Category: Bulimia

ABSTRACT

Lots of people, at some point in life, worry about their weight. But for some people it leads to really serious health problems. The role of social media, in our perception of beauty, is significant in explaining noticeable the increase in the number of people diagnosed with eating disorders. His report is going to consider number of explanations for anorexia nervosa and bulimia nervosa, and evaluate treatments for it. The DSM-5 classification recognises two specific diagnoses of eating disorders:

1. Anorexia nervosa – this is an eating disorder, which makes people to lose an unhealthy amount of weight. Anorexia is more common in females than males. However, it can affect anyone of any age, gender and background. People with this disorder drastically restrict the amount of the daily food intake, they may also exercise to burn the calories after eating. Anorexia nervosa is serious mental disorder and may lead to death ( Pinheiro, Root and Bulik, 2010).
2. Bulimia nervosa is an eating disorder characterised by eating a large quantity of food in a short amount of time, followed by vomiting or taking laxatives. People affected by anorexia may excessively try to stop gaining weight. Anyone can get bulimia but it is most common in young females (NHS, 2017).

BIOLOGICAL EXPLANATION

GENETICS

The studies have shown that if the closest relatives (parents, children and siblings) suffer from anorexia the risk of developing anorexia are very high. A study has shown that one of identical twins is 55% more likely to develop anorexia if the other twin has it. However, the chances of developing anorexia, for non-identical twins is only 7% ( Holland, 1984). Studies have shown that the genetic link for bulimia is lower than for anorexia. Kendler et al. (1991), in his research reported that 23% of identical twins suffer bulimia compared to 8,7% for dizygotic twins, (Cardel, Clark and Meldrum, 2000; Hill, 2009).

PHYSIOLOGY

Eating disorders may be linked to biochemical imbalance. Research has shown that the lateral hypothalamus (LH) and the ventromedial hypothalamus (VH) work together in controlling weight. LH is responsible for production of hunger and VH is involved in terminating hunger. Once either hormone is activated, the hypothalamus sends signals to the areas of the brain responsible for thinking and behaviours that will gratify whatever is activated. A fault in this part of the hypothalamus is a possible explanation for eating disorders. Low levels of endocrine, which can cause loss of the menstrual cycle, is very common in eating disorders, this is associated with a hypothalamus dysfunction. However, not enough research and evidence have been conducted to support this thesis ( Cardel, Clark, and Meldrum, 2000). Low levels of norepinephrine, dopamine and serotonin has been found to have a link to binge eating. Eating disorders have been associated with depression, which is linked to serotonin dysfunction (Hill, 2009).

EVALUATION

Biochemical imbalances are as likely to be a result as a reason, of the eating disorder, because it can be an effect of starvation and purging. Starvation has a significant effect on the human body and it may cause an imbalance in biochemical functioning. Environmental influence plays a bigger role in eating disorders than genetic impact. In the current studies, environment has not always been controlled. It is not clear what is actually inherited. Research says that some personality traits, like perfectionism, obsessionists and inflexibility, or predisposition to inherit mental illness, may be a reason for a person to develop an eating disorder. The MZ studies are nowhere near to 100% , which shows that environmental factors do appear to be involved. However, antidepressants that raise serotonin levels are very effective in treating bulimia, which proves that increasing levels of serotonin helps to treat it. Loss of the menstrual cycle can happen before weight loss, which suggests a low level of endocrine, which is related to a hypothalamus dysfunction. However, postmodern studies have not exposed damage in the hypothalamus of those with eating disorder. One of the strengths of this model is that the anorexic is not blamed for their behaviour, and is seen as a victim of a disorder, over which they have no control. This takes away problem of accountability and labelling the person, and places the blame firmly on the disorder. The biological approach is using scientific methods, which can be verified for reliability, ( Cardel, Clark and Meldrum, 2000; Hill, 2009).

One of the weaknesses is shown the twin study, which does not take in to consideration twins who not live together and assume that both twins have an identical environment in all research cases, (Cardel, Clark and Meldrum, 2000; Hill, 2009).

TREATMENT

Antidepressants (Prozac) have been shown to be helpful for treatment of bulimia nervosa. Researchers have found out that 60mg a day of fluoxetine produced a better reduction of bulimic symptoms compared to 20mg a day and placebo (Fluoxetine Bulimia Nervosa Collaborative Study Group, 1992; Goldstein et al. 1995). For some patients the side effects of taking antidepressants may be worse than symptoms of the mental disorder and in many cases when treatment is stopped, the problem reappears. On the other hand, by reducing depression and anxiety, antidepressants help to change a patient’s perception about their body image and reduces binge eating and purging urges. Antidepressants should be a part of recovery process, as they treat symptoms, not the causes, of eating disorders. They should be used along with psychotherapy like cognitive behavioral treatment because bulimia is a complex mental illness. The cognitive treatment concentrates on changing a distorted body image and believes that the person with the eating disorder cannot be valued unless he or she has ideal physical appearance. Effectiveness of antidepressants is a proof that chemical imbalance is the cause of eating disorders. However, some psychologists argue that it could be a result, rather than reason, for eating disorders. Long-term usage of antidepressants may lead to dependency upon the drug, ( Cardel, Clark and Meldrum, 2000; Hill, 2009).

PSYCHANALITICAL THEORY

In this theory the anorexic’s refusal to eat has been understood as denial of the adult role and the wish to continue to be a child or relapse to the childhood. This theory is supported by the timing onset of anorexia (puberty) and loss of menstruation. Hilde Bruch (1979) suggested that anorexia is linked to psychosexual immaturity. In one of the theories women unconsciously associate fatness with pregnancy. They think that eating will lead to pregnancy, therefore they starve themselves. Another suggestion is that the mother may want to limit her daughter’s independence and thus want to stop her from growing up. For the daughter it is a way of continuing to be reliant on her mother, ( Cardel, Clark and Meldrum, 2000; Hill, 2009).

Eating disorders have been linked to early traumatic experiences. Thirty percent of eating disorder patients had an early experience of sexual abuse ( McLelland et al. 1991). Sexual abuse may lead to rejection, by victim, of their own body. In puberty and adolescent it may lead to disgust and desire to destroy their own body (starving themselves, self-harm).

A study of anorexia and bulimia in males, suggests that sexual orientation is the main factor. Carla et al. (1997) observed 135 patients, from 1980 to 1994. The research conducted showed that 42 percent of the bulimia group were homosexual or bisexual, and 58 percent of the anorexia group identified themselves as asexual, (Cardel, Clark and Meldrum, 2000; Hill, 2009).

According to Freud, oral fixation may lead to the development of eating disorders like bulimia. People with oral fixation are preoccupied with eating and drinking, biting nails, mouth-base aggression or smoking, which helps them reduce tension. Anal fixation, on the other hand, leads to the development of expulsive personality; compulsive seeking order, tidiness and perfectionism. People who suffer from anorexia can be described as perfectionists, with a desire to achieve the ‘perfect’ body. Added to this, Freud believed that anorexia could be explained as the patient’s way of blocking sexual instincts. He also believed that the strong influence of the superego strictly limits the id, and explains the development of eating disorders. The superego stops a person from eating, and makes him or her feel guilty, or tells them they are fat and ugly if they do eat, (Cardel, Clark and Meldrum, 2000; Hill, 2009).

