person absorbs everything and has a constant appetite.


2. Selective appetite– you want something specific: sweet, sour, salty. This form is associated with a lack of some nutrients in the body: glucose, mineral salts, vitamins. This form of appetite comes from the cerebral cortex. On its surface there are areas responsible for the formation of eating behavior. A failure in this area causes periodic bouts of overeating certain foods.

Causes of bulimia

Bulimia is a mental illness. Often it is based on psychological trauma, as a result of which the functioning of the food center is disrupted.

1. Psychological trauma in childhood
   • the baby in infancy often experienced hunger;
   • the child did not receive enough parental love and attention in childhood;
   • the teenager does not have good relationships with peers;
   • parents rewarded the child with food for good behavior or excellent grades.
   In such situations, the child formed the concept that the main way to obtain pleasure is food. Eating is safe, pleasant, accessible. But such an attitude violates the basic rule of healthy eating: you need to eat only when you are hungry, otherwise the food center begins to fail.
2. Low self-esteem, which is based on flaws in appearance
   • parents convinced the child that he was too fat and needed to lose weight to become beautiful;
   • criticism from peers or a coach about appearance and excess weight;
   • A teenage girl's realization that her body is not like that of a magazine cover model.
   Many girls overly strive to have a model appearance. They are sure that a thin figure is the key to a successful career and personal life. Therefore, they resort to various methods of losing weight.
   A high risk of developing bulimia is found in suspicious people who try to control all events.
3. Effects of stress and high anxiety

   Bulimia attacks can occur after stressful situations. During this period, a person tries to forget with the help of food, to give himself at least a little pleasure. Often this can be done. After all, after eating, a large amount of glucose enters the brain and the concentration of “pleasure hormones” increases.

   Stress can be negative: loss of a loved one, divorce, illness, failure at work. In this case, food remains the only pleasure that helps to calm down. Sometimes pleasant events can trigger bulimia: a promotion on the career ladder, a new romance. In this case, overeating is a feast of joy, rewarding oneself for one’s merits.

4. Nutrient deficiencies

   Among bulimics there are a lot of women who constantly adhere to a diet. Such a restriction in food leads to the fact that a person cannot think about anything other than food. At a certain point, there is no more strength left to endure. The subconscious mind gains control of the situation and gives permission to eat in reserve. The body seems to understand that soon you will repent, and then hungry times will begin again.

   Episodes of uncontrolled binge eating occur in patients with anorexia. In this case, refusal to eat and aversion to foods is replaced by an attack of bulimia. Thus, the body, bypassing consciousness, tries to replenish the reserves of useful substances that were depleted during the period of hunger strike. Some psychologists believe that bulimia is a mild version of anorexia, when a person cannot completely refuse food.

5. Protection from pleasures

   It happens that a person is not used to giving himself pleasure. He considers himself unworthy of happiness or is convinced that pleasant moments are always followed by retribution. In this case, bulimia attacks play the role of self-punishment after sexual pleasure, relaxation or pleasant shopping.

6. Heredity

   If several generations of one family suffer from bulimia, then they talk about a genetic predisposition to this disease. The reason may be that the tendency to periodically overeat is inherited. It is caused by the peculiarity of the endocrine system and the lack of hormones that control appetite or the increased sensitivity of the receptors of the food center in the hypothalamus.

   In most cases, a person suffering from bulimia cannot realize what is driving him to an attack. If you find this trigger, you can take measures to keep your appetite in check, preventing attacks.

What happens during a bulimia attack

Before an attack, severe hunger or rather a craving for food appears. It happens that a person wants to eat only with his brain, although his stomach is full. This manifests itself in the form of obsessive thoughts about certain dishes, prolonged examination of products in the store, and dreams about food. The person loses the ability to concentrate on school, work or personal life.

Left alone, the patient pounces on food. He eats quickly, not paying attention to the taste of foods, which sometimes do not fit together at all or may be spoiled. Usually preference is given to sweets and other high-calorie foods. Due to the fact that the feeling of fullness disappears, the feast can continue until the food runs out.

After eating, bulimics feel that their stomach is full. It puts pressure on the internal organs, props up the diaphragm, compresses the lungs, preventing breathing. A huge amount of food causes spasms in the intestines, which are accompanied by severe pain. Euphoria is replaced by a feeling of remorse and shame, as well as fear of gaining a little weight.

In order to prevent the calories eaten from being absorbed, there is a desire to induce vomiting. Getting rid of excess food brings physical relief. To lose weight, sometimes a decision is made to take diuretics or laxatives. They remove from the body not only water, which is vital, but also mineral elements.

If at the initial stage bulimics overeat only after stress, then the situation worsens. Attacks become more and more frequent, 2-4 times a day.

Most victims of bulimia suffer greatly, but cannot give up their habit and carefully hide their secret from others.

Symptoms and signs of bulimia

Bulimia is a disease, like alcoholism and drug addiction, and not just bad behavior. It was officially recognized as a disease relatively recently, 20 years ago. The diagnosis of bulimia is made based on a thorough interview. Additional research methods (ultrasound of the abdominal organs, electrocardiography, computed tomography of the head) are necessary if there are disturbances in the functioning of the internal organs. A biochemical blood test allows you to determine whether the water-salt balance is disturbed.

