I’m well aware that the main topic of my blog isn’t about eating disorders or other psychological problems. I don’t want to be a psychologist. I just studied psychology at the university and learned something about it and want to share the knowledge. The reason I write this article is because I got in touch with a friend who teaches in a gym and encounters people suffering from different eating disorders on a regular basis. She asked about my two cents about the different disorders because I studied some of them during my time in college. So what you find here is a summary of the stuff I’ve been taught in class and my own thoughts and comments about it.

Disclaimer: This post contains general information, it isn’t intended to be a form of self-help or to give a diagnosis. If you suspect you may have Bulimia Nervosa, go to a physician for a diagnosis.

Bulimia Nervosa, what is it?
The word bulimia comes from the Latin and from the Greek  ???????? (boulimia), and means something like “ravenous hunger”. It’s an eating disorder which consists of periods of eating in moderation followed by episodes of binging. Most people who have bulimia purge or take laxatives after a binging episode. This is called the ‘purging type’ of Bulimia Nervosa. The other variant is called the ‘non-purging’ type of bulimia. Sufferers typically fast after binging or engage in excessive exercising to burn the calories.

The strategies used by bulimics to reach their goal are usually not very effective because the body takes up the calories as they are eaten. So when someone purges, she doesn’t purge all the calories as the body has processed them already. Taking laxatives doesn’t really help either. The laxatives being sold without a doctor’s prescription are the ‘bad’ ones who make your intestines lazy. Fasting slows your metabolism and makes the body digest food in a more efficient way, with weight gain as a result. Excessive exercise doesn’t help either because one can’t make up for the amount of calories eaten. This explains why bulimics aren’t necessarily thin, most of them are overweight or obese. It’s important to know that in essence Bulimia Nervosa has nothing to do with food or eating. It has to do with control, perfectionism and social comparison. The main causes stay hidden for the onlooker, however.

Another important thing is the difference between Bulimia Nervosa and Anorexia Nervosa. If someone has Anorexia Nervosa, the hallmark of their behaviour is refusing to maintain healthy weight (BMI > 18, note that the ‘normal range is between 20 and 25). Hence, she wants to be underweight, that’s the goal.
A person suffering from Bulimia wants also to get thin but is usually overweight or obese and therefore starts to diet. Usually she will choose to reduce caloric intake drastically to slim down. The method consist of skipping meals or eating very little while in the presence of other people. This causes huge food cravings and episodes of binging (eating between 3000 and 10.000 calories during a short period of time) and purging, since she feels a lack of control when the craving starts.

‘Abnormal’ eating, a definition
In my last blog I explained the four D’s behind psychological disorders, using information from Comer’s book Abnormal Psychology, which was used in my Clinical Psychology class at my university. A link to Amazon is included in the link section at the bottom.
These “four D’s” are used in clinical psychology to determine abnormal behaviour. When you don’t use these criteria, you can diagnose half of the planet with some kind of psychological disturbance, so that’s not useful. Someone has to engage in eating disorder behaviors who are dangerous (in case of bulimia: ruining your health and internal organs), deviant (e.g. in our society purging after eating isn’t considered normal eating behaviour), distressing (the bulimic feels very distressed and guilty after a binge), dysfunctional (the bulimic is obsessed with food, doesn’t function normally any more in social relations).

When does someone qualify for having Bulimia Nervosa?
The Diagnostic Statistic Manual (DSM) fourth edition (IV), text-revision (TR) is a widely used manual to determine psychological disorders and it gives the following list as symptoms for bulimia nervosa:

What Causes Bulimia Nervosa?
The fourth point made by the DSM-IV-TR, about self-evaluation, is the main cause of bulimia. It is not that someone is fat, but perceives himself or herself as fat. They believe being fat is being a bad person, so they feel bad, because they think they are heavier than the average person. This is called body dissatisfaction. To simplify things: they basically hate their body, and therefore hate themselves. Now are a lot of people, usually women, dissatisfied with their bodies.

Bulimics, however tend to see their body as an object, at a subconscious level: When eating, they don’t think about the food, but about the consequences of eating it for their bodies (e.g. becoming fat). They are constantly comparing their bodies with other people’s bodies. There’s some research done with the perception of vases, and it appears that people are able compare their bodies with non-living objects. Bulimics are so to say ‘detached’ from their bodies. So that’s an important hallmark of developing eating disorders.