EVALUATION

Psychodynamic theories focus on psychological explanations of mental disorders. Freud’s ideas had a large influence on psychology and psychiatry, and are used today. He focussed on individual patients and analysed them in detail, which is a strength. However, Freud’s concept is hard to test and verify scientifically. His concept is very subjective, it can be used to explain anything but which can predict very little. Freud used very small samples and his technics are open to bias in his research. Many of psychoanalytical concepts can be explained better and in a more scientific way (for example, the cognitive approach). Research has shown that early trauma in a female causes them to be self-critical and may lead to self-harm. Males, however, are expressing dominant and externally expressive behaviours, which may lead to aggression towards others. This can be used to explain why eating disorders are mainly female illnesses, ( Cardel, Clark and Meldrum, 2000; Hill, 2009).

ACCEPTANCE AND COMMITMENT THERAPY

The ACT is a mindfulness based therapy. The goal of this therapy is to change the actions (eating problems), and to reduce psychological inflexibility. It helps the patients to understand that they are not their thoughts. The ACT helps patients create new narratives for their lives and helps patients to shift attention from what they have no control over (eating habits) to what is in their control. Patients are encouraged to set the goals and are taught to identify fundamental values. The goal of ACT is to live an authentic life, not to feel good. The patients are encouraged to separate themselves from emotions and they learn that pain and anxiety are an ordinary part of life. ACT can be an effective treatment for eating disorders and it could be combined with the usage of antidepressants to reduce anxiety around food and eating, (Englen, 2017).

BEHAVIOURAL THEORY

This theory focusess on the symptoms, and behaviour of the patients. It does not take biological or psychodynamic factors in to consideration. Behaviourists state that eating disorders are learnt, through classical conditioning, operant conditioning, and social learning.

• FAMILY SYSTEM THEORY (also used in the humanistic and psychodynamic system) – controlling and high expectation people are more likely to be parents of children with anorexia. Minuchin et al. (1978) applied family system approach in the development of anorexia in children. He explained that families have very strong emotional connection, strict beliefs and loyalty towards each other. As a result, children very often feel like they cannot become individual because the family is over controlling them, (Cardel, Clark and Meldrum, 2000; Hill, 2009).

Kramer (1983) identified that people with eating disorders did have higher level of family dysfunction than people from a control group (no eating disorder).

In this explanation family dynamics could be blame for an eating disorder which is not always true. Also, this theory only describes the development of eating disorders in people living at home, which is not always a case. Correspondingly, young people and adults can develop eating disorder at any time at live, (Cardel, Clark and Meldrum, 2000; Hill, 2009).

• SOCIAL LEARNING THEORY – This states that environment affects behaviour through modelling, observation, imitation and reinforcement. As a result, people copy those they admire, for example actors or celebrities. In Western culture being slim is associated with being beautiful. The actors and models, or family members may appear to be successful because they are slim. Young people may observe and imitate behaviour of the role models, and alter their own actions to try to accomplish the same rewards (praise for being slim and attention). They may get admired at first for losing weight, and looking better. However, they may then continue to lose weight, which can lead to the development of anorexia nervosa, (Cardel, Clark and Meldrum, 2000; Hill, 2009).

Classical conditioning means that dieting becomes a habit. The person who diets, get positive comments about his or hers appearance. In result, they learn to associate being slim with approbation from others. Social worth and admiration from a society may praise weight loss and control, (Cardel, Clark and Meldrum, 2000;Graham Hill, 2009).

Operant conditioning happens as approbation from others further strengthens the dieting behaviour. As an addition, it can be rewarding, in the form of attention and concern gained from parents, doctors or partner. It can also be supported by online forums and groups where it can become a competition between the members. On the other hand, it can be a way of punishing parents or a partner, (Cardel, Clark and Meldrum, 2000; Hill, 2009).

Promotion of being thin, from magazines, television and social media, makes people associate being slim with being beautiful. Social media is taking over our lives and has an impact on our society. This is predominantly true when it comes to young people and eating disorders. Keel and Klump (2003) recognised the role of media influences. Rodin ( 1991) found out that pressure from a perfectionist mother, overly concerned with appearance, on daughter to be thin, may lead to anorexia. The University of Pittsburgh School of Medicine found that people who spend most of the day on social media are twice more likely to have an eating disorder (Allie Shah, 2018).

EVALUATION

Not all women develop eating disorders, but all are subject to the same pressures from the media. This proves that other factors are involved in an explanation for eating disorders (genetic or neural factors). However, social learning theory helps to explain why a number of people with an eating disorder has increased in recent years. Social media has more significant meaning in our lives, which has an effect on people’s perception of beauty. The behavioural model takes cultural and social differences in to consideration, which is a positive. However, it does focuse mainly on symptoms not causes of the illness, which may lead to recurrence of the illness, through different symptoms. Behaviourists believe if the behaviour has been learned it can be unlearned, through classical and operant conditioning, (Cardel, Clark and Meldrum, 2000 ; Hill, 2009).

TREATMENT

Family-based treatment for anorexia nervosa

This is an efficient and cost effective treatment for anorexia nervosa. This treatment recognises importance of parents being involved in a child’s recovery. They are in charge of recovery of the child and require their child to eat. Parents are the leaders of the child’s care, a therapist works as an adviser to them. It is an advantage because parents are people who know and love a child the best and this allows a child to have treatment at home. Parents are in charge of food choices, which helps the child to overrule the controlling need to restrict food. This treatment focuses on prompt weight gain, which very often leads to a decrease or disappearance of many symptoms of anorexia.

However, this treatment has its limitations. It is not recommended for families in which parents are physically or sexually abusive, take drugs or are abusing alcohol. For some families this type of treatment is impossible to implement, due to financial problems, working full time or other responsibilities. Some patients may not be able to gain weight at home and need to be hospitalised even with family support. Also, some patients may have other medical or psychiatric issues, that make home-based treatment dangerous. This treatment could be used with ACT to reduce psychological inflexibility, and change the patient’s negative self-evaluation and through that, reduce the chances of recurrence of the eating disorder, (Cardel, Clark and Meldrum, 2000; Hill, 2009).

CONCLUSION

Eating disorders are serious and complex mental illnesses. The consequences of using laxative and starvation are serious and permanent, and can lead to a person becoming infertile or even to death. There is some evidence suggesting a genetic link but it should not be isolated from the environmental impact. The behavioural model joins social and cultural ideals of slim being beautiful, and proposes that dieting is a habit powered by the media. The cognitive model, on the other hand, blames development of eating disorders on an illogical and faulty perception of body and weight. The psychodynamic and humanistic theories, recognise the connection between family dynamics, (Cardel, Clark and Meldrum, 2000; Hill, 2009).

BIBLIOGRAPHY

1. Cardwell, M., Meldrum, C. and Clark, L. (2004). Psychology. London: Collins.
2. Englen, R. (2017). Psychology Today UK: Health, Help, Happiness + Find Counselling UK. [online] Psychology Today. Available at: https://www.psychologytoday.com/ [Accessed 19 Dec. 2018].
3. Faudemer, K., Hayden, C., McHale, K. and Simson, C. (2015). A-Level psychology. Newcastle upon Tyne.
4. Hill, G. (2008). AS & A psychology through diagrams. Oxford: Oxford University Press.

