Five irreversible health consequences of bulimia

Bulimia nervosa

is an eating disorder. A person, through cleansing, tries to get rid of the extra calories he consumes. People cleanse in different ways. Some people induce vomiting by stimulating the gag reflex. Others abuse laxatives or diuretics. Some people go hungry after eating a large meal. The adverse physical side effects of bulimia may not be noticeable at first, but over time they can affect the entire body.

Bulimia can also impair a person's mental and emotional health. The side effects of this condition can be life-threatening, especially if the person does not receive treatment.

Causes of bulimia

Any eating disorder, including bulimia, is dangerous because in the long-term course of the disease, multiple physiological disturbances can occur. In addition, bulimia is often combined with other nervous and mental disorders, such as depression and suicidal thoughts.

Bulimia most often affects women, but men are also affected by this disease. Experts put the figure at 15% of bulimic men out of all those who sought help. However, it must be taken into account that men are less likely to seek help and may react aggressively to offers to receive psychotherapeutic treatment, so the actual number of patients with bulimia among men should be higher.

The causes of bulimia are not completely clear. Many researchers are guilty of double standards in the fashion industry: girls want to be like anorexic models, they develop a feeling of inferiority, which they try to eliminate by controlling their weight. At the same time, constant hunger strikes and strict diets cause the body to rebel, resulting in systematic, uncontrolled eating of food.

Other doctors note that a genetic predisposition to bulimia is also possible, and cases have been recorded in which children suffering from bulimia also developed this disease. However, in this case, it can be problematic to identify the root cause: the atmosphere in the family or a truly genetic factor.

The harm of bulimia is not in the fact of overeating, but in the fact that the eating process itself is disrupted. All body systems are vitally dependent on the supply of nutrients that it receives from food. With bulimia, it is absolutely impossible to call nutrition healthy; the situation is exactly the opposite.

What is bulimia?

Absolutely everyone knows that beauty requires sacrifice. This unhealthy passion for perfection has given rise to such terrible pathologies as anorexia and bulimia. Anorexia is an absolute refusal to eat to lose weight, while bulimia can be called uncontrolled eating of a huge amount of food. This psychopathic state is characterized by a hunger that cannot be satisfied. At the same time, patients with this diagnosis experience a feeling of guilt because they are unable to restrain themselves. And in order to somehow calm themselves down, victims of this disorder try to get rid of what they have eaten. They:

• use diuretics or laxatives;
• deliberately induce vomiting;
• use an enema;
• bring themselves to exhaustion in gyms or saunas.

What is the danger of bulimia

Bulimia may cause anemia, excessive dry skin and low blood pressure. When vomiting is induced, a rupture of the esophagus may occur, and various diseases of the gastrointestinal tract may occur. In women, the menstrual cycle may be disrupted, becoming irregular or disappearing altogether. The latter can affect the reproductive functions of the female body. Bulimia is especially dangerous during pregnancy: the birth of a child with various disorders is possible, since the fetus needs adequate nutrition from the mother.

It is quite easy to spot the symptoms of bulimia. Those susceptible to this disease often experience destruction of tooth enamel due to frequent exposure to stomach acid through vomiting. Scratches and damage to the fingers occur from damage to the skin upon contact with teeth. Patients may suffer from seizures and muscle spasms due to an imbalance of electrolytes in the body. Dehydration leads to increased dryness of the skin, which can begin to peel.

The triggering factor for the development of the disease can be a variety of troubles in the social environment. Problems at work, the feeling that a person is not valued, the inability to build relationships with the opposite sex. However, opposite, seemingly positive, factors can also lead to provoking the disease. An unexpected promotion at work, which is given an extremely valuable character, the beginning of a relationship with a new partner, the expectation of some joyful event can also cause illness.

Bulimia and psychosomatics

Bulimia is a psychosomatic syndrome characterized by a “voracious appetite” in which large amounts of food are consumed. For fear of gaining weight, patients often induce vomiting immediately after eating and/or try to limit food intake, fast, take medications, and exercise intensively. Mostly women aged 15 to 30 years are affected.

