I am a full-time freelance writer, attached to a couple of UK and North American-based research organizations. In the past I have carried out research and writing projects in business, marketing and other humanities-related fields. On occasion I have even worked on writing projects in fields as diverse as medicine, psychiatry, literature, geography and global warming. I earned a Masters in Business Administration from a prestigious university in the UK and hope to proceed to PhD-level studies in a year or two. Throughout the past ten years, I held a number of positions in the fields of banking, insurance and information technology, working for reputed organizations such as HSBC and ING Direct. I have worked in different managerial and consulting positions and have acquired professional qualifications in banking, marketing and human resources management.

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THE PSYCHOLOGY OF ANOREXIA AND BULIMIA

Abstract

This research paper looks at the psychology behind both anorexia nervosa and bulimia nervosa. The paper is divided into two sections, one each for anorexia and bulimia.

Each section begins with a brief description of the disorders and how the disorder can be recognized or diagnosed. Then it goes on to explain the causes of the disorder and especially what psychological aspects may precipitate the onset of the disorder. Finally each section briefly describes what can be done to prevent the disorder.

In this research paper we will first look at the psychology behind Anorexia Nervosa and then the psychology behind Bulimia Nervosa. We will also very briefly look at the causes and the treatments for these disorders.

Anorexia Nervosa

Anorexia Nervosa is an eating disorder. Low body weight, body image distortion and an obsessive fear of gaining weight characterizes this disorder. Individuals suffering from Anorexia Nervosa are obsessed about controlling their body weight through variety of means – voluntary starvation, purging, vomiting, excessive exercise or diet pills. Anorexia Nervosa is considered to be a complex condition involving psychological, neuro-biological and sociological components. (Lask & Bryant-Waugh, 2000, p.23)

Close to 10% of those diagnosed with the disorder die due to causes related to the disorder and as a result Anorexia is thought to have the highest mortality rate of any psychiatric disorder (Birmingham, Su, Hlynsky, Goldner & Gao, 2005, p.143). Suicide rates amongst anorexia sufferers too, are higher than in the general population (Pompili, Mancinelli, Girardi, Ruberto & Tatarelli, 2004, p.99). Further, a recent review suggested that less than one half recover from the disorder fully, only one third improve while around 20% remain chronically ill (Steinhausen, 2002, p.1285).

Psychology behind Anorexia Nervosa

Feelings of fatness and unattractiveness are known to cause this eating disorder. It is a well-known fact that individual’s suffering from this disorder have a tendency to over-estimate their unattractiveness and most of all their fatness. Research has concluded that this is not a perceptual problem but rather that the evaluation of this perception is impaired in anorexics.

High levels of obsession, restraint and perfectionism have been found to be common traits amongst people with anorexia. Many sufferers maybe have one or more mental illnesses that exist alongside this disorder. Substance abuse, clinical depression, obsessive-compulsive disorder and high levels of anxiety are some of the other illnesses that can exist alongside anorexia.

Professor Chris Fairburn of the University of Oxford has created a model, which explains how anorexia and similar disorders are maintained. It suggests how psychological treatment should be provided for sufferers of this disorder. The basis for this model is that major eating disorders except obesity share similar psychopathology that causes and retains the behaviors attributed to this disorder – such as interpersonal difficulties, chronically low self esteem, and mood intolerance.

It has been found that high rates of anorexia nervosa sufferers have experienced sexual abuse as children in comparison to the general population. These numbers are thought to be as high as 50%. While having experienced sexual abuse as children is not considered to be a particularly high risk factor, those who later develop the disorder have found to have more chronic symptoms.

Like other mental illnesses even anorexia can be caused by social and environmental factors. For instance those in careers such as modeling have a higher chance of developing the disorder caused by social and peer pressure to be thin. Further, exposure to media that promotes thinness as the ideal size for females too has been found to cause anorexia and similar eating disorders.

From everything that has been stated above it can be safely said that Anorexia Nervosa is a mental disorder that is characterized by an excessive fear of gaining excessive body weight and caused in most individuals who have low self esteem and are prone to depression and other forms of mental illnesses. Further individuals with this disorder are also known to be prone to higher levels of suicide.