Models of human thermoregulatory responses can predict how the body will react in nature. Comment by kristina nair: Way too broad – talk about it Humans react to extreme heat through homeostasis Function well 20+

Thermoregulation

The claim ‘Human thermoregulatory responses can predict how the body will react in nature’ is ambiguous and non-specific. The research on human thermoregulation is still fairly new and therefore the amount of research is limited on the topic. Although there have been numerous trails on the topic for example the research on military personnel (Andrew J. Young) “Thermoregulation is a process that allows the body to maintain its core internal temperature.” (Thermoregulation, n.d.) the core internal temperature for humans is 36.5 to 37.5. The temperature cycles regularly up and down throughout the day. Thermoregulation is crucial to human life. Without thermoregulation humans would not be able to adequately function and inevitably expire. The brain controls thermoregulation. Comment by kristina nair: Need to put in a source!!! Otherwise it’s a potential lose in mark.

Hypothalamus

The hypothalamus senses external temperature growing too hot or too cold and will automatically send signals to the skin, glands muscles and organs. Sweating is the body’s approach to cooling down. When the body is hot the hair on your skin lies flat, sweat is emitted and muscles relax. When the body is cold the skeletal muscles tense up which leads to shivering and bodily hair follicles are raised which traps the heat and create warmth. (Osilla & Sharma., 2019). The hypothalamus is small and located at the base of the brain near the pituitary gland. When the hypothalamus doesn’t work properly it is called hypothalamic dysfunction.

Eating Disorder

Eating disorders such as bulimia can cause hypothalamic dysfunction. the hypothalamus motivates people to eat. When people have eating disorders the brain sends signals to other regions that override the hypothalamus. This study suggests that can ultimately condition the brain to reject signals from the hypothalamus. Comment by kristina nair: Need a source here

Temperature

Extreme cold is any temperature well below zero. Hypothermia is when the body temperature is lower than 35 degrees Celsius. Hypothermia may be characterised into primary and secondary types. Primary is when a human’s body heat balancing mechanism are working properly but are introduced to extreme cold conditions. Secondary is when a human’s body heat balancing mechanism are impaired and cannot respond to mild cold weather. Comment by kristina nair: Need source here

Bulimia

Bulimia is a binge eating disorder. the binge episodes are associated with a sense of loss or control and immediately followed with feelings of guilt and shame. A person who has bulimia can become lost in a dangerous cycle of out of control eating and attempts to compensate by then throwing it back up which can lead to feelings of shame guilt and disgust. Many people experience weight fluctuations so they may lose or gain weight but they normally stay in a normal weight range. (national eating disorder , n.d.) people who have immediate family who have eating disorders are more likely to develop an eating disorder. Being overweight as a child or teen can also be a risk. (Mayo Clinic, 2018) bulimia is chronic and can last for years or even lifelong. There is an increased risk of suicide among those with bulimia with 34% of people self-harming. (Mirror Mirror eating disorder help, 2015 )

Extreme Heat

Extreme cold is classified as temperature below 0 degrees, although in some countries below zero degrees is the normal temperature. Extreme cold becomes dangerous when the body’s temperature reached 35 degrees Celsius or below. The body then exhibits hypothermia. Which can lead to serious injuries or death. When the body begins to get cold the body starts to shiver and the hair follicles raise to trap the heat. The heat is retained to the centre of the body where all the organs are.

Homeostasis

Homeostasis is the ability of a living organism to regulate its internal conditions, despite changing environments. If our body gets too high or too low, key cellular processes would break down this is known as thermoregulation. Homeostasis occurs in two stages

1. The body detects a change from the stable state, In either the internal or external environment
2. These changes are counteracted by responses in the body

This is known as negative feedback or stimulus response. Messages in the body are either carried out by the nervous system or hormones, which are produced by glands of the endocrine system. For example, in thermoregulation the skin is an effector, which causes a response such as sweating or hairs raising. Effectors are either muscles (which contract in response to neural stimuli) or glands (which produce secretions) once the stimulus has caused a response, there is feedback sent to the receptors about the new conditions. the feedback helps regulate the intensity of the response, and this is called negative feedback. Comment by kristina nair: The effector is the part of the body which brings about the necessary change needed to achieve homeostasis

Analysis

The extremities are more affected by cold exposure more than other parts of the body. When the human body cools, blood flow is reduced to the hands and feet decreasing the amount of warm blood flowing to these areas. The hands and feet have a low metabolic heat production. The balance of control within the human system depends on the response to cold exposure and interaction between the skin and the core body temperatures with the central nervous system. The preoptic-anterior hypothalamus contains neurons that respond to the temperature in the brain and receive input from the thermo-receptors from the skin and spinal cord. The system is even more sensitively programed, certain neurons in the hypothalamus that respond to cold stimuli also respond to chemical changes. For example, when the hypothalamic neurons are exposed to low glucose the cold sensitive neurons fire. In a study observations were recorded during a training operation where, personal complained of being cold when they were dehydrated or hungry. (ROBERT S. POZOS & and DANIEL F. DANZL) The intake of food plays a major part in maintaining and enhancing the metabolic rate of the subject. Figure 1 exhibits how when the human body is exposed to cold temperatures the skin temperature senses the change and the body increases its core temperature. A message is then sent from the spinal cord lateral to the central nervous system and then psychological outcomes are made.

Although the sample size of the studies was not known it was published by a professor in biology at San Diego state university and professor and chair, department of emergency medicine, university of Louisville, school of medicine. This is a reliable group as the group has many reputable locations. University of San Diego state has come out with credible studies before. Although the sample size and method was not known the study has credible source. the field in human thermoregulation Specifically in models predicting an outcome is still emerging and therefore there isn’t adequate testing as it poses ethical issues. The sample size and method of testing are also limited due to an emerging field and ethical issues that are faced. Comment by kristina nair: Limitations Don’t get published if it’s not fact.

Heat is lost from the body surface faster than it is replaced. As a result, whole body cold exposure causes skin temperature over the entire body surface to decline. Insulation begins to increase when skin temperature decreases below 35 degrees Celsius and becomes maximal when skin temperature is about 31 degrees Celsius. Figure 2 shows how over the 90-minute exposure time the skin temperature decreases to about 19 degrees Celsius. In addition to mechanisms that limit heat loss humans employ other means to defend body temperature. Metabolic heat production can increase in order to replace heat lost during cold exposure. Cardiac output increases with cold exposure. Figure 3 depicts the increase in terms of heart rate, stroke volume, and cardiac output. The cardiac output increases primarily because of an increase in stroke volume with little change in resting heart rate during cold exposure.

Shivering depends on adequate supply of substrate for the metabolic processes producing energy for the contractions. Those who are not adequately protected from the cold by clothing and shelter will shiver, and their nutritional energy requirements will be greater than in warmer climates. the national energy requirement will be proportional to the duration and severity of cold exposure. Carbohydrates and fat oxidation provide 18 percent and 59 percent respectively of the total energy expenditure in the neutral condition compared to 51 percent and 39 percent in the cold condition. These finding indicate that both fat and carbohydrate metabolism sustain shivering, but that carbohydrate is the dominant energy source. either blood glucose, muscle glycogen stores or both may provide the source of carbohydrate for shivering thermogenesis.