Bulimic “scenes of eating and vomiting” include impulsive actions against a background of pronounced affective stress, carried out in complete solitude. If other people come or other interference appears, then these actions are interrupted and shyly hidden. Patients often prepare for eating food by making large purchases or even stealing. They often hide it from others for a long time until everything comes out, disrupting the entire life situation: thoughts about food take up more and more space in the lives of these people, family, interpersonal and professional problems recede into the background or numerous somatic consequences arise. We are talking primarily about chronic forms, which ultimately lead to medical intervention. It is not easy for patients with bulimia to give up a form of behavior once adopted. In chronic and typical forms, we have to talk about the painful nature of the disorders, which indicate not only somatic risk, but also mental conflict situations and pathological development.

Bulimia differs in personality and behavior from anorexia nervosa, in which patients also induce vomiting to reduce body weight, primarily after inevitable family dinners or during hospital treatment. Patients secretly go to the toilet and free themselves from food. However, with anorexia, there are no typical attacks of “ravenous appetite”. In some cases, patients experience nocturnal attacks of “ravenous appetite”; Patients undergoing inpatient treatment sneak into the kitchen at night or eat what is in the refrigerator. But anorexia is also characterized by an overvalued idea of ​​losing weight, which has unfavorable self-destructive consequences, and patients obsessed with it ignore the real weight of their own body. Typical fasting anorexics with their struggles and their psychopathological picture are not difficult to distinguish from bulimics. The latter have normal or slightly increased body weight, and they are not in danger of fasting, which sometimes leads to death in anorexics.

Epidemiology and medical history of bulimia.

After the Second World War, bulimia in young women was described as casuistry, and in the last 30 years it has been increasingly mentioned in publications and clinical reports. Bulimia is increasingly overtaking anorexia nervosa in frequency, but not in need for clinical treatment. Unfortunately, for now we have to be content with approximate data on the frequency of bulimia. The largest number of patients is identified during population surveys. Thus, in Russia, 10% of women aged 15 to 35 years report bulimic episodes, but this does not reflect the actual situation. When examining the urban population, 1% of women of this age are affected by this disease.

A disorder that appeared only in the middle of the 20th century and whose frequency has been increasing in recent decades exclusively among women to an increasing extent, even among psychosomatic disorders, is unusual. It indicates a connection with the cultural value system and forms of social life and makes it justifiable to define it as an “ethical violation.”

When carefully studying patients with this disease, in most cases we have to talk about the painful nature of the disorder, which indicates mental pathology and conflict situations and, in addition, can have significant somatic manifestations. There are a number of parallels with anorexia nervosa, in some cases their combination and transitions are noted, but in general, taking into account the characteristic signs of these ailments, and first of all the preservation of normal body weight in bulimia, they are easy to distinguish from each other.

Symptoms.

A bulimic episode consists of abundant and rapid consumption of high-calorie, so-called filling foods, such as chocolate, butter, sausage, flour products, cottage cheese, etc. The average calorie content of one such meal is 3000–4000 cal, and sometimes reaches 10,000 cal. A person eats so greedily that he sometimes injures himself with his own teeth that have grown incorrectly or are deformed. This is followed by the act of vomiting, which most women induce with incredible ease, and some by manipulating instruments in the throat. In this case, damage may also occur, for example, with a knitting needle. Frequent and sharp increases in intra-abdominal pressure lead to typical swelling of the face or even hemorrhages in the conjunctiva, which attracts the attention of others.

The patient, 25 years old, unmarried, came for a psychosomatic consultation at the insistence of her parents. For 2 years, she has been treated by therapists for swelling of the face, which, after many weeks of observation in the clinic, was regarded as “idiopathic cyclic edema” and “secondary hypoaldosteronism”; receives diuretics, but without effect. Due to the suspicion of depression, she received various antidepressants for a long time, which also had no effect on the general well-being and swelling of the face. The patient complained of increased sensitivity to light, headache, a feeling of pressure in the head, difficulty concentrating, as a result of which she had long been unable to work. The patient herself believed that she had an organic disease, since she had no conflicts. And only when it was possible to overcome the patient’s persistent desire to deny everything, during intensive questioning it was discovered that she had been eating irregularly for 10 years, was monitoring her body weight in order to reduce it, and, most importantly, she was eating 3-4 times a week, and sometimes and 3 times a day there are attacks of ravenous appetite followed by profuse vomiting. She did not tell the doctor about this because “he never asked her about it.” During the first conversation, she denied the presence of any problems in herself and in relationships with other people, was reasonable, and rejected sympathy for her.

