Bulimia nervosa is an eating disorder common among young women and adolescent girls. According to the medical encyclopedia, binge and purge eating portray bulimia. It involves regular overeating and a sudden feeling of loss of control. This results in induced vomiting as well as the abuse of laxatives to stimulate weight loss. The American psychological association (APA) uses a precise manual for psychiatric disorders to classify this condition. The manual is also the diagnostic statistical manual of mental disorders (DSMV).
The DSM-IV criteria for binge eating comprise frequent episodes of binge eating, which is eating more food than an average person does in a similar time. In addition, the disorder entails a feeling of lack of control of one’s eating habits. It also includes compensatory activities such as purging, exercising or food abstinence to prevent weight gain from the overeating. For one to be certified as having bulimia, the related behaviors have to happen two times a week for at least three months.
Further categorization of bulimia nervosa is the exclusion of anorexia nervosa. Vomiting that occurs in bulimia nervosa is usually self- stimulated; “there is laxative, enema and diuretic abuse” (Polivy & Herman, 2002). The non-purging bulimia criterion must differ from anorexia nervosa in the tactic of eliminating calories and does not necessarily satisfy the ‘below 85% of expected weight criteria’ (APA 1994) as cited by Polivy and Herman (2002).
This disorder leaves experts in different fields working round the clock for possible solutions. A number of factors are put forward as causes of the disorder. Despite all the effort, much needs to be done to eradicate this issue among middle adolescents. This literature review is part of the effort towards eradication of bulimia nervosa. Theorized possibilities such as self-esteem and the influence of peer pressure are among some of the factors that this paper reviews.
Self-Esteem and Bulimia Nervosa
Bulimia nervosa can result from a poor body esteem that is a constituent of one’s self-esteem. Poor body esteem is associated with emotional eating and dieting (Filaire et al., as cited in Mak, Pang, Lai, & Ho, 2012). Adolescence is a stage with intense physical and cognitive changes. Female middle adolescents are likely to suffer from a distorted body image as compared to males. This is according to studies done by Duncan et al., 2004; Franko and Striegel-Moore, 2002 and Neumark-Sztainer et al., 2002 (Mak et al., 2012).
The study by Mak et al. confirms that body esteem largely hinges on the socialization of an individual (2012). Socialization is largely dependent on the fact that girls are socialized differently from boys. Boys seem to have a higher self-esteem than girls do. This finding is consistent with other studies done in the western world.
Mak et al. also discovered that older people seem to have greater body esteem than young adults and adolescents (2012). They demarcate the problem as young adults and adolescent issue. There is a strong correlation between self-esteem and development of eating disorders. Low body esteem and subsequent eating disorder is discovered among university students according to a research done by O’Brien and Hunter in 2006 (Mak et al., 2012).
Studies by Ferrand et al. and Shapiro et al. purport that female athletic swimmers have the same problem with university students (Mak et al., 2012). It is asserted that fear of getting fat and low body esteem from a psychiatric evaluation can lead to the development of eating disorders and unrestrained eating.
Peer Interactions and Bulimia Nervosa
Peer interaction is a paramount phase in the life an adolescent. In many cases, the feedback they get determines their behavior. Adolescents who are either overweight or perceived to be overweight suffer negative psychosocial interactions among their peers (Thompson et al., 2007).
They may receive negative comments from their peers hence withdraw socially. Neumark-Sztainer et al. discovered that at least 63% of overweight girls were teased by their peers due to their appearance (2002). Peer interactions encompass more than negative appearance-related feedback. They can revolve around peer modeling of image matters, conversations relating to appearance and popularity hinged on appearance.
Further research finds that an adolescent with dieting friends tends towards unhealthy weight-control behaviors such as diet pills, purging, and smoking (Thompson et al., 2007). This is especially common between average and overweight girls. In their recommendations, Thompson et al. give sound advice that is indeed a credible niche for future research (2007). They propose friends anticipating advice as a variable for future research.
This should be done with overweight subjects that are likely to foster a better understanding of their peer-related psychosocial experiences. They also suggest assessment of peer behavior is incorporated in the research tools. Ommundsen et al. further assert that negative peer relations because of negative interactions may result in the development of antisocial pathologies in adulthood (2006).
Parental Influences and Bulimia Nervosa
The role of parental influence in the development of bulimia nervosa is not spared from criticism. The feedback received from parents has weighty significance on the development of behavior just like feedback from peers. As Polivy and Herman note, eating disorders and related behaviors occur because of maladaptive perfectionist tendencies from parents (2002).
The situation is worse among mothers with a history of eating disorders. Perceived or real parental feedback among middle adolescents especially athletes spurs them into action. The actions can include events ranging from dieting to abuse of laxatives. Parents influence the nature of psychosocial sport experiences in middle adolescent athletes (Ommundsen et al., 2006).
Frantic efforts to lose weight are popular in adolescents whose parents are perceived as critical of the adolescents’ performances and exhibit high standards of achievement. The effect that social comparison can generate among middle adolescents female athlete is enormous. Bulimic middle adolescent athletes are reported to believe less in their capabilities and worry a lot about their performance.
