Modern technology has had a great impact on many aspects of young people’s lives. Pater et al. (2021) conducted a study into technology use among patients in relation to eating disorders. They researched the impact of social media and other technologies on mental health, including eating disorders. They reviewed the results of an interview-based study with 10 clinicians who treat people with eating disorders in order to understand the contexts and relations between eating disorders and use of technology. They found that technology, especially social media, plays a role in affecting eating disorders during this state as well as during recovery. They also found that the role that technology plays with eating disorders can also be critical during diagnosis. They also believe that these issues could have future implications within clinical psychology and the assessment and possible treatment of eating disorders.
Marks, Foe and Collet (2020) conducted a study into the relationship between social media, body image and eating disorders. They found that this relationship was primarily evident in Western cultures and that social media use contributes to body image issues and psychological distress. Social media content that promotes weight-loss and weight-management were found to have negative effects on body image and self-esteem. They discussed how the prevalence of social media use has influenced the information being shared online. The development of technology has facilitated the ability to share information, including information on idealized bodies, diets, exercise, and overall health and well-being. This common use of technology and social media has raised concerns about the influence this use of social media has on mental health, body image, and eating disorders. They also discussed possible information being shared about health and well-being that promotes weight-management that may be based on misinformation and assumptions, that could lead to people interpreting these as advice which could lead to issues with weight loss and weight gain, stress, excessive exercise or exercise avoidance, and even depression.
Santarossa and Woodruff (2017) also conducted a study into the relationship between social networking sites on body image, self-esteem, and eating disorders. A sample of 147 young adults completed an online survey which measured several variables: social networking site usage, problematic social networking site usage, body image, self-esteem, and eating disorder symptoms and concerns. They found that females spent more time on social networking sites than males. They also found that problematic social networking site use was related to body image, self-esteem, and eating disorder symptoms and concerns. In addition to this, social media activities, such as lurking on others’ profiles and posting comments on others’ posts, was found to be related to body image, whereas social media total time was found to be related to eating disorder symptoms and concerns.
Research suggests that women, young women especially, are more likely to be susceptible to being influenced by social media regarding body images and self-esteem. Irving (2011) studied the effects of ideal beauty standards on self-esteem and body image among women who show varying levels of bulimic symptoms. The typical onset of bulimia is during adolescence and early adulthood and is characterized by a fear of weight gain and distorted body image. There is often a greater dissatisfaction with body proportions and distortion of true body size among individuals with bulimia. As discussed in the study, research suggests that the increase in preference among women for thinner body shapes could be associated with increases in the prevalence of eating disorders and eating-related issues. In Irving’s study, they looked at the impact of exposure to images on thin, average, and oversized models on women’s self-evaluations who show varied levels of bulimic symptoms. They found that young women adopt an ideal body shape goal that is only achievable for 5% of the population. The results showed that regardless of level of bulimic symptoms, exposure to thin models was found to be related or lower self-evaluations. In addition to this, women who reported high levels of bulimic symptoms also reported greater pressure to be thin due to media, peers, and family.
In conclusion, there is a great amount of research that supports the impact of technology on eating disorders. Research suggests that the main reasons how technology, and in particular social media, contributes to eating disorders among young people are through the promotion of weight-management, which can be construed negatively and lead to many issues for young people, including self-esteem, body image issues, eating disorders, and depression. Due to social media, young people often view unrealistic body shapes and will risk their health and well-being trying to achieve these ‘ideal’ body types.
The sun was casting its last orange rays into the sky, marking the end of the day. Sarah just got back home from school. She looked pale, almost malnourished. Her skin had wrinkles, and her face looked hollow. She quickly tossed her bag to the side of her bed and ran to the mirror. In a split second, all of her clothes came off. Sarah stood there, all bare, with a weak smile etched on her face. She felt accomplished, elated, and proud of her physique. Her thighs were thin and her ribs were visible. To her, she looked fabulous. Sarah further continued by reaching for her diary placed neatly on her table. Pages were flipped until she landed on a specific page titled, days without eating. Sarah wrote down the number ten. In recent years, eating disorders among teenagers have become selectively popular. According to research conducted in the United States, as many as 10 in 100 teenagers suffer from an eating disorder. Regarding this pressing issue, many have voiced their concern and opinions. One of them is none other than Demi Lovato herself. In a recent interview, Demi sternly mentioned that eating disorders are serious illnesses, not lifestyle choices. On that note, based on the narrative above, the most essential question that should be running through your mind is, ‘What are the causes for teenagers to develop eating disorders?’ The answer is rather simple! The causes of eating disorders among teenagers are socio-cultural influences, genetic vulnerability, and psychological issues.
One of the primary causes of eating disorders among teenagers is due to genetic vulnerability. Precisely, genetic influences that are inherited from either parent contribute to developing an eating disorder. Although the connection between eating disorders and a person’s genes is still being heavily researched, studies have shown that the chance for an average person to become anorexic is about half a percent. Also, in the year 2000, researchers found that those who have anorexic family members increased the chance by eleven-fold. To summarize, people with anorexic family members run a higher risk of developing eating disorders. Changes in brain chemicals are also another factor in genetic vulnerability. When a person with anorexia is in the presence of food, they become overwhelmed with feelings and thoughts that make them more rigid, such as counting calorie intake at every meal, weighing themselves several times throughout the day, and making poor choices in the types of foods they eat. A study by Holsen in the year 2012 has shown those with anorexia have an internal mechanism that decreases appetite and the ability to detect hunger. To elaborate further, certain parts of the brain such as the hypothalamus which is the body’s thermostat in detecting hunger, the amygdala, the fear response region of the brain and the anterior insula, the part of the brain responsible for interoceptive awareness including the body and emotions slow down in the presence of food. Thus, we can concur that eating disorders have a genetic basis.
Apart from that, socio-cultural influences also play a role in the development of eating disorders among teenagers. This includes media culture in the form of magazines and television that portrays overweight people as ugly and unattractive while thin people are considered attractive and gorgeous. The message that thinner is better is everywhere, and researchers have shown that exposure to this can lower their self-esteem, which can lead to eating disorders. The discrimination or stereotyping based on a person’s weight is damaging and pervasive in our society. Reports have shown that in Fiji, after three years of exposure to Western television, women previously comfortable with their bodies and eating choices, developed serious problems. 74 percent of them felt “too fat;” 69 percent dieted to lose weight, 11 percent tried self-induced vomiting and 29 percent were at risk for clinical eating disorders. Equally, peer pressure in the form of bullying and teasing also increases the risk of eating disorders. When questioned, 60 percent of those affected by eating disorders said that bullying contributed to the development of their eating disorder. Those who are bullied for being overweight will feel ostracized and isolated from their fellow schoolmates. Many with eating disorders have also stated that they have few friends, social activities, and social support. So, there is strong evidence that socio-cultural influences play a role in the development of eating disorders among teenagers.
Next, psychological issues can also contribute to eating disorders among teenagers. Psychological issues here mean the constant obsession and concern of teenagers with their weight and eating patterns that negatively impact their physical and mental health. Research into eating disorders, specifically anorexia nervosa and bulimia nervosa has recognized multiple personality traits that may be present during an eating disorder. For example, perfectionism and body image dissatisfaction. Let us take a look at each one of them. Perfectionism or to be precise, self-oriented perfectionism involves setting unrealistic high standards of themselves. In other words, to scrutinize and drag their self-esteem down to meet their personal expectations. This was clearly obvious in the research conducted by Amanda Brown and her colleagues at Emory University, USA. They found that following strict food rules was significantly related to self-oriented perfectionism among the participants, ages 18 to 35. High levels of self-oriented perfectionism may lead to rigid food rules which can further increase the symptoms of disordered eating. On the other hand, body image dissatisfaction is defined as the way one perceives their physical appearance. Sadly, it is very common among teenagers to feel ashamed and unsatisfied with their own bodies. Hence, they fall into depression and eating disorders. Therefore, focusing too much on one’s weight and body size leads to dangerous eating behaviors.