There are 3 clear criteria on which it is based Diagnosis of bulimia.

1. Food cravings that a person cannot control and result in eating large amounts of food in a short period of time. However, he does not control the amount he eats and cannot stop
2. To avoid obesity, a person takes inadequate measures: induces vomiting, takes laxatives, diuretics, or hormones that reduce appetite. This happens about 2 times a week for 3 months.
3. A person develops low body weight.
4. Self-esteem is based on body weight and shape.

Bulimia has many manifestations. They will help determine if you or someone you love is suffering from this disease.
Signs of bulimia:

• Talking about excess weight and healthy eating. Since people's figure becomes the center of self-esteem, all attention is concentrated around this problem. Although bulimics often do not suffer from excess weight.
• Obsessive thoughts about food. A person, as a rule, does not advertise that he likes to eat. On the contrary, he carefully hides this fact and officially adheres to a healthy diet or some newfangled diet.
• Periodic weight fluctuations. Bulimics can gain 5-10 kilograms, and then lose weight quite quickly. These results are not due to the fact that overeating has stopped, but to the fact that measures are being taken to get rid of the calories eaten.
• Lethargy, drowsiness, deterioration of memory and attention, depression. The brain experiences a glucose deficiency, and nerve cells suffer from a lack of nutrients. In addition, worries about excess weight and bouts of overeating place a heavy burden on the psyche.
• Deterioration of the condition of teeth and gums, ulcers in the corners of the mouth. Gastric juice contains hydrochloric acid. During attacks of vomiting, it eats away the mucous membrane of the mouth and ulcers appear on it. Tooth enamel turns yellow and erodes.
• Hoarseness of voice, frequent pharyngitis, sore throats. The vocal cords, pharynx and tonsils become inflamed after injuries that occur during bouts of vomiting.
• Esophageal spasm, heartburn. Frequent vomiting damages the surface layer of the esophagus and impairs the functioning of the muscles that prevent food from rising up from the stomach (sphincters). In this case, the acidic gastric juice burns the inner lining of the esophagus.
• Burst blood vessels in the eyes. Red spots or streaks on the white of the eye under the conjunctiva appear after blood vessels rupture during vomiting, when blood pressure temporarily increases.
• Nausea, constipation or intestinal disorders. These disorders are associated with overeating. Frequent vomiting or taking laxatives disrupts bowel function.
• Inflammation of the parotid salivary gland as a result of frequent vomiting. High blood pressure interferes with the normal outflow of saliva, and stomatitis and other damage to the oral mucosa contribute to the penetration of microbes into the salivary gland.
• Seizures, heart and kidney problems associated with a deficiency of sodium, chlorine, potassium, phosphorus, and calcium salts. They are washed out in the urine when taking diuretics or do not have time to be absorbed due to vomiting and diarrhea, depriving cells of the ability to function normally.
• The skin becomes dry, premature wrinkles appear, and the condition of hair and nails deteriorates. This is due to dehydration and mineral deficiency.
• Menstrual irregularities and decreased libido, erection problems in men. Deterioration of metabolism leads to hormonal disruptions and disruption of the genital organs.

Complications of bulimia can be very dangerous. Victims of the disease die from cardiac arrest in their sleep due to salt imbalance, from stomach contents entering the respiratory system, from rupture of the stomach and esophagus, or from kidney failure. Severe alcohol and drug addiction and severe depression often develop.

Treatment for bulimia

Bulimia is treated by a psychotherapist or psychiatrist. He decides whether it is necessary to go to the hospital or to be treated at home.

Indications for inpatient treatment of bulimia:

• thoughts of suicide;
• severe exhaustion and severe concomitant diseases;
• depression;
• severe dehydration;
• bulimia that cannot be treated at home;
• during pregnancy, when there is a threat to the life of the child.

The best results in the fight against bulimia nervosa are achieved by an integrated approach that combines psychotherapy and drug treatments. In this case, it is possible to restore a person’s mental and physical health within several months.

Treatment with a psychologist

The treatment plan is drawn up individually for each patient. In most cases, it is necessary to undergo 10-20 psychotherapy sessions 1-2 times a week. In severe cases, meetings with a psychotherapist will be necessary several times a week for 6-9 months.

Psychoanalysis of bulimia. The psychoanalyst identifies the reasons that caused the change in eating behavior and helps to understand them. These may be conflicts that occurred in early childhood or contradictions between unconscious attractions and conscious beliefs. The psychologist analyzes dreams, fantasies and associations. Based on this material, he reveals the mechanisms of the disease and gives advice on how to resist attacks.

Cognitive behavioral therapy in the treatment of bulimia it is considered one of the most effective methods. This method helps to change thoughts, behavior and your attitude towards bulimia and everything that happens around you. In classes, a person learns to recognize the approach of an attack and resist obsessive thoughts about food. This method is perfect for anxious and suspicious people for whom bulimia brings constant mental suffering.

Interpersonal psychotherapy. This treatment method is suitable for those people whose bulimia is associated with depression. It is based on identifying hidden problems in communicating with other people. A psychologist will teach you how to get out of conflict situations correctly.

