Yes, we can cure bulimia and anorexia!But the fight is long and difficult.Doctors explain how to get out of the confinement in which women suffer from these eating disorders.If each story is singular, the therapists have nevertheless managed to make precious advice for all.
Anorexia, bulimia and bulimic hyperphagia are part of the most common eating disorders (TCA).They most often start in adolescence and the beginning of adulthood.The most affected people are essentially young teenage girls, even if TCA can also concern men and people of all ages.
Mental Bulimia and Mental Anorexia: Definitions
Mental anorexia, also known as nerve anorexia, is "a disorder of food behaviors which most often occurs at the time of puberty.It manifests itself by a categorical refusal to eat normally for a long period, to lose weight or not to take it, "writes Inserm (National Institute of Health and Medical Research) (Source 1).She declares herself most often between 14 and 17 years old, with a peak of maximum prevalence at 16 years old."About 20% of young girls adopt restriction and fasting behaviors at a time in their lives but only a minority of them become anorexic, then presenting all the diagnostic criteria associated with this disorder".
Mental bulimia, also called nervous bulimia, is characterized by quickly ingesting a very large quantity of food, in secret, with a feeling of loss of control - at least twice a week.Bulimia affects approximately 1.5 % of 11–20 year olds and concerns about three young girls for a boy, notes the High Authority for Health (HAS) (Source 2).
A person with mental anorexia will restrict their diet in order to control their weight.On the contrary, a person with mental bulimia has food compulsions that will prevent him from controlling his weight when she would like.
In some people, anorexia and bulimia can coexist: they then alternate bulimia crises, then voluntary vomiting and fasting periods.
What are the causes and what are the symptoms?
Most TCA have multifactorial causes.They would be the result of an interaction between psychological factors (personality, emotional stress, psychological shock, trauma, etc..) and environmental (education, family, social background...) and biological.
"The diagnosis of mental anorexia is based on precise clinical criteria, from international classifications (CIM and DSM 5)", explains the HAS (Source 1).These criteria are:
We can also cite the absence of rules for at least 3 months (amenorrhea) in the patient as well as a slowdown in growth.
Mental bulimia is characterized according to the High Authority for Health (Source 2) by:
People with bulimia generally have a normal BMI due to compensatory behavior, "said Inserm.
Nervous bulimia, nerve anorexia: what are the treatments?
Life has become hell, unbearable food disorder."I no longer had the courage to do anything," says Émilie, 24, like many others, made the decision to treat herself.But how and who to turn?"We must stop opposing approaches, but juxtapose for more therapeutic efficiency," insists Professor Dodin, psychiatrist.
Medical monitoring and nutritional rehabilitation make it possible to treat undernutrition, which occurs both in anorexia and in bulimia with vomiting.
Psychotherapy is in parallel, association of individual therapy of analytical inspiration, family therapy, group therapy, or behavioral and cognitive therapies.It is a question of revisiting the facts of its history which could have been painful and generate blockages, phobias or inhibitions.
Helping the person to understand what may have happened and build himself in him so that he arrives at such behavior, explains the psychotherapist Sophia Ducceschi.Over the sessions, the meshes of the self -esteem is undone.
During management, therapy also revisits erroneous representations concerning the food balance, the weight, the way in which the food is distributed over the body, the one that is perceived in relation to the others...
À lire aussiGeneral advice in the event of eating disorders
For Dre Colette Combe, chronobiology allows chaos of the first symptoms associated with bulimia as well as to anorexia."Patients are often surprised that I know that they also suffer from sleep disorders," notes the specialist, who advises eating and going to bed at regular hours, going up the bedtime, half an hour per half-hour."This framework reassured me, testifies Émilie.We let go of certain things, we regain control over others ".
The small victories are very gradual, and especially at first, you have to agree to move forward step by step.
Do not seek perfection, be in the whole or nothing, but rather to experience that small improvements change everything, observes Dr. Combe.
"In the case of bulimia, lose a kilo or two, and we breathe better.Take a little bit, and anorexic thoughts are less strong.The start of change is to experience failure is a lesson that allows you to improve.The only quality you need, and it depends on the motivation is to be regular in accessible and achievable efforts, "continues the expert.
Identify the advantages of being able to get out of this disease maintains the motivation.
"Anxiety is born not to have understood that error, failure is examed and think of it," said Dr. Combe.The psychiatrist proposes to talk about these failures with a friend, a loved one or a therapist with the intention of drawing "the lessons of the experience"."Speaking as we dream of two, putting symbolic images of experiences on emotions and feelings is the beginning of the treatment of the disorder, the images heal, the metaphors nourish", she explains.
À lire aussi"Imagine what you expect from your life, where you would take your desire for life if you were not sick.Don't worry if this is achievable or not.What do you want for the coming five years? "Asks his patients the Dre Combe, who knows that we only heal a disorder if one becomes more free to besame.
To be in your desires, even if it means changing orientation, trade, companion."I testify that those who healed have dared to be themselves, even if it is to be 'the ugly duckling' of the family," continues the specialist.The disease is no longer part of an identity.
It is important to surround yourself and see people who have really healed.This can be really encouraging and motivating for the sick person."As long as we have not seen them, it is difficult to believe," says Émilie.This materializes the possibility of getting out of it one day.
"In these pathologies, the body is not only abused, it is denied.Realizing and accepting that there is a way of treating yourself, "said Sophia Ducceschi.The idea is therefore to introduce a relief body treatment, which relaxes, which is good: massage, sophrology, osteopathy, yoga, tai chi, beauty institute, hammam...
"These activities allow you to refocus on the body, living, thrilling, which has rhythms.They "force" to take the time to listen to his body, "said Professor Dodin.