These findings are in harmony with previous findings by McArdle and Duda in 2004, which show that parents with an elevated ability and are also punitively structured accelerate concern over mistakes when involved in sports (Ommundsen et al., 2006). Parents can also influence the development of bulimia nervosa by the genes they pass on to their children. Such adolescents are found to have an abnormally elevated level of serotonin (neurotransmitter in the brain, which is responsible for controlling appetite and satiety).
Media and Bulimia Nervosa
The media’s role in the development of bulimia nervosa is rather shocking. Modern customs are unique as the media, for instance, movies, magazines, televisions and the internet have a dominant influence different from the past (Derenne & Beresin, 2006). There seems to be a general preference of super slim media personalities and celebrities. The public seems to have developed an obsession with the almost emaciated media personalities.
Celebrities are usually under public scrutiny on how they maintain their weight. They are believed to maintain slender bodies as a response to public pressure. The public keeps monitoring them for weight gain or weight loss. Those who seem to lose weight in extremely short periods are thereafter viewed as heroes. Celebrities maintain rather unrealistic body shapes. The reality, however, is that it is impossible for a common middle-aged adolescent to emulate the celebrities since it requires much effort.
In addition, the middle-aged adolescent cannot afford the flamboyant lifestyle that celebrities have and the extravagant expenses on personal trainers (Derenne & Beresin, 2006). Celebrities have means in terms of finances and can afford personal trainers, expensive creams and even keeping perfect diets. An average teenager who is mistaken that it takes simple dieting to emulate the celebrities ends up with unhealthy dieting habits that result in bulimia.
The media have a significant role in sending image messages to impressionable, young people as well as creating cultural ideals of physical perfection. Becker’s landmark study of comparing the frequency of eating disorders before and after arrival of television in Fiji in 1995 is marked as a critical study in understanding the influence of media on bulimia (Derenne & Beresin, 2006). Therefore, to control this disorder there needs to be sound balance between media and reality.
Psychological Factors Affecting Bulimia Nervosa
Bulimia nervosa can result from underlying emotional problems that are either difficult to express or handle. Bulimia nervosa offers a channel for expression of emotional problems. It makes the victims feel they are in control of the situation.
It is also a tactic to escape unpleasant realities. The victims adopt dissociative tendencies as a defense mechanism. They can immerse themselves in binge eating where traumatic elements are removed from consciousness (Polivy & Herman, 2002). This protects the person from emotional misery. Unfortunately, this is just a mask, but the reality is that they are incapable of dealing with their issues.
One’s dissatisfaction with their body image (body shape or weight) leads to dieting, which when uncontrolled can then spiral into bulimia nervosa (Polivy & Herman, 2002). There are certain personality traits associated with bulimia nervosa. They may include obsessive-compulsive disorder, bouts of depression, manic disorders, and distorted body image feelings of learned helplessness.
Bulimia nervosa has a psychosocial aspect. Certain cultures especially the western cultures tend to approve of a thin body as an image of success (Polivy & Herman, 2002). For middle adolescents, part of their developmental task is to have a sense of belonging. They can do anything to ensure they fit in the society and to fulfill societal expectations of them. This in their imagination is happiness that leads to success. Bulimia nervosa is the result of dietary habits that are beyond their control.
Dysfunctional relationships can trigger bulimia nervosa. Most people hold relationships such as marriage and friendships dear. A breakdown in the relationship or even a mere indication of failure can lead to bulimic tendencies. Stressful life events such as the loss of a loved one or bullying can also trigger bulimia nervosa (Polivy & Herman, 2002).
Abused individuals or those who have experienced traumatic experiences especially in childhood sometimes develop the disorder (Polivy & Herman, 2002). According to Polivy and Herman, emotional abuse in childhood has overwhelming influence on self-esteem and anxiety (2002). They further claim that emotional abuse in childhood is the only early days’ trauma that predicts eating disorders in adults.
Relevance of the Topic
Bulimia nervosa is characterized by numerous speculations. No researcher gives the exact causes for the development of the disorder. It is, hence, vital that additional studies be carried out to determine what factors contribute to the development of the eating disorder. Consequently, this topic is relevant for identification of such niches and analyzing the best possible methods to deal with the issue.
Statistics on Bulimia Nervosa
According to Phoenix and Walter about only 15% of bulimics are males (2009). This leaves no doubt that the disorder is prevalent among females. Bulimia is thought to be predominant in individuals with low-income socioeconomic status.
The 1970s report few cases of bulimia. However, the cases have “escalated to the level of a social epidemic” between the 1970s and the end of the nineteenth century (Phoenix & Walter, 2009). Statistics published by the American psychiatric association indicate that between 2 to 3 percent of American girls aged sixteen to twenty show bulimic behaviors.
The actual figure is about seven million American adolescents struggling with the disorder. Bulimia rates are rapidly growing in the western nations. At the time of the revelation of the statistics, it was approximated that bulimic incidences were 1.6 % with intense patterns of bingeing and purging carried out in secret. Bulimics receiving treatment are estimated at one tenth. However, they only seek treatment after staying with the condition for about seven years.