Family therapy Bulimia helps improve family relationships, eliminate conflicts and establish proper communication. For a person suffering from bulimia, the help of loved ones is very important, and any carelessly thrown word can cause a new attack of overeating.

Group therapy bulimia. A specially trained psychotherapist creates a group of people suffering from eating disorders. People share their medical history and experience of dealing with it. This gives a person the opportunity to increase their self-esteem and realize that they are not alone and others also overcome similar difficulties. Group therapy is especially effective at the final stage to prevent recurrent episodes of overeating.

Monitoring food intake. The doctor adjusts the menu so that the person receives all the necessary nutrients. Those foods that the patient previously considered prohibited for himself are introduced in small quantities. This is necessary in order to form the right attitude towards food.

It is recommended to keep a diary. There you need to write down the amount of food eaten and indicate whether there is a desire to sit down again or the urge to vomit. At the same time, it is advised to increase physical activity and engage in play sports, which help to have fun and get rid of depression.

Remote Internet treatment for bulimia. Work with a psychotherapist can take place via Skype or email. In this case, methods of cognitive and behavioral therapy are used.

Treatment of bulimia with medications

Used to treat bulimia antidepressants, which improve the conduction of a signal from one nerve cell to another through special connections (synapses). Remember that these drugs slow down your reaction time, so do not drive and avoid jobs that require high concentration during treatment. Antidepressants do not mix with alcohol and can be very dangerous when taken together with other medications. Therefore, tell your doctor about all the drugs you use.

Selective serotonin reuptake inhibitors

They improve the conduction of nerve impulses from the cerebral cortex to the food center and further to the digestive organs. They relieve symptoms of depression and help to objectively assess your appearance. But the effect of taking these medications occurs after 10-20 days. Do not stop treatment on your own or increase the dose without your doctor's approval.

Prozac . This drug is considered the most effective treatment for bulimia. Take 1 capsule (20 mg) 3 times a day, regardless of meals. The daily dose is 60 mg. The capsule should not be chewed and should not be taken with sufficient water. The duration of the course is determined by the doctor individually.

Fluoxetine . 1 tablet 3 times a day after meals. Minimum course 3-4 weeks.

Tricyclic antidepressants ,

They increase the concentration of adrenaline and serotonin in synapses, improve the transmission of impulses between nerve cells. They have a strong calming effect, help get rid of depression, and reduce bouts of overeating. A lasting effect occurs after 2-4 weeks. Unlike the previous group of drugs, they can cause heart problems.

Amitriptyline . The first days take 1 tablet 3 times a day with meals. Then the dose is doubled, 2 tablets 3 times a day. Duration of treatment is 4 weeks.

Imizin . Begin treatment with 25 mg 3-4 times a day after meals. The dose is increased daily by 25 mg. The doctor sets the daily dose for each patient individually; it can reach 200 mg. Course duration is 4-6 weeks. Then the dose is gradually reduced to the minimum (75 mg) and treatment is continued for another 4 weeks.

Antiemetics (antiemetics) in the treatment of bulimia

At the initial stages of treatment, it is recommended to take antiemetics to quickly suppress the gag reflex while antidepressants have not yet begun to act. Antiemetics disrupt signal transmission from the vomiting center, which is located in the medulla oblongata to the stomach, and block dopamine and serotonin receptors. Thanks to this, it is possible to avoid vomiting, which can be caused by certain types of food in bulimics.

Cerucal . Take half an hour before meals 3-4 times a day. The course of treatment is from 2 weeks. The drug not only reduces nausea, but also normalizes the functioning of the digestive system.

Zofran . Does not have a sedative effect and does not cause drowsiness. Take 1 tablet (8 mg) 2 times a day for 5 days.

Remember, treating bulimia is a long process that requires patience and faith in success. Learn to accept your body as it is and lead an active and fulfilling life. You will achieve the final victory over the disease when you learn to rejoice and get pleasure not only from eating food.

This article is a short encyclopedia of bulimia from Svetlana Bronnikova. Symptoms, course, consequences of the disorder, and most importantly - specific advice on what to do to get out of all this.

Katya's story

Katya is 27 years old. Katya starts every morning with black coffee, an egg and a cucumber. No bread. She is a successful PR specialist, passionate about her work... and “You understand, we work with celebrities, it is very important to look good.” Katya easily lights up, takes on new things with pleasure, and understands nutrition no worse than a professional nutritionist.

She professes a healthy lifestyle and proper nutrition: she drinks two liters of water a day, gets on a treadmill three times a week. At lunch, Katya also tries to eat right - steamed fish, salad, no, no, no dessert!

The hardest part begins at about 4 o'clock, when the strength is already running out, but the end of the working day is still far away. Katya decides to treat herself to a cup of coffee and candy. She doesn’t always manage to resist - sometimes, while drinking a cup of coffee, she starts eating one candy after another and can’t stop... A day that started correctly and well is hopelessly ruined.

Then, on the way home, she stops at ABC of Taste to buy croissants, marmalade, cake or pastries and another liter package of ice cream. When Katya gets home, she eats it all and then vomits in the toilet.

Katya is 27 years old. 6 of them she has bulimia.

