The Various Faces of Bulimia

Mini Review

Abstract

Bulimia is an eating disorder characterized by binge eating episodes followed by compensatory behaviors, such as self-induced vomiting, use of laxatives or diuretics, fasting, and excessive exercise. Although people with bulimia often maintain close to normal weight, they suffer from great concern about body shape and impaired self-esteem. The disorder usually appears in adolescence, affecting mainly women, and can be related to social pressures, family inheritance, and emotional conflicts. From a neuropsychic point of view, the ventromedian nucleus of the hypothalamus is associated with satiety, while the lateral zones regulate hunger. Alterations in these centers can lead to both anorexia and bulimia, indicating the complexity of the biological and psychological bases of the disease. In addition to physiological factors, bulimia is interpreted as a way of dealing with anxieties, emotional dissatisfactions, and unconscious conflicts. Food can take on different meanings: a substitute for love, an expression of affection or aggressiveness, a symbol of security, a form of protection against rejection, or even a mechanism of self-destruction (thanatism). Clinical cases illustrate how the relationship with food can reflect affective deficiencies, family tensions and difficulties in love bonds. Thus, bulimia and obesity are not only issues of dysregulated appetite, but multifactorial phenomena that combine biological, psychological, and social aspects. Food, in addition to nourishing, can become a defense, compensation or means of expression of internal and relational conflicts.