The sample was fairly small for each of the studies, where it was about 7-8 people for the study. Due to the fact it is an emerging field the sample size was reasonable, although an improvement would be getting different genders and ages. The intuition of medicine that published the study. The intuition of medicine is a reliable group that produces reliable information. The studies used military personnel, which is reliable as they cannot alter the results. The author Andre J. Young is in the thermal physiology and medicine division, environmental physiology and medicine directorate, U.S Army Research Institute of Environmental Physiology and Medicine Directorate, U.S. Army Research Institute of Environmental Medicine. The work was also copyrighted by the national academy of sciences. (Andrew J. Young)

Interpretation

Source 1 indicates that when the hypothalamic region lacks nutrients the hypothalamus cannot work to its full efficiency. Therefore, when someone with bulimia is exposed to cold conditions their hypothalamus isn’t able to detect temperature changes to the best of its ability die to the lack of nutrients. The hypothalamus can’t send messages to the receptors in the spinal cord and central nervous system. If the hypothalamus is lacking in nutrients it can’t respond to the cold stimuli due to the chemical changes.

Source 2 establishes that when heat is lost from the body’s surface faster than it is replaced. If someone with bulimia is in extreme cold environments and due to a chemical imbalance the hypothalamus, models can predict how the body will react. The body also relies on metabolic heat production although someone with bulimia may not have a metabolism sufficient enough to sustain themselves. This can lead to an increase in cardiac output and stroke volume can increase to an unhealthy level. In Figure 3 the resting heart rate increases post accumulation to about 80 bpm.

It shows the effect of immersion in 18 degrees’ Celsius water and the glycogen concentration in the muscle. The glycogen concentration is high for a few of the men although most remained low. This would affect someone with bulimia differently as the glycogen concentration in their muscles would be lower than normal as they would lack nutrition due to improper intake of food. Therefore, the shivering would burn too much energy in a pre-existing weak body.

Evaluation

The quality of evidence was limited ad the field is still an emerging field with many ethical issues emerging with it. The sample size for the studies is often small and limited. In source 2 the study was done with military personal, they were all Caucasian males. The assumption can be made that the military personnel all had the same if not similar training and therefore are build similar to each other. They are fitter then the average male and therefore the study also doesn’t take into account the sedentary lifestyles of many people. The study was also done with purely males and didn’t take into account how the female body would react to the tests. An improvement to the studies would be to include more people from different types of lifestyles, with different mental health positions. Although none of the studies included anyone with bulimia it would improve predictions.

Conclusion

Models of human thermoregulatory responses can predict how the body will react in nature. Models of human thermoregulatory response can predict how the body will react in nature to certain extent. Prediction of human thermoregulatory responses has a small range as it doesn’t factor in the differences in each person. Although the models do have an accurate representation of what would happen to a human body in the cold temperature. The condition bulimia would affect the human thermoregulatory on harsh climates. The limits in the investigate were that the information available to the public on the topic is low as the field is an emerging field and as a student some information may not be open to students. In conclusions bulimia affects the human thermoregulatory system in harsh climates.

References

1. Alberto Coccarelli, E. B. (n.d.). Modelling accidental hypothermia effects on a human body under different pathophysiological conditions. Retrieved from US National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680406/
2. Andrew J. Young, M. N. (n.d.). Nutritional Needs In Cold And In High-Altitude Environments: Applications for Military Personnel in Field Operations.
3. G.P. Kenny, A. F. (2014). The human thermoregulatory system and its response to thermal stress.
4. Hypothalamic mechanisms in thermoregulation. (n.d.). Retrieved from PubMed: https://www.ncbi.nlm.nih.gov/pubmed/6273235
5. Lenhardt R, K. A. (n.d.). Thermoregulation and hyperthermia. Retrieved from PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8901936
6. MARILL, M. C. (2019, 07 03). Wired. Retrieved from How extreme heat overwhelms your body and becomes deadly: https://www.wired.com/story/how-extreme-heat-overwhelms-your-body-and-becomes-deadly/
7. Mayo Clinic. (2018, May 10). Retrieved from Bulimia Nervosa: https://www.mayoclinic.org/diseases-conditions/bulimia/symptoms-causes/syc-20353615
8. Mirror Mirror eating disorder help. (2015 ). Retrieved from Statistics on Bulimia: https://www.mirror-mirror.org/bulimia/statistics-on-bulimia.htm
9. national eating disorder . (n.d.). Retrieved from Bulimia Nervosa: https://www.nedc.com.au/eating-disorders/eating-disorders-explained/types/bulimia-nervosa/
10. Osilla, E. V., & Sharma., S. (2019, March 16). Physiology, Temperature Regulation. Retrieved from NCBI- PUBMED: https://www.ncbi.nlm.nih.gov/books/NBK507838/
11. ROBERT S. POZOS, & and DANIEL F. DANZL. (n.d.). Chapter 11 HUMAN PHYSIOLOGICAL RESPONSES TO COLD STRESS AND HYPOTHERMIA.
12. Thermoregulation. (n.d.). Retrieved from HealthLine: https://www.healthline.com/health/thermoregulation#takeaway
13. Thermoregulation. (n.d.). Retrieved from Healthline : https://www.healthline.com/health/thermoregulation
14. Wang, F. (2014). Modelling of cold stress and cold strain in protective clothing.

Introduction

To begin with we need to define first eating disorders, and briefly mention the different types of eating disorders. Eating disorders are characterised by one or more seriously disturbed eating behaviours such as food restriction or recurrent episodes of uncontrolled food consuming, and weight-control behaviours including self-induced vomiting, excessive exercising or the misuse of laxatives or diuretics. (Murphy et al. 2010). There are few types of eating disorders, and the common two types are anorexia nervosa and bulimia nervosa. A person with anorexia nervosa or bulimia nervosa is preoccupied with their weight, and their self-worth is dependent largely, or even exclusively, on their shape and weight and their ability to control them (Murphy et al. 2010). In this essay we will be discussing bulimia nervosa, its causes, nursing diagnoses, nursing care management, prevalence, population, and issues current and future mental health nursing practice and research implications, treatment, consumer and carer experience and treatment. Bulimia nervosa is characterized by regular, overwhelming urges to overeat (binge), followed by the use of compensatory behaviours to avoid weight gain such as self-induced vomiting, excessive exercise, food avoidance or laxatives misuse. (APA 2013, P 345). According to Michael et al, (2020), environmental and genetic factors usually cause eating disorders. Even though a lot of people consider eating disorders as a modern illness, those illnesses have been around since the 17th century.

Nursing intervention

Bulimia Nervosa is an eating disorder it can also called binge-purge syndrome as it distinguishes bulimia from other eating disorders by extreme overeating followed by voluntarily trying to vomit and get rid of the extra calories in an unhealthy way. Understanding of bulimia nervosa in the teenage population provides nurses an essential knowledge base to plan the treatment interventions for patients. Patients should be supervised during mealtime and after meals as well. Patients should be provided with smaller meals and allow patients to choose their meals, because big meals can make them feel bloated and urges the patient to initiate self-induce vomit. Nurses should monitor patients and identify elimination patterns, in some cases patients may hide the food in pockets and waste bins instead of eating. Patients with bulimia remain in the day room area with no bathroom right for a specific period after eating to prevent self-induced vomiting after eating. The most important one is assessing suicide potential in patients during hospital stay and planning for discharge as well. Patients from non-English speaking backgrounds need more attention and interpreters should be used to get the clear picture of their thoughts, and family members should be involved in the care with patient’s consent.

Educate patients about the use of laxative emetic, and diuretic abuse in bulimia nervosa. Refer patients to nutritionists and dietitians and establish a realistic weight goal to achieve and maintain a regular weighing schedule. Refer patients to physiotherapy and make an exercise routine for them, moderate exercise will help with muscle tone and weight and also reduce depression, nurses may need to be more careful about patients exercise heavily to burn calories. Behaviour modification programs can be useful for patients and nurses, and it also builds trust between them. Nurses can involve patients while setting up the plan and giving them some controls in choices. Rewards can be provided to patients when they gain weight.