Sometimes attacks do not start with candy at work, but as if on their own. A hard day, an unpleasant conversation with your boss, a feeling of dissatisfaction with what you have done. Risky moments include buying clothes (just look at yourself in the fitting room mirror and discover that size 27 jeans are too small) and your mother coming to visit you from out of town. Mom’s caustic comments that Katya is still not married, doesn’t look very athletic, and that at her age, with such education and a good job, she could already take out a mortgage for an apartment, lead to despair.

Sometimes Katya gets tired from bouts of vomiting, and then she runs kilometers on the elliptical until she's stupefied, and sometimes she goes down to the pharmacy for a laxative.

Usually Katya doesn't feel like there's anything wrong with her. A good half of the girls in her circle disappear into the toilet after dinner and return with the scent of toothpaste and fresh lipstick. Everyone is on diets and constantly losing weight. This is a healthy lifestyle, isn't it? And only in the evenings, after an attack, does Katya cry because she feels fat and lonely. She feels that something is wrong with her.

Where did bulimia come from?

Bulimia is by no means a product of the new century with its cult of thinness. Attacks of overeating and induced vomiting have been known to mankind since ancient times. For example, doctors in Ancient Egypt recommended fasting and vomiting once a month for three days to maintain good health. It is widely known about the Roman emperors who introduced the fashion of inducing vomiting in order to “free up space” in the stomach to continue the feast.

It is less widely known that the anorexic medieval nuns, who exhausted themselves not in the name of Holy Thinness, but for the glory of our Lord, periodically developed bouts of overeating, attributed, of course, to the machinations of the devil, and some of them induced vomiting in order to “cleanse themselves from sins."

Does this mean that bulimia as an eating disorder has existed since ancient times? No. The most important component is missing: the need to control weight. We can only talk about full-blown bulimia when there is a goal of weight control.

Is bulimia congenital?

About 2% of the population of every developed country suffers from bulimia. To date, it has not been precisely established whether there is a genetic predisposition for the disorder. One thing is clear to scientists: there are hidden mechanisms, most likely innate, that facilitate the search and consolidation of so-called compensatory behavior - this is the name given to inducing vomiting and other measures to get rid of what has been eaten as quickly as possible.

The fact is that inducing vomiting is not so simple and not at all a pleasant experience. Try it and see for yourself. Who among us did not eat something inappropriate as a child? One common recommendation is to drink a lot of water and induce vomiting. So, often this is simply impossible to do - no matter how much we want, we can’t do it. The fact that people with bulimia do this easily and naturally sets them apart from everyone else. The nature of this difference is unknown to us.

We know for sure that social factors - a general belief in the necessity and usefulness of dietary behavior, dietary restrictions, the cult of thinness - provoke the development of bulimia. In so-called primitive cultures there is no bulimia. As you know, the disorder did not exist on the Fiji Islands until the 70s, when the Americans brought television there. After this, the statistics of bulimia quickly approached global levels.

Symptoms of bulimia

In order to be diagnosed with bulimia, a combination of several symptoms is necessary.

Bouts of overeating that is, consuming huge amounts of food in a limited period of time, accompanied by a feeling of loss of control.

Compensatory behavior, that is, any behavior aimed at getting rid of what you have eaten, whether it is inducing vomiting, using laxatives and diuretics, or excessive exercise (there is a term for this “sports bulimia”). Food cannot be a reason for increased physical activity. Even if you overeat and feel like you need to work off what you ate, you have symptoms of bulimia!

Now you understand that many healthy lifestyle apologists, Instagram divas with gym selfies, and even professional fitness trainers are just bulimics.

This is the paradox of modern life. People with eating disorders teach others about healthy lifestyles and nutrition.

Binges of overeating and compensation occur at least once a week within 3 months.

Self-esteem and self-awareness, even a person’s mood depends on size and weight bodies. I weighed myself in the morning - the scale showed a plus - my mood was ruined for the whole day. They told me at work that I’ve lost weight – I’m flying like I’m on wings. If you can’t fit into your new jeans, that’s a tragedy. In an evening dress, folds are visible on the sides - I’m not going to a party.

A person who suffers from bulimia, and this can be both men and women, has initially certain psychological characteristics. These are emotionally mobile, impulsive people who are easily involved in new activities. It is difficult to unequivocally classify them as introverts or extroverts - they are shy, reserved and timid in communication, and at the same time they want to be the center of attention and conquer others. The result of this combination is constant self-doubt.

Consequences

Okay, so what's so scary about that? Well, I ate too much - vomited, worked out or took a laxative, is it really that dangerous?

There is an opinion among people that if anorexia is fraught with serious health consequences, then they don’t die from bulimia - “all girls do it.” In fact, bulimia can be fatal and extremely damaging to your health.

The human body is not designed to spew out what it has just eaten - the bulimic’s body begins to consistently break down from the inside. The teeth suffer because gastric juice enters the mouth along with food. Anemia and tachycardia develop—the body lacks microelements. The endocrine system suffers - bulimics often experience hormonal destabilization and disruption of the thyroid gland. Gastritis and disorders of the gastrointestinal tract are also typical.

How to treat bulimia?

The first case of bulimia was described in 1979 - then the only method used in the treatment of mental disorders was psychoanalysis - and he did not find much success in the treatment of bulimia.

