Bulemia Nervosa Essay, Research Paper

Bulimia Nervosa

Colleges and universities around the country are reporting an increased prevalence of eating problems among young female students. Difficulties include obsession with food, starvation dieting, severe weight loss, obesity, and compulsive binge eating, often followed by self-induced vomiting (Hesse-Biber, 1989, p.71). Since the beginning of the women’s liberation movement in the 1970’s, the Western world has seen a severe increase in the rate of eating disorders, especially bulimia nervosa, in young girls, adolescents, and college-aged women. The questions that must be posed are: What are the reasons for eating disorders among college-aged women? Why has there been such a drastic rise in eating disorders in the past few decades? How can this be prevented? It is the purpose of this paper to discuss these questions (after first defining bulimia nervosa and attempting to explain its etiology) and give an overview of several possible answers, determined following an examination of current psychological literature in this area of concern. However, the reasons that many women have issues with food and eating are myriad and complex. They touch on every aspect of being female, and no single answer sufficiently explains the phenomenon of girls who overeat or undereat as a response to stress.

Bulimia, a term derived from the Greek words meaning “ox” and “hunger,” is a food obsession in which the sufferer repeatedly cycles between bingeing and purging (Chassler, 1998, p.397). “In comparing bulimia nervosa to true anorexia nervosa, the basic psychopathology is similar; both display a morbid fear of fatness. The anorectic patient will starve, and the bulimic patient, who can only maintain starving for a limited period, eat and purge” (Chassler, 1998, p.397). For a girl who suffers from bulimia nervosa, food becomes equivocal with comfort, relaxation, and escape. The binge begins because a person feels low, often rejected, and she turns to food almost as a narcotic. A typical binge session consists of consuming high-caloric foods and then vomiting, which “begins as necessary unpleasantness which evolves into a sensual, addictive muscular convulsion” (Chassler, 1998, p.398).

According to Freud, bulimia could be explained as a woman’s perception of eating as erotic. By blending oral incorporative mechanisms with active oedipal-genital wishes, the woman is reflecting the child’s wish to eat and thereby conceive father’s baby. He wrote, “Do you know, for instance, why X.Y suffers from hysterical vomiting? Because in phantasy she is pregnant, because she is so insatiable that she cannot put up with not having a baby by her last phantasy lover as well. But she must vomit too, because in that case she will be starved and emaciated, and will lose her beauty and no longer be attractive to anyone. Thus the sense of the symptom is a contradictory pair of wish-fulfilments” (Chassler, 1998, p.401). While Freud’s theory seems outlandish, psychoanalytic psychologists do propose that the syndrome seems to be rooted in psychological, social, and biological concepts of female sexuality. They have concluded, “bulimia is interpreted as the simultaneous enactment of conflicting wishes for merger and autonomy” (Chassler, 1998, p.402).

From a social-psychological standpoint, the disproportionate number of women compared to men afflicted by bulimia nervosa implies that the social construction of gender (the ways in which society defines gender, implying that sex is biological, fixed, and unchanging, while gender, or femininity and masculinity, is “done,” transient and ever-changing) plays an important part in the etiology of the disorder. It is hypothesized that the risk of developing this disorder depends, in part, on the composition of a woman’s gender identity (Klingenspor, 1994, p.407). Being feminine means being attuned to and responsive to the needs of others. “Independence, competence, and assertiveness, that is, the psychological tools for getting one’s own needs met, define masculinity” (Klingenspor, 1994, p.409). Thus, women are considered more compliant and passive compared to men. According to a study by Broverman, because masculine attributes are valued more than feminine ones, sex defines membership in unequal social categories. Corresponding to this finding, many studies indicate that the average adolescent Western girl is more anxious, insecure, depressed, and self-conscious than her male counterpart (Klingenspor, 1994, p.409).

In her book, Anatomy of a Food Addiction, author Anne Katherine (1991) calls eating the “great escape” and pinpoints the vulnerabilities of women to childhood origins (p. 70). She believes that girls are taught that they cannot fight or flee. Unlike boys, who have the outlets of strenuous play and fighting to release anger, girls are taught that they must cope within the difficult situation while remaining in it. In the girl-child’s attempts to find solace in a situation from which she cannot escape, she learns that sweet food will release chemicals that soothe her when she is frightened and angry. Thus, she learns rather early in life that food gives her a way to avoid feeling trapped and overwhelmed. This conditioned response to stress then carries over into maturation, and in situations where the young woman feels overwhelmed, frightened, cornered, confused, miserable, or lonely, the body seeks relief, and the whole organism tries to lead her into a way of release. Even if the woman has made a conscious decision to not overeat in response to stress, the whole person has been deeply trained to eat anyway, and she automatically, unthinkingly reaches for something to eat or drink. This drive for release is almost unstoppable (Katherine, 1991, p.71). Katherine describes this strong drive for eating in terms of Maslow’s hierarchy of needs–safety and security come far before appearance and artistic taste. Thus, if a girl is fearful or uncertain, it is natural to reach for substances that she has learned give her a feeling of security and safety.

Other branches of psychology assume that the causes of bulimia nervosa reflect the interaction of biological predisposition, intrapsychic conflict, family, social factors, disturbed interpersonal relationships, interpersonal sensitivity, and social isolation. Although how biological factors affect the development of bulimia is unclear, some scientists believe that bulimia may be a symptom of a biologically mediated affective disorder. However, this theory is quite controversial.

