- Distorted body perception–anorexics envisage themselves as being overweight.
- Mood disturbance – people with anorexia can often be depressed, anxious, irritable or have serious mood swings.
- Denial – anorectics deny that they are seriously underweight.
- Physical effects – people with anorexia show other symptoms of the disorder as well as weight loss; dry skin, brittle nails & bones and thinning hair are all consequences of starvation. Damage to the vital organs such as the brain and heart are also common.
There are many different outcomes of anorexia. About 20% of anorexics fully recover after one episode and about 60% go through episodes of recovery and relapse over a period of years. The remaining 20%, however, are severely affected and may need to be hospitalised. Approximately half of these which are severely affected will die.
Bulimia Nervosa
The word bulimia derives from the Greek words ‘bous’ meaning ox and ‘limos’ meaning hunger. Bulimics tend to binge eat, and then expel the food from their bodies by purging. Whereas anorexia tends to affect teenagers, bulimia is more common in slightly older women, generally in their twenties. This particular disorder will affect 3% of women at some point in their lives, and is more common than anorexia in the UK.
Clinical characteristics of Bulimia Nervosa:
- Normal weight – most people with bulimia are within 10% of their normal body weight.
- Binge eating – bulimics can have episodes of uncontrollable eating, this can sometimes be due to stress
- Compensatory behaviour – people suffering from bulimia will experience immense feelings of guilt and disgust after binge eating, and will try to rid themselves of the food. This can be done by self-induced vomiting, misusing laxatives, excessively exercising or fasting.
- Undistorted body perception – contrary to anorexia, bulimics are relatively near to the normal weight range, however they still have a disturbance about their image.
- Mood disturbance – it is common for bulimics to feel depressed, and sometimes after bingeing they can feel suicidal.
- Awareness – bulimics normally recognise that they need help
- Physical effects – purging can increase the risk of urinary infections, kidney disease, stomach rupture and the development of epileptic fits. Constant vomiting will cause the oesophagus and cheeks to become inflamed and swollen, and acid present in vomit will erode the enamel of the teeth.
Bulimia is more prevalent in the UK than anorexia, and in fact many bulimics were once anorexic. Approximately 3% of sufferers of bulimia die, usually due to the immense physical strain that their bodies have been put through.
Explanations for Anorexia and Bulimia
Each of the schools of thought have different explanations for why eating disorders exist and where they originate from.
The behaviourist model assumes that such behaviour that is linked to eating disorders is learned through conditioning. Advocates of behaviourism suggest that more economically developed countries promote the idea that ‘slim is beautiful’ which helps a little to explain why anorexia and bulimia are more common in these countries. If a person loses weight and then receives praise from the people around them due to their slimmer figure, they will then learn to associate being thin with feeling good about themselves. This is an example of classical conditioning and is built on a stimulus-response system. The stimulus is being thinner and the response is a feeling of contentment. An example of how operant conditioning plays a role is they way in which other people are admired for their thin figures. The person will learn that admiration and acceptance can be achieved if you are slim. Behaviourists also believe that environmental pressures can be responsible for triggering off unhealthy eating habits. In jobs where thinness and fitness are highly valued, there are higher percentages of women with eating disorders.
The assumptions of the cognitive model are different to those of the behavioural model in the sense that they establish a link between the way people think about their physical appearance and the way they eat. This model concentrates on the irrational thoughts of people, and explores their feelings of low self esteem and the devaluing of their body image. The cognitive model considers people with eating disorders to have distorted thoughts. An example of this being, “I must lose weight because I am not thin”.
The psychodynamic model also has contrasting assumptions. It has two main explanations for the existence of eating disorders, the first being repressed sexual impulses. Freud believed that eating deputises sexual expression, so therefore not eating is a way of subjugating sexual urges. Another way of interpreting it is to consider the idea that getting bigger is linked to becoming an adult. Consequently, not eating is an expression of not wanting to grow up, and a desire to regress to childhood. The second explanation is childhood sexual abuse. The experiences are repressed in the unconscious and during adolescence the person will begin to hate their bodies with immense feelings of disgust. In an unconscious attempt to cause harm to their bodies, they can develop an eating disorder.
All of the psychological models seem to have contrasting ideas, but how do they compare to the biological model?
Like the psychodynamic model, there are two main biological explanations for eating disorders, them being; 1) genetics and 2) biochemistry. There have been a number of studies carried out over the years which have investigated the role of genes in eating disorders. Most of these studies have used monozygotic and dizygotic twins to reduce the influence of environmental factors. If the concordance rate is higher in the monozygotic twins than in the dizygotic twins, then that would prove that genetics did in fact have an effect on eating disorders. Holland et. al. (1984) and Kendler et. al. (1991) both found evidence that supported the idea of genes playing a role in causing anorexia and bulimia. However, naturally neither of the studies had 100% concordance and neither could eliminate all environmental factors completely. Advocates of the biological model also assume that, like depression and obsessive compulsive disorder, eating disorders can be cause by a biochemical imbalance. Recent research has pinpointed certain hormonal chemicals, such as serotonin, norepinephrine and dopamine, which can be responsible for anorexia and bulimia (serotonin has a strong link to binge eating). However it is not yet completely clear whether it is these chemicals which can trigger off eating disorders or whether it is the physical strains caused by eating disorders which affect the balance of biochemicals.
Conclusion
In conclusion it is clear that there is more than one cause of eating disorders. Genetics, biochemistry and the environment all offer explanations for the existence of disorders such as anorexia and bulimia.
All three factors are substantial contributors, however in my opinion the environment plays the most important role. The media, home environment, culture and profession seem to be the biggest triggers of eating disorders. Of course each case should be considered individually, and sufferers of anorexia and bulimia should receive the appropriate treatment. Perhaps the only way to significantly reduce the number of people in this country with eating disorders, is for society to change.