Overall, it is crystal clear that socio-cultural impacts, genetic vulnerability, and psychological matters are the roots of eating disorders among teenagers. Therefore, appropriate treatment to assist teenagers on the road to recovery is crucial. This includes medication and therapy. Although medication can’t necessarily treat eating disorders, they work best to cure physical health problem related to the illness. As for therapy, it involves meeting a psychologist from time to time. However, it is proven that family therapy out of all works best in this case. This is because a concerned parent would do anything to help their children from misery. Likewise, parents should address the issue faced by their children and try their level best to solve it. Instead of rebuking, which inflicts more pain in them, speaking in the right tone and manner works best. Above all, our focus should also be on educating the public on the implications of eating disorders. Many still do not realize the seriousness of this issue as ignorance has already clouded their judgment. It shouldn’t be taken lightly! The public and the government must work hand-in-hand to curb this matter from getting out of hand. As for the teenagers out there, love and accept yourself for who you are. Only you know your true worth. You do you, you be you.
The DSM-5 describes a group of disorders related to feeding and eating behavior. These disorders include binge-eating disorder (BED), bulimia nervosa (BN), anorexia nervosa (AN), and avoidant or restrictive food intake. These disorders are characterized by continuous abnormal eating behavior that leads to altered food consumption and eventually significant impairment of physical health and social functioning (American Psychiatry Association, 2013:329).
BED is a major eating disorder where a person frequently consumes abnormally big portions of food which leads to them eating uncontrollably. The DSM-5 diagnostic criteria for BED: is the reoccurrence of binge eating that must occur, on average at least once a week over a time period of 3 months (American Psychiatry Association, 2013:350-351). An episode of binge eating is defined as eating, in a discrete time period, an amount of food that is definitely larger than the average person would consume in a similar lapse of time under similar conditions (American Psychiatry Association, 2013:350-351). Binge eating is associated with an increase in distress and must include at least 3 of the following characteristics: eating much faster than normal; overeating until one feels uncomfortably full/bloated; overeating without the physical need to eat (hunger is not evident); eating by oneself due to the fear of embarrassment because of the amount of food one consumes in a single time period; the feeling of disgust with oneself; the feeling of guilt after binge eating or the feeling of depression (American Psychiatry Association, 2013:350-351).
BN, which is commonly known as bulimia is a life-threatening eating disorder where the individual secretly purges after consuming an excessive amount of food in order to dispose of the extra calories consumed during the uncontrolled eating. In BN there are three essential characteristics: recurrent episodes of binge eating; recurrent inappropriate compensatory behaviors to prevent weight gain and self-evaluation that is excessively prejudiced by body shape and weight (American Psychiatry Association, 2013:345). Individuals with BN usually overeat in secret and they use various methods to induce vomiting after their binge session for diagnostic purposes, the binge eating must occur at least once a week for a period of at least three months (American Psychiatry Association, 2013:345).
AN, which is usually just referred to as anorexia, is a dangerous eating disorder associated with the person having an unusually low body weight, an extreme fear of putting on weight, and a very inaccurate perception of weight. AN comprises three vital characteristics: continuous energy intake limitation; extreme fear of putting on weight or becoming fat; persistent mannerisms that hinder weight gain and a disturbed perception of the way they see their weight and body shape (American Psychiatry Association, 2013:339). The individual has a body weight that is below the recommended BMI of a healthy individual (American Psychiatry Association, 2013:339).
Avoidant or Restrictive food intake (ARFI) is the last type of eating disorder that will be discussed in this review. ARFI was previously classified as a selective eating disorder. This disorder involves limitations in the amount and/or type of food that is consumed but it does not involve any fear or perceptions about body weight/shape or insecurities of size or weight gain. The main characteristic of ARFI is the avoidance or limitation of food consumption which is caused by the clinically significant failure to adhere to requirements for nutrition or inadequate energy intake by means of oral intake of food (American Psychiatry Association, 2013:334). One or more of the following essential elements must be present: significant weight loss; significant nutritional deficiency; an individual who becomes dependent on enteral feeding or oral nutritional supplements or a notable change in psychosocial functioning (American Psychiatry Association, 2013:334).
It is highly possible that these symptoms and characteristics are programmed in the limbic and cognitive circuits which have the function of regulating the neurological processes that are associated with cognitive control, appetite, and emotionality (Mishra et al., 2017:92).
Although the exact neurobiological mechanisms of the different eating disorders remain uncertain, human studies have shown that a dysregulation in the cortico-limbic systems in the brain is likely to be involved (Mishra et al., 2017:92). Eating disorders can be considered as a type of compulsion and this lends itself to the possibility to treat these disorders in the same way we treat obsessive-compulsive disorder (OCD). OCD results due to the over-powering effect that the overstimulation of the serotonin receptor has on the brain. OCD is treated by using a class of drugs that inhibits the uptake of the neurotransmitter serotonin. (Ackerman, 1992). A drug of note is Clomipramine, which successfully blocks the uptake of serotonin at synapses and affects noradrenaline uptake (Ackerman, 1992:50-51).
Studies that were recently conducted provide us with evidence that genetic factors could account for about 50-80% of the probability of developing eating disorders (ED) and this could lead to the neurobiological factors causing ED (Mishra et al., 2017:92). Other psychiatric disorders do not share the exclusive and multi-faceted appetitive symptomatology that is seen in ED and this could create the possibility that the ED reflect some irregularities in the appetitive pathways (Mishra et al., 2017:92).
The neurobiology of appetite consists of both the physiological and psychological drives of appetite. The physiological drive is the sense of hunger and is linked with the craving for food and various other physiological effects which results in the individual looking for an acceptable food supply. The psychological drive of appetite is the desire for food, usually a specific type and this is valuable as it helps the person decide the quality of food, he/she decides to eat (Mishra et al., 2017:92. The sense of satisfaction is achieved if the search for food is fruitful (Mishra et al., 2017:92). There are factors (metabolic and non-metabolic) that are involved in the commencement and upkeep of eating mannerisms (Mishra et al., 2017:92). Especially in the human race the non-metabolic factors (cues, reward, cognitive and emotions) play a vital role (Mishra et al., 2017:92) Homeostatic or hedonic are the terms given for the brain areas that regulate appetite (Mishra et al., 2017:92). If a person has not had any food intake for a long period of time, then the homeostatic processes would bring about the hunger awareness and if a person is not hungry but presented with a food stimulus may it be sight or smell or both, then the hunger awareness produces physical responses such as salivation (Mishra et al., 2017:92). The hypothalamus and brainstem form part of the homeostatic system that regulates food consumption which is based on caloric requirement and energy need (Mishra et al., 2017:92). These two areas integrate inputs from the cortical areas concerning the reward value of food which signifies that “hedonic” hunger is possibly neurally mediated thus the neural mechanisms in the hedonic system may supersede the homeostatic signs which contribute to ED (Mishra et al., 2017:92).