Only over the course of subsequent long conversations did she discover her own problems: that it was difficult for her to establish emotional connections with people, that she felt like a stranger and an outcast, and was happy when they left her and left her alone. But at the same time, she has a feeling of emptiness, abandonment, when she feels loneliness and there is nothing that would interest her, that would fill the emptiness. When, at the request of the doctors, she compiled a detailed description of her experiences, it turned out that during the day she often does not eat anything, but when experiencing emptiness in the evenings, and more often at night (wakes up 2-3 times) in a kind of “twilight” state, she satisfies attacks of hunger.

It is characteristic that all these “bulimic scenes” take place secretly, since the process of eating, like the subsequent vomiting, involves loneliness. If during the preparation or conduct of this ritual someone else appears and the isolation that is its indispensable condition is broken, then it is interrupted. This is due not only to the fact that eating and vomiting in the presence of others is experienced by the patient as something humiliating and shameful; it also implies, like scenes of sexual self-gratification, encapsulation, immersion in one's inner fantasy world.

The situation and mood that triggers bulimia is a feeling of inner emptiness and boredom, which leads to a difficult-to-identify feeling of tension that finds release in bulimic actions. In an inconsolable feeling of loss of self, people achieve pleasant sensations by greedily devouring food. Along with self-isolation, the process of eating represents, especially if the limits of saturation are exceeded, an attempt to replace the act of sucking the breast, which has already become impossible. Bulimic action leads not only to a feeling of satisfaction, but often to a reduction in anxious and negative tension.

During the bulimic cycle, eating and preparing for it increasingly occupy a person's thoughts and fill his day, so that everything else fades into the background. Bulimic Scenes eliminate everyday frustrations.

The patient is 22 years old, a student, and over the past 4 years her symptoms of bulimia have been increasing. She received outpatient psychotherapeutic treatment for 3 months. She told her therapist: “When I hear in recent weeks that I am sick, I run to town, although I don’t really know what I should do. I have money, I buy food, run home and “swallow it all” there. Then I make myself vomit. But I'm left alone all the time and don't feel anything. Then I go to my room and use a razor blade to cut my hand until it bleeds. Then I feel myself.”

At the beginning of bulimic development, body weight increases slightly, and then fluctuates widely with a characteristic general tendency towards excess body weight.

Due to the secret nature of “bulimic scenes”, many patients do this for years without attracting the attention of others. Under our supervision was a 30-year-old married woman with two children. The patient received treatment for general somatic complaints and for the first time, after many treatment sessions, told in great secrecy that she had had bulimic symptoms for 10 years with “attacks of eating and vomiting.” Neither the husband nor the children know anything about this.

Causes.

If we consider the conflicts in which young women with bulimic syndrome find themselves, the following conditions are discovered.

1. Young girls and women at school and later at work as employees, employees or students today are required to work no less than men, but at least as much. Women must improve their skills through education and additional training; the second and third decades of life are determined by their professional self-expression. They imagine marriage, pregnancy and raising children differently than their parents. At the same time, first sexual contacts and attempts to establish strong connections occur earlier.
2. For a woman’s attractiveness as a sexual partner, a decisive role is played by her body, its appearance, which corresponds to the existing ideal of beauty in the eyes of a particular man, his corresponding age group and, finally, the social ideal as a whole. Over the past 20 years, this ideal has increasingly shifted away from rounded shapes towards a more childlike and graceful figure. The ideal of beauty, as seen in the examples of fashion models, fashion models from glamor magazines and other magazines that appear every day, is an attractive, athletic, graceful, girl-like woman. Changes in the ideal of female beauty can be traced by the gradual and constant decrease in the volume of the breasts and hips. This ideal is especially difficult to achieve precisely during puberty and in the years following it, when there is a physiological increase in body weight, mainly due to the development of adipose tissue, and not muscle, as in men. It is difficult to refuse food in the family and during shared meals with friends and girlfriends. However, the number of young women who deliberately control themselves by limiting the amount of food they eat, dieting or other means significantly exceeds the number of women with bulimia.
3. Not all women and men between the ages of 15 and 30 equally experience the contradiction between social expectations regarding their professional activities, the ideal of grace and the excess of food consumption over food needs and fall into the “bulimic circle”. Women with certain personality traits are more likely to get sick. If test studies revealed an increased frequency of depressive symptoms, this does not necessarily indicate the initial characteristics of the personality, since it may be a consequence of the situation that caused it or bulimia itself. “Bulimic attacks” are experienced in any case as a defeat and lead to feelings of guilt, self-reproach, and, when repeated, to a state of hopelessness and despair. It is likely that women who take social criteria and demands for the ideal of female beauty especially seriously are more likely than others to underestimate themselves. Compared with patients suffering from classical neurosis, they give the impression of being rather extroverted, businesslike and prone to impulsive affective actions, as they subsequently show in “bulimic scenes”.
4. Bulimic actions, especially those performed for the first time, are associated with normal difficulties and moderately difficult situations, such as separation from loved ones, from friends or girlfriends, work circumstances, an overwhelming monotonous study situation, long and tiring lecture classes and preparation for exams, interest to which it decreases. Most women describe their condition before developing a bulimic attack as a feeling of loneliness, emptiness and disappointment in other people, a feeling of disconnection, boredom, and sadness. In such cases, the procedure of eating and drinking is comforting, as if removing one from a difficult situation. You want to experience this pleasure, known since childhood, as often as possible, as something that creates comfort, relieves stress, and gives temporary satisfaction and well-being. But this is at the same time something that depresses (if a woman does not want to give up basic pleasures as a woman), or, in any case, should be increasingly pushed back and delayed as much as possible. This situation finally leads to the appearance of a voracious appetite, to an attack of greedy eating and to the vicious circle that creates bulimia.

