. The epidemiological studies on bulimia and eating disorders in Europe and the United States show a disconcerting picture. Their incidence worries: in industrialized countries 10 out of 100 girls between 14 and 25 years of age suffers from some form of eating behavior disorder). But also the age of debut, increasingly early.
THE eating disorders They have a deep impact not only on those who are affected, but also on people who live with those who have this problem. So above all family members, in which contrasting feelings, tension and frustration are inevitable.
Many difficulties are also due to the dissemination of much inadequate or even wrong information. These generate confusion and false beliefs and make even more difficult to face these situations in the most appropriate way.
The alleged causes of bulimia
This is certainly also due to the fact that we do not yet have precise knowledge about Causes of eating disorders. The research showed how the development of the bulimia and eating disorders in general is due to a complex combination of genetic and environmental risk factors.
Unfortunately, however, certain theories that emphasize the primary role of family relationships in the onset of these ailments (which have led to coin deductive terms such as “anorexogenic mother”) are still in circulation and hard to die. Yet these have been recognized as excessively simplistic and erroneous.
The theoretical models that have identified in family styles the cause of the disorders bring wrong ideas and contribute to developing the same senses of guilt and reactions that can actually help to aggravate or maintain the disorder. Today we know that The family does not “cause” eating disorder. However, family emotional methods can influence its trend and therefore have a role in maintaining or aggravating the disorder or, on the contrary, favor its improvement. In particular, critical comments and hostilities seem to have a negative impact on the treatment.
Correct information on the causes of bulimia and eating disorders
The word “bulimia” derives from the Greek and literally means “hunger from ox”. There Bulimia nervosa It typically begins with a iron diet whose restriction is interrupted after a certain period from the binges. In most cases the bulimic episodes are followed by behaviors at the end of the compensatory such as self -induced vomiting, the inappropriate use of laxatives and/or diuretics, fasting or excessive exercise to prevent excessive weight gain.
The first fundamental thing to keep in mind is that the disorder of the bulimic person It is not the consequence of a personal choice, nor is it due to a lack of will. It is the result of a complex interaction of factors.
The current research has in fact agreed in considering the genesis of eating disorders according to multifactorial models that refer to a bio-psycho-social perspective. The cause of these disorders is not unique, but it should be considered a concomitance of factors that can interact with each other in a varied way and that can favor its appearance and maintenance.
Predisposing factors
According to Garner (1993), all possible causes that may prepare and facilitate the onset of the problem can be defined as predisposing factors. Among these we have genetic factors, factors related to the mechanism of hunger and satiety, socio -cultural factors (in an environment where beauty and personal value are associated with thinness), individual factors (poor self -esteem, feelings of impotence, extreme sensitivity to criticism, conflict between autonomy and dependence, perfectionism and research research) and factors linked to the emotional experience in family relationships.
Precipitating factors
Among the precipitating factors they play a central role thedissatisfaction with one’s body And the choice of restrictive behavior as a dysfunctional solution to improve self -esteem and self -control. Puberty, changes of life, negative criticisms about one’s physical appearance, mourning, traumatic experiences and the choice to undertake a rigid diet are therefore all factors that can lead to the actual onset of bulimia.
Maintenance factors
Among the factors that instead contribute to maintaining the symptoms we have precisely i fasting symptomsthe reinforcement reactions of others with respect to the physical form obtained with the restriction (as they are appropriate to the standards proposed by the company), critical comments with respect to the problematic behaviors of the bulimic person.
How to relate to those suffering from bulimia
Encourage the person to ask for professional help just to make an evaluation and not to start a treatment
You have to point out that the bulimic person In most cases it has a profound ambivalence with respect to urge a cure. This is the first aspect you work when you start treatment. Some patients do not consider eating disorder as a problem, others have an extreme fear of becoming fat, others are generally fear of changing and have difficulty abandoning their control system.
In addition, bulimic people can have a profound sense of shame compared to their behavior and react very badly to attempts to assist and help from family and loved ones in general, not successfully receiving the efforts made by others to help them.
Help yourself and the person sick person to see beyond the problems of weight and food
The bulimic person needs to understand, not to be guilty. The symptom is in fact the way the person has found to face a problem or internal conflict, a pseudosolution (dysfunctional) and must be helped to understand and find more functional ways.