Treatment

Treatment of bulimia nervosa is available in a few steps and it involves several types of specialists, doctors, allied health, and patients may have to attend various appointments in different clinics. The treatment goal of bulimia is to restore normal eating behavior, and also address any psychological problems or trauma, and to treat any medical complications associated with bulimia.

Even though the treatment strategy depends on the patient’s needs. The combination of nutritional counselling and psychotherapy can be initiated, and cognitive behavioural therapy (CBT) is preferred as well. The American Psychiatric Association (APA) guidelines for treating bulimia nervosa recommend the above-mentioned treatments. (Publishing, 2020). Nutritional counselling is preferably used to break the cycle of binge eating and purging. In this session patients are given the structure and pace of the meals and daily calorie intake also considered to maintain the weight of the patient. Cognitive behavioural therapy is the most effective therapy in adults with bulimia nervosa. This therapy is liked by patients as well, they identify manipulated thoughts about themselves and food, which underline their uncontrollable behaviour and then identify ways to cope with day to day life. The CBT provides 20 sessions over a five-month period and there is a guideline provided by APA to start medication after the 10th session if sessions only do not reduce symptoms. In practise, CBT combined with medication or with another psychotherapy works well and there is research to support this. (Publishing, 2020). Interpersonal therapy frames problems as a function of difficulties in relationships and tries to improve the relationship to address the eating disorder. (Publishing, 2020). Self-help strategies are available as well, there are some support groups available, online modes are to help. However, the research evidence is not as strong as compared to other therapies. It can be regarded as second help but not as primary treatment.(Publishing, 2020). SSRIs are used with eating disorder patients such as fluoxetine. The research has found out that this medication is helpful in adults and adolescents as well. Sertraline is also available but there is a little research about the drug, and it is mainly effective in adults. The dosage of the drug is usually higher to treat bulimia nervosa and can be prescribed from nine months to a year. SSRIs work well and must be combined with therapy for effective results. (Publishing, 2020)

There are some other medications are available as well, but the evidence is weak for alternatives. Monoamine oxidase inhibitors or tricyclic antidepressants are not well studied in bulimia nervosa. There is a warning issued by FDA against bupropion because it increases the risk of seizure. Topiramate trails show useful effects but often cause adverse effects and weight loss is one of the adverse effects.(Publishing, 2020)

Prevalence, population, and issues

Eating disorders in general affect people from different ages and different backgrounds. Most people affected by bulimia nervosa are between 16-18 years old, however, recently there is a growing number between people younger than 16 years old. According to (Butterfly foundation,2012), approximately 913,986 people in Australia have some sort of eating disorder which is almost 4% of the population, nearly 12% of those have bulimia nervosa. Females are more affected with bulimia nervosa than males. Bulimia nervosa is a hidden condition and hard to detect, and this is because normally people with bulimia nervosa have a normal weight unlike anorexia nervosa where people tend to be extremely underweight. 3% to 5% of the population in Australia have bulimia nervosa. (Gaskill, & Saunders, 2000). According to, (NEDC,210), Lifetime prevalence of bulimia nervosa in females is 0.9% to 2.1% and in males is only 0.1%. A study has been conducted in South Australia where almost 2977 participants were interviewed in the Health Omnibus Surveys, the study results were the following, the lifetime prevalence of bulimia nervosa was 1.21% for males while 2.59% for females. Another study was conducted 3 months ago and found that the bulimia nervosa prevalence was 0.40% for males and 0.81 for females. (Bagaric et al, 2020). In conclusion, based on the last study we can say that bulimia nervosa prevalence is not increasing in Australia. Asian women are getting affected by eating disorders due to westernization, and from the research we can see there is an increase in numbers since 2003. From the studies we can see three are two main reasons for the development of bulimia nervosa in Asian women, they are acculturation and culture clash. This survey was completed by eighty-one Chinese women and they were affected by perceived sociocultural influences to lose weight, overprotective parents, and self-perception of physical appearance. Those women were under high pressure to lose weight, and that pressure was coming from family and friends, especially parents. To lose weight the well-educated women were pressurized mainly from their fathers and best male friends, while on the other hand traditional women experienced the pressure from their mothers. Overall, as a result, those women found binge eating, self-inducing as the only solution to overcome their stress and pressure. (Humphry,T. et al, 2003).

Consumer and carer’s experience

This study aimed to identify the experiences of teenagers and their parents during care for eating disorders, these experiences can be positive or negative depending on the healthcare treatment settings or depends on the methods or ways of care that could be improved by the full analysis. Qualitative studies in the teenage case can help to facilitate a good comprehension of what consumers perceive as best care (Schmidt et al., 2017). Having a teenager with an eating disorder impacts the whole family and as well as the child. The family members emotional involvement, as well as such changes in routine including meetings with therapists and care groups, these all cause disturbances to family relationships and daily life patterns. The purpose of this study is to identify the difficulties that parents face and how they adapt these changes. There is one example to explain parents’ experience and impacts of this on children. A questionnaire that includes subjective and qualitative enquiries finished by 52 moms in Ontario. These findings show there is a noteworthy impact on relationships associated with the age of a kid. Personal leisure and the confusion level in the family. These findings differentiate the way how families cope up the situation when their child is in crisis, either empathetically. The guardians give accommodating suggestions to scientists, professionals, and service providers (McArdle, 2017). By analysing some more experiences, teenagers and their parents want better care that can fastly lead them towards recovery. Eating disorders lead to anxiety, depression, substance abuse or alcohol, self-injury, borderline personality disorder or obsessive-compulsive disorder. These things can affect people’s occupation, their relationships, and their personal life. Depression leads to sadness, changes in sleeping habits, suicidal ideations, or self-injury (Jones et al., 2012).

Current and future mental health practice and research implementation

The prevalence and incidence of Eating Disorders in Australia is increasing and constitutes the third most common chronic disorder in adolescence. Effective, targeted prevention and intervention strategies will reduce the incidence and duration of the illnesses (Eating disorders Victoria, n.d.). In current mental health practice, comprehensive cognitive behavioural approach, self-monitoring, body image therapy, energy balance training, psychoeducation and relapse prevention has been effective evidence based practice for the treatment of bulimia nervosa (oxford academy, 2017). Research supports the recovery from eating disorders such as bulimia nervosa is possible, though it might take longer. A recent, large 22‐year follow‐up study of 228 women with anorexia nervosa or bulimia nervosa treated in a specialist centre found the majority around two third of them recovered, and patient with bulimia nervosa were among the most successful recovered within 9 years (Wiley online library, 2020). Care for people with eating disorders should be provided within a framework that supports the values of recovery-oriented care (Australian Health Ministers Advisory Council, 2013). Effective psychological therapies are the first line in care and most people recover in the medium to longer term. The National Institute of Clinical Excellence (NICE) guidelines suggest that people should have equal access to treatment regardless of their cultural background, gender, and age. It has given Cognitive behaviour therapy the grade of ‘A’ reflecting the evidence of strong empirical data and recommended a psychological therapy as the initial intervention for a psychiatric disorder. evidence also supports guided self-help (GSH) can be used effectively as the first line of treatment (NICE, 2018). A major issue associated with bulimia nervosa in the culturally and linguistically different background is that they delay seeking help and care for a decade or longer. Research shows there has been an increased number of eating disorders in Chinese Australian population since 2003 due to the acculturation and cultural clash (Humphry, T. et al, 2003). National eating disorders collaboration (2010) suggest the consistent, coordinated national continuum of care approach to the promotion, prevention, early intervention, treatment, and management of eating disorders. By Involving multidisciplinary team of registered dietitian, specialist physician/paediatrician, psychiatrist, nurses, an exercise therapist, activity/occupational therapist and social worker or family therapist will enhance care and outcomes of people with eating disorders in both inpatient and community treatment settings (Wiley online library. 2020).For the future practices, Eating Disorders need to be recognised as a significant priority and focus on providing care that meet the individualise need and providing a recovery-oriented care approach involving families and communities. Research found that one of the significant challenges is to be able to provide accessible and seamless delivery of treatment services across the full continuum of care, which can be achieved by accessing different collaborative services, cross-sector professional networks and eating disorder centres. However, more research is needed to fully understand the effectiveness of this program (National eating disorders collaboration, 2010).

