Bulimia: diagnosis and treatment

In order to diagnose bulimia, a doctor needs to take a careful medical history . At the same time, he can ask about the eating habits, physical and mental condition, lifestyle and social environment of the patient. In addition, the doctor will perform a thorough physical examination and may request some other tests. The goal of bulimia treatment is to “normalize” eating habits and maintain a stable body weight .

Bulimia diagnosis

The diagnosis is established on the basis of an anamnestic interview and after clarification of physical and mental problems or problems:

• History, diseases and complications . The doctor is interested, for example, in damage to the teeth (e.g. tooth decay ). He also needs to find out any other diseases or complications, such as esophagitis ( inflammation of the esophageal mucosa ), malabsorption syndrome , osteomalacia , osteoporosis , constipation , hypertrophic osteoarthropathy, electrolyte imbalance disorders , cancer and mental illness (e.g. depression , personality disorders ). . Possible consumption of alcohol or drugs and potential abuse of medicines must also be taken into account .
• Laboratory examination . The diagnosis also includesthe determination of various laboratory values, such as blood count , kidney function test( creatinine and urea ), lipid metabolism ( triacylglycerols and cholesterol ), urine test , electrolytes , total protein and albumin , amylase , transaminase and glycemia . In addition , the doctor can have the level of certain hormones (such as thyroid hormones ) or other laboratory values ​​determined.
• Another examination. The doctor may also indicate an ultrasound examination of the abdomen and, if necessary, some other examinations, such as EKG , gastroscopy and/or computed tomography .

Bulimia treatment

The goal of bulimia treatment is to “normalize” eating habits and stabilize body weight . This can mostly be achieved through psychotherapy . In some cases, it is also necessary to take medication. Treatment is focused not only on physical, but also mental co-morbidities . The doctor decides on the most suitable form of treatment. Not only the patient, but also his/her relatives are informed about the disease itself and its treatment. Especially at the beginning of treatment, but also later throughout its course, it is often very important to maintain the motivation of the affected person for treatment.

Outpatient treatment, day care or hospitalization

Treatment of bulimia is most often carried out on an outpatient basis and according to a stepped plan. In recent times, the support of specialized therapists has proven itself . Under certain circumstances, treatment may be necessary in the form of a daily inpatient stay or even hospitalization (e.g. in very poor health, danger of self-harm, suicide or some type of addiction ). When deciding on the form of treatment, the doctor takes into account not only the individual physical condition, but also the psychological and social factors of the affected person. In any case, treatment should be started as soon as possible.

Eating habits

Eating habits can be normalized with a balanced healthy diet . Sometimes it is also necessary to ensure the supply of certain vitamins and minerals (e.g. vitamin D , calcium , etc.). It is often necessary to monitor the sufficient intake of fluids and electrolytes, which can be achieved, for example, by drinking suitable mineral waters or a mixture of fruit juices and mineral water. In some cases, additional administration of electrolytes is also necessary (e.g. by intravenous infusion ).

Attacks of overeating can be prevented, for example, by regular food intake. The patient sometimes has to learn how to differentiate between appetite and hunger. Information about a healthy and balanced diet and the consequences of starvation can be obtained from nutritional counseling.

Medicinal treatment

In some cases, for example, if the sufferer is diagnosed with depression at the same time as the eating disorder , the doctor may prescribe medication (e.g. antidepressants ).

Family environment

For the success of the treatment, the contribution of the parents is often decisive in all stages of the diagnostic and treatment process: from the recognition of symptoms to the diagnosis to intensive cooperation with the therapeutic team.

Not only for children, but also for teenagers, important decisions and tasks rest on the shoulders of their parents or legal representatives . They often have to first convince the affected person to undergo treatment at all, and at the same time, if possible, not interfere too strongly with his/her autonomy (especially in the case of juveniles).

At the same time, relatives usually find it difficult to come to terms with the fact that they can help relatively little. Many relatives bear the burden of not being able to constantly check on their child, although they are interested in the course of treatment and would like to participate in it. During treatment, conflict situations may arise in the family, which are sometimes better resolved with professional help, e.g. with the use of psychotherapy, family therapy or couple therapy. The patient often successfully hides his bouts of overeating and compensatory behavior. Not only for this reason, relatives often do not even notice bouts of overeating, especially at first.

For more information on this topic, see the article Eating disorders: what can relatives do?

Treatment control and relapse prevention

Recurrences may occur during treatment and after its termination, or even (repeated) interruption of treatment. During the treatment, regular examinations are carried out, the purpose of which is to control the progress of the treatment. In addition, it is necessary to prepare the patient for the period after the treatment is finished. The doctor can thus talk with the patient and his/her relatives about the future return to “normal life” and what to do in the event of a relapse.

Who can I contact?

Adults should first contact their GP , while children and adolescents should first contact their GP . If necessary, the general practitioner will provide further examination and treatment. Doctors of various specializations, possibly even psychotherapists, participate in the treatment itself.