Running head: BULIMIA NERVOSA
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Bulimia Nervosa
Amanda Fox
Concordia University
October 19, 2012
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Bulimia-nervosa is a very serious disease in the United States. According to Marrow
(2010), “bulimia nervosa is a complex disorder and despite continuous efforts from mental health
specialists and doctors to understand its dynamics, researchers believe that a variety of factors
(biological, psychological, and environmental/sociocultural factors) work together in
determining if the disorder will occur”(pg. 1). A lot of progress has been made over the past few
years to determine the causes as well as treatment options. Multiple factors has been found to
impact this disease including; genetics, abuse history, social upbringing, etc. It is important to
know what influences this disease in order to prevent it as best as the community can.
In order to help figure out what causes the disease as well as the frequency levels
throughout the public, epidemiologists do numerous research studies to gain and much
information as they can. “Epidemiology is defined as ‘the study of the distribution and
determinants of disease frequency in human populations’” (Schneider, 2011, pg. 65). There
must be a clear understanding of a disease in order to study it to its full extent. Bulimia nervosa
is a complicated disease that affects many people throughout the world. Many people look at
this disease in only the psychological perspective but epidemiologists also study the disease in
the public health realm. There are many complications in studying this disease because of its
complexity but epidemiologists have been able to find risk factors and distribution of the disease
in the population.
The prevalence of eating disorders has increased over the years, especially in developed
countries. The disease is typically more prevalent in adolescent females than any other
age/gender group. Although people with eating disorders are secretive about their disease,
epidemiologists have done studies on the prevalence of the disease throughout the population.
According to Orlis (1998) there are 12.2 cases per 100,000 of the population. As stated above,
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the disease is a lot more prevalent in females than males. The disease affects 90% of women and
10% of males (Orlis, 1998). Another study was done on the prevalence of the disease in college
females. According to Ahira (2010) around 19% of college females are bulimic. The majority
of people with bulimia are known to have a college education. A lot of people who have the
disease do not disclose information that they have it so epidemiologists do the best they can in
figuring out numbers of cases.
There are many risk factors involved in bulimia nervosa, both environmentally and
genetically. According to the American Psychiatric Association (2006), some risk factors
include age, gender, ethnic factors, socioeconomic factors, personality disorders, accompanying
emotional disorders, being overweight, body image disorders, excessive physical activity,
vegetarianism, diabetes or other chronic diseases and early onset of puberty. As seen with these
risk factors, a lot deal with different psychological disorders but many are environmental as well.
Along with these risk factors comes the role of genetics. According to Brownell and Fairburn
(2002) bulimia nervosa is several times more common within biological relatives who have
bulimic tendencies than the general population. To go along with that information, they also did
studies with monozygotic twins and dizygotic twins. In the study, they found a strong
concordance rate between the monozygotic twins with bulimia than dizygotic implicating a
strong role for genetic factors (Brownell & Fairburn, 2002). As seen, there are many risk factors
involved with this disease. Some can be avoided, some cannot. More research is being done on
genetics and the relationship with bulimia.
Another area to look at for numbers of those affected by the disease is biostatistics.
Biostatistics plays a major role for the research aspect in public health. According to Schneider
(2011), “statistics are a vital part of public health’s assessment function, used to identify special
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risk groups, to detect new health threats, to plan public health programs and evaluate their
success, and to prepare government budgets” (pg. 117). When it comes to bulimia-nervosa,
statistics can be hard to come by. This is because it is a psychological problem so a lot of cases
go undetected. Researchers are trying really hard to get as much information and research on
this disease as possible. Many different studies and information has been collected on this
dangerous disorder.
There are many different ways to collect data for health problems. When it comes to
bulimia, researchers want to know the age, race, gender, etc. of who this disease is affecting.
One of the ways data is collected for this illness is through surveys. An example of a certain
research project that was created for individuals, who described themselves as being recovered
from bulimia, was a survey made for those recovered individuals on the internet. The
description of this survey is “a mixed-method online survey that examined the types of treatment
accessed by those who had recovered from bulimia, their attitudes about recovery, and their
descriptions of what changed with their relationships to food, body, self, and others during
recovery” (Reynen, 2012). This survey produced both quantitative and qualitative data which
was made for professionals to help show what the best treatment methods were according to
people who experienced the illness.
