Bulimia as an Eating Disorder - Essay Example

HEALTH PSYCHOLOGY Bulimia Nervosa Eating disorders has been the of much discussion from as early as 1694 (Cooper, 2009). It was prevalent especially among adolescents, and it still is today. Richard Morton, an English physician, first detected symptoms of eating disorders when he examined a young girl whose condition he described as ‘a skeleton clad only in skin’ (Ibid). The term ‘anorexia nervosa’ was introduced much later in 1874 by Sir William Gull, Physician Extraordinary to Queen Victoria. One of its key features provided by the American Psychiatric Association was the intense fear of gaining weight or becoming fat (Ibid). Another eating disorder emerged, however, towards the end of the 1970s, when there were reports of an increasing number of adolescents who indulged in overeating, followed immediately by induced vomiting. This disorder was first named ‘bulimarexia’ (Ibid), as it shared some similar features with those suffering from anorexia nervosa. It was in 1979 when the term ‘bulimia nervosa’ was introduced by a London psychiatrist, Professor Gerald Russell in a seminal paper which he published in the psychiatric journal Psychological Medicine (Abraham, 2008). DEFINITION Bulimia means ‘to eat like an ox” (Abraham, 2008). Professor Russell described 40% of his patients suffering from a clinical condition as that of ‘an ominous variant of anorexia nervosa”, a disorder he termed ‘bulimia nervosa’. He explained that these groups of people periodically went on eating binges, while at the same time adopted extreme measures like induced vomiting to prevent themselves from becoming fat (Abraham, 2008; Cooper, 2009). In his paper, he proposed three definitions for bulimia nervosa: 1) powerful and intractable urges to overeat; 2) attempts to avoid the ‘fattening’ HEALTH PSYCHOLOGY effects of food by inducing vomiting, abusing purgatives, or both; and 3) a morbid fear of fatness (Cooper, 2009). His definitions set a trend over the next few years, as clinicians and researchers used them as guidelines in identifying people with bulimia nervosa. The criteria for recognizing the onset of the disorder, however, became the subject of much debate as to how widespread bulimia nervosa was. CRITERIA In 1994, the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), published by the American Psychiatric Association, provided some guidelines which has since then been widely accepted by mental health professionals (Schulherr, 2008). Some of these included episodes of binge-eating and purging, characterized by the person’s inability to control the unusually large amount, and types of food eaten within two hours. Extreme measures like induced vomiting, fasting, excessive exercise, abuse of laxatives, diuretics, enemas and other forms of medications would then be carried out to prevent weight gain. This form of compensatory behavior would occur at least twice a week for three months, and the person’s self-evaluation is excessively influenced his or her body shape and weight. This criterion is different in some ways with those suffering from anorexia nervosa. THEORIES A considerable amount of research has also been conducted as to why eating disorders occurred among adolescents and young adults between the ages of thirteen and twenty-five. Women suffer from eating disorders more than men (Lock & Grange, 2005). Some theories were put forth to explain the eating disorder which lead to bulimia nervosa, four of which would be discussed here: 1) the adolescent period; 2) the social pressure; 3) the psychological factors; and 4) the genetic make-up. HEALTH PSYCHOLOGY The Adolescent Period. A case study would help explain why teenage girls are predisposed to the idea that one must look thin in order to be accepted by everyone in society. Blair was a sixteen-year-old school girl who had set high standards for herself (Lock & Grange, 2005). Even though she was never teased at by her friends at school, and her boyfriend had not complained about her being overweight, Blair decided that she must look great and beautiful for the junior prom. She had seen how overweight girls were teased at, and she was afraid she might be next. She was determined to lose 15 pounds, and she started off by skipping breakfast, and then lunch. She followed this up by going to the gym after school and exercising for two hours. She kept to her routine despite feeling hungry at night, and she finally succeeded in losing 15 pounds for the prom. Both her friends and boyfriend congratulated her for her wonderful appearance, and they were curious to know how she did it. After the prom, however, Blair began having difficulties keeping to her diet plan. She became too tired to workout in the gym after school. Afraid that she might gain weight, she compensated for her lack of exercise by eating less. But when she was stricken by hunger pangs, she began eating boxes of cookies. Feeling guilty, but unable to workout at the gym, Blair decided to throw up the cookies. Subsequently, she found herself trapped in a cycle of binge-eating and purging. She then resorted to using diet pills and laxatives which she took from her mother’s medicine cabinet. Her mother became suspicious when she heard Blair vomiting in the shower, and when she noticed some laxatives missing from the cabinet. Blair’s mother finally took her to see a psychologist, when she was informed that Blair had been throwing up in school. Blair was then diagnosed with bulimia nervosa. HEALTH PSYCHOLOGY The Social Pressure. Messages from the media, women’s magazine, the fashion industry, advertising, and entertainment relentlessly bombard women of all ages with the need to stay slim and fit (Siegel, Brisman & Weinshel, 2009). They splash the irresistible ideal bodies of slim and slander women on the cover pages of these magazines. They convince women that a slim woman is successful, attractive, healthy, happy, fit, and popular (Abraham, 