“I was in crisis every night, it was becoming unmanageable, I asked to be hospitalized”

At Saint-Anne hospital in Paris, the addiction unit for bulimic withdrawal admits patients to treatment for a period of three weeks. Less known than anorexia, bulimia affects around 1.5% of 11-20 year olds and affects around three young girls for every boy.

“It was complicated to go shopping“, blurted Nephatali, “being around all these food things, it reminds me of my binge eating.”

Isabelle, 54 years old, Naphtali, 20 years old shyly cross the threshold of the room which houses the cooking workshop on the second floor of the mental illness and brain clinic also called CMME. An induction hob, a sink, kitchen utensils furnish this room and on a table are the provisions that these two patients bought a few hours earlier in the company of a caregiver from the establishment.

This morning, Isabelle and Naphtali, hospitalized for eight days now, are participating in their first cooking workshop. Under the supervision of several nurses, they prepare their own meals. On the menu this lunch: omelette with bacon, potatoes and apple pie.

Each ingredient is weighed, each gesture is discussed with the nursing staff. “It’s a very first exposure to food. We put them in confrontation with foods with which they have bouts of bulimia.“, explains Charlotte Payen, nurse in the department.

“I was in crisis every night so and that’s why I asked to be hospitalized, it was because it was really becoming too heavy, too unmanageable” confides Isabelle. “For example, one evening I’m going to eat a kg of pasta. It’s monstrous! And then I’m going to vomit. That’s why I have blocks on my hands, it’s from forcing myself to vomit. , so putting my fingertips in my mouth (…) I have the image of myself as an 85 kg woman”

There are no physical signs to detect that Naphtali and Isabelle have suffered for many years from bulimia, an ED, an eating disorder. For this TCA category, “We consider that the subjects have a normal weight. They will present both hyperphagia attacks or bulimia attacks”, explains Dr Clément Vansteene, psychiatrist, addictologist, responsible for’Addictology unit for bulimic withdrawal in Saint-Anne hospital in Paris.

“This means that they will eat a lot of food and will associate themselves with weight control strategies” or “purge lines” such as vomiting, physical hyperactivity or even taking laxative substances.

For three weeks, throughout their care journey, “an intensive withdrawal treatment“, Isabelle and Naphtali will meet several types of patricians: doctor, psychiatrist, psychomotor therapist, dietician, occupational therapist. Patient care here is multidisciplinary (somatic, psychological, nutritional, social and family), adapted to the age of the patient and the intensity of their disorders. “There is an extremely close correlation between self-esteem, weight, perceived figure, and what we ate“, explique Clément Vansteene.

First, during this withdrawal treatment, patients are closely monitored by healthcare personnel. They must eat their entire tray. They do not have access to the toilets after meals “because they would be tempted to vomit.” They do not have the opportunity to do independent physical activity.”We are going to set up a food contract. In fact: three meals a day and we will restrict access to compensatory behaviors as much as possible.” declared Clement Vansteene.

“There is a 10-day phase which is, what we call, a closed frame phase where patients have very little access to the outside and at the end of these 10 days, it is a period of progressive exposure, that is to say that the patient will gradually regain contact with the external environment and a certain number of tools that he acquired during the first period to try to regulate his diet.explains the head of the unit.

The service mainly receives adults between 20 and 40 years old. “We have to understand that they have between 5 and 10 years of illness behind them, it’s something complicated. Our goal of care is to allow the patient to understand much more precisely how their illness works, since everything is designed to hit the symptoms of the disease”arguments Clement Vansteene.

Bulimia can be a tyrannical disorder that significantly impacts the daily lives of these patients and their loved ones.“My whole family is trying to keep things under control and I’m pretending,” testifies Isabelle. “My husband, for example, will try to make sure he comes home earlier than me to avoid me having to prepare food alone, he will go through the trash to see if I really haven’t bought something that I I ate.“

The individual’s entire existence will be reorganized around the eating disorder

If you have to do two hours of exercise every morning, you have to get up earlier and if you get up earlier, you can’t go out in the evening. If you must eliminate, you avoid any situation in which you do not have control over what you eat. You refuse invitations to restaurants and invitations to friends’ houses”develops the head of the unit addictology.

During the meal workshop, Isabelle and Naphtali experienced some emotional moments. “I no longer knew what a normal quantity of food was. I was shocked when I said to myself, but in fact, these are normal rations“, testifies one of them.

“The objective pursued is that they overcome their difficulties, that they regain confidence”says Charlotte Payen, nurse.“All the work that is done here is to ensure that they reduce their binge eating. In fact, I say reduce on purpose, and I do not say eliminate. In the sense that since it is an addiction, relapses are part of of addiction. There is enormous guilt felt. It is a vicious circle because this guilt causes a feeling of intense stress which leads to a binge. We must try to relieve the relapse of guilt.explains Charlotte Payen.

According to the High Authority of Health, lbulimia affects approximately 1.5% of 11-20 year olds and concerns approximately 3 young girls for 1 boy. Binge eating disorder which involves eating large quantities of food without control or compensation is more common. She touches 3 to 5% of the population, both men and women, and it is more often diagnosed in adulthood.