Another big way researchers study eating disorders is in twins and families. It is found
that eating disorders are hereditary. A big study was done in 1996 by a foundation called the
Price Foundation. According to Shaw (2005), “an international group of scientists collected an
astounding amount of data: first, on some 600 families with two or more members who have
anorexia or bulimia, and later, on another group of 700 families with three members who have
anorexia or bulimia along with 700 "control" women for comparison studies”(pg. 1). Within this
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study, they found that certain genes may increase the person’s vulnerability to the disorder. This
was a huge finding because before the concept of genes came to play. Before this discovery,
researchers thought the reason for the disorder was due to overly-controlling parents. This was a
huge finding in research to see that genes and chromosomes have an influence on the disease
making them risk factors.
Seeing that studying families found genes playing a role-genetics then became a
biological factor of this disease. Another study that was done on genes found that half of the risk
of getting an eating disorder is inherited (Hirst, 1998). DNA samples have found similar genetic
characteristics in identical twins with eating disorders compared with those who did not. Seeing
that this disorder is partially due to genetics, explains why it is very difficult to treat the disease.
The study of genetics still has work to do to fully prove its significance but answers are starting
to be found, especially in identical twin studies.
Another biological characteristic that is involved with this disease is faulty
neurotransmitter links in the hypothalamus. The hypothalamus deals with hunger and satiety. In
humans, the ventromedial and lateral hypothalamus are what specifically deals with eating
behavior (Hirst, 1998). These two regions keep the body at the certain set point weight it is
supposed to be at. This study has been done in rats, which professionals know are not like
humans, but shows that damaging one of these areas actually can cause the rat to starve or
overeat. Researchers know rats are different than humans but have similar neurotransmission
functioning. With that being said, this could prove that damage done in humans alters their set
point and causes drastic weight loss or gain (Hirst, 1998).
Going along with neurotransmitter links is the study of hormones. People with eating
disorders have disturbances in serotonin. Serotonin is what helps regulate feeding, mood and
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neuroendocrine activity (Harris Center for Education, 2008). Bulimics binge on carbohydrate
rich food. The body uses the carbohydrates to convert to tryptophan which is then used to create
serotonin (Dombeck, Engel, & Reiss, 2007). Researchers are finding that the binge behavior in
bulimics may be a result of low serotonin levels because they are not getting a sense of satiety
while they eat. Going off of that, though, is that the abnormal eating behaviors could also knock
off serotonin levels causing the rest of the abnormalities within the brain.
More research was done concerning serotonin levels on individuals with bulimia and
found that the levels stay abnormal even after the bingeing and purging stop. “It is now believed
that serotonin imbalances contribute to the long-term mood disturbances, obsessionality and
perfectionism seen in individuals with bulimia” (Harris Center for Education, 2008, pg. 1). This
allows professionals to suggest that there have been serotonin abnormalities even before the
onset of the disease. This finding could explain the eating disturbances in these patients. Studies
are still being done to determine the exact ways the serotonin levels work in patients with eating
disorders.
Although a lot more research needs to be done on this disorder, one thing has been made
known within the biological aspect of the disease: Genetics is a main characteristic in knowing
if one is at risk for the disease. Some research has been done on neurotransmitters and hormones
in the brain to determine abnormalities in these areas can affect eating behaviors in those with
the disorder. More research needs to be done to show this is a 100% fact, but they are leaning in
the direction of those being biological factors of bulimia.
In order to find all the information professionals have on this disease, a lot of research
has been gathered. There are different methods researchers use to get information on this disease
such as surveys, gathering information from psychological professionals, and gathering
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information from people who have overcome this disease. It is a little more difficult gathering
information on this disease because people are not open about having it but with the different
research and findings coming in, more is becoming known about it. The new known finding is
the genetic relationship between family members. This finding taught researchers a lot about the
illness. There is also research being done on trying to prevent the disease as well as figuring out
the best methods of treatment.