Does this mean that psychoanalysis is ineffective? Of course not. The problem with eating disorders is that they affect both the emotional sphere and behavior. Stabilizing the emotional sphere may reduce the frequency of attacks, but is unlikely to help get rid of them. The fact is that bulimics all come to weight loss offices with the same request: “I’m addicted to food” - although in fact they are addicted to attacks.

An attack is a method of getting rid of negative emotions, calming down, and “rebooting.” Indeed, after such a shocking experience there is simply no resource left for emotions - emotions are turned off. Over time, the connection “attack - pleasant oblivion and relaxation” is formed, and addiction is formed.

More hope for bulimia sufferers came with the advent of CBT - cognitive behavioral therapy. CBT is based on the idea that our behavior is caused by faulty thoughts. If you change the way you think, you will change your behavior. Indeed, bulimics tend to entertain negative, critical thoughts about themselves. CBT is not always effective for bulimia, but it is still one of the evidence-based treatment methods.

Some of the best results in terms of effectiveness in the treatment of bulimia today have DBT - dialectical behavioral therapy. 80% of patients stop having attacks and are kept from them for 2 years. This is the “younger daughter” of CBT, which focuses not on wrong thoughts, but on destructive emotions that a person cannot cope with. Using carefully selected techniques, DBT teaches you to master your emotions, regulate them, understand and analyze them - and change behavior from a more stable and calm state.

It can be difficult to get treatment. Admitting that you have an eating disorder can be very embarrassing.

In fact, bulimia is the same disease as hepatitis A or thyroiditis. It is not your fault that you are sick. Bulimia rarely goes away without treatment - you need professional help.

How to help yourself?

Your enemy is not overeating, but undereating.

Every day you start with a new attempt to eat healthy. Leave these attempts for a while if you want to get rid of attacks. Eat nutritious meals at least 5 times a day until you feel comfortably full.

Remember - there should be no excluded products on your menu! Potatoes, breads and sweets, pasta and bacon should be part of your menu. Satiety and variety of tastes are what will protect you from attacks.

The art of the pause.

Do not set yourself the task of suppressing or preventing an attack. Set yourself the task of “delaying” it. Before you start eating “food for overeating,” take a time—let it be 15 minutes at first—and do something else, and after the time has passed, ask yourself whether the desire is still as strong or if it can already be dealt with. Thus, bring the pause to at least half an hour, adding a minute with each episode.

Escape from the attack.

Bulimia attacks always occur in approximately the same circumstances - most often at home, when no one is home. When you feel an attack coming on, leave the house for a long walk, go shopping, window shop, or walk the dog.

Call a friend.

Agree with a friend that you will call him/her in case of emergency. When you feel that you are being “overwhelmed,” call and ask them to distract you with conversation for as long as possible—or better yet, come and go for a walk with you.

Bulimia is not a harmless side effect of a “healthy lifestyle” or “an easy way to get rid of what you eat.” Bulimia drags on, and now you are flushing large sums of money, health, and free time literally down the toilet. For people with “advanced” forms of bulimia, body weight and slimness cease to be of great importance - since almost the whole life is devoted to servicing attacks. Don’t let it get to this point - seek help on time.

Treatment plan

At IntuEat Intuitive Eating Center, we offer the following treatment plan for people suffering from bulimia:

• Individual nutrition counseling: structuring meals and avoiding diets with the help of program “Down with diet!” — “Traffic rules” .
• Group therapy - training emotional regulation using the DBT method, seizure control training.
• Group Conscious or Intuitive nutrition is a way to bring back the pleasure of food to life and gain self-confidence.

Mental disorders accompanied by violations of normal eating habits are the scourge of modern youth. Bulimia and anorexia are two friends that often occur in the same person. Bulimia is gluttony when you feel unbearable and irresistible hunger, despite the fact that a huge portion of food has already been eaten. After eating, a person with bulimia experiences a feeling of guilt and shame for the food eaten, as he is afraid of gaining weight. To remedy the situation, he tries to induce vomiting and takes laxatives. The circle closes and everything repeats itself again.

How to recognize bulimia in yourself

Very often, a person with bulimia does not admit to himself or others that he is addicted. He doesn't even consider it an addiction or a disease. But it is still possible to recognize this mental disorder. Here are some signs that characterize the behavior of a person with bulimia.

1. The huge, incredibly huge amount of food a person can eat. Bouts of gluttony may occur at night. Sometimes a person with bulimia tends to chew something constantly. After eating so much food, pain and cramping occur in the abdomen, and various disorders of the digestive system occur.
2. - a constant companion of bulimia. After an attack of gluttony, a person tries to correct the situation and carries out various “cleansing” procedures for the intestines - giving an enema, inducing vomiting, taking laxatives and diuretics.
3. Bulimia is often accompanied by various psychological disorders - depression, stress, anxiety, deterioration in sleep quality.
4. A person with bulimia is obsessed with their weight. Losing weight, dieting and nutrition are all that are of interest to him. In fact, maintaining the desired weight becomes the main goal in life.
5. Bulimia alternates periods with anorexia. For a long time, a person exhausts himself with hunger strikes and loses a lot of weight. But at some point his brain simply turns off, and the patient eats a portion of food that is equal in calorie content to the weekly diet of an ordinary person.
6. A patient with bulimia cannot be distinguished among healthy people. He has a normal average weight and does not stand out among others when it comes to food intake. Overeating occurs only when alone; he usually hides his tendencies from friends and family members.