The thinness ideal in media doesn’t help combating these processes either: because these women (subconsciously) compare their bodies with other people’s bodies, seeing very thin models in the media everywhere can make things only worse (see also this link). What actually happens in the brain is that the connections feeding these processes are enhanced. So these processes are even harder to extinguish.
Researches have also found a positive correlation between ideal body weight in the media (dimensions of models) and eating disorders like bulimia. When the models were thinnest, the prevalence of eating disorders peaked (source 1 and source 2). So the current opinions about the ideal body (’size zero’) is definitely one of the major ingredients for acquiring an eating disorder. It’s not causing it, but it is part of an “explosive mixture” which as a whole can trigger an eating disorder. I said earlier that eating disorders, when you strip everything down and look to the core, have nothing to do with eating. They have a lot to do with self-esteem, perfectionism, self-image, confidence etc.

It appears that you need to have a genetic vulnerability for it and you have to experience certain things before the trigger is pulled. To put it graphically: genetics and environment load the gun, certain events can pull the trigger. This means that someone can be very vulnerable and living in a body-obsessed society and never develop an eating disorder. Only when there are major stresses (e.g. divorce, assault, mourning a loved one etc. ) the trigger will be pulled. This ‘coping level’ varies from person to person, this has to do with a person’s temperament. Some people experience this in their teenage years (with a lot of emotional turmoil going on), others can develop this after divorce, for instance.

Another factor I talked about earlier in a blog is crash dieting. When you crash diet your body changes rapidly, your mood changes, your way of thinking changes, your metabolism changes. So, when you are vulnerable, dieting and experience a lot of stress, you can be on your way to an eating disorder. Note that crash dieting can increase experienced stress levels. More about this you can read here. An English journalist (Kate Spicer) describes vividly in The Times what happened to her when she tried one of the famous Hollywood crash diets.

So when does someone start binging? The short answer is: because certain emotions trigger a huge craving for food. The longer answer is due to low self-esteem and other psychological factors, someone decides to diet. Low amounts of food are eaten, because she does some fad/crash diet, therefore she’s hungry all the time. Hence, she develops cravings, the treshold is lowered by low mood. Suppose she flips through a ladies’ magazine and feels bad, because she is comparing herself with them on a subconscious level. She feels inadequate, her craving becomes uncontrollable. So she binges. After the binge is over, she realises what she has done. She either decides to fast or to sport excessively to burn all those calories, or she heads for the toilet to throw them up, feeling worse because she let this happen (again). She says to herself she may never binge again and has to eat smaller meals. The next time she feels inadequate, the whole process starts over again.

Consequences when not treated
What will happen when someone doesn’t look for help? Well, to be short: that person is at high risk to die at a young age. A (in)famous example is Terry Schiavo. Complete list of health problems is found at wikipedia: click here.
Trying to diet doesn’t make people happy, it doesn’t improve self-esteem, you don’t start feeling better etc. I explained in another post that an eating disorder is really an effort made by a person to cure / treat some bad feelings. For example, someone thinks that the other gender isn’t interested in them because of their size, or they will get more popular when they just lose some weight etc.
If you are a proxy (peer) of someone with an ED, you might have guessed already what may help: give them your unconditional support. They way you see or treat them has nothing to do with their weight, it’s about them and not about the way they look. For most people this is rather obvious, but a lot of (usually) women tend to associate success with weight.

Treatment
There are a lot of different treatments that can be offered, cognitive behavioural therapy seems one of the most promising approaches. The therapies aim to change someone’s ways he or she copes with stress. You can see why this is important: even if you learn to control the eating disorder, it can return in a stressful situation. So if you are able to create a balance, inner peace, you will lower the possibility for the eating disorder to return, because you did something to change the things that were causing or feeding it. So working on your inner self, boost self-esteem, self-efficacy is the goal of most therapies. I wrote about the ipop-ins earlier, but these work only in mild cases, sub-clinical cases and not when you have a full blown eating disorder.

Another way to stay balanced after doing cognitive behavioural therapy to get everything back on track could be yoga (linked from Science Daily). Remember that I said people tend to view their bodies as objects, they detach themselves from their bodies? Well, when you practice yoga, you aim to integrate mind and body, to feel your body, to grow your inner self. (i.e. accept yourself, learn to see you’re valuable as a person etc.) So you get stronger, both mental as physical which could make you more resistant against eating disorders, because you did something to change the cause, rather then fighting the effects (eating behaviour). At this blog you find an in-depth article about yoga and eating disorders.

http://www.myspace.com/nancybratt

More information for people who want to know more:

Posted under Psychology