A Look At Bulimia Nervosa Essay, Research Paper
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Running Head: Bulimia Nervosa
A Look at Bulimia Nervosa
Eric W. McKinley
Central Texas College
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Eating disorders are becoming more prevalent in the United States. One of these eating disorders is Bulimia Nervosa or bulimia. Bulimia affects 4 percent of adolescent females today. Symptoms of bulimia occur in two stages: Binging and purging. During a binge a bulimic will consume vast amounts of food in a small amount of time. After a binge a bulimic will feel guilty and ashamed of their eating and will try to rid themselves of the food calories by self-induced vomiting, overuse of laxatives, fasting, excessive exercise and other dangerous practices. Social influence, chemical imbalances in the brain, traumatic experiences and many other factors can cause bulimia. There are many approaches to the cure of this disorder. Antidepressant drugs, behavioral and group therapies, and Cognitive-behavioral therapy are among the many approaches to cure bulimia.
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A Look at Bulimia Nervosa
An eating disorder is defined as a disorder characterized by physical and/or psychologically harmful eating patterns. (Sue, D., Sue D., & Sue, S. 1997). There are two types of eating disorders recognized by psychologist today. Theses two eating disorders are Anorexia nervosa and Bulimia nervosa. Bulimia nervosa, usually referred to as bulimia, is the eating disorder that this paper will concentrate on. Bulimia nervosa (its Greek and Latin roots mean “ox like hunger of nervous origin”) is defined as two or more episodes of binge eating (rapid consumption of a large amount of food, up to 5,000 calories) every week for at least three months. The binges are sometimes followed by vomiting or purging (use of laxatives, diuretics or enemas) and may alternate or only be followed by fasting and excessive exercise for the non-purging bulimic (Harvard Mental Health Letter [HMHL] 1997). There are two subgroups of bulimia that can be distinguished: purging type and a non-purging type. The non-purging bulimics engage in fasting and excessive exercise to rid themselves of the calories taken in during a binge (Frankford ). Non-purging bulimics tend to be heavier than those who purge; they also binge less frequently and show less psychopathology than do the purging bulimics (Davidson, Neale 1998). The purging bulimics engage in self-induced vomiting and the use of laxatives, diuretics or enemas to rid the extra calories (Frankford). Purging bulimics tend to be thinner than those that do not
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purge, however, they usually binge more often and show more psychopathology than there counterparts. (Davidson, Neal 1998). Bulimia nervosa is at least two or three times more common than its counterpart anorexia. It is estimated that 2 percent of the general population and at least 4 percent of woman aged 18 to 30 are diagnosed with bulimia. This would conclude that adolescent woman are the majority of bulimia sufferers. As many as 10 percent of woman may suffer from bulimia at some time in their lives (Davidson, Neal 1998). It has been found that adolescents who develop bulimia are likely to come from families with a history of eating disorders, physical illness, and other mental health problems including mood disorders and substance abuse. Anxiety and mood disorders are commonly found in bulimic adolescents. (Frankford).
Bulimia can have dangerous physical affects. Fatigue and weakness follows excessive exercise and fasting. Constipation may occur after binging. Due to constant vomiting, a bulimic will often have bad teeth due to erosion of the tooth enamel. Constant vomiting will also lead to sore throats and in some cases tearing of the esophagus. Overuse of laxatives can cause stomach upset, digestive problems, dehydration and a loss of potassium. (Davidson, Neal 1998).
There are many factors and influences to the cause and reason for bulimia Genetics can play a role in developing eating disorders such as bulimia. Studies
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show that young woman with female relatives with eating disorders are five times more likely to develop an eating disorder themselves (Davidson, Neal 1998). In a survey of 4,000 women that are unhappy with their bodies, 81 percent had mothers that were unhappy with their own bodies (Zimmerman, 1997).
Social and psychological factors are important to understanding the causes for bulimia. Cultural standard for body shape, especially in woman, has changed over time (Davidson, Neal 1998). Famous nude paintings from the seventeenth century show that what was considered beautiful and sexy then would be considered unattractive and overweight by today’s standards. The feminine ideal of body shape has changed significantly even in the last 40 years in America (Davidson, Neal 1998). Social factors go beyond simply feeling attractive. It was found in one study that woman associated being slim with professional success and intelligence (Silverstein, Perdue 19998).