This disease plagues teenagers, mostly girls. During puberty, their psyche is unstable, they are dissatisfied with their appearance. Very often girls feel like they are overweight. Due to the lack of experience in losing weight and proper nutrition, they simply refuse to eat, which often leads to anorexia. Prolonged fasting causes exhaustion of the body, followed by an uncontrollable attack of gluttony. This is bulimia nervosa, which needs to be treated by a neurologist.

Eating disorders often originate in childhood. In many families there is a cult of food, when the child is forced to eat regardless of his desire. “You won’t get up from the table until you’ve eaten all the contents of the plate” - this is completely wrong behavior for adults in the family. Usually in families where there is a cult of food, the majority suffer from excess weight. The child himself feels when and how much to eat. If you want him to eat a portion of soup, you need to increase his exposure to fresh air, give him the opportunity to play outdoor games and limit access to candy, cookies and other sweets until lunch. And then he will eat the treasured plate without persuasion and with appetite.

It is not uncommon to experience bulimia in older adults, around 25-30 years of age. This type of bulimia occurs against the background of various psychological problems, stress at work, and failures in your personal life. The patient simply “seizes” the problem. Temporary gustatory joy helps to distance oneself from life’s failures, but everything is imaginary. Indeed, with an advanced form of bulimia, a person simply does not feel the taste of foods.

When an adult sees food only as a consolation and an escape from emotional distress, this often leads to eating disorders. Bulimia harms more than just the digestive system. Frequent eating causes teeth to spoil, bad breath to appear, and the thyroid organs to suffer. All this is accompanied by memory deterioration, impaired sleep quality and long-term depression.

To cure this disease, you need to remember that bulimia is a mental disorder. First you need to direct your thoughts in the right direction, and only then begin to treat the body itself. If you suspect that you, a friend, or a member of your family may have bulimia, you need to take immediate action. It is possible to recover from bulimia; it requires patience and discipline.

1. First, accept and understand your problem. Denial will not lead to anything good. To defeat a disease, you need to admit its presence with your head held high. And then see a doctor. Self-medication in this case is extremely undesirable and even dangerous.
2. At the doctor there is no need to be ashamed of your illness. Honestly and frankly tell the specialist about your bulimia attacks - how often they occur, against the background of what emotional state. The doctor will prescribe a course of medications that will heal organs damaged by malnutrition. Along with this, you will receive a prescription for antidepressants. They will help you not feel the anxiety that you eat. They will also write out a detailed diet for you, indicating the portion size and meal times.
3. As for self-treatment, psychological motivation is important here. You need to love yourself for who you are. Look at yourself in the mirror. There is no need to compare yourself to skinny girls and model-looking girls. In life, men often like women who are full of health, not emaciated women. Love yourself just the way you are. Find and list all your advantages - there will be many of them.
4. To get rid of bulimia attacks, try to plan your day. Lead a healthy lifestyle. You need to eat healthy foods, follow a diet and not break it. Before eating, put on your plate exactly as much as you plan to eat. No additives. Don't sit at the common table. As soon as you have finished the last bite from your plate, you need to get up from the table. It is better to communicate with family in a different environment, for example, in the living room.
5. Don't look for comfort or reward in food. For example, you go to an important exam and make a promise to yourself that if you can pass it successfully, you will allow yourself to eat cake. This is fundamentally wrong. You cannot reward yourself with food, because you are a person, not an animal. Tell yourself that if the exam is successful, then buy yourself that fashionable handbag that you have been dreaming of for so long or give yourself a membership to the pool. Learn to look for joy beyond food.
6. Keep yourself busy so you don't think about food. Often we experience an imaginary feeling of hunger, just because we are bored and have nothing to do. It only seems to us that we are hungry. In fact, you just need to keep yourself busy. Sign up for language courses, play sports, meet with friends more often. This will take your mind off food.
7. Stop taking weight loss medications. Train yourself not to vomit even after a bulimia attack. Accept that the food you eat is already in you and there is no way to get it out of there. Throw out all laxatives and diuretics from the house - they should not be used so often. It is better to work off the calories you eat on the exercise machine than to induce vomiting.
8. If you feel that you are experiencing stress that you cannot cope with on your own, you need to seek help from a specialist. An experienced psychotherapist will identify the root of your problem and help you overcome it.
9. Find a purpose in life and go towards it. Understand that losing weight, diets and nutritional rules are far from the main thing. You already look great, let nutrition correction and diet be the norm for you, which you don’t need to think about. After all, you brush your teeth every day, but don’t think about it all day? So it is here. If you intend to lose weight, you just need to eat right and move more. But you can’t think about it every second. Find yourself a more interesting goal. Perhaps you want to get a second education, buy your first car or learn Spanish. Go for it! There is so much more interesting in the world besides worrying about food.
10. To cope with a ravenous appetite, you can use herbal decoctions. Alfalfa, aloe vera, chickweed, burdock, licorice root, fennel, nettle, green tea, plantain. All these plants have excellent appetite suppressant properties. They can be used alone or in combination with each other. A few tablespoons of the herbal herb should be poured into a liter of boiling water and allowed to brew. Then you need to strain the broth and drink 200 ml when an attack of bulimia is approaching. If you feel unbearably hungry even though you have eaten recently, just drink this warm decoction. In a few minutes you will feel better.