Homeostatic regulation involves the lateral nuclei of the hypothalamus which performs the function of the feeding center by starting the motor drives to set out on a quest for food (Mishra et al., 2017:93). The function of the satisfaction center is the ventromedial nuclei of the hypothalamus (Mishra et al., 2017:93). Hormones which control food intake and energy use, are released from the gastrointestinal tract (GIT) and adipose tissue and come together at points in the hypothalamus known as the arcuate nuclei (Mishra et al., 2017:93). Neural signals from the GIT provides the hypothalamus with sensory information about stomach filling, satisfaction from nutrients in the blood, GIT hormones, hormone signals related to the adipose tissue as well as signals from the cerebral cortex which all have some role in the feeding mannerisms (Mishra et al., 2017:93). The hypothalamic feeding and satisfaction centers contain high concentrations of receptors for a variety of neurotransmitters that control an individual’s feeding mannerisms (Mishra et al., 2017:95). “These neurotransmitters are broadly categorized as (1) orexigenic substances that stimulate feeding (example – Neuropeptide Y (NPY), Agouti-related protein (AGRP), Melatonin concentrating hormone (MCH), Orexin A & B, Endorphins, Galanin (Gal), glutamate & GABA, Ghrelin, Cortisol, endocannabinoids etc.) or (2) anorexigenic substances that inhibit feeding (Example – a-MSH, leptin, serotonin, CRH, norepinephrine, insulin, glucagon-like peptide (GLP), cholecystokinine (CCK), cocaine and amphetamine regulated transcript (CART), peptide YY (PYY)). Gastrointestinal Filling, CCK, PYY, GLP, Ghrelin, and various “oral factors” (chewing, salivation, swallowing, and tasting) are operative in the short-term regulation of food intake” (Mishra et al., 2017:95). There is a collaboration within the hypothalamus between temperature control and a food consumption regulation system which influences the homeostatic regulation of food consumption (Mishra et al., 2017:93). Due to the hormone known as leptin, which is secreted by adipocytes, the stimulation of various sites occurs in the hypothalamus which assists to reduce fat storage, reduce the manufacturing of orexigenics and increase the manufacturing of anorexigenics in the hypothalamus (Mishra et al., 2017:93).
Non-homeostatic regulation occurs when there is an exclusively cortical decision made about food intake without any hunger signal which is seen in homeostatic regulation. Hence, no hunger signal is evident, and the individual just wants to eat (Mishra et al., 2017:93). The external environment influences the degree of food consumption. The main components that regulate the appetite mannerisms of an individual are intrinsically intertwined structures and they are the amygdala/hippocampus, orbitofrontal cortex (OFC), insula, and striatum (Mishra et al., 2017:93). These structures incorporate not only the homeostatic data but also play an active role in learning what the individual likes, what they want and there is also a reward factor with regards to food by assigning attention, effort, and motivation for it (Mishra et al., 2017:93). The cognitive regulation of appetite is mediated by the modulatory regulation of the prefrontal cortex which overrides the appetite areas (Mishra et al., 2017:93).
There are various neurotransmitters that play a role in the standard feeding mannerisms (Mishra et al., 2017:93). The neurotransmitter serotonin (5-HT) has a hyperphagic effect which is most likely mediated by the post synaptic serotonin 2C receptors whilst the serotonin 1A and 1B receptors have contrasting effects on the food consumption mannerisms (Mishra et al., 2017:93). Another neurotransmitter known as Dopamine (DA), acts via the nucleus accumbens and is linked with reinforcing the effect in feeding (Mishra et al., 2017:93). Dopamine which is released in the hypothalamus has a linkage with the duration of food intake which therefore incorporates portion size (Mishra et al., 2017:93). Changes in the norepinephrine levels can result in an individual either eating more or reducing their food intake.
The sun was casting its last orange rays into the sky, marking the end of the day. Sarah just got back home from school. She looked pale, almost malnourished. Her skin had wrinkles, and her face looked hollow. She quickly tossed her bag to the side of her bed and ran to the mirror. In a split second, all of her clothes came off. Sarah stood there, all bare, with a weak smile etched on her face. She felt accomplished, elated, and proud of her physique. Her thighs were thin and her ribs were visible. To her, she looked fabulous. Sarah further continued by reaching for her diary placed neatly on her table. Pages were flipped until she landed on a specific page titled, days without eating. Sarah wrote down the number ten. In recent years, eating disorders among teenagers have become selectively popular. According to research conducted in the United States, as many as 10 in 100 teenagers suffer from an eating disorder. Regarding this pressing issue, many have voiced their concern and opinions. One of them is none other than Demi Lovato herself. In a recent interview, Demi sternly mentioned that eating disorders are serious illnesses, not lifestyle choices. On that note, based on the narrative above, the most essential question that should be running through your mind is, ‘What are the causes for teenagers to develop eating disorders?’ The answer is rather simple! The causes of eating disorders among teenagers are socio-cultural influences, genetic vulnerability, and psychological issues.
One of the primary causes of eating disorders among teenagers is due to genetic vulnerability. Precisely, genetic influences that are inherited from either parent contribute to developing an eating disorder. Although the connection between eating disorders and a person’s genes is still being heavily researched, studies have shown that the chance for an average person to become anorexic is about half a percent. Also, in the year 2000, researchers found that those who have anorexic family members increased the chance by eleven-fold. To summarize, people with anorexic family members run a higher risk of developing eating disorders. Changes in brain chemicals are also another factor in genetic vulnerability. When a person with anorexia is in the presence of food, they become overwhelmed with feelings and thoughts that make them more rigid, such as counting calorie intake at every meal, weighing themselves several times throughout the day, and making poor choices in the types of foods they eat. A study by Holsen in the year 2012 has shown those with anorexia have an internal mechanism that decreases appetite and the ability to detect hunger. To elaborate further, certain parts of the brain such as the hypothalamus which is the body’s thermostat in detecting hunger, the amygdala, the fear response region of the brain and the anterior insula, the part of the brain responsible for interoceptive awareness including the body and emotions slow down in the presence of food. Thus, we can concur that eating disorders have a genetic basis.
Apart from that, socio-cultural influences also play a role in the development of eating disorders among teenagers. This includes media culture in the form of magazines and television that portrays overweight people as ugly and unattractive while thin people are considered attractive and gorgeous. The message that thinner is better is everywhere, and researchers have shown that exposure to this can lower their self-esteem, which can lead to eating disorders. The discrimination or stereotyping based on a person’s weight is damaging and pervasive in our society. Reports have shown that in Fiji, after three years of exposure to Western television, women previously comfortable with their bodies and eating choices, developed serious problems. 74 percent of them felt “too fat;” 69 percent dieted to lose weight, 11 percent tried self-induced vomiting and 29 percent were at risk for clinical eating disorders. Equally, peer pressure in the form of bullying and teasing also increases the risk of eating disorders. When questioned, 60 percent of those affected by eating disorders said that bullying contributed to the development of their eating disorder. Those who are bullied for being overweight will feel ostracized and isolated from their fellow schoolmates. Many with eating disorders have also stated that they have few friends, social activities, and social support. So, there is strong evidence that socio-cultural influences play a role in the development of eating disorders among teenagers.
Next, psychological issues can also contribute to eating disorders among teenagers. Psychological issues here mean the constant obsession and concern of teenagers with their weight and eating patterns that negatively impact their physical and mental health. Research into eating disorders, specifically anorexia nervosa and bulimia nervosa has recognized multiple personality traits that may be present during an eating disorder. For example, perfectionism and body image dissatisfaction. Let us take a look at each one of them. Perfectionism or to be precise, self-oriented perfectionism involves setting unrealistic high standards of themselves. In other words, to scrutinize and drag their self-esteem down to meet their personal expectations. This was clearly obvious in the research conducted by Amanda Brown and her colleagues at Emory University, USA. They found that following strict food rules was significantly related to self-oriented perfectionism among the participants, ages 18 to 35. High levels of self-oriented perfectionism may lead to rigid food rules which can further increase the symptoms of disordered eating. On the other hand, body image dissatisfaction is defined as the way one perceives their physical appearance. Sadly, it is very common among teenagers to feel ashamed and unsatisfied with their own bodies. Hence, they fall into depression and eating disorders. Therefore, focusing too much on one’s weight and body size leads to dangerous eating behaviors.