Conclusion

Eating disorders are common in Australia and increasing in population with culturally and linguistically different backgrounds. Young people with eating disorders encounter enormous stress and pressure due to acculturation and culture clash. In addition, sociocultural influences of weight loss, family pressure and physical appearance play a big role in binge eating and developing eating disorders. However, recovery is possible but the way to recovery can be sustained. Through effective treatment and intervention, people with eating disorders and bulimia nervosa need consistent support from the medical services in addition to psychological therapy, evidence-based practice, family therapy, involving communities and recovery-oriented care.

Bulimia is an eating disorder. The term ‘bulimia’ comes from the Greek word meaning ‘cow’ and ‘hunger.’ There are many explanations for this disease, but two explanations are more authoritative. According to the Webster Medical Desk Dictionary, published in 1993, this is food distress characterized by repeated overeating, followed by forced vomiting, prolonged fasting or abuse of laxatives, enemas, diuretics, and amphetamines. In DSM 4, it refers to ‘preventing inappropriate compensation methods to prevent weight gain affected by body shape and weight’.

Bulimia begins when a person turns to food for comfort, relaxation, and escape. It can temporarily relieve other problems such as fear, depression, anger, and emotional pain. The carnival started because a person felt low, often rejected, and then turned into a kind of almost narcotic food. His or her mind is almost always flooded with the thought of food, leading to a lack of concentration. Bulimia patients deal with most guilt by washing after overeating. Purge means they can maintain a normal weight. Most patients describe the desire for overeating as different from hunger.

When comparing bulimia nervosa to true anorexia nervosa, the basic psychopathology is similar. Both show a morbid fear of obesity. Patients with anorexia will starve to death, while patients with sepsis can only maintain limited hunger, eat and cleanse. Both reduce weight below optimal levels. This is extreme in anorexia and less extreme in bulimia. These conditions differ in the frequency of amenorrhea, the level of sexual activity and fertility. In anorexia, menstruation and fertility are discontinued, and most patients show significant stagnation or loss of sexual behaviour.

From symptoms to illness, ‘bulimia’ has undergone a long development process. A review of the anorexia nervosa literature over the past century has shown that bulimia is a symptom and was widely known at the time. Later, the case study of ‘Ellen West’ (Binswanger, 1944) constituted the first and most well-documented example in the bulimia nervosa syndrome literature with partial relief of bulimia nervosa syndrome. Since then, Boskind Lodahl (1976) has coined the term ‘bulimia’, suggesting a link between anorexia and bulimia. However, this phrase has not been widely adopted. At this moment, Russell (1979) first conducted a systematic study of bulimia as a unique eating disorder. He referred to bulimia as ‘nervous bulimia’ to show his kinship but was related to anorexia nervosa. The disease is different. Russell noted that it is too early to consider the disease as a unique syndrome, as symptoms of bulimia may occur in people who have no history of weight disorders and obese people. Therefore, the question arises whether it should be considered a unique diagnostic entity among psychology researchers. Lacy (1982) proposed that normal-weight septic syndromes are heterogeneous and that there are at least three clinical forms, although their underlying pathogenesis is similar. At this point, the syndrome seems to be rooted in the psychological, social, and biological concepts of female sexuality.

Disagreement between what constitutes abnormal and normal behaviour in childhood disorders is a recurrent issue in the field of child psychopathology. For parents, identifying problematic behaviours within their child is not an easy or obvious task. Many parents lack knowledge of childhood disorders and may not be able to recognize the signs and symptoms that accompany a disorder, especially when it comes to childhood and adolescent eating disorders. The distinction between abnormal and normal eating behaviours in children and adolescence is very obscure and may present a problem for parents and teachers when it comes to identifying this behaviour. In almost all cases, parents and teachers play a critical role in assessing childhood and adolescent eating behaviours. There are many limitations to parental and teacher perceptions of childhood and adolescent eating disorders that affect their assessment and diagnosis.

This paper will serve to discuss the barriers of parental and teacher perception in the assessment of childhood and adolescent eating disorders, particularly focusing on childhood and adolescent obesity, anorexia nervosa, and bulimia nervosa. The paper will begin with a discussion about parental involvement in the childhood home environment, eating pathology, and the parent-child relationship surrounding the consumption of food and body image. Subsequently, discussion around the active role of teacher recognition, help-seeking, and teacher-parent communications will also be reviewed. This paper will conclude with a discussion of maternal psychopathology pertaining to eating disorders and how this may influence the assessment and diagnosis of eating disorders in their children.

Child-Home Environment, Eating Pathology, Parent-Child Relationship

Researchers have argued that the dynamics surrounding the family and home environment may play a causal role in the development of eating disorders among some children and adolescents. Reports of child and adolescent eating behaviours are typically based on parent interviews or questionnaires, which makes them the proximal agents when it comes to recognizing the signs of an eating disorder (Harvey et al., 2015). These measurements are highly variably and may be biased based on parental perceptions of eating pathology and the dynamics within the home and between themselves and their child. Substantial evidence indicates that parents have a powerful impact on child body weight, food choices, and physical activity (Braden et al., 2014). Researchers have hypothesized some risk factors to maladaptive eating behaviours, such as poor general family functioning, lower socioeconomic status, inappropriate parenting style, and the experience of traumatic life events (Gibson et al., 2007).

One maladaptive eating behaviour observed in children and adolescents with eating disorders is emotional eating. Emotional eating, or eating in response to negative emotional states, has been identified as a trait that contributes to the development of bulimia nervosa, binge-eating disorder, and obesity in children and adolescents (Braden et al., 2014). A central element of the etiology of emotional eating appears to be the family’s contribution to the child’s development of negative emotional states (Haslam et al., 2008). The onset of negative emotional states is related to both general parenting style and specific feeding practices within the home (Braden et al., 2014; Haslam et al., 2008).

General parenting style describes how parents interact with their children, such as the level of warmth, control, and acceptance directed towards the child (Braden et al., 2014). Parents who tend to minimize their children’s negative emotions, provide little support, are controlling, over-involved, or overprotective may contribute to the child’s development of negative emotional states (Braden et al., 2014; Haslam et al., 2008; Scheel, 2012). In these circumstances, the child has learned that is it not acceptable or safe to experience such states, such as depression, anxiety, sadness, or dejection. Many of these emotional states are associated with body dissatisfaction and the drive for thinness, which many adolescents experience and contribute to the onset of certain eating disorders. Maladaptive perceptions made by parents surrounding emotional dysregulation create an invalidating environment for the child’s emotional experiences (Braden et al., 2014; Haslam et al., 2008). The child may begin to use blocking mechanisms, such as those involving impulsivity (such as binge-eating and purging) and/or compulsivity (such as dietary restriction and compulsive exercise) to reduce the awareness of the emotions that are regarded as unacceptable (Field et al., 2001; Haslam et al., 2008; Mash & Wolfe, 2019).