If you suffer from bulimia, you don’t need to torment yourself and worry about it. Like any other disease, bulimia is highly treatable. However, for an effective and accurate result, you will have to be patient - only a year after the absence of bulimia attacks can you consider yourself completely healthy. Love and accept yourself for who you are, because you are truly beautiful!

Video: how to cure bulimia

I want to talk about what helped me cope with bulimia. The methods are simple, the main thing is to turn off the autopilot. Start looking at the world around you and listening to your feelings. To ask questions. And feed yourself with laughter, play, care and love. Then one day everything will fall into place again: eating for energy and pleasure, and not to drown out fear, sadness, resentment and anger.

PRESENT

"I am crazy?"- you ask yourself in despair after another bout of gluttony-vomiting. A person suffering from bulimia is well aware that his relationship with food is abnormal. One of the strongest fears is that the body will eventually not withstand the hellish regime of gluttony and vomiting and will become ill with some terrible disease. Ignorant well-wishers on forums are scary: “You are sick, you need to see a psychiatrist.” They think they are helping, but in fact they only increase the horror and provoke new attacks. You would like to stop, but you don’t have the strength. In principle, a competent psychotherapist could come in handy here - just as he might come in handy for your neighbor who can’t live without a cigarette for more than two hours, or for a friend if she’s terribly afraid of riding the subway. What I mean is that bulimia is just a neurosis, the same as nicotine addiction or panic attacks, it does not make you crazy.

Moreover, your bulimia is, in fact, a gift of fate. I know, it sounds mocking now, when your throat is sore, your stomach is bursting from tons of food, tooth enamel is melting before your eyes and it’s scary to look at your swollen face in the mirror. But one day you will look back and realize that bulimia saved you. It gave you a chance to understand yourself, showed you what you are afraid of and what you would like more than anything in the world. Helped you discover inner strength that you didn’t realize you had in yourself - so that you believe in yourself and start making your dreams come true.

I like this short poem by Mary Oliver: “Someone I loved once gave me a box full of darkness. It took me years to understand that this, too, was a gift". (“The one I loved once gave me a box full of darkness. It took me years to understand that this, too, was a gift.”) A box full of darkness that is actually a gift is what bulimia is. Remind yourself of this as often as possible. Try to look at her as a friend and not an enemy.

THE TRUTH PROTECTS

Bulimics are subtle and impressionable people, creative people with a rich imagination. They sense the mood of those around them well, know how to inspire and support others, but they themselves easily fall into a state of panic and hopelessness. Food is an opportunity to satisfy the need for tenderness and security, which they lack, to relax and forget about fear, at least for a while. You behave like a child who is afraid of a thunderstorm - you draw exaggeratedly scary pictures in your head and dive under the covers or hide from it in the closet.

Walk into your fear. Every day, do at least one thing that scares you. I'm serious. If you can’t imagine life without weighing yourself in the morning, don’t weigh yourself for at least a couple of days. If you are afraid to call on the phone, call and speak, even if your voice trembles. If you don't know the answer to a question, say so. If you turn off the road because you don’t want to meet an unpleasant person, go straight to him and say hello first. These small feats seem to have nothing to do with food, but they greatly increase self-esteem. And with high self-esteem, you will feel confident and happy - you won’t need to calm yourself down with food.

Also: you are used to eating secretly, because you are ashamed of the scale of what you have eaten. Plan your meals so that you only eat in the company of someone. The more fears you “bring out of the darkness” in this way, the less you will want to overeat. The salvation is to stop lying to yourself. Try not to induce vomiting after a bout of gluttony. Yes, it will be hard and scary, but you will take responsibility for your action and honestly go through the consequences. Next time, remember how you feel from a full stomach: they will help you hold on. Remind yourself that the more often you choose to act honestly (not vomit), the stronger you are, and the weaker and less likely you are to bulimia. Facing the truth is your defense.

NEURAL TRAILS

At your worst, you feel like a zombie - as if food controls you, won't let you stop, even despite the pain. This is the great illusion of bulimia: you are like a sleeping Gulliver whom the Lilliputians are trying to tie up. In fact, the desire to eat is just a conditioned reflex. It arose due to the fact that you did the same thing many times (the kids are annoying - I’ll eat a chocolate bar; I’m walking past the store in the evening - I’ll go in and buy some food; I sat down in front of the computer after dinner - I started throwing everything in the refrigerator). New pathways have formed in the brain - they are called neural pathways. These neural pathways link a stimulus (for example, sitting in front of the computer after dinner) with the desire to eat. Over time, a specific situation automatically arouses the desire to snack.

The good news is that neural pathways emerge and become overgrown under the influence of our thoughts. When you don't go to the candy store despite your strong desire or stay in front of the computer instead of running to the kitchen, you weaken old neural pathways and create new ones - without the participation of goodies. Banning, distracting, running away will not work. The only way to free yourself and take control of eating is to go through temptation (an old habit) and thus create a new one. So next time, rejoice when a bout of gluttony strikes - this is your chance to erase the conditioned reflex. Don’t be afraid, don’t tear your hair out - calmly say: “Yes, now I want to give myself free rein and eat. Yes, I can do it, no one can stop me. Then this conditioned reflex will become stronger. But I can give myself free rein and create a new one - I DO NOT overeat in the evenings. I DO NOT buy tons of food at the store.”

