Bulimia Introduction - OmniMedicalSearch.com

Conditions & Diseases: Eating & Weight Disorders

Bulimia Nervosa

Bulimia Nervosa Introduction

One of the main challenges when defining bulimia nervosa is to determine the frame of reference or model that best describes the disorder. Some of the questions that continue to seek answers are: What is bulimia nervosa? Is it a disease in itself, a variant of another illness, or a manifestation of a personality disorder?

If bulimia nervosa would be defined as a disease, inevitably we should be able to identify an underlying pathophysiology and a predictable course. However, the disease model does not fit what is know about bulimia because "no one has yet been able to delineate a specific pathophysiology for this condition, or a specific, predictable, longitudinal course." (1) The alternative perspective that bulimia may be a variant of another illness resulted in two models: bulimia as a variant of affective disorder (based on the evidence that a high percentage of individuals with bulimia are depressed) and bulimia as a variant of substance (alcohol/drug) abuse (based on the evidence that drug abuse problems are quite common among individuals with bulimia). Even though some of the patients with bulimia suffer from a personality disorder, the evidence is not strong enough to support the possibility that bulimia is a manifestation of a personality disorder. Unfortunately, although the research guided by these models bring a great contribution to the understanding of the condition, they fail in their attempt to fully explain bulimia nervosa.

Another strong formulated model is that bulimia nervosa is a culture-bond syndrome. The importance of cultural variables in the development of the condition are difficult to prove, but there is evidence that do support such association. A cultural-bond syndrome has been defined as a "constellation of signs and symptoms, categorizes as a dysfunction or disease, that is restricted to certain cultures primarily by reason of distinctive psychological features of those cultures." (3) In cultural contexts where the human body is valued differently, eating habits are not associated with personal control and self-discipline, while obesity does "not signify a moral offense or esthetic blemish", and starvation is an "unavoidable fact of life" rather than a voluntary choice, therefore eating disorders (such as bulimia nervosa) are not a concern. (3)

One piece of evidence that may support the association between the cultural variable and bulimia is the growing and predominant preoccupation with being thin. In Western societies where food is abundant and "the average weight in women has increased," the ideal body type portrayed in the media has decreased. In today's society, the thin ideal symbolizes "success, social status, wealth and self-discipline" and weight "...has became a quick and tangible measure of women's self-worth, desirability and ranking in relation to other women." (2) Over the years the dietary practices shifted from the "eighteenth-century concern for a long life as a religious value" to the present concern "...for the efficient quantification of the body."(3) In some past or present European cultures, women fast as a symbolic form of sanctity, empowerment, and purity through suffering. The fasting experience is a spiritual purification and "domination of the flesh" that brings these Christian women closer to God. Some claim that through fasting these women are trying to develop a sense of identity, but their inner self is completely different than the modern, western self shaped through dieting and physical exercises in the attempt to achieve an aesthetic ideal of beauty. "In the former, the denial of food is aimed at serving the soul; in the latter the concern with diet and ideal weight becomes a project in service of the body." (3)

Another possible cause that can create a vulnerability towards eating disorders such bulimia is the meaning associated with being slim. Slimness has become synonymous with self-discipline, control, attractiveness, and being successful. Life in a capitalist and industrialized society led to the need of a new lifestyle "embodied in the ethic of calculating hedonism" but also characterized by more leisure time where self-indulgent and instant gratification behaviors enabled the development of a new personality trend - a narcissistic personality. Unfortunately, dietary practices have become a self-presentation aid because the Western consumerism mentality "... have blurred the exterior marks of social distinction (status) and personal difference (identity)." In order to be successful in a competitive society, the person needs to display a "...successful body, disciplined to enhance personal value with the help of a growing sector of 'body work professions' (dietitians, cosmetologists, plastic surgeons)."(3) The duplicity of the consumer capitalism between "producer-selves" that must repress the desires for instant gratification and "consumer-selves" that hunger for immediate gratification has been translated in "the agnostic and unstable construction of the modern personality" of a bulimic. The unconstrained consumption takes the form of uncontrollable food binges while the need for taking firm control is expressed through the person's necessity to vomit, to exercise compulsively, or to purge.

Due to the intense emphasis on being thin as the a model of attractiveness, many women have developed a distorted perception regarding their body image. They perceive themselves more heavy than they really are which could lead to abnormal eating-related behaviors. While many are aware that the ideal thin body is unrealistic, most women remain unhappy with their weight and body shape and this dissatisfaction tends to be stronger among young women than any other age category.

"Young women anxiously want to be socially accepted; they think they will be penalized socially if they are overweight and rewarded, both personally and socially, if they achieve their 'thin ideal' weight." (2)

It is believed that young women are "more vulnerable to the enticing messages" to conform to the current ideal weight standards and easily "resort to dieting" in order to achieve this goal. Unfortunately at this young age, dieting can easily "develop into an intense preoccupation with weight" and in combination with other factors can become a full blown eating disorder. "Young women can change from having a normal relationship with food and eating to being obsessive about their weight and dieting."(2)

Another group of cultural variables identified as a possible risk for the development of bulimia is among women that grew up during times of dramatic changes in society's perception of women's role. These women are confronted with dual roles such as being "attractive and domestic in traditional feminine roles" while also being independent and seeking "equal vocational parity with men." (1)

Although this model raises questions whether the current culture for slenderness is linked to the occurrence of bulimia nervosa among the female population, based on the available evidence the cultural influences "do not in a precise sense cause" bulimia nervosa. The cultural context is mediated by psychological factors and the social context of the family either "predisposing or protecting for any particular disorder."(3)

One of the strongest construct that seem to offer the best explanation is that bulimia nervosa is a behavioral disorder. Bulimia nervosa is a condition that involves "certain behaviors in various combinations and at various frequencies, and the practice of these behaviors, over time, is associated with the development of certain predictable psychosocial sequelae, including low self-esteem and depression."(1) From the perspective of this model, bulimia as a behavioral disorder can occur as an additional feature in other disorders, can occur in individuals with no additional psychological and/or behavioral problems/conditions, and can be triggered by cultural factors.

Article by Alina Morrow
MS Psychology
Medical Writer
OmniMedicalSearch.com