From the author: For decades, the situation with the desire and simultaneous inability of people to keep their weight under control has not changed. Advertising promotions and “weight loss” products will dominate the market until people understand that the solution to their problem lies in their own head... In the struggle between the heart and the head, the stomach ultimately wins. Stanislav Jerzy Lec Why it’s dangerous Bulimia Bulimia (kinorexia) is an eating disorder in which a person eats a large amount of food in a short time. Bulimia is characterized by uncontrolled attacks of a sharp increase in appetite, accompanied by an unbearable feeling of hunger (“ravenous hunger”), weakness and even pain in the epigastric region. The diagnosis is made if the following criteria are met (according to G.V. Starshenbaum): 1) two or more episodes of compulsive overeating a week for three months; 2) constant preoccupation with food and irresistible cravings for food; 3) dissatisfaction with one’s own fatness, morbid fear of obesity; 4) attempts to prevent weight gain with the help of artificial vomiting, enemas, laxatives, diuretics, intermittent fasting, thyroid medications, appetite suppressants. The causes of overeating can be both nervous disorders and mental illnesses, as well as disruption of the endocrine system. The insidiousness of the disease lies not only in possible obesity from overeating. Patients with bulimia strive to control their weight, so after eating they induce vomiting or take certain medications (diuretics, laxatives, emetics). Sometimes, after a period of overeating, they practice complete abstinence from food. This gradually leads to exhaustion of the body and other negative consequences. The paradox of the disease is that most often people with normal body weight suffer from bulimia. It turns out that the basis of the disease is not so much biological as psychological factors. One of them is a clinical disorder of body perception. It lies in the fact that a person is frankly mistaken about his own physical parameters, in other words, he considers himself fat. But, in addition to subjective opinion, there are objective indicators of normal weight, the so-called body mass index. To determine whether you are really “too fat” or just think so, use the Broca index, according to which body weight in kilograms should be equal to height in centimeters minus 100. But do not forget that today's ideals require subtracting 10% for men and 5% for women from the resulting figure. If the final data does not please you, do not rush to get upset. Pay attention to the following figures: the initial stage of obesity is determined by an increase in body weight by 15-20% of the normal value, taking into account height and age. Only when body weight increases by 30% does obesity become obvious. As is known, obesity can be caused by both exogenous (external) factors and endogenous (internal) factors, which primarily include hormonal disorders. Among the psychological causes of obesity, the following are most common (according to I.G. Malkina-Pykh ):• Frustration at the loss of the object of love. For example, obesity can be caused, more often in women, by the death of a spouse, separation from a sexual partner, or even leaving the parental home (“boarding obesity”). It is generally accepted that the loss of a loved one can be accompanied by depression and at the same time an increase in appetite (“bite the bitter pill”). Children often react with increased appetite when the youngest child is born.• General depression, anger, fear of loneliness and feelings of emptiness can lead to impulsive eating. Factors that lead to obesity in one person do not necessarily affect another. In addition, each person has his own situations of increased tension that can awaken an exacerbation of oral needs, inas a result, a person turns to increased eating or smoking. In addition to rejection of one’s own appearance (dysmorphophobia), bulimia is often accompanied by pronounced depressive symptoms or social phobia, which only confirms the importance of psychological factors in the origin of “excess weight.” Psychological characteristics of the individual An analysis of the literature does not allow us to identify any single type of patients. However, many of them exhibit traits of inner twitchiness, apathetic gloomy despair and signs of flight into loneliness. Patients feel imperfect, vulnerable, and incompetent. Hyperphagia (overeating), decreased activity and, as a result, excess weight provide illusory protection against a deep feeling of insufficiency: having become massive and impressive, an obese person seems stronger and more protected. Psychodynamically, an increased intake of calories is explained as a protection against negative, especially from depressive-tinged emotions and fear. In this case, the process of eating seems to shift (albeit temporarily) negative emotions to the side. At the same time, there is a clear temporal connection between the appearance and intensification of cravings for food with some kind of frustration (unpleasant emotions associated with resentment, unfair treatment, etc.). Simply put, an overweight person consoles himself with food for the lack of self-love from other people. The clinical follow-up method revealed a significant frequency of stress in personal and family relationships, i.e. the sphere of interpersonal interaction seems to be the most problematic for obese patients. They show increased sensitivity (sensitivity) in relation to interpersonal conflicts. Bulimia usually develops in connection with interpersonal conflict in the family, sexual or educational-professional sphere, joining a new team; maladjustment often develops in all areas of life. It is most often caused by the death of a spouse, separation from a sexual partner, leaving the parental home, as well as exam fever or a situation of open