Overall, it is crystal clear that socio-cultural impacts, genetic vulnerability, and psychological matters are the roots of eating disorders among teenagers. Therefore, appropriate treatment to assist teenagers on the road to recovery is crucial. This includes medication and therapy. Although medication can’t necessarily treat eating disorders, they work best to cure physical health problem related to the illness. As for therapy, it involves meeting a psychologist from time to time. However, it is proven that family therapy out of all works best in this case. This is because a concerned parent would do anything to help their children from misery. Likewise, parents should address the issue faced by their children and try their level best to solve it. Instead of rebuking, which inflicts more pain in them, speaking in the right tone and manner works best. Above all, our focus should also be on educating the public on the implications of eating disorders. Many still do not realize the seriousness of this issue as ignorance has already clouded their judgment. It shouldn’t be taken lightly! The public and the government must work hand-in-hand to curb this matter from getting out of hand. As for the teenagers out there, love and accept yourself for who you are. Only you know your true worth. You do you, you be you.
The DSM-5 describes a group of disorders related to feeding and eating behavior. These disorders include binge-eating disorder (BED), bulimia nervosa (BN), anorexia nervosa (AN), and avoidant or restrictive food intake. These disorders are characterized by continuous abnormal eating behavior that leads to altered food consumption and eventually significant impairment of physical health and social functioning (American Psychiatry Association, 2013:329).
BED is a major eating disorder where a person frequently consumes abnormally big portions of food which leads to them eating uncontrollably. The DSM-5 diagnostic criteria for BED: is the reoccurrence of binge eating that must occur, on average at least once a week over a time period of 3 months (American Psychiatry Association, 2013:350-351). An episode of binge eating is defined as eating, in a discrete time period, an amount of food that is definitely larger than the average person would consume in a similar lapse of time under similar conditions (American Psychiatry Association, 2013:350-351). Binge eating is associated with an increase in distress and must include at least 3 of the following characteristics: eating much faster than normal; overeating until one feels uncomfortably full/bloated; overeating without the physical need to eat (hunger is not evident); eating by oneself due to the fear of embarrassment because of the amount of food one consumes in a single time period; the feeling of disgust with oneself; the feeling of guilt after binge eating or the feeling of depression (American Psychiatry Association, 2013:350-351).
BN, which is commonly known as bulimia is a life-threatening eating disorder where the individual secretly purges after consuming an excessive amount of food in order to dispose of the extra calories consumed during the uncontrolled eating. In BN there are three essential characteristics: recurrent episodes of binge eating; recurrent inappropriate compensatory behaviors to prevent weight gain and self-evaluation that is excessively prejudiced by body shape and weight (American Psychiatry Association, 2013:345). Individuals with BN usually overeat in secret and they use various methods to induce vomiting after their binge session for diagnostic purposes, the binge eating must occur at least once a week for a period of at least three months (American Psychiatry Association, 2013:345).
AN, which is usually just referred to as anorexia, is a dangerous eating disorder associated with the person having an unusually low body weight, an extreme fear of putting on weight, and a very inaccurate perception of weight. AN comprises three vital characteristics: continuous energy intake limitation; extreme fear of putting on weight or becoming fat; persistent mannerisms that hinder weight gain and a disturbed perception of the way they see their weight and body shape (American Psychiatry Association, 2013:339). The individual has a body weight that is below the recommended BMI of a healthy individual (American Psychiatry Association, 2013:339).
Avoidant or Restrictive food intake (ARFI) is the last type of eating disorder that will be discussed in this review. ARFI was previously classified as a selective eating disorder. This disorder involves limitations in the amount and/or type of food that is consumed but it does not involve any fear or perceptions about body weight/shape or insecurities of size or weight gain. The main characteristic of ARFI is the avoidance or limitation of food consumption which is caused by the clinically significant failure to adhere to requirements for nutrition or inadequate energy intake by means of oral intake of food (American Psychiatry Association, 2013:334). One or more of the following essential elements must be present: significant weight loss; significant nutritional deficiency; an individual who becomes dependent on enteral feeding or oral nutritional supplements or a notable change in psychosocial functioning (American Psychiatry Association, 2013:334).
It is highly possible that these symptoms and characteristics are programmed in the limbic and cognitive circuits which have the function of regulating the neurological processes that are associated with cognitive control, appetite, and emotionality (Mishra et al., 2017:92).
Although the exact neurobiological mechanisms of the different eating disorders remain uncertain, human studies have shown that a dysregulation in the cortico-limbic systems in the brain is likely to be involved (Mishra et al., 2017:92). Eating disorders can be considered as a type of compulsion and this lends itself to the possibility to treat these disorders in the same way we treat obsessive-compulsive disorder (OCD). OCD results due to the over-powering effect that the overstimulation of the serotonin receptor has on the brain. OCD is treated by using a class of drugs that inhibits the uptake of the neurotransmitter serotonin. (Ackerman, 1992). A drug of note is Clomipramine, which successfully blocks the uptake of serotonin at synapses and affects noradrenaline uptake (Ackerman, 1992:50-51).
Studies that were recently conducted provide us with evidence that genetic factors could account for about 50-80% of the probability of developing eating disorders (ED) and this could lead to the neurobiological factors causing ED (Mishra et al., 2017:92). Other psychiatric disorders do not share the exclusive and multi-faceted appetitive symptomatology that is seen in ED and this could create the possibility that the ED reflect some irregularities in the appetitive pathways (Mishra et al., 2017:92).
The neurobiology of appetite consists of both the physiological and psychological drives of appetite. The physiological drive is the sense of hunger and is linked with the craving for food and various other physiological effects which results in the individual looking for an acceptable food supply. The psychological drive of appetite is the desire for food, usually a specific type and this is valuable as it helps the person decide the quality of food, he/she decides to eat (Mishra et al., 2017:92. The sense of satisfaction is achieved if the search for food is fruitful (Mishra et al., 2017:92). There are factors (metabolic and non-metabolic) that are involved in the commencement and upkeep of eating mannerisms (Mishra et al., 2017:92). Especially in the human race the non-metabolic factors (cues, reward, cognitive and emotions) play a vital role (Mishra et al., 2017:92) Homeostatic or hedonic are the terms given for the brain areas that regulate appetite (Mishra et al., 2017:92). If a person has not had any food intake for a long period of time, then the homeostatic processes would bring about the hunger awareness and if a person is not hungry but presented with a food stimulus may it be sight or smell or both, then the hunger awareness produces physical responses such as salivation (Mishra et al., 2017:92). The hypothalamus and brainstem form part of the homeostatic system that regulates food consumption which is based on caloric requirement and energy need (Mishra et al., 2017:92). These two areas integrate inputs from the cortical areas concerning the reward value of food which signifies that “hedonic” hunger is possibly neurally mediated thus the neural mechanisms in the hedonic system may supersede the homeostatic signs which contribute to ED (Mishra et al., 2017:92).
Homeostatic regulation involves the lateral nuclei of the hypothalamus which performs the function of the feeding center by starting the motor drives to set out on a quest for food (Mishra et al., 2017:93). The function of the satisfaction center is the ventromedial nuclei of the hypothalamus (Mishra et al., 2017:93). Hormones which control food intake and energy use, are released from the gastrointestinal tract (GIT) and adipose tissue and come together at points in the hypothalamus known as the arcuate nuclei (Mishra et al., 2017:93). Neural signals from the GIT provides the hypothalamus with sensory information about stomach filling, satisfaction from nutrients in the blood, GIT hormones, hormone signals related to the adipose tissue as well as signals from the cerebral cortex which all have some role in the feeding mannerisms (Mishra et al., 2017:93). The hypothalamic feeding and satisfaction centers contain high concentrations of receptors for a variety of neurotransmitters that control an individual’s feeding mannerisms (Mishra et al., 2017:95). “These neurotransmitters are broadly categorized as (1) orexigenic substances that stimulate feeding (example – Neuropeptide Y (NPY), Agouti-related protein (AGRP), Melatonin concentrating hormone (MCH), Orexin A & B, Endorphins, Galanin (Gal), glutamate & GABA, Ghrelin, Cortisol, endocannabinoids etc.) or (2) anorexigenic substances that inhibit feeding (Example – a-MSH, leptin, serotonin, CRH, norepinephrine, insulin, glucagon-like peptide (GLP), cholecystokinine (CCK), cocaine and amphetamine regulated transcript (CART), peptide YY (PYY)). Gastrointestinal Filling, CCK, PYY, GLP, Ghrelin, and various “oral factors” (chewing, salivation, swallowing, and tasting) are operative in the short-term regulation of food intake” (Mishra et al., 2017:95). There is a collaboration within the hypothalamus between temperature control and a food consumption regulation system which influences the homeostatic regulation of food consumption (Mishra et al., 2017:93). Due to the hormone known as leptin, which is secreted by adipocytes, the stimulation of various sites occurs in the hypothalamus which assists to reduce fat storage, reduce the manufacturing of orexigenics and increase the manufacturing of anorexigenics in the hypothalamus (Mishra et al., 2017:93).