Recently, familial contributions to the etiology and course of bulimia nervosa have been accounted for. Often, women who overeat or undereat have been cited to have had a childhood background of profound deprivation and emotional deficit. Such individuals learned in their families that they were not wanted, worthwhile, or valued. They did not learn to ask for help or to expect their needs to be met. They did not learn healthy ways to handle conflict, difficult emotions, or disappointments. Neither did they learn that the solution to loneliness is to seek friendship. Such individuals may have been severely abused in their homes and have no knowledge of awareness of the abuse (Katherine, 1991, p. 52). “In these families there is a tension between unmet individual needs and equally or more powerful family system needs that require individual self-sacrifice’ (Chassler, 1998, p.400). This type of woman may have been screamed at as a child when she expressed a need. She has become accustomed to fear. With such a background, the food addict is a person who expects to only have minimum needs met. She has learned that her needs will probably go unmet, even if she asks, and she adapts. The needs for affection, trust, safety, and honesty do not go away, but they move underground and surface in the adaptive response of food difficulties. Most people who suffer from eating disorders have severe, long-term deprivation in regard to their emotional needs.

As mentioned previously, bulimia began to manifest itself in the 1970’s concurrent with the women’s movement. As the female role began to change, confusion set in and an increasing obsession with thinness began to invade society. Girls who are severely insecure or full of self-doubt take refuge society’s demand of thinness as way of proving themselves to be deserving of respect. Leighton Whitaker (1989) discusses the specific characteristics of the college environment and lifestyle that contribute to the widespread and increasing problem of female students with food. The college environment is similar to a family. It may bring demands, attitudes, support systems or lack of support. There are constant concerns with finances, transitions, the physical structure and atmosphere, as well as relationships with faculty, staff, and the other students. The academic studies themselves may be unfamiliar and difficult at times. Student support services may not contribute any help to the student who has eating difficulties (Whitaker, 1989, p. 117). Going to college is an important transition for most students, and a sizable number of freshmen experience leaving home for the first college semester as traumatic. The persistent, unrecognized dependency on parents and their lack of experience in making decisions on their own causes problems of functioning in the less-controlled college environment. Living in a dorm or apartment with other college individuals means getting along with others, withstanding the normal comings and goings as students leave school, and such a situation carries within it all the dynamics that contribute to problem eating. These interpersonal situations impact women more than men because women have greater needs for relationships and have been socialized to be care-givers, always sensitive to the needs of others (Whitaker, 1989, p. 118). For certain vulnerable students who function rather rigidly, the sudden availability of new choices and options may feel unbearable and unmanageable. This type of student may not trust the sorority big sisters or resident hall RA’s and turn their negative feelings upon themselves. Students from small communities may feel lost on campus. Women who have used and learned to abuse food since the crib and highchair days learn to misread their bodies’ signals and without therapy or education easily reach for food as a substitute for love, rather than making new friends (Whitaker, 1989, p. 119). In a larger sense, the young female student has not observed others handle stress in a mature way, so she experiences loss of self-esteem and automatically seeks a safe emotional outlet which has brought her relief in the past – food.

Many college women who seek counseling for assistance with eating disorders have problems in their relationships with their mothers. These students experience dependency conflicts, a diminished sense of individuality, beliefs about personal ineffectiveness, qualities of distrust and immaturity, and an inability to distinguish between emotion and hunger Friedlander & Siegel, 1990, p. 77). The difficulty in determining whether she is hungry or lonely, hungry or tired, hungry or afraid, greatly increases the chance that such a student will eat instead of meeting the emotional need in a healthier way. The young female student with eating problems feels worthless and inadequate. She has a poor sense of personal control. She may be hypersensitive and feel merged with others. She is unable to regulate herself and may be grandiose, exhibitionistic, even tyrannical. This type of student likely comes from a dysfunctional background, one in which individual differentiation is not valued or promoted. It is unfortunate that the eating disorder serves to further tie her in an unhealthy way to her parents, who in turn, do not wish to let her grow into personal independence.

Clearly, there is no one set reason for girls’ and adolescents’ difficulties with eating disorders. They are many and complex. Some of the roots are in society itself – a society that teaches women to acquiesce to pressures and intimidation rather than to fight or change their circumstances and a society that teaches women that they are supposed to look a certain way in order to be acceptable. In addition, the relationship between the family of origin and the resulting eating disordered behavior seems to be great. Families with addictions, punitive behavior, anger, hostility, blurred identities, and lack of support for growth and individuation create young women who are unable to cope with the stresses of college living without their maladaptive eating. They do not know how to handle the difficulties of relationships, seeking support, and handling the normal changes of life without reverting to the learned childhood behavior of seeking solace in food. The problem is multifaceted and further aggravated by the isolation of young women, who may not understand the nature of their difficulty.

Chassler, Linda. (1998). “Ox Hunger”: Psychoanalytic Explorations of Bulimia Nervosa.

Clinical Social Work Journal, 26, 397-409.

Klingenspor, Barbara. (1994). “Gender Identity and Bulimic Eating Behavior. Sex Roles: A Journal of Research, 31,, 407-428.

Friedlander, M. L., & Siegel, S. M. (1990). Separation Individuation Difficulties and

Cognitive-behavioral Indicators of Eating Disorders Among College Women. Journal of Counseling Psychology, 37, 74-78.

Hesse-Biber, S. (1989). Eating Patterns and Disorders in a College Population: Are college

women’s eating problems a new phenomenon? Sex Roles: A Journal of Research, 20, 71-88.

Katherine, Anne. (1991). Anatomy of a Food Addiction: The brain chemistry of overeating.

New York: Prentice Hall. Rebert, W. M., Stanton, A. L., &

Whitaker, L. C. (1989). The Bulimic College Student: Evaluation, treatment and prevention.

New York: The Haworth Press.