1.Bulimia nervosa is an eating disorder characterized in individuals, as being a disorder where the patient has a strong fear of gaining weight and is obsessed about his/her body image. Generally patients with Bulimia experience recurring episodes of binge eating, where the patient eats incredible amounts of food, which are usually high calorie. The patient then feels the need to compensate for the binge eating and engages either in vomiting, laxatives, extreme exercising or dieting. The prevalence of Bulimia nervosa is hard to establish as often patients don’t come forth with their disorder, which can be due to embarrassment, not being informed about the disorder or other reasons. Therefore the prevalence of Bulimia is often speculation.
However, some attempts at finding the prevalence have been made, such as a survey in 1980 by the Cosmopolitan magazine, which encouraged readers to send them letters if they utilized vomiting as a measure of weight control. Analysis showed the 83% of the respondents fulfilled the criteria for Bulimia. Furthermore, Keel et al. in 2006, found that 40% of college women showed symptoms of Bulimia and a study of visitors to a family planning hospital revealed that 1.9% of the patients had Bulimia. However one must distinguish between age groups, social standing and gender when looking at the prevalence of Bulimia because there is a significant difference. Freud supposed that the female: male ratio of Bulimia patients lies at around 10:1 and further studies have shown that around 99% of the cases were female.
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Furthermore, there seems to be a greater number of people with Bulimia from upper social classes, which could be due to a greater pressure to present a positive body image. Also, Bulimia seems to be more common in people in their twenties, where again there is a higher pressure of a positive body image as this is the time where most people get married or engaged. Geographically the main difference doesn’t seem to lie in culture but rather in how industrialized a country is. For example, the prevalence of bulimia in Japan, a very conservative yet developed country, is at around 5.79% for women aged 15-29, which is similar to the US. In LEDC’s less research has been conducted which means that there is less data, however, the research done indicates a much lower prevalence.
2.Concerning the etiology of Bulimia, it is obvious that Bulimia isn’t the result of a single factor. Much rather bulimia seems to be caused by an interaction of biological, sociocultural and cognitive factors. The extent to which each of the elements contributes to the disorder is debatable and will be investigated in this essay. There are two biological factors that could contribute to bulimia, these are genetics and the neurotransmitter serotonin. The ingestion of carbohydrate-rich meals triggers the synthesis of serotonin, this signal will reduce the likelihood that a person will eat carbohydrate-rich foods in their next meal. One theory concerning bulimia nervosa is that it is the behavioural manifestation of the under-activity of serotonin. This is supported by a study by H.E. Gwirtsman who injected rats with drugs that enhance serotonin-energetic transmission and found that they affect the number of dietary carbohydrates and proteins that are consumed by the rats.
Therefore the constantly low manifested serotonin levels could be an explanation for the binge eating. Another biological factor that can influence bulimia is the genetic makeup of a person. Certain genetics could increase the chances of a person getting bulimia. This is shown in a study by Kendler et al. in 1991, who focused on bulimia in female twins. They investigated the concordance for bulimia nervosa in monozygotic and dizygotic twins. The study used 2163 female twins of which at least one had bulimia. The results were that the concordance rate for MZ twins was 23% while for DZ twins it was only 9%. This study shows that there is a certain correlation between genetics and bulimia as the concordance was far higher in MZ twins. However, it also clarifies that bulimia is definitely not purely due to genetics as the concordance rate was far below 100%.
Sociocultural factors can also influence the development of bulimia in a patient. Especially in Western societies, outward appearance is of high importance and women see other women as awarded for looking slim and often envy the attention and admiration they get. According to Cooper (1994), the “Social Identity Theory” will lead many women to imitate this rewarded behaviour and strive to be slim, which is vicarious reinforcement. The effect of society on the development of bulimia can also be seen in a study by Nasser in 1986. Nasser compared Egyptian women studying in Cairo and in London. He found that none of the women in Cairo developed an eating disorder, while of the women studying in London, 12% developed one.
This study demonstrates that again cultural influence isn’t the primary factor as otherwise, all women studying in London would have developed an eating disorder, however it does show that the cultural factor contributes to the development of bulimia. This is also suggested in a study by Lee, Hsu and Wing in 1992, who investigated Chinese and American women. They found that in the US, women have an intense fear of becoming fat, while in China slimness is associated with ill-health. They noted that in China obesity is seen as a sign of health, wealth and prosperity and that bulimia was nearly nonexistent. Cultural setting plays a large role in the development of bulimia. In the study, women were far more likely to develop the disorder bulimia when there is the social pressure of being thin, compared to when there isn’t.
This pressure is especially strong for women and this could be an indication of why the prevalence of bulimia is higher in women. Fallon and Rozin in 1998, found that when families were asked to compare their body shape to their ideal body, only the sons reported their body shape as acceptable, while especially mothers and daughters wanted to be thinner. The pressure society puts on women probably has an effect on the development of bulimia. Similar to anorexia nervosa, bulimia nervosa can also be influenced by the cognitive factor of self-perception. Generally, people who develop bulimia are not overweight but suffer from a distorted perception of their body image. The correlation between the body image people have of themselves and bulimia prevalence is shown in a study by Jaeger et al. from 2002. They sampled 1751 medical and nursing students from 12 countries, including a mixture of Western and non-Western ones.
A self-report method was used to obtain data on body dissatisfaction, self-esteem and dieting behaviour. The result was that extreme body dissatisfaction was found in Mediterranean countries, followed by northern European countries, countries in the process of modernization and then non-Western countries had the lowest levels of body dissatisfaction. As this is also very similar to the order of the greatest prevalence of bulimia it implies that there is a correlation between self-perception and bulimia. Overall all the above factors can be seen as part of the etiology of bulimia, however, none can be viewed as singularly causing bulimia, as neither in genetics nor anywhere else was there a rate of 100% of people developing bulimia when a certain factor was given. Therefore all factors contribute and the development of bulimia comes from an interaction between them.