Non-homeostatic regulation occurs when there is an exclusively cortical decision made about food intake without any hunger signal which is seen in homeostatic regulation. Hence, no hunger signal is evident, and the individual just wants to eat (Mishra et al., 2017:93). The external environment influences the degree of food consumption. The main components that regulate the appetite mannerisms of an individual are intrinsically intertwined structures and they are the amygdala/hippocampus, orbitofrontal cortex (OFC), insula, and striatum (Mishra et al., 2017:93). These structures incorporate not only the homeostatic data but also play an active role in learning what the individual likes, what they want and there is also a reward factor with regards to food by assigning attention, effort, and motivation for it (Mishra et al., 2017:93). The cognitive regulation of appetite is mediated by the modulatory regulation of the prefrontal cortex which overrides the appetite areas (Mishra et al., 2017:93).
There are various neurotransmitters that play a role in the standard feeding mannerisms (Mishra et al., 2017:93). The neurotransmitter serotonin (5-HT) has a hyperphagic effect which is most likely mediated by the post synaptic serotonin 2C receptors whilst the serotonin 1A and 1B receptors have contrasting effects on the food consumption mannerisms (Mishra et al., 2017:93). Another neurotransmitter known as Dopamine (DA), acts via the nucleus accumbens and is linked with reinforcing the effect in feeding (Mishra et al., 2017:93). Dopamine which is released in the hypothalamus has a linkage with the duration of food intake which therefore incorporates portion size (Mishra et al., 2017:93). Changes in the norepinephrine levels can result in an individual either eating more or reducing their food intake.
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.
Bulimia nervosa is an eating disorder common among young women and adolescent girls. According to the medical encyclopedia, binge and purge eating portray bulimia. It involves regular overeating and a sudden feeling of loss of control. This results in induced vomiting as well as the abuse of laxatives to stimulate weight loss. The American psychological association (APA) uses a precise manual for psychiatric disorders to classify this condition. The manual is also the diagnostic statistical manual of mental disorders (DSMV).
The DSM-IV criteria for binge eating comprise frequent episodes of binge eating, which is eating more food than an average person does in a similar time. In addition, the disorder entails a feeling of lack of control of one’s eating habits. It also includes compensatory activities such as purging, exercising or food abstinence to prevent weight gain from the overeating. For one to be certified as having bulimia, the related behaviors have to happen two times a week for at least three months.
Further categorization of bulimia nervosa is the exclusion of anorexia nervosa. Vomiting that occurs in bulimia nervosa is usually self- stimulated; “there is laxative, enema and diuretic abuse” (Polivy & Herman, 2002). The non-purging bulimia criterion must differ from anorexia nervosa in the tactic of eliminating calories and does not necessarily satisfy the ‘below 85% of expected weight criteria’ (APA 1994) as cited by Polivy and Herman (2002).
This disorder leaves experts in different fields working round the clock for possible solutions. A number of factors are put forward as causes of the disorder. Despite all the effort, much needs to be done to eradicate this issue among middle adolescents. This literature review is part of the effort towards eradication of bulimia nervosa. Theorized possibilities such as self-esteem and the influence of peer pressure are among some of the factors that this paper reviews.
Self-Esteem and Bulimia Nervosa
Bulimia nervosa can result from a poor body esteem that is a constituent of one’s self-esteem. Poor body esteem is associated with emotional eating and dieting (Filaire et al., as cited in Mak, Pang, Lai, & Ho, 2012). Adolescence is a stage with intense physical and cognitive changes. Female middle adolescents are likely to suffer from a distorted body image as compared to males. This is according to studies done by Duncan et al., 2004; Franko and Striegel-Moore, 2002 and Neumark-Sztainer et al., 2002 (Mak et al., 2012).
The study by Mak et al. confirms that body esteem largely hinges on the socialization of an individual (2012). Socialization is largely dependent on the fact that girls are socialized differently from boys. Boys seem to have a higher self-esteem than girls do. This finding is consistent with other studies done in the western world.
Mak et al. also discovered that older people seem to have greater body esteem than young adults and adolescents (2012). They demarcate the problem as young adults and adolescent issue. There is a strong correlation between self-esteem and development of eating disorders. Low body esteem and subsequent eating disorder is discovered among university students according to a research done by O’Brien and Hunter in 2006 (Mak et al., 2012).
Studies by Ferrand et al. and Shapiro et al. purport that female athletic swimmers have the same problem with university students (Mak et al., 2012). It is asserted that fear of getting fat and low body esteem from a psychiatric evaluation can lead to the development of eating disorders and unrestrained eating.
Peer Interactions and Bulimia Nervosa
Peer interaction is a paramount phase in the life an adolescent. In many cases, the feedback they get determines their behavior. Adolescents who are either overweight or perceived to be overweight suffer negative psychosocial interactions among their peers (Thompson et al., 2007).
They may receive negative comments from their peers hence withdraw socially. Neumark-Sztainer et al. discovered that at least 63% of overweight girls were teased by their peers due to their appearance (2002). Peer interactions encompass more than negative appearance-related feedback. They can revolve around peer modeling of image matters, conversations relating to appearance and popularity hinged on appearance.
Further research finds that an adolescent with dieting friends tends towards unhealthy weight-control behaviors such as diet pills, purging, and smoking (Thompson et al., 2007). This is especially common between average and overweight girls. In their recommendations, Thompson et al. give sound advice that is indeed a credible niche for future research (2007). They propose friends anticipating advice as a variable for future research.
This should be done with overweight subjects that are likely to foster a better understanding of their peer-related psychosocial experiences. They also suggest assessment of peer behavior is incorporated in the research tools. Ommundsen et al. further assert that negative peer relations because of negative interactions may result in the development of antisocial pathologies in adulthood (2006).
Parental Influences and Bulimia Nervosa
The role of parental influence in the development of bulimia nervosa is not spared from criticism. The feedback received from parents has weighty significance on the development of behavior just like feedback from peers. As Polivy and Herman note, eating disorders and related behaviors occur because of maladaptive perfectionist tendencies from parents (2002).
The situation is worse among mothers with a history of eating disorders. Perceived or real parental feedback among middle adolescents especially athletes spurs them into action. The actions can include events ranging from dieting to abuse of laxatives. Parents influence the nature of psychosocial sport experiences in middle adolescent athletes (Ommundsen et al., 2006).
Frantic efforts to lose weight are popular in adolescents whose parents are perceived as critical of the adolescents’ performances and exhibit high standards of achievement. The effect that social comparison can generate among middle adolescents female athlete is enormous. Bulimic middle adolescent athletes are reported to believe less in their capabilities and worry a lot about their performance.