Avoid negative critical comments
Often these comments are the result of incorrect information on the disorder. We must keep in mind that behaviors such as having binges or excessive exercise are not the result of personal choices, let alone a sign of weakness or poor discipline. Instead, they are an expression of the disorder itself.
It may be useful to keep the same attitude that would be spontaneously held if the family member suffered from a somatic disease that prevents him from performing adequate behavior.
Also avoid comments on the weight and shape of the body, it is better to focus on negative effects of bulimia on positive and healthy life dimensions such as friendships, school or sport.
Avoid judgments, threats, hostile reactions and aggression
These reactions are also often due to a wrong interpretation of Symptoms of the bulimic person But they do nothing but intensify negative emotions. They generate guilt and shame in the sick person, who often accentuates the use of dysfunctional behavior precisely to manage these emotional expressions.
Those who want to help a bulimic person must be patient, healing takes time. The bulimic person also needs to feel not judged but supported, also through listening and empathic attitudes.
Do not ignore the problem
Sometimes ignoring the problem is a way to avoid conflicts and try to create a peaceful environment. However, this behavior can be interpreted as a lack of affection and interest, further worsening self -esteem and helping to maintain the problem.
Do not treat the bulimic person in a condescending way
You can be open and honest about your concerns and be specific and concrete compared to problematic behavior. However, it is not useful to force the person compared to his way of eating, better to delegate these aspects to the specialist
Provide information material and encourage to carry out an evaluation by a specialist adequately formed according to the approaches of proven effectiveness
The treatment of eating disorders has made numerous progress and many others must do. As regards bulimia, however, there are approaches whose effectiveness has been widely documented by rigorous studies.
The National Institute for Clinical Excellence (Nice) in the United Kingdom has developed guidelines based on scientific evidence. Cognitive-behavioral therapy (CBT-BN, conceived by Fairburn in the 80s at the University of Oxford) is recommended as a first choice for adults with Bulimia nervosa. This recommendation is based on the empirical support of more than 20 controlled clinical studies that have shown not only its effectiveness, but also its superiority over other psychotherapy or pharmacological interventions.
The most effective psychotherapy
A form of “enhanced” CBT-BN has recently been developed called CBT-E (Cognitive Behavior Therapy-ENHANCED) derived from the transdiagnostic theory and designed to treat all eating disorders. The specific diagnosis is therefore not relevant for the treatment, the content of which is adapted to the mechanisms of maintenance of the individual patient.
Initially designed for the treatment of adult patients in outpatient treatment, it was then adapted also for more intensive care levels and for adolescent patients. In fact, the treatment model develops for subsequent steps adapted both according to the needs of the patient and according to the resources available in the community and in the territory.
The DSM -5 (APA 2013) has inserted traumatic life events within the environmental risk factors for the onset of eating disorders.
In light of this it is necessary to identify adequate therapeutic methods for the resolution of symptoms but also that they can intervene directly on traumatic memories. In this way, the person reorganizes their operating system finding more adaptive methods than those of the symptom. EMDR psychotherapy allows you to intervene directly on these experiences and is recognized by numerous controlled studies as an effective intervention in related stress disorders (Chemtob et al, 2000).
Bibliography
- American Psychiatric Association (2013) DSM-5. Diagnostic and Statistical Manual of Mental Disorders 5 (Trad. It. DSM-5, Raffaello Cortina, Milan).
- Balbo M. (2015). EMDR and Food Disorders. Between past, present and future. Giunti Editore, Florence.
- Chemtob Cm, Tolin DF, Van der Kolkb.a., Pitnam Rk (2000), “Eye Movement Desensitization and Reprocessing”. In Foa and et al., “Effective Treatments for Ptsd: Practice Guidelines from the International Society for Traumatic Studies”, Guilford Press, New York.
- From the serious R. (2014). Food disorders: a practical guide for family members. Positive Press, Verona.
- Fairburn, CG (2010). Cognitive behavioral therapy of eating disorders. Florence: Eclipsi ed.
- Garner D. (1993) “Self Report Measures for Eating Disorders“. Current Content, Social and Behavoral Sciences, 8.
- National Institute of Clinical Excellence. (2004). Eating Disorders. Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. Clinical Guideline 9.
