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Introduction
Eating disorders have come into the spotlight in conversations on metal and physical health in modern times. With social media and popular culture upholding the unrealistic body standards, and online influencers promoting dieting products it is evident that the unhealthy obsession with weight is externally reinforced. Due to the increased online presence of the modern young people, their exposure to these pressures grows accordingly. Thus, there is a high likelihood a social worker would encounter the cases of bulimia nervosa in their practice, potentially on a somewhat regular basis. This section of the literature review examines the prevalence o the disorder, its description and potential causes as encompassed by aetiology.
Prevalence
Bulimia Nervosa, together with Anorexia Nervosa, is known to be the most prevalent eating disorder in the modern world. It typically develops during adolescence, leading to the young adults being considered the risk group for this disorder by the medical professionals.
The cases among adults and younger children are also present, yet the cases among teenagers consist the clear majority. The existing research comments on this statistic by discussing the sensitivity to public perception and search for approval characteristic for a teenage psyche (Hail & Le Grange, 2018). Throughout the adolescence, one’s personality continues to form, and is more susceptible to outside influences then in older age. Consecutively, teenagers tend to be more self-conscious about their appearance, as well as more vulnerable to cultural pressures in relation to body weight and dieting.
Additionally, it has been established that young women and girls are more likely to develop the disorder then their male counterparts. This observation can be explained by the greater social pressure that women experience in relation to beauty standards and body image. Although men and women alike struggle with unrealistic expectations of their bodies, fueled mostly by popular media, women and specifically teenage girls are often shamed relentlessly for their weight. Overall, they present one of the most vulnerable and mentally fragile demographics, largely but not exclusively due to the structural social inequalities of sexist nature. They form the risk group for eating disorders overall, including Bulimia Nervosa as one of the most frequent ones.
In the United States, the average age for patients diagnosed with Bulimia Nervosa is quite young, amounting to around 12.5 years. Within the studied sample, 0.9% indicated the lifetime prevalence, with 0.6% reporting the prevalence over the previous 12-month period. Out of bulimic adolescents, 41.3% admitted purging, with the rest part taking in other compensatory behaviors, such as fasting or laxative consumption (Lydecker & Grilo, 2019). However, it is important to specify that current diagnosis criteria have been a subject to scrutiny, with multiple researchers commenting how the existing system underestimates the prevalence of the disorder.
Description of the Problem
Bulimia Nervosa is a severe eating disorder that affects those who suffer from it both mentally and physically. It is characterized by recurring episodes of overeating, commonly referred to as binging, and thus consuming unusually large amounts of food. While binging, patients with bulimia are unable to properly control themselves, which becomes a significant issue if treatment is attempted. These episodes are then followed by damaging compensatory behaviors, such as use of laxatives, self-induced vomiting or prolongated fasting (Forrest et al, 2019). These phases are commonly referred to as purging, and are associated by patients with cleansing their organisms after the overeating phase. Within the current classification system, these episodes must occur at least once a week for a prolongated period of three months or over.
Aside from the core behavioral patterns, bulimia can often be identified at its earlier stages by the set of less evident secondary symptoms. For example, patients are commonly extremely preoccupied with their weight and bodily appearance, often having an overtly negative perception o their physique. They are haunted by the fear of putting on weight and organize their diet and daily routine around an eternal goal of not doing so.
Their perception of food shifts, establishing false associations between eating and engaging in a morally reprehensible activity. Consecutively, those who suffer from bulimia often eat in secret and avoid others seeing them eat at all. Many of the family members of adolescents with bulimia commented on noticing their strange looking, secretive behaviors. With binging episodes being characterized by loss of control, some of the bulimic patients consume food they are not entitled to, worsening their relationship both with food and with their social circle.
Furthermore, the outlined behaviors present serious, lasting dangers for bulimic patients, on physiological and psychological levels alike. Purging behaviors lead to a body having to deal with the lack of nutrients and energy to perform daily activities. Additionally, if a person is succeeding in an extreme weight loss in spite of the binging phases, they risk to permanently damage their internal organs, particularly the digestive tract. Severely underweight patients experience issues in their cardiovascular systems, dental problems caused by the lack of calcium and vitamins, and other, more individualized consequences (Gibson et al, 2019). In certain cases the consequences of the bulimic compensatory behaviors might be fatal or lead to chronic complications.