These findings are in harmony with previous findings by McArdle and Duda in 2004, which show that parents with an elevated ability and are also punitively structured accelerate concern over mistakes when involved in sports (Ommundsen et al., 2006). Parents can also influence the development of bulimia nervosa by the genes they pass on to their children. Such adolescents are found to have an abnormally elevated level of serotonin (neurotransmitter in the brain, which is responsible for controlling appetite and satiety).
Media and Bulimia Nervosa
The media’s role in the development of bulimia nervosa is rather shocking. Modern customs are unique as the media, for instance, movies, magazines, televisions and the internet have a dominant influence different from the past (Derenne & Beresin, 2006). There seems to be a general preference of super slim media personalities and celebrities. The public seems to have developed an obsession with the almost emaciated media personalities.
Celebrities are usually under public scrutiny on how they maintain their weight. They are believed to maintain slender bodies as a response to public pressure. The public keeps monitoring them for weight gain or weight loss. Those who seem to lose weight in extremely short periods are thereafter viewed as heroes. Celebrities maintain rather unrealistic body shapes. The reality, however, is that it is impossible for a common middle-aged adolescent to emulate the celebrities since it requires much effort.
In addition, the middle-aged adolescent cannot afford the flamboyant lifestyle that celebrities have and the extravagant expenses on personal trainers (Derenne & Beresin, 2006). Celebrities have means in terms of finances and can afford personal trainers, expensive creams and even keeping perfect diets. An average teenager who is mistaken that it takes simple dieting to emulate the celebrities ends up with unhealthy dieting habits that result in bulimia.
The media have a significant role in sending image messages to impressionable, young people as well as creating cultural ideals of physical perfection. Becker’s landmark study of comparing the frequency of eating disorders before and after arrival of television in Fiji in 1995 is marked as a critical study in understanding the influence of media on bulimia (Derenne & Beresin, 2006). Therefore, to control this disorder there needs to be sound balance between media and reality.
Psychological Factors Affecting Bulimia Nervosa
Bulimia nervosa can result from underlying emotional problems that are either difficult to express or handle. Bulimia nervosa offers a channel for expression of emotional problems. It makes the victims feel they are in control of the situation.
It is also a tactic to escape unpleasant realities. The victims adopt dissociative tendencies as a defense mechanism. They can immerse themselves in binge eating where traumatic elements are removed from consciousness (Polivy & Herman, 2002). This protects the person from emotional misery. Unfortunately, this is just a mask, but the reality is that they are incapable of dealing with their issues.
One’s dissatisfaction with their body image (body shape or weight) leads to dieting, which when uncontrolled can then spiral into bulimia nervosa (Polivy & Herman, 2002). There are certain personality traits associated with bulimia nervosa. They may include obsessive-compulsive disorder, bouts of depression, manic disorders, and distorted body image feelings of learned helplessness.
Bulimia nervosa has a psychosocial aspect. Certain cultures especially the western cultures tend to approve of a thin body as an image of success (Polivy & Herman, 2002). For middle adolescents, part of their developmental task is to have a sense of belonging. They can do anything to ensure they fit in the society and to fulfill societal expectations of them. This in their imagination is happiness that leads to success. Bulimia nervosa is the result of dietary habits that are beyond their control.
Dysfunctional relationships can trigger bulimia nervosa. Most people hold relationships such as marriage and friendships dear. A breakdown in the relationship or even a mere indication of failure can lead to bulimic tendencies. Stressful life events such as the loss of a loved one or bullying can also trigger bulimia nervosa (Polivy & Herman, 2002).
Abused individuals or those who have experienced traumatic experiences especially in childhood sometimes develop the disorder (Polivy & Herman, 2002). According to Polivy and Herman, emotional abuse in childhood has overwhelming influence on self-esteem and anxiety (2002). They further claim that emotional abuse in childhood is the only early days’ trauma that predicts eating disorders in adults.
Relevance of the Topic
Bulimia nervosa is characterized by numerous speculations. No researcher gives the exact causes for the development of the disorder. It is, hence, vital that additional studies be carried out to determine what factors contribute to the development of the eating disorder. Consequently, this topic is relevant for identification of such niches and analyzing the best possible methods to deal with the issue.
Statistics on Bulimia Nervosa
According to Phoenix and Walter about only 15% of bulimics are males (2009). This leaves no doubt that the disorder is prevalent among females. Bulimia is thought to be predominant in individuals with low-income socioeconomic status.
The 1970s report few cases of bulimia. However, the cases have “escalated to the level of a social epidemic” between the 1970s and the end of the nineteenth century (Phoenix & Walter, 2009). Statistics published by the American psychiatric association indicate that between 2 to 3 percent of American girls aged sixteen to twenty show bulimic behaviors.
The actual figure is about seven million American adolescents struggling with the disorder. Bulimia rates are rapidly growing in the western nations. At the time of the revelation of the statistics, it was approximated that bulimic incidences were 1.6 % with intense patterns of bingeing and purging carried out in secret. Bulimics receiving treatment are estimated at one tenth. However, they only seek treatment after staying with the condition for about seven years.
Cultures sharing the western culture values and attitudes are reported to have disordered eating patterns. Findings of a Swedish study among high school girls show that at least 50 percent thinks they are fat, and about 10 percent experiences eating disorder symptoms.
A similar report is generated by a survey of college students in England in the 1980s. In the 1990s, similar studies carried out in countries such as Great Britain, Netherlands, France, and Denmark yield consistent. There is an emphasis on beauty in thinness and young women are willing to do the impossible to the extent of torturing themselves both physically and psychologically to achieve slenderness.
By the year 2000, studies indicated that at least 10.7 percent of 100,000 women sought treatment on eating disorders. In Japan, 1 in every 500 women have bulimia, a phenomenon that sees the opening of eating disorder units in most Japanese clinics. Bulimia is also evident in African countries even with the general notion that African women ought to be fat as a sign of beauty and fertility.
Conclusion
Further research can be done on possible factors that influence the development of bulimia. This paper does not delve much into biological and genetic factors, which are critical in learning more about the disorder. Lasting solutions to the problem can be generated with each discussed aspect.
Bulimia is a disorder that can be prevented, but it calls for the combined effort from all the relevant stakeholders. It can begin with psycho education on the adverse effects of bulimia. Adolescents suffering from emotional problems can also be advised on how best to express their concerns. Bulimia can also be eradicated by demystifying of popular belief that physical attractiveness is achieved by maintaining low body weight. Parental control on the type of media their children access also needs enforcement.
References
Derenne, L., & Beresin, E. V. (2006). Body image, media, and eating disorders. Journal of Academic Psychiatry, 30(3), 257–261.
The article discusses the influence of the media on development of eating disorders in males and females. It gives sound recommendation on parental influence on harnessing the good rather than the evil part of media on child development. The authors also discuss the importance of balance between healthy food and snacks. Its downside, however, is that the methodology is not clearly discussed hence does not give a thorough evaluation.
Mak, K., Pang, J. S., Lai C., & Ho, C. R. (2012). Body esteem in Chinese adolescents: Effect of gender, age, and weight. Journal of Health Psychology, 18(1), 46–54.
The literature review carried out on this study is impressive. It covers a vast area on related and similar topics of study. The methodology is carefully followed with clear detail on accuracy, and the validity is well established. Relations among multiple peer influences and body dissatisfaction are well established. However, since it is done in china the limitation of lack of generalizability of the results is likely to create some differences in a different population.
Ommundsen, Y., Roberts, C. G, Lemyre, P., & Miller, B.W. (2006). Parental and coach support or pressure on psychosocial outcomes of pediatric athletes in soccer. Clinical Journal of Sport and Medicine,16(6), 522–526.
The aim of this article is to examine supportive and compelling influences of parents and trainers on youthful athletes’ maladaptive perfectionist tendencies, relationships with friends, and competency perceptions in soccer. This paper achieves these aims. The authors successfully show the relationship between parental influences and maladaptive tendencies in development of pediatric eating disorders.
