Vomiting Syndrome - The Vomiting Pathology

" The real mystery is what you see and not the invisible "
Oscar Wilde

 

In recent years, eating disorders have been evolving towards more specialized and sophisticated forms such as Vomiting Syndrome (Nardone et al., 1999). There are various forms of eating pathology (bulimia nervosa, anorexia nervosa, binge eating, bulimia nervosa, anorexia nervosa with elimination ducts), and it is clear that there is an association between bulimia nervosa with self-induction of vomiting (Vomiting Syndrome).

In recent times there has been a significant increase in cases of Vomiting Syndrome or voting, compared to anorexia and bulimia. Girls with bulimic or anorexic tendencies find that throwing up allows them to keep their weight under control without having to give up the pleasure of food and also avoid alarming the family as they manage to keep a few pounds above or below their ideal weight. so they don't feel pressured.

The literature (APA, 1994) ranks the vomiting as a variant of anorexia and bulimia nervosa but, empirical research (Nardone et al., 1999; Nardone et al., 2005) has shown that vomiting is based on a different structure and perceptual model. Bulimia (binge eating and gaining weight) and anorexia (abstaining from food to lose weight) form the matrix but, once established, the vomiting it loses all connection with the disorder that caused it to arise. For the person the vomitting it represents a way to lose weight or avoid gaining weight by continuing to feed, an attempted dysfunctional solution. The latter works at first but, when the binge / vomit cycle is repeated, it turns into a pleasant ritual and in a few months, it becomes a pleasure that cannot be done without. Subjects binge intentionally and then vomit (Nardone, Verbitz & Milanese, 1999). The pleasure experienced is not the result of eating but is given by the sequence of three phases:

• Excitatory phase: desire is transformed into physiological activation of the organism;
• Consumer phase: you eat until you feel completely full;
• Discharge phase: is represented by vomiting.

Once the Vomiting syndrome has established itself, the problem is no longer that of keeping food under control, but the compulsion to pleasure. Eating and vomiting represent a metaphorical encounter with a "secret lover".

George Nardone and his group of researchers, in the twenty-year study on eating disorders and their treatment in a short time, found that about 70% of cases of vomiting pathology, has self-harming compulsions (self-harming compulsion). Both represent compensatory and self-regulating acts which, with the passage of time, turn into irrepressible compulsions and then become a real pleasure rite.

The two forms of disorder play a fundamental role for those affected as they represent either the pure search for transgressive sensations or a sedative against pain and frustrations. The two compulsive aspects do not develop simultaneously. The data collected by Strategic Therapy Center of Arezzo they show how in the vast majority of cases, the eating disorder emerges first, then when the latter has become compulsive, self-injurious behaviors are added; the eating disorder constitutes its basic pathology.

Eating, vomiting and torturing oneself is structured as a compulsive pathology based on pleasure or on the sedative effect and differs both from other forms of fear-based compulsive disorder and from the eating disorder that initially originated it. The treatment differs both from that of anorexia and bulimia and from the therapy of obsessive-compulsive disorders.

Brief Strategic Psychotherapy focuses on the transformation of the perception of the subject's reality through specific strategies and stratagems aimed at leading the problem to extinction. Each subject is the architect of his own reality, just as he can get trapped in a problem, he can also find the solution.

The Strategic Therapist it induces the patient to assume different perspectives regarding himself and his problem. A particular way of posing is used strategic questions in a spiral sequence, followed by the clarification of the answers obtained through progressive restructuring paraphrases.

Through the use of a logical and analogical language and evocative modalities, the patient is stimulated to "hear" as well as understanding his own problem and reactions in a different way, to lead him to overcome resistances and to create the therapeutic alliance.

The technique of strategic dialogue (Nardone & Salvini, 2004) and through it the patient discovers how his problem works and how to solve it, based on the answers he himself gives to the therapist's questions. In this way, the first session it is not only diagnostic but also therapeutic.

Therapeutic techniques are used that are adapted to the problem, and which aim to alter the pleasant perception that makes the compulsion to eat and vomit irrepressible and if it is present, in bringing self-injurious behaviors to extinction. The solution fits the problem and flexibility is a fundamental rule.

The first two stages of Brief Strategic Psychotherapy are geared towards achieving strategic change while the third phase consolidates the change to structure it as a new persistent balance. The person, after overcoming the disorder, persistently modifies all aspects of his life that have been deteriorated by it.

For the strategic therapist very important are also the follow-up meetings which are an integral part of the therapy as they represent a possibility for the person to compare and verify their personal growth with the therapist as well as measure the effectiveness of the therapeutic process.

 

                                     “It is the cure and the medicine that have to adapt
to the patient and his disorder "

                                                                                                                                                                      Hippocrates

 

                                                 Dr. Orsola Farina
(Psychotherapist and official researcher of the Strategic Therapy Center)

 

 

REFERENCES

▪ Nardone, G., Verbitz, T., & Milanese, R., (1999). The food prisons. Milan: Ponte alle Grazie.

▪ Nardone, G., (2003). Beyond the love and hatred of food. Milan: Ponte alle Grazie.

▪ Nardone, G., & Salvini, A., (2004). The strategic dialogue. Milan: Ponte alle Grazie.

▪ Nardone, G., (2007). The paradoxical diet. Milan: Ponte alle Grazie.

▪ Nardone, G., & Selekman, M., (2011). Get out of the trap. Milan: Ponte alle Grazie.

▪ Nardone, G., (2013). Psychotrap. Milan: Ponte alle Grazie.

▪ Nardone, G., & Portelli, C., (2015). Change to know. Milan: TEA Edition.