The personality structure of patients with bulimia is as ambiguous as with anorexia. However, with bulimia there are fewer pathological traits and there is hardly a tendency towards a borderline personality structure, much less towards the formation of psychosis. In connection with extroversion and a tendency to dramatize, within the psychology of neuroses we can talk about hysterical traits. There is also a tendency towards substance abuse and the danger of addiction to alcohol or other drugs. In the anamnesis and with the so-called search for psychoetiological traces in early childhood, it is not possible to establish traumas or environmental conditions common to all patients. In some cases, an increase in the frequency of bulimia in families and in identical twins has been noted. But this only indicates that adult women with a certain personality type are especially sensitive to social demands and contradictions, and this “overload” leads to the development of bulimia. The assumption in the process of “searching for psychoetiological traces” about the presence in early childhood or infancy of an “oral basic disorder” is the common opinion of many psychoanalysts, and it is as unprovable as it is incredible, because in this case one would have to agree with some dramatic change in the nature of child care in recent decades.

In general, bulimia should be explained by the social contradictions in which modern women grow up. This is, firstly, leaving the parental family and the task of developing one’s autonomy; secondly, a developmental problem in connection with rejection of one’s sexually mature body and conflict in connection with sexual identification. These problems became critical against the background of the female post-pubertal period of development at the end of the 20th and beginning of the 21st centuries. The period of adolescence is presented as a kind of “psychosocial moratorium,” but it is during this time that a person is given the responsibility to work and love.

The primary physical causes of bulimia are unknown and not even suspected. It is all the more important to study secondary consequences with serious somatic complaints and serious changes. As follows from the examples above, patients turn to doctors about weakness, exhaustion or apathy, without mentioning their long-standing bulimia. An external sign of bulimia can be a puffy face with swelling in the area of ​​the salivary glands, especially the parotid glands. Upon careful examination, they often find damage and scars on the hands, as well as on the palate, which arise as a result of frequent vomiting, and erosion of tooth enamel due to the influence of the acidic contents of the vomit.

Laboratory studies show shifts in electrolyte composition, tissue dehydration, and decreased vascular tone. These secondary physical changes are not life-threatening as in anorexia nervosa, but they should be taken as seriously as secondary mental disorders. As bulimia develops, the patient’s attention is increasingly occupied by thoughts about preparing for and avoiding subsequent nightly bulimic attacks. When questioned, many young women report that these thoughts occupy them for almost half the day. In this regard, they are increasingly isolated from others, neglecting work responsibilities, studies and friends. However, with bulimia, patients are relatively more likely than with anorexia to have strong connections with other people. But interest in the opposite sex steadily decreases during the development of the disease due to feelings of guilt and shame, fear of becoming physically unattractive, etc.

Differential diagnosis.