Comprehensive literature review on the subject is carried out. Nevertheless it is not spared by the limitations of using questionnaires and lack of generalizability of results.
Phoenix, E. L., & Walter, L. (2009). Critical food issues: Problems and state-of-the-art solutions worldwide. California: Greenwood Publishing Group.
This essential book attempts to give statistics of eating disorders. A detailed chronology of the disorder from the 1700s to the twentieth century is provided. The statistics, however, given for Africa are rather scanty.
Polivy, J., & Herman, C. P. (2002). Causes of eating disorders. Annual Review of Psychology 53(2002), 187-213. Doi: 10.1146/annurev.psych.53.100901.135103.
The article does justice in discussing eating disorders such as anorexia nervosa and bulimia by reviewing them. Literature on the development of these disorders is put forward. A number of factors are reviewed including sociocultural factors, family factors, negative effect, low self-esteem, and body dissatisfaction.
In addition, cognitive and biological facets of the disorders are reviewed. Some factors are noted to be responsible for the appearance of eating disorders, but none is deemed sufficient. It finally deals with the disorders as a representation of emotional issues.
Thompson, K. J, Shroff, H., Herbozo, S., Cafri, G., Rodriguez, J., & Rodriguez, M. (2007). Eating disturbance, and self-esteem: A comparison of average weight, at risk of overweight, and overweight adolescent girls. Journal of Pediatric Psychology, 32(1), 24–29. Doi:10.1093/jpepsy/jsl022.
This article takes research to a higher level. It identifies a critical niche in understanding peer influence on adolescents. The systems by which peers reinforce social messages concerning attractiveness are identified. However, it is essential to note that this research is not done comprehensively. The research is guided by the tripartite influence model, which recommends three formative influences of peers, parents and media unlike the traditional model of a single index of peer influence.
The traditional focus is on one item that reflects a construct. The research faces limitations in terms of generalizability of the findings. This is revealed by the fact that the research is done in only one school. This, therefore, leaves room for further research that will perhaps give room for a causal rather than correlational relationship investigation to be done.
Bulimia is an eating disorder which is portrayed by binging on food and subsequently vomiting in several attempts of purging. “removal of nutrients in form of purging entails forced vomiting, excessive exercise, laxative use, or fasting to shed weight that could have been put on from binging and eating food. Bulimia is mainly widespread amongst adolescents and young adult women” (Parker 2). Persons with bulimia will have normal weight or near-standard weight. “People with bulimia are often characterized with feelings of guilt over their behavior and a feeling of loss of control over their consumption” (Parker 2). This paper is therefore an analysis of the causes of bulimia and its treatment or management. In the paper, a case study done on bulimia will also be discussed.
Causes of bulimia
The exact causes of bulimia are not established but several factors are capable of influencing its occurrence (Parker, 2).
Genetics and family influences. Studies indicate that bulimia mostly occurs in relatives of persons who have had cases of bulimia than in those who have not.
According to researchers, altered levels of serotonin which is a chemical in the brain can cause bulimia.
Cultural factors to a great extent affect eating disorders particularly in contemporary society’s where people emphasize a degree of thinness, therefore, influencing people’s acceptance of self.
Symptoms
“Eating large quantities of food frequently in a short period could be in less than 2 hours” (Grohol, 1).
“Purging (eliminating the calories one has eaten) by excessive exercise, forced vomiting, fasting, abusing laxatives or enemas” (Grohol, 1).
Cases of binge-purge cycles
Building self-worth and self-esteem on weight and body shape.
Being afraid and feeling guilty of eating too much and fear of gaining weight,
Treatment
Management of bulimia is pegged on behavioral therapy and counseling. Eating disorders are more often than not founded on self-perception and self-esteem. Other therapies are also pegged on emotional grounds like support groups and family support as well as self-acceptance. In this case, dialectical cognitive behavior therapy is used for Bulimia Nervosa.
Case study
The study entailed Thirty women aged between 18 and 65 years being signed up using an advert in the newspapers and clinic referrals. On average each of them had at least one purge/binge a week for the preceding three months. There was a need to widen the applicability of the study, a customized DSM-IV criterion comprising binge/purge episode a week instead of the full DSM-IV criteria of two episodes as necessary was used for treatment. Among the participants, twenty-five met the full criteria while only six met the customized criteria. The customized criteria involved
Use of BMI (Body mass index) of 17.5
Neurosis or severe depression amid suicidal schemes
Alcohol or substance abuse which is active
Synchronized involvement in psychoanalysis or simultaneous use of mood stabilizers or antidepressants
The participants were put on a 20-week waiting list and phones were used to re-examine them to determine therapeutic participation throughout the period.
Enlisted contestants were allocated to the therapy program or waiting- list randomly in masses of eight. This ensured a balanced number of members in every condition. Eight envelopes that were sealed were given to the participants. “Four of sealed envelopes contained assignments to the treatment condition and the other four, the waiting-list condition” (Safer, Telch and Agras, 633). To randomize them, the envelopes were first shuffled and numbered then given to the contestants.
“The patients assigned to the waiting-list conditions were given dialectical behavior therapy upon conclusion at the 20-week state waiting- list” (Safer, Telch and Agras, 633). Post-treatment and baseline procedures were applied which included the following;
“The negative mood regulation scale (14)
The Rosenberg self-esteem scale (18)
Positive and negative affect list (17)
Eating disorder examination (13)
Multidimensional personality scale (16)
Emotional eating scale (15) and
Beck depression inventory (14)” (Safer, Telch and Agras, 633)
Weekly, twenty sessions of individual psychotherapy that took 50 minutes were used to particularly instruct emotional management to cut purging or binge eating. To perform the study, the psychiatrist used a bulimia management manual from Linehan’s Skills training manual on personality disorders.
In a nutshell, this behavior therapy model for bulimia visions emotional deregulation as the heart of Bulimia Nervosa disorder. Therefore, purging and binge eating are seen as attempts to control, alter, or manage painful emotional status. Patients have trained a selection of skills to change dysfunctional emotions and behaviors.
By 20 weeks of dialectical behavior therapy, four of the patients were ascetic from purging tendencies and binge eating contrary to the none participants in the group on the waiting list. The other five members only demonstrated mild signs and a reduction of episodes of binge eating by approximately 88%. The other two in the waiting-list group patients recorded no significant fall in the purge or binging episodes while the other 12 continued with the symptoms. In dialectical therapy, five contestants continued to be indicative of the signs.
Conclusion
The results indicated that the levels of binging and purging reduced to a great extent after the therapy intended to train adaptive feelings regulation proficiency.
“The limitations of the study can be linked to its small sample size which limits the ability to extract concrete differences between the two groups of participants” (Safer et al, 634). Additionally, lack of comparisons between groups with more conditions except for the waiting-list condition will be difficult to conclude with certainty that dialectical behavior therapy affects bulimia symptoms. Nonetheless, as a preface account, the results of large improvements in purge behaviors and binge eating are indicative of a positive impact.
Medical adherence directly influences the treatment’s results. Non-adherence can cause adverse outcomes. Patients’ non-adherence to medical advice presents a common problem in the health care system.
Medical non-adherence and lack of commitment increase health care costs. Medical non-adherence can source from patients’ misunderstanding of treatment. Complicated medical directions negatively influence patients’ understanding of adherence’s importance for health outcomes. In some cases, patients perceive absence of painful symptoms as rationale to skip treatment. More complicated cases include the patient’s avoidance of new medication and fear of side effects.
