A Scientific Research About Bulimia Nervosa
Abstract
Bulimia Nervosa is one of the six common types of eating disorders. It impacts more than six million U.S. populations, especially females, in adolescence or young adulthood. People with bulimia show significant interest in large food consumption(usually more than 3000 kcal) in a short period (<2 hours), and subsequently having extreme actions to reduce intake, such as fasting, laxation, medication, etc. The ongoing cycle of binge eating and fasting creates a sense of guilt, while it is important to understand that the causes for bulimia vary. The main categories for the causes are: biological and psychological. Even though the factors vary, the subsequence for bulimia extends to life-threatening levels. Bulimia is a reversible disorder that can be fixed by counseling and medical treatments.
Keywords: Bulimia Nervosa, Eating Disorders, Females, food consumption, binge eating, biological, psychological.
Bulimia Nervosa Defined
An eating disorder is a behavioral disorder, usually characterized by extreme eating habits with stressed emotions. Bulimia Nervosa is one of the eating disorders scientists and doctors discovered in society today. During the Middle Ages, wealthy people usually vomited out their consumptions from the feast to keep on eating, which can be traced as the beginning of bulimia nervosa(Coe 2020). According to Psychiatrist Fairburn, Bulimia Nervosa can be explained as people who “View themselves with extreme disdain during childhood, had encountered certain types of conflict with their parents, and had grappled with obesity early in life”(Bower 1997). It is a combination of binge eating disorder and purging disorder.
Binge eating disorder is the continued consumption of large quantities of food in a short amount of time, even past the point of discomfort. People who binge eat always feel a sense of losing control when eating food, and the eating episode usually follows with guilt and shame(National Eating Disorders Association).
Purging disorder is a compulsion to get rid of the food that has been consumed after eating, and the person is frequently accompanied by the worry of weight gain and food intake(MedicineNet 2019). The continuous cycle of binging and purging leads to bulimia nervosa.
Today, approximately 1 percent of young females and 0.1 percent of young males have bulimia nervosa. Since bulimia is often found by others (not self-reported), the number for the statistics could be greater.
Causes of Bulimia
The main cause of bulimia is often a mixture of several factors. The main factors for bulimia nervosa can be categorized as biological, psychological, and environmental. Associations of various reasons lead people to become uncomfortable about their appearance, eventually leading to the dysregulated association with food.
Biological factors
Scientists indicate that women are more likely than men to have bulimia nervosa. Women who begin the menstruating cycle by the age of twelve are more likely to have bulimia than women who have later. The families associated with obesity or some type of eating disorder among the family members increase the likelihood for a person to have bulimia than other people(Bower 1997).
The hormone can also play a big part in people’s eating habits. Research shows that people who have relatively high testosterone feel hungry in a short time and crave high caloric food for satisfaction. Experimental research treated twenty-one women with bulimia with estrogen-dominated oral contraceptives, and after three months, half of the subjects decreased their craving for food, and three out of twenty-one were completely cured. (Paddock 2007)
Psychological Factors
Unfortunately, bulimia nervosa often accompanies other psychological disorders such as depression, anxieties, and suicidal tendencies. Patients usually have low self-esteem that degrades their body image and outer appearance(Walden Eating Disorder 2020). The obsession with weight loss and a certain type of body image always are the leading causes of mood swings among bulimia patients.
From a neuroscience perspective, the dysregulation of the anterior cingulate cortex(ACC) can also be a factor. ACC manages thought regulations and behavioral regulations. People who have dysfunctional ACC cannot control their behaviors, which can explain the reason why people with Bulimia have an impulse for binge eating, even at the point of discomfort(Stevens et al. 2011).
Environmental Factors
The living environment plays an important role in people’s thought processes. People who are continually attacked or criticized by family or friends about their weight and body type are more likely to get bulimia. Families that valued weight heavier than healthy psychological development are more likely to have members who get bulimia nervosa (Bower 1997).
Sometimes, big life changes can also be a factor in bulimia. Examples such as moving, unemployment, divorce, or a stressful environment.