Subsequently, many parents perceive maladaptive eating behaviours as unmanageable in their children and use certain feeding strategies such as offering food to regulate these negative emotional states (Braden et al., 2014; Estrem et al., 2016; Thomson et al., 2012;). Parents may learn that food has a calming effect on their child, resulting in increased reliance on encouraging food when the child is distressed (Braden et al., 2014; Scheel, 2012). This “quick-fix” approach often leads the child to rely on food as a security vessel to downregulate their negative emotions in future circumstances. These commonalities are observed in patients suffering from bulimia nervosa, binge-eating disorder, and obesity.

In studies that use parental report measures, many have reported that their experience with a child who displayed problematic feeding and eating behaviours created a burden that impacted their day-to-day lives (Estrem et al., 2016). Parents report struggling with children who refuse to eat or have restrictive eating and often blame themselves or feel guilty that they could not recognize the signs sooner (Estrem et al., 2016; Gibson et al., 2007). Parents often report feeling powerless with respect to managing their child’s eating difficulties, and also report difficulty with comprehending the idea that their child’s pattern around food and body image may not be normal (Thomson et al., 2012). Parents from a study conducted by Thomson et al. (2012) found it hard to conceptualize their child’s difficulties as an illness and many reported feelings of denial as a consequence of using the words “anorexia” or “obese” to label their children. These ideas may prevent parents from seeking help for their children because they fear the reality of their child’s difficulties and fear the parental stigma that is associated with such disorders.

Feeding practices in the home are also reliant on the parent’s lifestyle. Many parents that are single-parents may find it difficult to afford nutrient-dense food options for their children (Gibson et al., 2007). With restricted access to less energy-dense foods and adequate facilities for recreational exercise, many children who are predisposed to a history of family obesity, may struggle to maintain a healthy weight (Gibson et al., 2007). Studies have shown that having overweight parents and family members increases the likelihood of a child being overweight or obese (Gibson et al., 2007). Similarly, parents (particularly mothers) that struggle with anorexia or bulimia nervosa can influence the onset of eating disorder symptoms in their children (Lydecker & Grilo, 2017). Parents attitudes regarding the eating environment can have an impact on their child’s eating behaviour, especially if the attitudes around food and body image are detrimental to the child’s mental health. Parent’s who do not have a willingness to change their lifestyle or seek help for their own disorder may not see the need to seek help for their child.

Teacher Recognition, Help-Seeking, Parent-Teacher Relationship

Recognition of eating disorders is a very real issue for teachers working in secondary schools. With the peak age of onset of eating disorders being between the ages of 10 and 19, most school staff members are likely to encounter students suffering with eating disorders several times throughout their school career (Knightsmith et al., 2013). The consequences for a student suffering from an eating disorder during their time at school can lead to impacts on both their academic and social development, which makes teachers a crucial asset in the recognition, diagnosis, and assessment of childhood and adolescent eating disorders (Knightsmith et al., 2013). Many researchers have studied teacher recognition of eating disorders among students in secondary schools and have similarly concluded that school staff are ill-equipped when it comes to the matter of eating disorders.

One of the most widely cited studies by Knightsmith, Treasure and Schmidt (2013) investigated teachers’ perceptions on eating disorders in students. The study consisted of school staff members from a secondary school in England who were asked to discuss topics in relation to eating disorders, such as school culture, knowledge and understanding, communication with students, support strategies, and working with parents and external agencies. Derived from participant discussions, the researchers recognized four key themes in their experiences with eating disorders. The first two being that many staff do not have a basic understanding of eating disorders which makes them uncomfortable when talking to students about these disorders. The third theme was that eating disorders and other mental health issues were seldom discussed in the staffroom and among staff members. The final theme was the lack of relationships and communication with parents regarding food and their child’s eating behaviours.

This study, and many similar studies, reveal the barriers in teacher perceptions and assessment of eating disorders in students and how many teachers may not be equipped to spot the warning signs or offer support (Knightsmith et al., 2013). Many staff members would not know how to respond if a student had a suspected eating disorder which highlights the need for training for school staff to improve their basic understanding and recognition of eating disorders (Knightsmith et al., 2013). For children and adolescents to get the support they need, teachers need guidance on how best to talk to students about their eating disorder and prepare staff so that they feel comfortable in this area. Based on findings from this study, it is also suggested that teachers and parents work together with the child so students have support in multiple domains in terms of recovery (Knightsmith et al., 2013). Guidance about how to work with parents and how to approach parents regarding eating disorders in their children would be beneficial training for school staff so that the collaboration between teacher-parent is proactive (Knightsmith et al., 2013). Extensive training and guidance for teachers will allow them to feel comfortable discussing eating disorders with their students and ensure that the information expelled is educating students on the dangers of maladaptive eating behaviours.

Maternal Psychopathology

A subsequent barrier to the recognition and assessment of childhood and adolescent eating disorders is maternal psychopathology. Maternal psychopathology significantly impacts child development, including child behavioural and emotional functioning, and child eating behaviours (Braden et al., 2014; Gibson et al., 2007). Specific disorders, including eating disorders, depression, and anxiety have all been linked to the development of childhood feeding and eating disorders in as young as children 4 years old (Braden et al., 2014). Children who are exposed to psychopathology in their parents, particularly their mothers, may observe them eating in response to their own negative emotions, which may contribute to child emotional eating and eventual weight gain and body dissatisfaction (Braden et al., 2014). Similarly, overeating behaviours in mothers, such as binge-eating, or night eating have also been correlated to unhealthy eating patterns in children (Braden et al., 2014; Lydecker & Grilo, 2017).

A study conducted by Lydecker and Grilo (2017) examined the differences in child eating-disorder behaviours and parental feeding practices between a sample of parents exhibiting core features of anorexia nervosa, bulimia nervosa, binge-eating disorder, or purging disorder compared to parents with no eating-disorder characteristics. Mothers with eating disorder psychopathology reported greater perceived feeding responsibility, greater concern about their child’s weight, and more monitoring of their child’s eating (Lydecker & Grilo, 2017). These mothers also report concern about transmitting eating disorder psychopathology to their children by modelling, and report difficulty managing their own psychopathology during food preparation and feeding (Lydecker & Grilo, 2017). These concerns are communicated with their child (particularly their daughters) in the form of encouragement to lose weight or encouragement of behaviours such as restricted eating (Lydecker & Grilo, 2017).

It is evident that in conjunction with maternal eating disorders, maternal anxiety and depression are factors that may influence whether or not parents seek treatment for their overweight or underweight child (Braden et al., 2014; Gibson et al., 2007; Harvey et al., 2015; Lydecker & Grilo, 2017). A parent may be emotionally unavailable for the child because they are consumed by their own interests or has an untreated disorder (Scheel, 2012).