Adherence to Medical Advice in Patients with Bulimia
Bulimia is an eating disorder that involves overeating episodes, also called binge eating. Bulimia presents a serious mental health issue that significantly threatens patients’ physical and emotional health. Both bulimia and anorexia involve the aspect of patients’ control of eating. Anorexia nervosa leads to excessive control of eating, causing health issues. Bulimia manifests in patients’ inability to control eating, threatening the health. Medical adherence implies a patient’s ability to control his behavior accordingly to recommendations from professionals. Therefore, adherence to medical advice in patients with bulimia requires additional attention. However, as eating disorders are sourced in mental health issues, patients’ adherence to treatment can be worsened by shame and pressure from other people.
The use of health apps allows patients to overcome shame or guilt in eating disorder treatment, increasing adherence. There are many discussions about the benefits mobile apps for eating disorder treatment. According to Pellek (2021), the self-monitoring component in mobile apps can increase the patients’ adherence as it requires less effort than the pen-and-paper method. Apps provide a significant amount of information on the topic of eating disorders which can educate users about necessary coping strategies. According to Lindgreen et al. (2021), adult patients who had no previous history of treatment for bulimia benefited from the use of mobile apps.
The internet sources for bulimia and eating disorders also allow patients to eliminate shame and guilt during treatment. The results are strongly associated with the web platform’s interface and user experience. Depending on the patients’ age, their experience with the inclusion of web services for self-monitoring can be different. According to Yim et al. (2020), to increase patients’ adherence to medical advice, web platforms and apps should offer an opportunity to embed them in patients’ daily lives. Thus, one of the ways to help patients with bulimia adhere to medical advice is the development and integration of a sophisticated self-monitoring system in the treatment.
Yim, S., Bailey, E., Gordon, G., Grant, N., Musiat, P., & Schmidt, U. (2020). Exploring participants’ experiences of a web-based program for bulimia and binge eating disorder: Qualitative study. Journal of Medical Internet Research, 22(9), 1-13. Web.
First of all, it is worth noting that Heston uses only one theoretical model such as Dorothy Orem’s version. The essence of the approach is to combat the lack of self-care of the patient, where the responsibility for progress lies with Rita (Agras, 2019). This is noticeable primarily in the types of medical interventions that Hudson uses when interacting with Rita. It is assumed that as a result of these processes, Rita should come to realize the wrongness and perniciousness of her own behavior and lifestyle. In addition, the most striking example is keeping a food diary (Waller et al., 2014). The patient should self-record episodes of food and calorie intake, as well as her subsequent behavior. The nurse here performs rather an auxiliary function, sets the vector for Rita’s reflection and development.
Cognitive Behavioral Model of Bulimia Nervosa (NB)
Cognitive behavioral therapy (CBT) for bulimia nervosa is highly effective. The technique is based on the classic Beck approach, which has been successfully used to treat depression, as well as anxiety and personality disorders (Waller et al., 2014). The three main goals of the psychotherapy of eating disorders are the restructuring of nutrition, the change of attitudes regarding body schema and negative feelings associated with one’s figure (Waller et al., 2014). With the help of CPT, Rita’s case is solved as follows:
Power restructuring. Patients with BED (binge eating disorder) are characterized by a chaotic eating style and a tendency to be overweight. The phobia of certain products, which in itself can be a risk factor, is removed (Waller et al., 2014). The APA recommends that nutritional rehabilitation for NB should focus on helping the patient develop a structured eating plan.
Therapy of stress reactions. Cognitive behavioral therapy uses problem solving training and stress coping training (Waller et al., 2014). In the first, the emphasis is on identifying what is a problem for the patient, and then looking for alternative ways to solve it until a positive sustainable result is obtained (Waller et al., 2014). In the second training, the patient, under the guidance of a therapist, analyzes the occurrence of his stress reactions and their consequences, and then, based on the analysis, an effective strategy for coping with stress, both short-term and long-term, is developed.
Reasons for Rita’s Unwillingness to Participate
Rita’s treatment is significantly complicated by her unwillingness to participate in some of the behavior change processes. There are reasons for this, which the specialist needs to take into account and eliminate as much as possible (Halmi, 2013). Bulimia is often caused by sharply negative emotions towards food consumption. At the same time, a person is irritated or repelled not by the products themselves, but by the consequences of their consumption, in particular, by their body (Halmi, 2013). In this way, it can be established that the reasons for the unwillingness to be patient are psychological difficulties and disorders. In order to overcome them, it is necessary to understand the prerequisites for the occurrence of such consequences (Halmi, 2013). The most useful here is the interaction with the patient and the recognition of his character, past and the necessary aspects of socialization. For example, bullying by peers or family, low self-esteem, hysteria or depression can be the root causes of the disease (Halmi, 2013). Without the elimination of triggers and psychological barriers, it is impossible to position the patient to begin effective treatment, in particular, food intake.
The Need for Third-Party Specialists
After establishing the main psychological prerequisites for both the onset of the disease and the inhibition of treatment, it makes sense to recommend additional specialists. Integration into the treatment process of a psychologist is the most effective way out of this situation (Dejesse & Zelman, 2013). In addition to professional medical care, Rita needs to work through and destroy the disorder that aggravates her well-being and pain (Dejesse & Zelman, 2013). It was noted that Rita mostly feels a sense of shame, which means that the presence of complexes is potentially likely. It is this that needs to be worked out by a psychologist who will introduce additional therapy and exercises for the patient (Dejesse & Zelman, 2013). A professional will be able to analyze the reasons for failures, unwillingness or impossibility of any step for Rita more efficiently than a nurse.
Potential Pitfalls and Ethical Issues in Collaboration
However, when two specialists collaborate, difficulties may arise in their interaction. First of all, Heston’s activities are aimed at regularity and achieving a positive effect on Rita’s health. At the same time, the psychologist may determine that it is too early to implement any of the interventions due to the patient’s condition, which means that it should be postponed (Agras, 2019). There is a potential conflict of interest because the nurse will come to modernize her approach. In addition, from the point of view of a psychologist, some of Heston’s actions may exert unnecessary and negative pressure on Rita, which will also complicate and slow down the healing process (Agras, 2019). Finally, it makes sense to highlight ethical principle regarding the fact that everything Rita said to the psychologist is confidential information (Agras, 2019). This means that the specialist cannot divulge information and also share it with the nurse (Agras, 2019). Another ethical principle here is respect for the problems and slowness of the patient, caused by serious complexes (Agras, 2019). These difficulties can be avoided if Heston chooses more flexible treatment methods that do not suffer from the integration of psychological therapy.
Effectiveness of Treatment Interventions
When analyzing Heston’s treatment interventions, it was found that not all of her solutions are effective enough. For example, the first two stages, the essence of which is to familiarize Rita with useful information, are useless in the context of bulimia. This is explained by the fact that in the presence of serious complexes and psychological disorders, the patient is not able to fully realize the danger or unfavorability of his situation. Accordingly, Rita perceives information detachedly, without comprehending it fully. However, it should be noted that the method of keeping a food diary is a useful and effective method. The idea of interaction with Rita is useful in that the patient does not feel like a burden or an extra element of the whole treatment, but is aware of her own participation and responsibility.
Conclusion
Thus, two of Heston’s trait interventions were found to be ineffective. It is necessary to develop three additional methods that could simplify the work of the nurse and at the same time take into account the integration of the psychologist into the treatment process. The first intervention has already revealed the study of disorders and psychological complexes that serve as the root causes of the appearance of bulimia and negative emotions in relation to oneself and one’s body (Lutter, 2017). The second method is to offer exposure therapy, the essence of which is the modeling of various situations (Agras, 2019). In the context of Rita, it would be appropriate to experience the state prior to the binge episode – without the ability to carry it out. Finally, the most striking method of achieving recovery is to recommend group psychotherapy (Hay, 2020). For Rita, the actual feeling of shame, and the peculiarity of the strategy in overcoming this emotion and providing interpersonal feedback and group support.
Lutter, M. (2017). Emerging treatments in eating disorders.Neurotherapeutics: the journal of the American Society for Experimental NeuroTherapeutics, 14(3), 614–622. Web.