Eructophilia in bulimia nervosa: A clinical feature

Abstract

This report offers the first detailed description of repetitive eructation (belching) in a patient with bulimia nervosa. The case was a man in his 30's with bulimia nervosa characterized by daily bingeing and purging behavior. Detailed assessment revealed repetitive eructation which was construed as a learned behavior precipitated and maintained by aerophagia (air swallowing) secondary to regular binge-eating. Eructation was associated with a strong sense of "relief" that shared a common phenomenology with other purging behaviors. Repetitive eructation was addressed as part of outpatient treatment using a cognitive-therapy approach. Eructation became less frequent during outpatient treatment but the patient disengaged after six sessions. We define a new term "eructophilia" where repetitive eructation takes on an ego-syntonic, self-contained, and autonomous quality which serves as a reinforcing stimulus in itself. Issues of phenomenology and motivating factors are further discussed.

Paroxysmal belching: Epileptic or nonepileptic?

“…Anecdotally, uncontrollable belching has been treated by hypnotic suggestion [9] . Repetitive belching has also been observed in psychiatric patients with obsessive compulsive disorder [4] and bulimia nervosa [7] , further establishing it as a psychological phenomenon.…”

“…Ictal eructation is an automatism only twice reported so far: Cole described a patient with episodes of isolated eructations accompanied by bilateral theta activity prominent in the left frontotemporal area [2] ; more recently, Mestre et al detailed eructations as part of more complex psychomotor partial seizures [3] . An important differential diagnosis is paroxysmal belching of nonepileptic origin, which can be somatic or psychogenic [4] , [5] , [6] . The former would usually present with underlying gastroenterological conditions [5] .…”

Supragastric belching: Pathogenesis, diagnostic issues and treatment

“…[ 20 ] SGB has been described in patients with psychiatric troubles such as obsessive-compulsive disorder, depression, anxiety disorders, and eating disorders (bulimia nervosa and anorexia nervosa). [ 21 22 23 24 25 ]…”

Managing a patient with excessive belching

“…Patients with belching disorders report significant anxiety, and excessive belching has been described in patients with psychiatric disorders, such as obsessive compulsive disorder and eating disorders 17 21 22. Patients with supragastric belching have impaired health-related quality of life.…”

“…However, this was a small, open study involving just 11 patients. Other behavioural therapies such as diaphragmatic breathing, cognitive behavioural therapy and biofeedback have been reported to be effective 20 22 26–29. Hypnosis has been reported to be beneficial in a single case report 30.…”