Cultural pressures to be thin are believed to be at least partly responsible for bulimia.
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Women get the message early in life. To be thin is to be beautiful, valued and successful. Pre-schoolers play with Barbie with the long, slim legs and incredibly tiny waist. For adolescents and teens standards of beauty are dictated by TV stars, singers and fashion models–almost all of whom are thin, some emaciated.
The gap between this rigid cultural ideal of beauty and the reality of developing into a normal woman’s body creates conflict and a negative self-image in many young women. Cultural pressures to be thin are believed to be at least partly responsible for bulimia, an eating disorder characterized by episodes of binge eating followed by purging, either by vomiting or use of laxatives.
Bulimia nervosa affects up to three percent of young women and is about 10 times more common in women than in men. A much larger percentage of young women suffer from a milder form of the disorder.
A clinical diagnosis of bulimia requires that binge eating episodes occur frequently (at least twice a week) for three months or more. Eating binges are then followed by self-induced vomiting, use of laxatives, excessive dieting or extreme exercise to counter the excess calories. Bulimics often engage in binge eating in private, viewing it as shameful .Attempts to purge are also usually carried out in secret.
About one quarter of women with severe bulimia have a history of anorexia and some women cycle between the two. Anorexia is a serious eating disorder that involves severe calorie restriction in response to a distorted body image. Bulimics also have higher rates of depression, obsessive compulsive traits and low self-esteem.
Because of the secrecy and the fact that bulimics often maintain a normal weight, bulimia can be difficult to detect.
Repeated vomiting and abuse of laxatives can lead to a number of health problems including erosion of dental enamel, bleeding and ruptures in the esophagus and stomach, heart arrhythmias and low blood pressure. It’s important for young women with symptoms of bulimia to recognize the long-term damage and to seek help.
Bulimia is normally treated either with medication, psychological therapy or a combination of the two. Fluoxetine (Prozac) or other SSRIs are often a first choice as they are considered safe and relatively effective, at least over the short term. Studies show a 50 to 75 percent improvement within six to eight weeks.
Although antidepressants may provide short-term relief, experts point out that bulimia is not a short-term illness and recommend psychological therapy in addition to drug treatment.
A study by researchers at Columbia and Stanford compared cognitive behavioral therapy with interpersonal therapy in 220 women with bulimia. After one year, 40 percent of the cognitive behavioral group and 27 percent of the interpersonal therapy group had recovered.
Cognitive behavioral therapy focuses on changing thought patterns and habits related to eating, exercise and body image. Patients work on issues related to self-esteem and on recognizing the unrealistic ideals of thinness fostered by the media. Interpersonal therapy focuses on a patient’s personal relationships and explores themes such as loss, social isolation and loneliness.
One 10-year follow-up of treatment approaches found that cognitive therapy plus treatment with antidepressant medication had the best overall results.
There is no one known cause for bulimia. As well as cultural pressures to be thin, there are a number of other risk factors. Conflict with parents, a family history of eating disorders, low self-esteem and a history of anorexia all increase a woman’s risk. A history of anorexia is seen in 40 percent of women with severe bulimia, and some researchers speculate that dieting may set the stage.
Although a relatively small percentage of women meets the criteria for a diagnosis of bulimia, many more women have a milder form. It’s estimated that two thirds of college age women engage in binge eating at least once a year, and 15 percent follow with attempts to purge.
A large percentage of teens and young women diet frequently. Strict diets that create feelings of deprivation and food cravings can’t be maintained and lead to uncontrolled binge eating. Women become locked in an unhealthy binge/purge cycle that has a negative effect on mood, self-esteem and health.
Rather than hide their symptoms, women with bulimia should seek professional help that ideally includes therapy to counter self-defeating thoughts and behavior related to food and body image. The best chance of success lies in a combination of medication and therapy.
Bulimia Is Western Disease
Bulimia and other eating disorders are far more common in industrialized than in nonindustialized countries. Western standards of beauty are believed to be at least partly responsible.
Recent decades have seen a continuing shift toward increasing thinness as an ideal for females. The ideal for males focuses more on muscular strength.
Ninety percent of those diagnosed with bulimia are women. The problem is most likely to develop in teens and young women between the ages of 15 and 24.
[SOURCE: Barbara Klingenspor, “Gender-Related Self-Discrepancies and Bulimic Eating Behavior,” Sex Role: A Journal of Research, July 2002]
White Women Face Higher Risk of Bulimia
White women in the United States are eight times more likely than black women to suffer from bulimia.
In a study of black and white women diagnosed with bulimia and a group of healthy controls, researchers found that white women were more concerned with issues relating to body weight, body shape, eating and dieting than were black women.
Although black women have lower rates of bulimia, they have a similar rate of binge eating disorder.
Researchers concluded that the obsession with thinness that permeates white culture places white women at increased risk for developing bulimia.
