Bulimia Causes & Risk Factors - OmniMedicalSearch.com, by Lindsey Ricciardi, Ph.D

Bulimia nervosa is a complex disorder and despite continuous efforts from mental health specialists and doctors to understand its dynamics, it is not clear yet what causes the condition to develop. As it is for many other psychological conditions, researchers believe that a variety of factors (biological, psychological, and environmental/sociocultural factors) work together in determining if the disorder will occur.

Although at first glance, bulimia nervosa is considered to be triggered by a woman's need to "fulfilled a culturally imposed ideal body image," studies show that the condition has a significant biological component. The genetic predisposition is supported by the increased number of females that suffer from bulimia that come from families with a history of an eating disorder. Also, the condition is more likely to be diagnosed in identical twin sisters than non-identical twins.

Scientists are trying to understand the genetic characteristics of those that develop an eating disorder such as bulimia. It was observed through clinical work that for some bulimics, it is more difficult to break away from the cycle of binge eating and purging cycle than others and some recover after a short-term treatment while others follow a chronic evolution. A group of researchers led by Howard Steiger (director of the Eating Disorders Program at Douglas Hospital) have found that "a substantial portion of individuals with bulimia have a genetic predisposition to impulsivity." (7)

There is a direct link between impulsivity and serotonin, a neurotransmitter that regulates the mood, impulse control and eating behaviors both in humans and animals. Previous studies showed that when there is a reduced serotonin transmission in the brain, compulsive and binge eating behavior increases. According to the study conducted by H. Steiger, some individuals display a difference in the form of a specific gene called serotonin transporter gene. Individuals that have a specific form of this gene know as S-allele have a lower serotonin reuptake and exhibit increased levels of impulsivity, greater mood instability and "have suffered more childhood abuse than other types of bulimics." (7) Also, such individuals are less responsive to treatment comparing to those with an alternative form of the gene. Reduced serotonin activity has been associated with abuse during childhood and dieting.

It was also discovered that serotonin can determine when people start and stop eating when associated with the activity of two regions from hypothalamus (in the brain). Ventromedial and lateral hypothalamus play a significant role in governing eating behaviors in both humans and animals. The ventromedial hypothalamus is known as the satiety center and when stimulated it creates the feeling of being satiated therefore the eating behavior stops, while the individual feels the need to eat when the lateral hypothalamus is stimulated. In a normal situation when both areas of the hypothalamus are operating properly, the body maintains a specific body weight (known as the set point). This set point modifies when there is a dysfunction in one of these regions. Experiments conducted on laboratory animals showed that when serotonin is released either into the ventromedial or lateral hypothalamus the eating behavior stops and starvation results, while if the level of serotonin is reduced the animal becomes obese.

Serotonin was also linked to feelings of well being and satiation. Recent studies showed that after the ingestion of a diet rich in carbohydrates the body converts the sugars into tryptophan, a precursor of serotonin. Based on this discovery, binge eating episodes might be triggered by a brain chemical imbalance cause by reduced levels of serotonin.

Studies conducted on the role of feeling satiated suggest that bulimics may have a faulty satiation response. In one study, it was observed that healthy individuals compared to bulimics tend to feel satiated more often after a normal meal, which can somehow explain why bulimics ingest a high amount of food rich in carbohydrates. Low levels of serotonin were also linked to depression, a common manifestation in people suffering from an eating disorder.

There are studies suggesting that some regions on chromosome 10 are linked to bulimia and obesity. Individuals suffering from bulimia are more likely than the healthy population to have an overweight or obese parent or to have struggled with weight problems during childhood.

According to statistics, the younger population (especially females) are more prone to develop bulimia. There are several factor that contribute to this high risk which include:

1. The immediate social environment. Young women are more vulnerable to develop an eating disorder if the immediate family or social group is placing a significant importance on looking thin and controlling the body weight. Girls raised in a strict familial environment that emphasized the need for physical attractiveness and being skinny face an increased risk to engage in dysfunctional eating behaviors such dieting which can lead to a dysfunctional eating habits and an eating disorder.

