Eating Disorders: Anorexia Nervosa, Bulimia Nervosa
Michael J. Prince, B.A., Psychology
To understand eating disorders and the differences between anorexia and bulima, it is helpful to establish some identifying characteristics. First and foremost, both of these disorders can be life threatening and lead to death if not treated, so they are not to be taken lightly. Here are a few definitions that will be expanded on in this section.
- Eating Disorders: A disorder characterized by gross disturbances in eating behavior and the way individuals respond to food.
- Anorexia Nervosa: An eating disorder characterized by an intense fear of becoming obese, dramatic weight loss, concern about weight, disturbances in body image, and an obstinate and willful refusal to eat.
- Bulimia Nervosa: An eating disorder characterized by repeated episodes of binge eating and fear of not being able to stop eating, followed by vomiting or use of laxatives, diuretics, compulsive exercising, or weight reduction drugs.
In the United States the ratio of women to men with eating disorders is ten to one. Research has indicated that females are more conscious of weight gains, their shape and weight, and they way they perceive themselves in society (Schlundt & Johnson, 1990). Another psychological reason is a disharmonious family life or having maladjusted parents increases the risk of eating disorders.
Psychologically the individual begins to withdraw from from society and eventually enters a state of depression. The withdraw makes the individual question why and how they placed themselves to eating behaviors above their relationships with others, and experience guilty feelings for their lack of concern. Guilt and isolation does not lead them to emerge from their disorder, but leads to strengthening of their dependence on food. This creates a desire to change and seek help. Factors that lead to their behavioral changes include increases in self-esteem, decreases in social isolation, time to analyze their wrong doings, and increased awareness of the harmful affects. It is through these factors that a behavioral change is initiated that will allow them to undergo treatment.
Anorexia is a starvation disease characterized by an obstinate and willful refusal eat. These individuals come from all levels of background, have an intense fear of being fat and relentlessly pursue becoming thinner. The anorexic's refusal to eat eventually brings about emaciation and malnutrition. This can cause permanent damage to the heart muscle tissue with cells dying. Behind this disorder is psychological and physiological orgins of the disease, including many changes (may lack a hormone thought to induce a feeling of fullness) taking place as early as puberty that might influence the disease's emergence (Attie & Brooks, 1989). The average model of fashion magazines weighs 23% less than the average woman in society. Young women and business professionals are under a lot of pressure to be thin. Advertising of diet drugs, drinks, food and fashions all show America's obsession to a thin form as the expected goal for females. Those afflicted are obsessed with the path of perfection, which though unattainable, holds out compelling promises. All believe that if they attain the perfect body, life's problems will magically be solved for them (Rivera, 1997).
Many Bulimics suffer from low self-esteem and come from families they preceive as having poor relationships and a high level of conflict (Johnson & Larson, 1985); and have experienced some kind of clinical depression in the past (Walsh, et al., 1985). Some women may eat as a means of lightening their mood swings and regulating tension. When they binge, all negative feelings they are experiencing disappear and they feel a release. This temporary rewarding feeling fuels the binge/purge cycle. After binging they feel guilty. To lessen their guilt and the potential consequence of gaining weight, they "get away with something" by purging themselves. It is believed that purging reduces post-binge anguish. Bulimic women become entirely involved in food-related behaviors to the exclusion of contact with other people and family members (Johnson & Larson, 1982). Many Bulimics are the victims of child abuse and sexual assault. It is estimated that 50-65% of people with eating disorders have been subjected to some form of physical or sexual abuse. If they are afraid to report the crime against their bodies they may develop an eating disorder as a means of coping. Other Buliamics are the victims of violence. Binging can be their way of stuffing down the emotions they are feeling and purging can be a way for them to release the inner feelings of anger and rage.
Individuals that have dissociated themselves from the abuse may find themselves experiencing nightmares, obsessive thoughts, crying uncontrollably, panic and anxiety attacks. Other problems that may be associated are depression, poor self-esteem, hopelessness and the inability to function in relationships. The disorder becomes the means of survival and there is a fear of giving up the practice, afraid they cannot survive without the eating disorder. Some Bulimic women may have metabolic system disturbances, as well as disturbances in their perception of taste and the feelings of fullness (Devlin et al., 1990). Associated physiological symptoms are electrolyte abnormalities, hypokalemia, hyponatremia and hypochloremia. Stomach acids attack the teeth causing enamel loss and cavities.
The DMS-IV lists two types of Bulimia Nervosa. In the Purging type the individual regularly engages in self-induced vomiting, misuse of laxatives, diuretics, or enemas during the current episode. This 1st type also experiences more symptoms of depression, greater concern of body shape and weight than in nonpurging types. In the Nonpurging type the individual uses inappropriate compensatory behaviors, such as fasting or excessive exercising, but does not regularly induce vomiting or use other means of food expulsion.
In Bulimic individuals there is an increased frequency of depressive symptoms (low self-esteem), or Mood Disorders (Dysthymic Disorder, Major Depressive Disorder). The Mood disorder begins at the same time or just following the development of Bulimia Nervosa. There maybe an increase frequency of anxiety symptoms (Fear of social situations) or Anxiety Disorders. About 30% of Bulimics suffer from substance abuse, often stimulants to control appetite and weight. From 30-50% of Bulimic individuals meet the criteria for one or more Personality Disorders (borderline PD).
Four Diagnostic Criteria
- Refusal to maintain body weight over minimum expected for age and height.
- Intense fear of gaining weight or becoming fat.
- Distorted body image.
- Cessation of menstrual cycle (Gordon, 1990)
- Anorexia and Bulimia: Anatomy of Social Epidemic. Gordon, R. (1990). T. J. Press Ltd.
- Anorexia:The Social Eating Dilemma. Rivera, G. (1997). http://ccmail.sunysb.edu, pgs. 1-3.
- Bulimia: An analysis of Moods and Behavior. Johnson, C., & Larson, R. (1982). Psychosomatic Medicine, v. 44, pgs. 341-351.
- Bulimia and Depression. Walsh, B. T., Roose, S. P., Glassman, A. H., Gladis, M. & Sadik, C. (1989). Psychosomatic medicine, v. 47, pgs. 123-131.
- Eating Disorders. Schlundt, D. G., & Johnson, (1990). Boston: Allyn & Bacon.
- Development of Eating Problems in Adolescent Girls: A Longitudinal Study. Attie, I., & Brooks, J. (1989). Developing Psychology, v. 25, pgs. 70-79.
- Family Characteristics of 105 Patients with Bulimia. Johnson, C., & Flach, A. (1985). American Journal of Psychiatry, v. 142, pgs. 1321-1324.