Bulimia should be distinguished primarily from anorexia with bulimic attacks, since approximately 50% of women with anorexia nervosa experience bulimic attacks. It is not uncommon to see that initially overweight women initially perceived as suffering from anorexia nervosa later turn out to be suffering from bulimia. Typical bulimia is characterized by maintaining normal body weight or an ideal idea of ​​normal weight, which is only slightly reduced. Body weight in patients with bulimia often fluctuates, sometimes there are transient irregularities in the menstrual cycle, but there are no long-term loss of cycles. Bulimia should also be distinguished from chronic neurosis with vomiting in women with a hysterical personality structure, who suppress psychotherapists and others with stories about their vomiting, without hiding them at all.

The personality structure in patients with bulimia has as little unity as in anorexia, but is characterized by a greater frequency of neurotic traits. Hysterical features that predominate in anorexia nervosa are more often found. There are practically no transitions to psychosis, but along with neurotic forms, a group of deeply pathological personalities has been described who also develop alcoholism, uncontrolled sexual behavior and, for the most part, demonstrative suicidal attempts. These cases highlight the need for different therapeutic approaches.

Treatment.

As with psychosomatic diseases in general, in order to choose adequate treatment, in each individual case of bulimia one should take into account the characteristics of the patient, i.e. age, motivation, chronicity, ability for adequate self-esteem, physical and mental state, severity of personality disorder, alcohol abuse, risk of suicide, etc. Representatives of different schools report the effectiveness of almost any treatment - from classical psychoanalysis to family therapy, from behavioral therapy to Indian meditation. At the same time, over the past 10 years, comparative data on indications and prognoses for various treatment methods have been obtained.

1. Psychotherapeutic treatment, in which the patient remains in his usual conditions, is adequate for most sick women and is often sufficient. And only if pronounced abnormal personality traits, suicidal tendencies, alcohol abuse, etc. come to the fore in the picture of the disease, inpatient treatment is indicated for those suffering from bulimia.
2. When eating behavior causes damage to the body, one cannot ignore the symptoms and limit oneself to uncovering unconscious damage hidden in early childhood. As with other eating disorders and forms of drug addiction, indirect revealing psychotherapy is contraindicated. The method of choice is system-centred, confrontational and structured interventions and active management of treatment aimed at overcoming symptoms, especially in time-limited forms. The success of treatment is stabilized by subsequent protective, accompanying and, if necessary, further revealing forms of treatment; the effective use of mesopsychology methodology.
3. In one or more diagnostic conversations with the patient, her current eating behavior and general life situation are clarified: mostly chaotic and hidden from others and from herself, eating behavior in all its details - the number of meals, its quantity, preparation for food, situations, etc. in which such behavior arose, and first of all the mood preceding it, and then the emotional background in the current life situation with its difficulties and conflicts and external and internal circumstances.
4. The patient is offered a new eating regimen in the form of a written program with clear regulation of the frequency and time of intake, quantity and type of food. To do this, all the details of nutrition are noted in the notebook that the patient keeps daily.
5. A specially dedicated page of the notebook describes the most important events of the day, mood and, above all, situations in which relapses of bulimia occur, with their dependence and connection with the emotional state.
6. The development of general life and conflict situations, as well as the symptoms of relapses of bulimia, are discussed once a week in an individual half-hour conversation with a psychotherapist. The nutrition and life plan for the next week is drawn up taking into account the physiological need for carbohydrates. The patient is weighed in the presence of her doctor, who thus “documents” responsibility for her body weight and health status.
7. Next comes group conversations with patients with bulimia, conducted by two psychotherapists (often of different genders). Individual interviews can also be conducted by experienced nurses and social workers.

This stage of treatment lasts more than 10 weeks; Conversations are conducted in the afternoon or evening individually or in groups or a combination of these techniques. Experience shows that it is necessary to take into account the possibility of relapse after the first meeting with a doctor. However, the success of treatment when maintaining the integrity of this specialized program gives good results. The treatment tactics are such that after a 10-week intensive program it is necessary to conduct individual conversations with patients, first at small and then at increasingly large intervals of time (after several weeks, then months), but always within a firmly established time frame. For patients, the fact that someone is constantly interested in them and will share responsibility with them if they report subsequent relapses is a major support.

Treatment methods for bulimia

People with an unbalanced psychological structure, who tend to overestimate the significance of events, are more susceptible to bulimia. Therefore, a productive, kind atmosphere in the family is especially important for the prevention of this disease. A child should never be punished or rewarded with food. And if he is prone to being overweight and is worried about this, it is necessary, together with a nutritionist, to select a suitable diet for him, without fixing the child’s attention on this fact.