2008). A survey conducted among teenagers revealed that most of them believe that being slim will give them a better chance of getting a job, find a boyfriend, be popular with their peers, be and look fit and healthy, and get on well with their family (Ibid). Yet at the same time, they communicate contrasting messages with recipes for rich, enticing desserts, and that eating is a pleasurable social activity among friends and peers (Siegel, Brisman & Weinshel, 2009). Some of these confusing messages from television and women’s magazine include, “You must be slim”, “Eating is enjoyable”, “Try different foods”, “Eat with your friends”, “Eat low-energy foods”, “Diet”, “Eat fast foods”, “Do not get fat”, and “Exercise more” (Abraham, 2008). Such are the trappings of today’s culture that most women, and even men, find themselves inexorably going to extremes just to measure up to peer and social expectations. The Psychological Factors. Dr. Balasa L. Prasad, a psychiatrist and anesthesiologist, believed that eating disorder is a problem of the mind, and not the body ( ). He said that the intellectual division of the mind is capable of reasoning, judgment, logic, discretion, calculation, imagination, analysis, and anticipation. This division is complex and sophisticated, and it uses the five senses – sight, smell, hearing, taste, and touch – to absorb and analyze the barrage of information it receives from the environment, and to program an appropriate response. He argued that only the mind is HEALTH PSYCHOLOGY capable of understanding the world we live in, and assessing the situations we encounter. The mind, however, can be controlled by the emotional division which dictates terms to fulfill the needs of the body. Dr. Prasad further argued that the mind knows what’s good for the body, but, its rational thoughts are inhibited by powerful emotional drives. He gave the example of many of his clients who told him that they knew that they had to stop their habit of binge-eating and purging, but somehow they were helplessly overcome by their emotional urges to conform to social expectations. Other health professionals believed that those who suffered from bulimia nervosa showed features of borderline personality disorder, guilt, anger, sadness, anxiety, and poor self-esteem (Abraham, 2008). Professor Peter Cooper, a Psychologist at the University of Reading, reported that about a third of those suffering from bulimia nervosa developed this eating disorder after having had an episode of anorexia nervosa. He said that certain psychological characteristics like low self-esteem, loneliness, depression, a profound sense of ineffectiveness, unhappy childhood experiences, and physical and sexual abused, contributed to making people vulnerable to developing an eating disorder (2009). Although these psychological factors are inconclusive, health professionals worked alone these characteristics in identifying and helping their patients. The Genetic Make-up. According to Professor Suzanne Abraham, co-director of the Eating Disorders Unit at the University of Sydney (2008), investigation is still going on to determine if a defective gene could be the cause of an eating disorder. She suggested that, instead of a single gene defect, there could be a combination of genetic factors that contributed to the development of an eating disorder. For example, a recent theory has been advanced that involved the hormones leptin and Ghrenlin. Leptin is said to be involved in the energy balance in the body, and it is secreted by fat (adipose) tissue, HEALTH PSYCHOLOGY which reflected the amount of energy stored in the body as fat. The higher the body weight, the higher the levels of leptin in the bloodstream. Letpin tells the body when a person is full and do not need anymore food, whereas Ghrenlin tells the body when to eat. Furthermore, receptors in the hypothalamus of the brain are sensitive to the levels of leptin, and regulate the amount of body fat by controlling the appetite and increasing energy output. Professor Abraham said that the most potent appetite stimulant in the brain is called neuropeptide Y (NPY), and letpin decreases appetite by suppressing NPY. Ghrenlin does the opposite by stimulating NPY. Other hormones released from the stomach, intestines, and bloodstream, including insulin and cholecystokinin, in turn regulate leptin and ghrenlin. Insulin acts as a messenger of satiation, and is produced by the pancreas in response to an increase in blood glucose. Cholecystokinin is produced by the duodenum, and is thought to regulate the size of the meal eaten. How the sight, smell, and taste sensations associated with food, are integrated with the chemical and neural messages received by the brain is still unclear, as these sensations may encourage or discourage eating (Ibid). CONCLUSION There seems to be an agreement among health professionals today that all the above factors so far explored and investigate are neither inconclusive nor exhaustive. These are just some combining factors said to have contributed to the triggering and perpetuating the onset of eating disorders. One suggestion made, was to relate to the victim, instead of the eating disorder. In this sense, it would help the person gain a clearer perspective of a sense self-worth and srengths (Siegel, Brisman & Weinshel, 2009). References: Abraham, Suzanne, (2008), Eating Disorders, 6th ed, Oxford University Press, Great Clarendon Street, Oxford, New York. Cooper, Peter J., (2009), Overcoming Bulimia Nervosa and Bing-Eating, Constable & Robinson Ltd., UK. Lock, James, Grange, Daniel Le, (2005), Help Your Teenager Beat An Eating Disorder, The Guilford Press, New York. Prasad, Balasa L., ( ), Stop Overeating For Good, The Penguin Group, USA. Siegel, Michele, Brisman, Judith, Weinshel, Margot, (2009), Surviving An Eating Disorder, Collins Living Publishing, USA. Schulherr, Susan, (2008), Eating Disorders for Dummies, Wiley Publishing Inc., USA. Read More