When it comes to bulimia-nervosa, professionals are trying to understand how different
factors affect certain individuals and are coming up with different ways to promote these
individuals to live healthier lives (Schneider, 2011). There are now many different models
professionals use to explain how these psychosocial factors influence these bulimic behaviors. It
is very important for professionals to fully understand this disease to help people who have it
want to change their behaviors. It is a terrible disease that needs better understanding to help
people in need. Recently, professionals have used the transtheoretical model of behavioral
change to study the readiness of change for people with bulimia. Schneider (2011) states that the
transtheoretical model involves five stages of change; precontemplation, contemplation,
preparation, action, and maintenance. Professionals try to figure out which stage someone is in
with this disease to help them move to the next stage, until finally reaching the end and
overcoming the disease.
There are many behavioral and social factors involved with bulimia-nervosa. There is a
lot of information found relating genetics to the onset of bulimia but family factors and
sociocultural causes also play a big role. Researchers have found that interpersonal relationships
within the family impact the risk of the onset of bulimia. A study was done to show that there is
a significant relationship between children being sexually abused and later developing bulimia
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because of that (Encyclopedia of Mental Disorders, 2012). They have also found that if there are
food struggles in the family, such as parents being restrictive or overly obsessed with food, as
well as parents being overly obsessed with their weight, shows correlation to the child
developing an eating disorder. Certain sports also play a role in determining if a child is at
higher risk for developing bulimia. Kids who are in certain sports such as gymnastics, dance,
figure skating, modeling and wrestling also have a higher susceptibility to having an eating
disorder because these sports require strict weight control (Encyclopedia of Mental Disorders,
2012).
Along with behavioral factors comes the impact of sociocultural causes and eating
disorders. The media plays a huge role in promoting unhealthy eating habits. The emphasis on
being extremely skinny and relating that to beauty and being desirable creates distorted thinking
in certain individuals. Professionals say that this "ideal" female figure the media has created is
unattainable by most women, and is lighter than most standards correlated with good health by
insurance companies (Encyclopedia of Mental Disorders, 2012). They also have found that
models in 1965 weighed about 8% less than the average American woman and they presently
weigh about 25% less (Encyclopedia of Mental Disorders, 2012). Women are shown that
looking like this is ideal and in order to be somebody in this world, they must look and act this
way. They will not be successful if they do not meet this standard that has been set by media.
Professionals who work with people with eating disorders look at the transtheoretical
model to determine the roles of readiness to change and which treatment methods are best in
determining engagement and outcome of treatment. Different treatment methods such as
cognitive behavioral therapy and motivational enhancement therapy were used in a study to see
which one would help patients more in their recovery process. They found that treatment
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methods made no different, rather which stage of change the patients were in made the biggest
different. Of course, they found patients in the action stage had better outcomes than patients in
the contemplation stage (Treasure et al. 1999). Overall, they found that patients who were more
ready to change as well as those who formed a good alliance with their therapy workers were
more likely to diminish bulimic behaviors.
Another approach used when looking at the behavioral factors of eating disorders is the
ecological model of health behavior. According to Schneider (2011), "the ecological model
describes five levels of influence that determine health-related behaviors" (pg. 233). The first
aspect looked at on the ecological model is the individual level. When an individual goes in to
see a health professional, this professional is trying to help them with their knowledge, attitudes
and beliefs on the disorder (Brown, 2011). When it comes to the interpersonal intervention, the
family is one of the biggest support groups for the person dealing with the disorder. The family
must help and encourage healthy living for this person. When it comes to the organizational
level for eating disorders, support groups and even in and outpatient facilities can help encourage
individuals and give them tools they need to help them deal with their disease (Brown, 2011).
The next level is the community and this can be a little tricky with eating disorders but some
communities put together eating disorder awareness events to get the community aware and give
education tips to help prevent the disease. The last level to this model is public policy. This
needs the most help when it comes to eating disorders. Diminishing media influences on "ideal"
weight is something that can definitely help in prevention of the disease.
As seen, a lot more research needs to be done on bulimia to get a better understanding of
the disease. Numerous groups are involved in the study of the disease including;
epidemiologists, biostatisticians, mental health professionals, researchers, doctors and
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community health workers. A lot has been done to find biological, environmental, sociocultural
and other factors that influence the occurrence of this disease. Progress has been made to find
different ways to try and prevent this disease through talking with patients who have recovered
from it, internet surveys, and lab studies on genetics of those who have been diagnosed with the
disease. So much progress has been made in the past few decades to get a much better
understanding on the disease but because it is so complex, a lot more research needs to happen to
fully understand the extent of the illness.
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References
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