One theory would say that people with bulimia overeat in order to sooth themselves with food as a replacement or compensation for something missing in
their lives or as a form or display of control. The overeating subdues feelings that the person is often unaware of and later become guilty and ashamed of the way
they have behaved. This guilt and self-hatred causes them to indulge in the second half of bulimia: self-induced vomiting, fasting, etc (Sue et al 1997). Trauma can also play a role in eating disorders. In one case study, a patient was
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found to be reenacting childhood abuse of being forced to eat spoiled food and vomiting it up by binging and purging acts of bulimia (Allen 1995).
Research shows that chemical imbalances in the brain can also be responsible or at least play a role in bulimia. Hardy and Waller (1988) hypothesized that bulimia could be a result of low levels of endogenous opioids, which are thought to promote craving. Some data would go to support this theory. For example, research has found low levels of the endogenous opioid beta-endorphin in bulimic patients (Waller, Kiser, Hardy, Fuchs, and Feigenbaum 1986). This study also showed that the more severe cases of bulimia had lower levels of beta-endorphins. Serotonin also can have a big part to play in the cause and treatment for bulimia nervosa. Other studies have shown that bulimic patients had low levels of serotonin. In conjunction, we have found through animal research that high levels or serotonin cause a feeling of satiety. This finding helps promote the fact that carbohydrate craving is related to low levels of serotonin and could be one reason why bulimics binge (Davidson, Neale 1998).
The overall goal of bulimia treatment is to help the patient develop normal eating patterns. Many treatment approaches are used to reach this goal. Bulimia is often treated successfully, partly because bulimic patients generally want to be treated. Antidepressant drugs are often used in the treatment for bulimia. The use
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of antidepressants in treatment are highly successful because they raise the level of serotonin in the patent, have few side affects and tend to cause weight loss rather than weight gain. Prozac became the first drug specifically approved by the Food and Drug Administration (FDA) for the treatment of bulimia in 1997 (HMHL, 1997).
Behavioral and group therapies are widely used in treatment for bulimia. One behavioral treatment for self-induced vomiting is called exposure and response prevention. In this treatment, a patient would be allowed to binge until they were nauseated. They would then be asked to concentrate on their discomfort and write down their thoughts and feelings. Self-induced vomiting is forbidding in this therapy setting. The effectiveness of this form of therapy is disputed (HMHL, 1997).
Group therapy is popular and widely used as treatment for bulimic patients. Groups are an efficient way to present information and advice on eating habits. In this setting the patients feel less ashamed because they realize that they are not alone, and they can correct their distorted notions about themselves with the help and support of other bulimics (HMHL, 1997). Cognitive-behavioral treatments can be used to try and teach a bulimic patient that weight control can better be
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achieved by better eating on a regular basis than by extreme dieting, which is often unsuccessful. In this setting a patient might be asked to bring a small piece
of a forbidden food to eat in the session. Relaxation would then be used to control the urge to induce vomiting (Davidson, Neale 1998).
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Allen, J. G. (1995). Coping with Trauma. (pp. 225-227). Washington, DC: American Psychiatric Press Inc.
Davidson, G. C., & Neale, J. M. (1998). Abnormal Psychology. (7th ed.). (pp. 207-224).
New York: John Wiley & Sons, Inc.
Eating Disorders. (1997, Oct). Harvard Mental Health Letter, pp. 1-5.
Frankford Hospital Home Page. Retrieved April 9, 2001 from the World Wide Web: http://www.frankfordhospitals.org
Hardy, B. W., & Waller, D. A. (1998). Bulimia as substance abuse. In W. G. Johnson (Ed.). Advances in Eating Disorders. New York JAI.
Silverstein, B., & Perdue, L. (1998). The relationship between role concerns, preference of slimness, and symptoms of eating problems among college woman. Sex roles, 18 101-160
Sue, D., Sue D., & Sue, S. (1997). Understanding Abnormal Behavior.
(pp. 489-495). Boston: Houghton Mifflin Company
Waller, D.A., Kiser, S., Hardy, B. W., Fuchs, I., &Feigenbaum, L. P., (1986). Eating behavior and plasma beta-endorphin in bulimia. American Journal of Clinical Nutrition, 4 20-23.
Zimmerman, J. S. (1997, Spring). Our Bodies, Our Daughters. New York, 72-77.