conflict. Against this background, experiences of abandonment, loneliness, emptiness and disappointment in other people, boredom, sadness and depression arise. Out of childhood habit, patients try to console themselves with food and drink, but they go beyond the boundaries, gain excess weight and then try to control it, as with anorexia. Patients in premorbidity (the period before the disease) are characterized by increased anxiety, impulsiveness, decreased self-esteem, extroversion, and communication skills. violations, a tendency to form various dependencies. An irresistible craving for food can help relieve neurotic symptoms: anxiety, depression, tension. As part of deviant behavior, food pleasure turns into an alternative to a boring and regulated life. To experience the “thrill”, people begin to eat unusual foods in excess. In addition, overeating and excess weight are a challenge to parental and public opinion about proper nutrition and an ideal figure (according to G.V. Starshenbaum). In obese patients, a noticeable increase in stable personal anxiety was found, which is considered as a basal mental property that predisposes to increased sensitivity to stressful influences. Situational anxiety reaches a neurotic level in severity. The psychological background for the development of bulimia nervosa is often the patient’s desire to control his life with the absolute impossibility of escaping from the care of (parents, spouse, coach, etc.). In this case, his attention is transferred to imaginary control over his own eating behavior. Insatiable consumption of food allows you to relax, provides an opportunity to forget about problems: stress, humiliation, financial dependence or illness. The roots of the problem are in childhood. Since food has the value of substitute satisfaction, then with its help a person gives himself pleasure and replenishes the missingpositive emotions. Food creates a feeling of security, eases mental pain and reduces feelings of loss and disappointment, as in childhood, when parents gave the child sweets for comfort. As in the case of anorexia nervosa, bulimia reveals the fact of a broken parent-child relationship in the patient's life. Overfeeding can be associated with family food traditions and excessive, one-sided use of food in order to give the child pleasure and comfort. It is typical for such upbringing that parents offer the child food instead of satisfying his actual needs and treat him well only when he eats well. As a result, the child grows up unaware of his emotional needs and does not know when he is hungry and when he is full. Without relying on internal criteria, such a child focuses on his parents, without feeling like the master of his own body, without controlling his own behavior, needs and impulses. With overeating, more often than with anorexia nervosa, family conflicts, an insensitive attitude of parents towards the child, a dismissive attitude towards his personality. The family is usually dominated by the mother, who establishes a symbiotic relationship with the child, delays his motor development and does not encourage the child’s readiness for social contacts, fixes him in a passive-receptive position (according to G.V. Starshenbaum). Certain forms of early childhood development and family development are described environment in children with a tendency to obesity. Mothers of such children show hyperprotection and over-attachment. Parents who allow everything and do not prohibit anything, cannot say “no”, compensate with this their remorse and the feeling that they are not giving enough to their children. Fathers in such families are weak and helpless (according to N. Bruch). Oral spoiling is often motivated by parents getting rid of the feeling of guilt for their emotional alienation, for their indifference and internal rejection of the child. Feeding children is the only possible means of expressing affection for them, which parents are not able to show by talking, touching, playing with them. In the psychodynamic interpretation, food for a child is more than just nutrition, it is self-affirmation, stress relief, maternal support. Many obese patients have a strong dependence on their mother and fear of separation from her. Since 80% of parents of obese patients are also overweight, we can think about a predisposition factor, as well as particularly intense family ties and adherence to traditions, a relationship style where direct expressions of love are rejected, and their place is taken by oral habits and connections (according to A. Meyer). For most obese patients, it is important that they have always been fat, and already in infancy and early childhood they were prone to being overweight. It is interesting that in frustrating and difficult life situations, feeding and excess food can become a stress-regulating factor for both parents and their growing children. Obesity and food as a substitute for satisfaction are therefore not a problem for one person, but for the whole family. Why diets don't help Even the most wonderful diets in the world promise only external changes, which are short-lived in the absence of supporting internal factors. Now that you know the true cause of your weight problems, you cannot continue to turn a blind eye to your own unresolved problems and fears and give in own laziness and lack of will, relying on miracle drugs. Now you understand that any attempt to lose weight without any psychological correction of your own eating behavior is unpromising. There is only one way out: change as a person. The secret of your problem is that the craving for food reflects a withdrawal from reality, and the very act of eating food reduces situational anxiety and depression by shifting attention to the body, the weight of which is easier to control than the situation and your emotional state . Considering that certain foods may have different symbolic meanings. 9-11.