Bulimia Nervosa

The Diagnostic and Statistical Manual of Mental Disorders, Fourth edition, Text Revision (DSM-IV-TR) recognizes Bulimia Nervosa as an eating disorder. Individuals with this disorder experience frequent episodes of binge eating that lead to emotional distress because they feel out of control. This sense of loss of control causes them to have compensatory behavior patterns in order to prevent weight gain. These compensatory behavior patterns could include excessive exercising, periods of strict dieting and starvation, self induced vomiting, these individuals are also known to experience laxative abuse and diuretic abuse they are even known to use appetite suppressants and medication to speed up metabolism. DSM-IV-TR diagnostic criteria require episodes of binge eating that occur at least twice weekly for 3 months. People with bulimia nervosa are also dissatisfied with their body shape, weight, or both.

Bulimia is considered distinct from the only recently recognized syndrome of binge-eating disorder, here no regular or consistent compensatory behavior accompanies the bingeing episodes. The DSM-IV-TR recognizes 2 major variants of bulimia nervosa, as follows: purging and non-purging Many reports suggest that people with bulimia often have a history of anorexia nervosa. Some reports have suggested this association in as many as 60% of cases. While people with uncomplicated binge-eating disorder tend to be obese, people with bulimia nervosa are typically of normal weight. The natural history of eating disorders is such that individuals may pass through several diagnoses over time, meeting criteria for anorexia nervosa, bulimia nervosa, and binge-eating disorder at various points (Uwaifo & Daly, 2005).

Psychology behind Bulimia Nervosa

Bulimia too like anorexia is related to deep psychological issues and a feeling of lack of control. Therefore sufferers attempt to gain control over their lives through their destructive eating habits. In order to do this they may hoard food. When they are stressed or lose control they binge and consume great quantities of food sometimes in the neighborhood of 20,000 calories or more.

Often after sometime these individuals will realize that they have no control over the binging and purging habits any longer. At that point binging becomes an addiction that they are unable to break and they will not be purging any longer either. This in turn causes them to gain weight which will then lead to anxiety and the sufferer will revert back to having bulimia.

Different states of anxiety, boredom, emotional tension, exhaustion and substance abuse are known to have potential to precipitate an event of binge/purge cycles in individuals suffering from the disorder. Further other psychological factors such as low esteem and affective self-regulation are also known to be present simultaneously in the individuals.

An inappropriate concern about body image and an excessive preoccupation with thinness seem central to both anorexia and bulimia nervosa. Some evidence suggests an association of bulimia (particularly the bingeing episodes) with disinhibition for food intake.

The rather common association of eating disorders with affective disorders suggests a possible relationship between them. Major depressive disorder (MDD) is particularly common in this regard. It is still unclear whether the association is causative (primary), secondary to the bulimia itself, or represents a common set of risk factors for bulimia and MDD. Furthermore, obsessive-compulsive disorder is more common in persons with bulimia than in those without bulimia. Anxiety disorders, other related neuroses, and phobias also have been noted to be more common.

The role of sexual abuse in the development of eating disorders is controversial. Some reports suggest a strong association, while others detect no association. Some evidence suggests a relationship between addictions and eating disorders, particularly in binge-eating disorder (Uwaifo & Daly, 2005).

While it is not known how to prevent the onset of bulimia, less emphasis on physical perfection in a social and cultural sense may help reduce the number of individuals afflicted with the disorder. Further it has been found that early intervention through psychotherapy can help immensely. Encouraging children to adopt healthy eating habits too will help prevent or reduce the onset of bulimia later in life. Another very effective step would be also to teach children to pay more attention to internal qualities rather than external characteristics.

Works Cited:

Birmingham CL, Su J, Hlynsky JA, Goldner EM & Gao M. (2005) The mortality rate from anorexia nervosa. International Journal of Eating Disorders, 38 (2), 143-6.

Lask B, & Bryant-Waugh, R (eds) (2000) Anorexia Nervosa and Related Eating Disorders in Childhood and Adolescence, Hove: Psychology Press.

Pompili M, Mancinelli I, Girardi P, Ruberto A & Tatarelli R. (2004), Suicide in anorexia nervosa: a meta-analysis, Int J Eat Disord, 36 (1), 99-103.

Steinhausen, H.C. (2002,) The outcome of anorexia nervosa in the 20th century, Am J Psychiatry, 159 (8), 1284-93.

Uwaifo, G. & Daly, R., (Dec. 1, 2005), Bulimia, eMedicine from WebMD, Retrieved on Nov, 12, 2007 from http://www.emedicine.com/med/topic255.htm