Cultures sharing the western culture values and attitudes are reported to have disordered eating patterns. Findings of a Swedish study among high school girls show that at least 50 percent thinks they are fat, and about 10 percent experiences eating disorder symptoms.
A similar report is generated by a survey of college students in England in the 1980s. In the 1990s, similar studies carried out in countries such as Great Britain, Netherlands, France, and Denmark yield consistent. There is an emphasis on beauty in thinness and young women are willing to do the impossible to the extent of torturing themselves both physically and psychologically to achieve slenderness.
By the year 2000, studies indicated that at least 10.7 percent of 100,000 women sought treatment on eating disorders. In Japan, 1 in every 500 women have bulimia, a phenomenon that sees the opening of eating disorder units in most Japanese clinics. Bulimia is also evident in African countries even with the general notion that African women ought to be fat as a sign of beauty and fertility.
Further research can be done on possible factors that influence the development of bulimia. This paper does not delve much into biological and genetic factors, which are critical in learning more about the disorder. Lasting solutions to the problem can be generated with each discussed aspect.
Bulimia is a disorder that can be prevented, but it calls for the combined effort from all the relevant stakeholders. It can begin with psycho education on the adverse effects of bulimia. Adolescents suffering from emotional problems can also be advised on how best to express their concerns. Bulimia can also be eradicated by demystifying of popular belief that physical attractiveness is achieved by maintaining low body weight. Parental control on the type of media their children access also needs enforcement.
Derenne, L., & Beresin, E. V. (2006). Body image, media, and eating disorders. Journal of Academic Psychiatry, 30(3), 257–261.
The article discusses the influence of the media on development of eating disorders in males and females. It gives sound recommendation on parental influence on harnessing the good rather than the evil part of media on child development. The authors also discuss the importance of balance between healthy food and snacks. Its downside, however, is that the methodology is not clearly discussed hence does not give a thorough evaluation.
Mak, K., Pang, J. S., Lai C., & Ho, C. R. (2012). Body esteem in Chinese adolescents: Effect of gender, age, and weight. Journal of Health Psychology, 18(1), 46–54.
The literature review carried out on this study is impressive. It covers a vast area on related and similar topics of study. The methodology is carefully followed with clear detail on accuracy, and the validity is well established. Relations among multiple peer influences and body dissatisfaction are well established. However, since it is done in china the limitation of lack of generalizability of the results is likely to create some differences in a different population.
Ommundsen, Y., Roberts, C. G, Lemyre, P., & Miller, B.W. (2006). Parental and coach support or pressure on psychosocial outcomes of pediatric athletes in soccer. Clinical Journal of Sport and Medicine,16(6), 522–526.
The aim of this article is to examine supportive and compelling influences of parents and trainers on youthful athletes’ maladaptive perfectionist tendencies, relationships with friends, and competency perceptions in soccer. This paper achieves these aims. The authors successfully show the relationship between parental influences and maladaptive tendencies in development of pediatric eating disorders.
Comprehensive literature review on the subject is carried out. Nevertheless it is not spared by the limitations of using questionnaires and lack of generalizability of results.
Phoenix, E. L., & Walter, L. (2009). Critical food issues: Problems and state-of-the-art solutions worldwide. California: Greenwood Publishing Group.
This essential book attempts to give statistics of eating disorders. A detailed chronology of the disorder from the 1700s to the twentieth century is provided. The statistics, however, given for Africa are rather scanty.
Polivy, J., & Herman, C. P. (2002). Causes of eating disorders. Annual Review of Psychology 53(2002), 187-213. Doi: 10.1146/annurev.psych.53.100901.135103.
The article does justice in discussing eating disorders such as anorexia nervosa and bulimia by reviewing them. Literature on the development of these disorders is put forward. A number of factors are reviewed including sociocultural factors, family factors, negative effect, low self-esteem, and body dissatisfaction.
In addition, cognitive and biological facets of the disorders are reviewed. Some factors are noted to be responsible for the appearance of eating disorders, but none is deemed sufficient. It finally deals with the disorders as a representation of emotional issues.
Thompson, K. J, Shroff, H., Herbozo, S., Cafri, G., Rodriguez, J., & Rodriguez, M. (2007). Eating disturbance, and self-esteem: A comparison of average weight, at risk of overweight, and overweight adolescent girls. Journal of Pediatric Psychology, 32(1), 24–29. Doi:10.1093/jpepsy/jsl022.
This article takes research to a higher level. It identifies a critical niche in understanding peer influence on adolescents. The systems by which peers reinforce social messages concerning attractiveness are identified. However, it is essential to note that this research is not done comprehensively. The research is guided by the tripartite influence model, which recommends three formative influences of peers, parents and media unlike the traditional model of a single index of peer influence.
The traditional focus is on one item that reflects a construct. The research faces limitations in terms of generalizability of the findings. This is revealed by the fact that the research is done in only one school. This, therefore, leaves room for further research that will perhaps give room for a causal rather than correlational relationship investigation to be done.