All you need to do is sit quietly with an unpleasant feeling of tension and anxiety (this is created by the anticipation hormone dopamine, which makes you feel like something is pushing you to eat). Wait it out like a summer rain without an umbrella - the wave washed over and passed. You can read more in the book Gillian Riley Eat Less. Stop overeating."

HEALTHY AGGRESSION

Bulimics usually give the impression of being very gentle, sociable, pleasant people. This gentleness is deceptive and comes at a cost to them: they first drown out anger, resentment at injustice, humiliation with food, and then splash it out with vomiting. They are afraid to say no, to express what is boiling over, to fight back - even for the purpose of self-defense. Hence the sudden mood swings from which loved ones suffer - I was just a sweet, caring girl and suddenly a monster is rude, rude, and hysterical. It’s as if a good and an evil twin live in the same body and first one comes out, then the other.

Start expressing not only your positive but also your negative feelings. This is absolutely natural and does not make you a bad person if from time to time you experience anger, disappointment, hatred, jealousy, panic, envy, resentment. To admit means to say to yourself or out loud in a moment of stress: I'm angry because... This person makes me angry because... I'm jealous... I'm sad... I'm offended... You will see, it will become easier and your mood will level out. If you have the opportunity, speak directly about your feelings not only to yourself, but also to the person who causes them. “I feel unpleasant/offended/angry when you say/do such and such...” The more often you practice openly expressing your feelings, the higher your self-esteem will be, the easier it will be to communicate with people and build relationships without resorting to food as a self-defense.

THERE ARE NO MISTAKES, THERE IS EXPERIENCE

Give yourself permission to make mistakes. Fall and rise again. When you were learning to skate or ride a bicycle and took a couple of good flops before something started to work out, it didn’t occur to you to blame yourself for your inexperience and mistakes? It's the same with bulimia. Accept that two and two make four, that it is impossible to lose weight once and for all and eat “perfectly.” For the simple reason that we are not robots, but people. You need to understand and accept periods of overeating, gluttony, and mood swings. THEY WILL. Just honestly telling yourself: “I feel bad, I’m having a breakdown, an attack of gluttony” at the moment when they occur means gradually minimizing them.

ENJOY INEDIBLE TREATS

An excessive craving for sweets and baked goods is also our longing for smells, colors and sounds. Imagine that the 5 senses (vision, touch, hearing, taste, smell) are five flowers on the windowsill. They need to be watered every day and make sure there is enough light and warmth in cold weather. You mercilessly fill the flower called “Taste”, gobbling up chocolates and cakes, while the rest are wasting away from thirst.

We distinguish approximately 10,000 smells, millions (!) of shades of color, and a symphony of sounds. We feel a touch on the skin: gentle, quick, rough, encouraging, timid, passionate, loving... All this is wasted - you are used to deriving joy only from food. You live as if in a remote closet: you woke up, ate your fill, threw up, and so on in a circle. There is a huge beautiful world around and it is full of inedible pleasures. Learn to enjoy them. What smells immediately lift your mood? I love the aroma of freshly washed clothes, peonies, earth after rain, apple pie, freshly brewed coffee.

Try to experience new sensations every day. Wear more bright, rich colors (clothes, manicure, berry makeup, flower hair clips). Fill the space around you with color: colored paper, a notepad, a pen, funny stickers, rhinestones, a lamp in the bedroom. Choose floral and sweet body creams, perfumes, aromatherapy oils and candles. Go to a store for artists, musical instruments - buy small funny things. I have already written about how important it is for good health to hug loved ones, friends, and pets - at least 6 hugs a day!

LAUGHTER

Try to look at your gluttony with humor. Laughter awakens the child in us - it makes it easier to accept the paradox of life and give vent to emotions. Believe in the best and continue to live despite any problems. For example, imagine yourself in the place of the girl in the picture eating the cake. “Yes, I’m hungry and I’ll eat until I burst!” Look for a reason to laugh heartily. This could be a video (here dad figured out how to quickly do his daughter’s hair, but it’s better not to repeat it) or a funny picture, joke, song, whatever.

Collect photos of laughing people, animals that warm and make you happy: look through them from time to time. Keep a funny toy mascot on hand (how do you like my cheerful pink llama in stylish glasses?) Another source of positive energy is films/series where situations related to food and excess weight are shown with humor. One of the best is the tragicomedy “Muriel’s Wedding” with Toni Colette.

Set yourself a goal to smile at least once a day - to a funny kid you met on the way to work, to a salesperson, to a colleague, to a passerby chewing a popsicle in 20-degree frost, to an unfamiliar elderly woman with tired eyes on the subway. Before going to bed, ask yourself: what made me most happy today? why this? If the day turned out to be difficult, what was funny about it? Every time you can see the funny side of a difficult situation, you come out a winner.

If you have a question about bulimia/weight loss or you feel that it is very difficult and need support, write to: