EATING DISORDERS – BULIMIA AND ANOREXIA

EATING DISORDERS – BULIMIA
AND ANOREXIA
Eating disorders have attracted a great deal of attention in recent years, particularly in university settings where they tend to be prominent. Yet despite greater public awareness, certain misconceptions still exist. For example, many people think eating disorders are brought about by vanity. This couldn’t be further from the truth. Rather than being vain, people with eating disorders struggle with issues about who they are, what they are worth, whether they will be able to take care of themselves and how to negotiate relationships. Eating disorders are complex and difficult to overcome. There are currently two eating disorders included in the ICD-10 and DSM-IV – bulimia nervosa and anorexia nervosa. Although they differ in important ways, they have four things in common: 1. a distorted body image (inaccurate assessment about shape and weight); 2. an intense fear of being fat; 3. a sense of self that revolves around the individual’s body and weight; and 4. eating that is regulated by psychological rather than physiological processes, although the form of eating regulation is quite different for the two disorders.

symptoms

People with bulimia tend to be of normal weight and are sometimes even overweight. Bulimia nervosa is characterized by recurrent episodes of binge eating and purging. During a binge, bulimic people consume an enormous number of calories in a brief period of time and feel an overwhelming loss of control as they are doing so. The binge is then followed by purging behaviour – usually vomiting, taking laxatives, taking diuretics or using enemas, and sometimes fasting or excessive exercise.

1. Other symptoms may include:
2. somewhat chaotic lives;
   a tendency to be impulsive, emotionally labile, sensitive to rejection and in need of attention;
   depression and/or substance abuse.

Anorexia nervosa is characterized by a refusal to maintain normal body weight. People with anorexia restrict their food intake through diet and typically engage in excessive exercise. Their weight often becomes so low that their bodies stop functioning normally (e.g. females stop menstruating), and they often appear emaciated. Anorexics also tend to: be perfectionist, rule-bound and hard-working; have a strong need to please others, but never feel special themselves;
be high-achievers, but also feel uncertain of their capacity to be independent.Some people with anorexia also engage in binging and purging and have other features of their personalities and lives in common with bulimics. The course of eating disorders Both bulimia and anorexia typically begin in adolescence and can become chronic. For example, about one third of people with anorexia will have a lifelong disorder. Both anorexia and bulimia pose significant health risks. This is particularly true for anorexia, in which almost 5 per cent of people die from malnutrition and other related complications. Causes of eating disorders and factors affecting their course 1 Genetic and biological factors Research supports genetic transmission, but some suggest that it may not be the disorder itself that is inherited. They believe that a set of personality traits – such as obsessiveness, rigidity, emotional restraint in the case of anorexia and impulsivity and emotional instability in the case of bulimia – might increase the likelihood of poor coping. The eating disorder is seen as a maladaptive way of coping with stress (e.g. Strober, 1995). Biological models focus on dysfunction in the hypothalamus (the part of the brain related to eating behaviour;and on serotonin dysregulation (e.g. Wolfe, Metger & Jimerson, 1997; see Ferguson & Pigott, 2000). There is presently no evidence that these dysfunctions actually cause eating disorders, but they may affect their course.

2 Psychosocial factors One of the primary sets of psychosocial factors in the development and course of eating disorders are social pressures and cultural forces. In cultures where thinness is the ideal of beauty, eating disorders are most prevalent. There are expectations of thinness everywhere – in the media, in the family, and in society at large. Adolescents, particularly young women, often internalize these expectations, and their entire sense of self-worth may become dependent on being thin. Furthermore, they are usually socially reinforced for being thin. Think how often you have heard someone say, or have even said yourself, ‘Oh, you’ve lost weight – you look great!’ For vulnerable young people, a seemingly benign comment like this reinforces the belief that they must be thin in order to be worthy of attention. But if everyone in a culture that values thinness grows up facing the same pressures, why do some develop eating disorders and some not? Apart from possible genetic or biological vulnerabilities, the way people think about themselves and the world may make them vulnerable. Cognitive distortions such as, ‘If I eat one cookie, I will be a fat, horrible person’ or ‘Being thin will make all the problems in my life go away,’ may increase vulnerability to eating disorders (e.g. Butow, Beumont & Touyz, 1993). People who come from certain types of families may also be more vulnerable to particular types of eating disorders (Bruch, 1978; Minuchin, Rosman & Baker, 1978). For example, anorexia is thought to develop when families are very concerned about external appearances and prefer to maintain an impression of harmony at the expense of open communication and emotional expression. These families tend to be enmeshed (family members are unaware of or unable to maintain personal boundaries), overprotective, rigid and conflict-avoidant. Anorexia might be a rebellion or an assertion of independence and autonomy, or it may serve to mask the real problems in the family. Other risk factors include families who diet, or parents who are critical of their child’s weight or appearance (e.g. Pike & Rodin, 1991). A recent perspective, which fits with family and genetic/personality models, suggests that eating disorders are the product of maladaptive emotion regulation processes (e.g. Wiser & Telch, 1999). So food is used to help regulate emotions (typically negative ones) when the person has not developed more adaptive strategies. Attachment theorists take a similar position, suggesting that people with certain forms of insecure attachment (e.g. avoidant) may distract themselves from upsetting, attachmentrelated concerns (e.g. fear of intimacy, low self-worth) by focusing on food and weight (Cole-Detke & Kobak 1996