It is important to open another window on your life than studies, the profession, or the family...Find an occupation, an activity, an interest, going to music, singing, drawing, theater, board games allows you to discover the relationship with the other to be less afraid of it.And to discover.
Advice in case of bulimia
Dr. Combe advises to add starchy foods and proteins each meal to reduce the frequency of crises.This is the reason why she directs towards an Anglo-Saxon breakfast, with bread and proteins: cheese, cottage cheese, ham or egg.
"I do not give any notion of quantity, preferring to play on quality".The meat also makes it possible to reintroduce the symbolism of chewing, to bite life."To redo the teeth and bite, in life, rather than engulfing, makes it possible to rebuild orality".
À lire aussiThe end of the meal is normally triggered by the fact that the stomach is full."This is not the case with someone whose stomach is dilated", he cannot stop, says Colette Combe.
The first thing is to reduce the size of the stomach: do not drink at the same time as you eat, and do not expand your stomach with hypocaloric foods (yogurts, apple, raw vegetables, green salads).The second, to eat nourishing foods in the energetic sense of the term, starchy foods and proteins.
"For most bulimic people, it's easier to eat with someone than alone.If this is not the case, I advise to take breaks, to listen to music for example.The meal must be a happy and calming moment, "said Dr. Combe.
Identify strong, sad or joyful emotions, which can trigger crises makes it possible to anticipate delicate situations and put in place strategies to avoid them.Some are easier than others to be eliminated, starting with the first is a good start.
"In the happiest case, motivation, projects, the desire to be like the others, are enough to reduce them.If this is not the case, they must be erode one by one, decrease from four to three, then from three to two crises per day or per week...", Continues Professor Dodin."When there is no more vomiting for three weeks, it's over.We realize that we find his energy and his emotional balance, "notes Colette Combe.
"It's not going", "I have it across the throat", "I can't swallow it"...are expressions that underline the symbolism of food."A difficult fact to take can manifest itself by a discomfort in food," says Dr. Combe.
It is a state of crisis, a simple form of the adolescence crisis, protest or reaction to disappointment with adults.However, disappointment, injustice are part of adult life.Knowing that if you close on it, they get worse, is often enough to assimilate it.In parallel, you have to give a taste for believing that you can invent something else.
It is a question of reintroducing the proteins and starchy foods, in small quantities at least at the beginning, for two to three weeks: half a-stage, three tablespoons of cooked rice, pasta or mash, and swap the yogurts byA piece of cheese, goat, sheep, gruyère, more nourishing.Knowing that "proteins do not get fat and that they give energy to have its will," explains Dr. Combe.
In terms of starchy foods, "it is going back to the first diet of the child, so it's easy to enhance a digestive tract that hasn't eaten for some time," continues the specialist.
Anorexic people cannot realize like the others so easily, the microvilli of the intestine, a sort of carpet on which the food is cut in molecules, being atrophied.
In addition, attributing achievable objectives gives confidence in the ability to achieve them because very quickly, there is a Renutrition which allows you to get out of the fog.This step past, it is proposed to increase the quantity of food, to vary the menus, textures and tastes.
At first, as during puberty, weight gain is not harmonious."The body loses its bone appearance, it is rounded.This transformation is all the more afraid that she is not pretty, "says Émilie.
"Fortunately, my therapist reassured me many times and repeated that it was transient, that in the long term the lines and the curves would be more harmonious.It helped me accept to look at myself, not to release my efforts, to tell me that this little belly was growing, it was mine and that it might be fine! ".
Eating disorders: where to find help?
The National Federation of Associations related to Dressing Due Drivers (FNA-TCA) helps people with TCA, as well as their loved ones: families, spouses or companions, friends, work colleagues ....With her thirteen years of existence, she participates in the recognition of TCA as a major public health problem.
The Association Enfine is an association law 1901 bringing together professionals (psychologists) and non-professional volunteers wishing to bring listening and support to people suffering themselves, or having those around them suffering from TCA.
Founded in 1999 in Strasbourg by professionals and parents, Artta is a regional network whose mission is to promote and support all forms of treatment, aid and support for anorexia and bulimia.
The French Federation Anorexia Boulimie (FFAB) is an association which brings together specialists in screening, diagnosis, management, treatment and research on food behavior (TCA), as well as representatives of federations andfamily and user associations.
Anonymous anorexics anonymous are a fraternity of women and men who share their experience, their strength and their hope in order to solve their common problem and help other anorexic and bulimic to recover.
Association Boulimie Anorexie (ABA) is an association of volunteers, parents and ex-malades, in order to help parents, to provide support and information also to relatives as well as to patients faced with the problem of food disorders.
Source 1: "Mental anorexia - an essentially feminine disorder, on the border of somatic medicine and psychiatry", National Institute of Health and Medical Research (Inserm), 13/06/2017.
Source 2: Recommendations of good practice "Bulimia and Bulimic Hyperphagia: Locating and general elements of care", High Authority for Health, 12/09/2019.
A lire aussiAuteur : SNathalie CourretExperts : Dr Gérard Apfeldorfer, psychiatre psychothérapeute, Groupe de recherche sur l’obésité et le surpoids ; Dre Colette Combe psychiatre, psychanalyste, responsable du DU des troubles des conduites alimentaires, université Lyon 1 ; Pr Vincent Dodin psychiatre, chef de service Groupe hospitalier de l’Institut catholique de Lille ; Sophia Ducceschi psychothérapeute spécialisée TCA (troubles du comportement alimentaire). Article mis à jour par Mathilde Pujol, Journaliste santé