Treatment for bulimia usually does not require hospitalization. The specialists who treat this disease are a psychotherapist, a psychologist and a nutritionist. Cognitive behavioral therapy for bulimia, in which the patient is taught to consciously control their eating behavior, has shown good effectiveness. The patient conducts self-observation, fills out a diary, where he notes the frequency of food intake, its quantity, as well as cases of breakdowns.

Medications for the treatment of bulimia are prescribed only in the presence of concomitant diseases. Most often, bulimia is accompanied by depressive disorders or neuroses, so antidepressants are prescribed.

However, the main treatment method for bulimia is psychotherapy, which is prescribed individually by a doctor. It is impossible to say in advance which method of psychotherapeutic treatment will suit a particular patient. This depends on many factors, both on the individual characteristics of the patient and on his social environment.

Good effectiveness is shown by visiting self-help groups that work according to the 12-step program. This program was originally developed for the treatment of alcohol addiction, but now the principles of this program are applied in many cases where a variety of addictions are observed. In any case, self-medication for bulimia is contraindicated; it is better to consult a professional doctor.

Diagnosis of the disease

It is very easy to diagnose the disease in yourself and it does not present any difficulty for the patient. He quite consciously observes strange eating habits and loss of control over eating behavior, but may not know that these are signs of a dangerous disease. Therefore, you need to listen very carefully to your feelings and not let everything take its course if your eating behavior or depression interferes with your life and occupies all your thoughts.

It is most difficult to diagnose the disease in loved ones. Often, people suffering from bulimia hide their illnesses from others, trying to cope with them on their own. It also happens that the sick themselves are fully aware that they are in danger and even ask for help from loved ones, but they do not heed their requests, because they believe that there is nothing life-threatening. This position is wrong and extremely dangerous. It is very important to understand that bulimia is largely a mental illness. And people suffering from mental illness can be unpredictable in their actions. People with low self-esteem and constant feelings of hatred towards themselves and their bodies may practice suicide. I'm not even talking about the clinical picture of the disease.

Overeating due to lack of positive emotions

When to see a doctor

The effectiveness of treatment for this disease depends on how promptly the patient consults doctors. The disease is treated by a psychotherapist who can refer the patient for consultation with a psychiatrist and nutritionist.

You should seek medical help as soon as possible if:

• there is no feeling of satiety;
• periodically there are attacks of overeating, which the patient does not control;
• there is a fear of gaining excess weight;
• the patient is dissatisfied with the appearance;
• Eating alone is preferable;
• the patient is afraid to start eating because he will not be able to stop;
• after eating, a feeling of irritation and anger appears;
• behavior becomes impulsive.

JSC "Medicine" (academician Roitberg's clinic) in Moscow offers the services of qualified psychotherapists and psychiatrists in the field of treatment of bulimia. The clinic is located at the address: 2nd Tverskoy-Yamskaya lane, building 10, a 5-minute walk from the Moskovskaya metro station. Highly qualified psychotherapists and the use of modern treatment methods allow patients to be confident in the success of therapy.

Diagnostics

Diagnosis of bulimia nervosa requires at least two attacks per week. In addition to the identified symptoms, the condition of the entire body is necessarily analyzed to identify disturbances in the functioning of internal organs.

When diagnosing, attention is usually paid to three main signs of the disease:

• Firstly, overeating. This symptom may occur in attacks throughout the day or at night.
• Secondly, the patient uses various methods to correct body weight - vomiting, laxatives, fasting, diets and exercises.
• Third, the disorder is usually associated with a strong dependence of self-esteem on appearance.

If all three signals are present, we can talk about the presence of symptoms of bulimia nervosa and begin urgent treatment.

Symptoms and signs of bulimia

If bulimia occurs, the symptoms in most cases are characteristic, which simplifies the diagnosis:

• a person does not stop while eating even when he feels full;
• the patient is constantly looking for a way to prevent weight gain;
• the patient evaluates his body very critically, and the evaluation affects self-esteem;
• the feeling of hunger does not subside even while eating;
• problems with the digestive organs begin;
• salivation increases;
• inflammation of the throat becomes more frequent;
• dermatitis appears;
• moral and physical strength weakens.

Despite the fact that signs of bulimia develop, the weight of patients remains within normal limits.