References

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2. Estrem, H.H., Pados, B.F., Thoyre, S., Knafl, K., McCornish, C., and Park, J. (2016). Concept of pediatric feeding problems from the parents’ perspective. The American Journal of Maternal/Child Nursing, 41, 1-8. doi: 10.1097/NMC.0000000000000249
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Mental disorders consist of a range of ailments that usually have different symptoms. Mental disorders are generally characterized by an expression of abnormal behavior, thoughts, relationship, and emotions with others. There are several mental disorders attributed to general medical conditions, such as catatonia, acquired agraphia, general paresis, eating disorder, acquired alexia, personality disorder, dysphoric disorder, and interracial psychosis (Sachdev et al., 2014). This research expounds on eating disorders and lays focus on Bulimia. Eating disorders are complex mental health conditions that often require the intervention of psychological and medical experts. The recent statistics show that over 30 million people in the United States have or have had experienced an eating disorder in their life (Brownell & Walsh, 2017). There are six types of eating disorders: anorexia nervosa, Bulimia, eating disorder, pica, rumination, and avoidant disorder. Eating disorder is described as a range of psychological conditions that cause the development of unhealthy eating habits. If not treated and given immediate attention, it can be deadly or lead to dangerous health effects. They affect both genders at any life stage, but they are most common in young women and adolescents (Mehler & Andersen, 2017). Eating disorders are manifested by an obsession with body shape or food.

History shows that Bulimia has been plaguing people since before we understood them. Bulimia is believed to have been in existence for a long time though it was hardly understood. It is described as a series of life-threatening eating disorders (Smink, Hoeken, Oldehinkel & Hoek, 2014). People ailing from this disease eat a lot of food and afterward try to get rid of the excess calories in an unhealthy means. According to Mehler et al., (2017), 70% of the respondents described the situation as typical in campuses, and more than half of the women respondents knew at least two people with eating disorders.

To overcome life-threatening threats of Bulimia, people must be aware of its signs and symptoms. The disease is secretive, and it affects people of all body sizes and shapes. A person ailing from Bulimia will eat a large quantity of food and then show compensatory behavior. This means they more food within short periods than the expected limits. Such victims cannot control their eating habits and end up feeling ashamed and guilty. These feelings lead to compensatory behaviors aimed at getting rid of the extra calories consumed (Schmidt, Treasure, & Alexander, 2015). Such practices include; abuse of laxatives, over-exercise or fasting, self-induced vomiting, and diet pills. Also, victims feel dehydrated or very weak. Laxative abuse and self-induced vomiting make individuals lose a lot of calcium and potassium, which leads to dangerous electrolyte imbalances and dehydration (Agh et al., 2016). During such cases, the victims experience lethargy, severe cardiac irregularities, and lightheadedness.

People with Bulimia have unusual behavior, such as disappearing to the bathroom following a meal. Moreover, they excessively take fluids after a meal, and they prefer eating alone in private or isolation. They also have an intense fear of gaining weight, express strong dissatisfaction about their appearance or body size, have dental issues due to self-induced vomiting. Vomiting leads to the build-up of acid levels in the mouth, which further causes tooth decay, discoloration, and erosion (Levinson et al., 2017). Scars on fingers or knuckles are another indication of Bulimia, and they are common amongst individuals who repeatedly practice self-induced vomiting. Besides, bulimia patients show signs of self-withdrawal whereby they isolate themselves to avoid social interaction during mealtime. Occasionally, the patients tend to over-exercise to get rid of extra calories, even though not all over-exercises are a sign of Bulimia. Exercise is currently used as an alternative to burning calories and is mostly embraced by men. The main side effects of Bulimia are swollen salivary gland, irritation of gut, hormonal disturbance, and inflamed and sore throat. In women, it can lead to increased physical damage, such as bloating, dehydration, seizure, menstrual irregularities, and muscular cramps.

The specific cause of Bulimia is yet to be identified, but it is believed that several factors such as environmental, cultural, psychological, and genetic factors have contributed to this disorder. Some of the causes are; poor self-esteem, negative body image, professions, history of abuse, and stressful transitions (Knott, Woodward, Hoe kens, & Limbert, 2015). Bulimia has become a challenging illness. According to Knott et al (2015), 5 % of American women are affected by the disease during their lifetime, and the standardized mortality ratio is 1.93. Besides, 3.9% of people with Bulimia end up dying, while only 6% of the affected individual obtain treatment.

According to Schmidt et al., (2015), the first step is conducting a physical examination, blood or urine tests, and psychological evaluation. Psychological evaluation is useful in determining a person’s relationship with body image and food. Mainly, doctors use criteria from the Diagnostic and Manual of Mental Disorders, which uses standard language and criteria to diagnose mental disorders (Smink et al., 2014). The procedure entails regular purging through vomiting, proper binge eating, persistent purging behavior, improving self-worth from body shape and weight, bingeing, and lack of anorexia nervosa. Binge eating is eating in a discrete period; for instance, one hour, a large amount of food that would be consumed for a longer period. Usually, the patients have a constant urge to eat. Diagnosis test is also conducted to eliminate other medical causes. Physical examination is done, and it involves measuring weight and height, temperature, the rate of heartbeats, observing the skin color, and abdominal review. A laboratory test is performed to check for protein and electrolyte and functioning conditions of the liver, thyroid, and kidney. After proper analysis of these tests, the appropriate treatment is then recommended.

In other instances, the treatment of Bulimia requires a combination of psychotherapy and antidepressants. Psychotherapy involves a comprehensive discussion of the disorder with a mental health professional. There are three types of therapy, cognitive behavioral therapy, family-based treatment, and interpersonal psychotherapy (Knott et al., 2015). Cognitive-behavioral therapy helps the victim in normalizing eating patterns and identifying unhealthy behaviors and negative beliefs and substituting them with positive and healthy behaviors. Family-based treatment allows parents to intervene in their children’s harmful eating behavior to normalize their behaviors. Interpersonal psychotherapy addresses problems experienced in relationships hence improving problem-solving skills and communication. Also, medications, such as antidepressants, reduce the symptoms of Bulimia, and they are used along with psychotherapy (Schmidt et al., 2015). The commonly used drug is fluoxetine. Besides, nutrition education helps overcome Bulimia by designing an eating plan to help achieve healthy eating behaviors. Victims need to eat regularly and avoid restricting their food intake.

According to Sachdev et al., (2014), most of the people affected by eating disorders rarely seek treatment, and this adversely affects their health. Victims who seek treatment improve their eating habits and take control of their eating disorder. The outlook for people with Bulimia is more positive (Perez, Diest & Cutts, 2014). However, there is no scientifically proven cause of Bulimia.

To wrap up, Bulimia is a common and treatable eating disorder. People with Bulimia have an average or above-average weight, water-electrolyte imbalance, vomiting due to overeating, bad breath, dental dryness, inflammation of gut, constipation, and irregular menstruation. Once diagnosed early, it is treatable. Fluoxetine and CBT are the most commonly used treatments. People need to be advised to seek medication after experiencing the above symptoms. Eating disorders are life-threatening and result in deaths of almost 10% of the individuals diagnosed with it (Knott et al., 2015). Scientific research needs to be conducted to find out the cause of Bulimia. Parents need to monitor their children on their eating habits and correct them and in advanced cases, seek medical attention. If a person is not keen, it might be challenging to recognize Bulimia. The diagnosis criteria and diagnostic tests are essential tools in diagnosing a patient’s ailment to administer the proper medication. Therefore, with the appropriate observation of the symptoms and proper medical care, the number of deaths caused by Bulimia can be minimized.