EATING DISORDER: BULIMIA

Eating Disorders  Eating Disorders are characterized by severe disturbances in eating behavior  The sufferer may eat too much or two little  Over 5 million people are believed to experience an eating disorder in the United States

Bulimia  Bulimia Nervosa is characterized by repeated episodes of binge eating followed by inappropriate compensatory behaviors such as:  Self-induced vomiting  Misuse of laxatives, diuretics, or other medications  Fasting  Binge eating  Excessive exercise  A disturbance in perception of body shape and weight is an essential feature of Bulimia Nervosa  Symptoms must occur twice a week for three months

Bulimia  Patients may consume more calories in a binge than an average person eats in a day  This results in feelings of disgust and guilt – egodystonic behavior The patient experiences the symptoms as something distressing that they cannot control  They vomit to reverse these feelings  Hard to spot because usually have an average BMI

Prevalence  National Institute of Mental Health: 2-3% of women and % of men suffer from Bulimia  40% of college women report binging and purging (Keel et al 2006)  Onset is typically late teens and early twenties  More common in industrialized countries

Symptomology  Affective  Feelings of inadequacy, guilt, or shame  Behavioral  Binge eating, vomiting, use of laxatives, exercise, or dieting to control weight  Cognitive  Negative self-image, perfectionism, faulty attributions  Somatic  Swollen salivary glands, erosion of tooth enamel, stomach or intestinal problems, heart problems

Etiology  Biological  Genetics  Low Serotonin Levels  Cognitive  Body-Image Distortion Hypothesis  Cognitive Disinhibition  Sociocultural  The role of the media and social norms in creating self- schemas  Social Learning Theory

Biological Etiology: Genetics  Genetic predisposition may lead to developing and eating disorder  Kendler et al (1991)  Studied 2000 female twins  Findings: 23% concordance rate of bulimia between MZ twins 9% concordance rate of bulimia among DZ twins  In other studies the DZ rates vary 23-83%  But Strober 2000 Found that any women with first-degree relatives suffering from bulimia are 10 times more likely to develop it Questioning is it genetics, or social learning which causes the disorder

Biological Etiology: Neurotransmitters  Serotonin  Serotonin may play a role in the development of bulimia Increased serotonin may stimulate the medial hypothalamus and signal the body to decrease food intake  Carraso 2000 Found that bulimic patients have a lower level of serotonin, resulting in the lack of a signal to stop eating They binge eat as a result Purging occurs because these patients feel guilt after a binge  Smith et al (1990) Gave a drug that reduced the levels of serotonin in recovered bulimic patients Results: Patients reported regressing to previous cognitive patterns, such as feeling fat and showed an increase in food intake

Cognitive Etiology  Body-image distortion hypothesis (Bruch 1962)  Eating disorder patients suffer from delusions that they are fat – they over-estimate their size  Slade and Brodie (1994) Interviewed patients diagnosed with bulimia They asked the patients to estimate their weight and size They also asked patients to report how confident they were in these measurements Participants primarily over-estimated their weight and size They also reported not being confident in their knowledge of their true weight

Cognitive Etiology  Cognitive Disinhibition  Dichotomous thinking – all-or-nothing approach to judging oneself Bulimic patients follow a very strict dieting pattern to reach a weight they believe is ideal When they break the rules, they binge eat It is all, or nothing when it comes to dieting  Thoughts about eating (cognitions)act to release all dietary restricts (disinhibitions)

Polivy and Herman (1985)  Dieters and non-dieters were asked to take part in a taste test  Before the test, they were given a chocolate shake  After, they were asked to try three types of ice cream  They were told they could eat as much as they wanted  Results:  The dieters ate significantly more than non-dieters  They reported feeling that since they had already broken their diet, why not go “all out.”  CRITIQUE:  But this is more descriptive than explanatory, why do women develop these faulty cognitions

Mackenzie et al (1993) cognitive distortions  Interviewed female eating disorder patients and a control group about their body weight, shape and ideals, and got them to estimate their own size in relation to other women.  They found that:  When asked to compare themselves with controls who were the same size, ED patients tended to overestimate their own body weight.  When asked to indicate their ideal body shape/weight, ED patients chose a weight/shape significantly lighter/thinner than the control group.  The participants were then given a chocolate bar and a soft drink to consume. Following this they were asked to re-estimate their body weight/shape.  The ED patients judged that their size has increased, while the control group judged that their size had not changed.

Sociocultural Etiology: Social Schemas  In the western world, the media portrays the “idea” body image  Overtime that image has changed from curvy, to very thin  Only 5% of women are biologically able to attain the current media’s ideal body image

Sanders and Bazalgette  Analyzed the shape of three of the most popular dolls given to girls in the US  Barbie, Sindy, Little Mermaid  Measured the hips, height, waist, and bust  Found:  Relative to a real women, the dolls had tiny hips and waists, and generally exaggerated leg measurements  This creates a distorted idea about what is normal and acceptable starting in childhood (Schemas)  This causes children to be dissatisfied in their own shape even if it is healthy