2. Parental behavior. When a child is raised in an insecure and unsafe family environment, they can develop an insecure attachment. An insecure attachment was linked to greater weight concerns and lower self-esteem later in life which increases the risk for developing an eating disorder. Studies conducted on the implications of a poor parenting style have shown significant connections with the presence of an eating disorder later in life. Lots of bulimics were raised by mothers that were described as critical and detached.

3. Dieting. When living in an environment where discussions about weight and diet are frequent or there is pressure to be thin, many young girls turn to diet to achieve their weight goal. Dieting can become dangerous when associated with feelings of frustration and desperation. When the diet does not work or it does not lead to significant results in a short period, some people can turn to stricter or more aggressive weight loss methods such as diuretics, diet pills, laxatives, enemas, vomiting, spitting out food that has been chewed, food fadism (choosing to eat only certain good groups), fasting, or using a sauna to sweat off water weight. Also, an agressive diet can deregulate the appetite leading to binge eating.

According to Remuda Ranch Programs for Eating Disorders, (an inpatient treatment center for women and girls with anorexia and bulimia), the diet turns into a full-blown eating disorder "when the restrictive calorie level or limited foods on the diet leads to episodes of binge eating [...] or the person purges calories by self-inducing vomiting" multiples times per week and for three months or more. (8)

Unfortunately, most western societies have developed an obsession for dieting. According to statistics, more then 80 percent of the female population in the US are unhappy with their physical appearance and want to lose weight, while 50 percent of the women are dieting. Approximately 10 percent of those women that are on a diet "progress to partial or full eating disorders." (8)

4. Life transitions. Any major transition in a person's life such as a relationship break-up, major career or job changes, moving, or a personal loss can cause a significant level of emotional stress. One of the coping mechanisms associated with emotional pain and stress is engaging in behaviors that can bring comfort and create a sense of control such as eating. "However, excessive control of over eating can lead to eating disorders." (9)

5. History of abuse. Women with bulimia have a higher incidence of sexual abuse. There are studies that identify a sexual abuse rate of 35 percent among women suffering from bulimia.

6. Professions or activities that emphasize thinness. Bulimia tends to be more prevalent among professions that emphasize the thin ideal such as modelling, dancing, acting or television careers, certain sports (gymnastics, wrestling, or long-distance running).

7. Media and society. Although it is not clear whether the society and media influences and shapes the public's attitude towards being thin and being obsessively preoccupied with dieting, there are voices that claim that society and more strongly the media through their "parade of skinny beauties" influence the young population in equating being thin with being successful and popular.

There are certain personality traits and psychological factors that might predispose a person to develop bulimia. Individuals with bulimia exhibit low self-esteem, feelings of helplessness, inadequacy, and not having control over life, intense dissatisfaction with their body weight, anxiety, depression, and anger. Also, bulimics have significantly higher levels of impulsivity and a negative body image.

According to a study conducted by the Department of Basic and Clinic Psychology and Psychobiology (Universitat Jaume I, Spain), the most frequent pathological personality patterns in women with anorexia and bulimia are the avoidant and self-destructive personality type. Also, studies point to personality traits such as neuroticism, obsessive tendencies, perfectionism, and self-criticism to play a significant role in facilitating bulimia to develop. Bulimics tend to be very competitive by nature and driven to succeed. They tend to compare their appearance and achievements with unrealistic standards based on social derived and peer pressure standards rather than personal expectations. Bulimics are more concerned with what others think rather than what they think about themselves. Due to their perfectionist nature, bulimics "always strive to meet the highest standards of performance possible" which pushes them into "a self-defeating cycle of fear and dissatisfaction" when they cannot achieve their unrealistic and in most cases unhealthy expectations and goals. Unfortunately, this self-defeating cycle represents "the fuel and motivation that perpetuates a renewed drive toward thinness, perfection, and control." (10)

During clinical work with individuals suffering from eating disorders, psychologist and clinicians have noticed that bulimics lack important coping skills so they use disordered eating behaviors to compensate and provide themselves with "comfort, numbness, attention, tension release, structure, identity, self-punishment, cleansing, protection." (10) Also, disordered eating behaviors become the main coping mechanism for emotional pain and stressful situations such the loss of a close person, abuse, stressful transitions, family conflict, or academic/career pressure.

Conditions & Diseases: Eating & Weight Disorders

Bulimia Nervosa

Bulimia Nervosa Causes and Risk Factors