[SOURCE: Mark De La Hey, “Racial Differences Found in Women with Binge Eating Disorder,” The Journal of Addiction and Mental Health, January- February 2002]
Eating Disorders Pose Special Risk for Diabetics
Eating disorders are common in teens and young women. If those women also have insulin-dependent (type 1) diabetes, they face an especially serious risk.
Diabetics must observe a controlled diet plus take regular insulin shots. When eating disorders and diabetes overlap, there is a risk that some patients might skip insulin doses as a means of losing weight. Serious long- and short-term health problems can develop as a result, including kidney and eye disease and the risk of diabetic ketoacidosis, a potentially life-threatening condition.
Although eating disorders are no more likely to occur in diabetics than in the general population, patients with eating disorders need education and counseling from a supportive professional team.
[SOURCE: L. Poirier-Solomon, “Eating Disorders and Diabetes,” Diabetes Forecast, November 2001]
Obsessive Symptoms Common with Bulimia
A significant number of women diagnosed with bulimia also have symptoms of obsessive-compulsive disorder. Obsessive-compulsive symptoms, including fear of contamination, repeated washing and compulsive checking and ordering, were found in 26 percent of patients with bulimia, although only 11 percent had symptoms serious enough to warrant a diagnosis of obsessive-compulsive disorder.
[SOURCE: Heidi Splete, “Bulimics and OCS,” Clinical Psychiatry News, January 2002]
Pregnancy Can Improve Symptoms of Bulimia
For women diagnosed with bulimia, pregnancy may offer an opportunity to intervene. Symptoms improve for many women when they are pregnant and, for about one third of women, the remission continues for at least a year after childbirth. These observations were based on a study of 94 pregnant women who suffered from bulimia at the time they became pregnant.
Those least likely to improve were women with a history of anorexia and those with more severe bulimic symptoms.
One year after childbirth, 35 percent no longer had symptoms of bulimia, 4 percent were improved, 57 percent were worse than at conception and 4 percent were unchanged.
[SOURCE: Carl Sherman, “Pregnancy Often Relieves Bulimia Symptoms,” Family Practice News, June 15, 2000]
Japanese Study Links Bulimia and SAD
A Japanese survey of 30 patients diagnosed with bulimia found that 40 percent experienced either mild or serious seasonal depression, far higher than a rate of 10 percent found in those not suffering from bulimia. Research shows that binge eating also increases in winter.
Based on the results of the survey, researchers suggested that light therapy, effective in the treatment of seasonal affective disorder, may also be helpful in the treatment of bulimia. Studies to evaluate this theory have not yet been conducted.
[SOURCE: International Journal of Eating Disorders, January 2003.]
Effects of Therapy
When bulimics receive treatment, most of the improvement occurs in the first 15 months; after that time, progress is more gradual. Studies show that after 10 years, about half of patients make a full recovery, 10 to 15 percent still have bulimia and about one third have improved but still have some form of eating disorder.
[SOURCE: Phillipa Hay and Josue Bacaltchuk, “Bulimia Nervosa,” British Medical Journal, July 7, 2001]
REFERENCES:
W. Stewart Agras, “A Multicenter Comparison of Cognitive-Behavioral Therapy and Interpersonal Psychotherapy for Bulimia Nervosa, JAMA, September 20, 2000.
David I. Ben-Tovin et al, “Outcome in Patients with Eating Disorders: a 5-Year Study,” The Lancet, April 21, 2001.
“Diabetes and Eating Disorders,” Nutrition Research Newsletter, May 2001.
Christopher Fairburn, “The Natural Course of Bulimia Nervosa and Binge Eating Disorder in Young Women,” JAMA, October 18, 2000.
Phillipa Hay and Josue Bacaltchuk, “Bulimia Nervosa,” British Medical Journal, July 7, 2001.
Barbara Klingenspor, “Gender-Related Self-Discrepancies and Bulimic Eating Disorder,” Sex Roles: A Journal of Research, July 2002.
Jim McCaffree, “Eating Disorders: All in the Family?” American Dietetic Association, June 2001
Karl Miller, “Cognitive Behavioral Treatment of Bulimia Nervosa,” American Family Physician, February 1, 2001.
Elizabeth Morrill and Haron Nickols-Richardson, “Bulimia Nervosa During Pregnancy,” Journal of the American Dietetic Association, April 2001.
“Relationship Between BED and Bulimia,” Nutrition Research Newsletter, March 2001.
“Review: Anti-depressants Increase Remission and Clinical Improvement in Bulimia Nervosa,” Evidence-Based Mental Health, August 2002.
“Review: Psychological Treatment Is as Effective as Antidepressants for Bulimia Nervosa, But a Combination Is Best,” Evidence-Based Mental Health, August 2002.
Carl Sherman, “Pregnancy Often Relieves Bulimia Symptoms, June 15, 2000.
Michael Strober et al, “Controlled Family Study of Anorexia Nervosa and Bulimia Nervosa,” American Journal of Psychiatry, March 2000.
“Treatment of Bulimia and Binge Eating,” Harvard Mental Health Letter, July 2002.
“TX for Panic, Bulimia,” Family Practice News, October 15, 2002.