Diagnosis of Bulimia
Below is the diagnostic criterions adopted from the Diagnostic and Statistical Manual of Mental Disorders Volume 5:
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
Self-evaluation is unduly influenced by body shape and weight.
The disturbance does not occur exclusively during episodes of anorexia nervosa.”
Symptoms
The symptoms or the aftereffect of bulimia nervosa can be severe. Weight gain or constant bloating can be the symptoms at an early stage. As the condition progresses, more serious situations would happen. Symptoms can also be categorized as physical and psychological.
Physical:
Generally, abnormal weight fluctuations are the basic sign of bulimia. Purging can lead to tooth decay and gum diseases, the constant refloating of food can cause increased stomach acid(Mayo Foundation for Medical Education and Research 2018). Binge eating often follows with a large amount of food intake, which causes digestive problems, even stomach cramps. The severe side of the physical symptoms can be heart problems and dysregulated menstrual cycles.
Research shows that females who have bulimia have a lower bone mineral density(BMD) and a higher frequency of osteopenia (Kjellberg & Kennedy, 2003). The main reasons for decreasing BMD are closely associated with hormones. Scientific studies showed that bulimia is related to the following hormones: low level of estradiol and thyroid hormone increased cortisol, and activity of hypothalamic-pituitary-adrenal axis (Bailer, Kaye 2003). The androgen is also increased. Each of these hormones is associated with BMD, for example, low thyroid hormone would affect bone remodeling and growth. Endocrine and hormones are important for bone metabolism, and because of the irregular hormonal levels among bulimics, their BMD is significantly decreased.
Emotional:
Bulimics often have low self-esteem and self-confidence, especially in the area of body image and weight. People usually report feeling worthless and have a higher probability of self-injury. Some people who have BN are perfectionists who use eating to deal with emotional triggers(Mental Health Foundation 2017).
During the binge eating period, bulimics appear to be uncomfortable eating with others and hesitate to purge after large caloric consumption.
Approximately sixty percent of the bulimics have the probability of getting depression, and about sixty-five percent of the bulimics have the chance of getting anxiety. Research shows that BN and depression can be bidirectional, that they are comparable mental disorders(Puccio et al. 2016.).
Treatments of BN
When early symptoms of BN, or when a person checks multiple points of self-diagnose criteria, they should first seek doctors and family members for help.
Most importantly, the bulimics should build a healthy mindset of body image, that learning to accept their body type is the most important step to take(Mayo Foundation for Medical Education and Research 2018). Eating meals with family and friends in a regular time, and avoiding constant mentioning or self-reminding of weight and body type.
Go to primary care doctors for medical treatment when the bulimic can not control their own psychological and physical behaviors. When the situation is unmanageable, the doctors might prescribe medications to assist recovery, such as the antidepressant. Depression, as mentioned above, has a mutual relationship with BN, hence the medication can be applied to BN as well. Cognitive behavior therapy can also be part of the treatment process(National Collaborating Centre for Mental Health et al. 2004).
Conclusion
Bulimia nervosa affects many people, especially women at a young stage, to have an irregular relationship with food intake. Bulimics usually have a cycle of binge eating and purge eating to satisfy their emotional need for food and psychological relief from large food consumption. Low esteem of body image and sensitivity to weight gain is the common cause for BN, whereas biological effects like hormonal imbalance also contribute to BN. Diagnostic and Statistical Manual of Mental Disorders Volume 5 provides detailed criteria for BN diagnostic. The symptoms, in general ways, are weight fluctuations and emotional inconsistency. On the severe side, low BMD, heart problems, stomach problems, and isolation from society. Scientists indicate that depression and BN can be bidirectional, they are closely associated. This relationship is also shown in the treatment process, where antidepressant is the prescribed medication from doctors to bulimics. Cognitive-behavioral treatment is also a way doctors help bulimics in the recovery path. Ultimately, healthy perception of body image and support from the surroundings are the most consistent and desirable treatment.
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