Finally, the severity of the problem lies in the psychological nature of the bulimia, despite the disease primarily manifesting in active physical behaviors. As any other eating disorder, bulimia is a mental illness, and needs to be treated as such. Bulimic patients struggle with control and responsibility, often interpreting their appetite as a derailing factor that destroys the illusion of a fully controlled environment. Thus, the addictiveness of the coping mechanisms is double-edged: on one hand, the human body adapts to the self-harming practices, such as self-induced vomiting. On the other hand, patients are often unwilling to break the cycle due to the thrilling sense of control coping behaviors provide them with.
Etiology
As with other eating disorders, it is difficult to pinpoint the exact causes that constitute the etiology of the disease. Its psychological and behavioral nature makes it all more challenging to identify the causal relationships between the influential factors in a patient’s life and their diagnosis. However, the existing literature has summarized a set of prerequisites that put a patient into a risk group for bulimia, and can facilitate the unhealthy coping mechanisms of the disease.
Biological prerequisites of the Bulimia Nervosa focus on the genetic relationship with a close relative with an eating disorder or a mental health condition. The closest the relation is, the more it places a person in the risk-group, with awareness campaigns often targeting the first-degree relatives of patients with eating disorders. Additionally, bulimia is often correlated with the insulin-dependent diabetes disorder, since the latter is associated with a restrictive diet. Food restrictions in general often contribute to the development of eating disorder, since they facilitate the brain’s increased hunger tolerance.
Psychological reasons include such personal traits as perfectionism and body image dissatisfaction. Self-oriented perfectionism in particular, which involves a beholder putting the unrealistically high expectations on themselves, is considered to be one of the main risk factors for eating disorders. A negative body image illustrated by a dissatisfaction with both self-perception and the presumed perception by other people, is observed in nearly all of the patients with Bulimia Nervosa. Other potential psychological causes for the illness include the personal history with the anxiety disorder and lack of flexibility in daily behaviors (Levinson et al, 2017). A routine-focused behavior is easy to merge with food rescripting, and both often stem from the increased need for control in one’s life.
Finally, the important social causes for the Bulimia Nervosa development include personal isolation, bullying, weight stigma and unrealistic standard internalization. An isolated teenager aspiring to look like a fashion magazine model without a proper friend group to rely on would be an ideal image of the risk group member. Furthermore, a socially ostracized or teased teenager is more likely to experience the sense of powerlessness in their life in general. Hence these teenagers attempt to gain the sense of control in areas they are capable to influence directly, such as food.
Finally, cultural connotations of beauty and weight, specific to various ethnic groups vary, leading to statistically significant differences in prevalence and types of eating disorders in various cultures. The risk is particularly high for the ethnic minority groups undergoing rapid westernization, as well as their individual members attempting to assimilate in a western society. In the modern culture it is the Eurocentric beauty standard specifically that uplifts the emphasis on skinny bodies, which naturally takes a toll on the ethnic minority group members attempting to reach this standard.
References
Forrest, L. N., Jones, P. J., Ortiz, S. N., & Smith, A. R. (2018). Core psychopathology in anorexia nervosa and bulimia nervosa: A network analysis. International Journal of Eating Disorders, 51(7), 668-679.
Gibson, D., Workman, C., & Mehler, P. S. (2019). Medical complications of anorexia nervosa and bulimia nervosa. Psychiatric Clinics, 42(2), 263-274.
Hail, L., & Le Grange, D. (2018). Bulimia nervosa in adolescents: prevalence and treatment challenges. Adolescent health, medicine and therapeutics, 9, 11.
Levinson, C. A., Zerwas, S., Calebs, B., Forbush, K., Kordy, H., Watson, H.,… & Bulik, C. M. (2017). The core symptoms of bulimia nervosa, anxiety, and depression: A network analysis. Journal of abnormal psychology, 126(3), 340.
Lydecker, J. A., & Grilo, C. M. (2019). Food insecurity and bulimia nervosa in the United States. International Journal of Eating Disorders, 52(6), 735-739.
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