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Biology 202
2002 First Paper
On Serendip

Anorexia and Bulimia Nervosa

Asra Husain

Today, both anorexia and bulimia are the most common eating disorders and affect almost 15 percent of American teenagers. Eating disorders are fifteen times more likely to occur in adolescent girls than adolescent boys. They can be fatal and thousands die from every year but this is one mental illness that can be beaten. Anorexia is increasing more rapidly in developed countries than in underdeveloped countries. Bulimia is becoming the more common type of eating disorder among teens. It is difficult to diagnose because many bulimics are deeply ashamed of their rituals and few share their problems with close friends (4). If these two eating disorders are becoming more and more widespread around the world and occurring in a certain age group, then is there a common chemical imbalance or erroneous thought process that leads to such behavior? If so, then how can these eating disorders be handled?

The distinct factor that separates anorexia nervosa from bulimia nervosa is the binging-vomiting/purging cycle and the role it serves in the maintenance of body weight for the sufferer (4). Bulimics are usually within normal weight range while anorexics are extremely underweight. The difference between anorexic and bulimic people are that bulimics can spend all day planning their next binge, while anorexics can spend all day thinking about what they canít eat at their next meal. When recovering from the eating disorder those with anorexia work at valuing the accomplishments theyíve made, while those with bulimia work at gaining control of their lives (2).

Surveys show that people with anorexia tend to have high intelligence, and superior scholastic performance, but the two almost overwhelmingly consistent personality traits are those of perfectionism and obsessionality (4). Physical symptoms of anorexia result from the behavior of trying to achieve weight loss. Losing the insulated layer has consequences such as sensitivity to temperature, dry skin, brittle hair, vitamin deficiency, heart rate slows, and blood pressure falling due to the fact that the body maybe adjusting to the loss of energy intake (1).

This behavior has biochemical disturbances as well, which have more serious implications. The main disturbances are dehydration and changes in the levels of some electrolytes in the blood. Potassium and chloride fall causing the blood to become alkaline producing a metabolic alkalosis. Low levels of potassium and dehydration cause weakness and fatigue. Low body potassium and alkalosis can cause irregular heartbeat and alterations in the electro-cardiogram. (1)

An anorexics biggest fear is becoming overweight and continue to think they are overweight even after they become extremely thin, are very ill or near death. Often they will develop strange eating habits such as refusing to eat in front of other people. Sometimes the individuals will prepare big meals for others while refusing to eat any of it (5). The goal for an anorexic is to find ways to avoid eating food and exercising for long hours in order to keep the pounds off.

Bulimia is known as the "binge-purge syndrome" and was once considered to be in the same category of anorexia until recently. This syndrome mostly occurs in females starting in their late teens and who say that episodes of binge eating occur two or three times a week. The prevalence of bulimia may be as great as one-in-six tertiary students (3). Bulimics often feel as thought they have no control over their lives. So, it is a struggle between uncontrollable eating and desperate attempts to purge excessive food (2).

Some specific physical symptoms associated with bulimia is the potential for gastric rupture during periods of binging, inflammation and possible rupture of the esophagus during vomiting, and for those who habitually induce vomit may have a swelling look to their face due to the enlargement of the salivary glands as well as damaged teeth due to the acidity of the vomit (4). Bulimia has similar biochemical disturbances to anorexia.

Binging and purging are the behavioral aspect is a way of dealing with unpleasant emotions. A bulimic that is about to binge has a sense of anxiety and tension and once they start to binge they are overcome with a feeling of freedom and their negative thoughts disappear. During the binge period the bulimic may induce vomit, which can reduce tension. At the end of the binge, most binge-eaters feel less tense and anxious, but may not like themselves because of what they have done to their bodies (1). Feeling guilty about inducing vomit may cause more anxiety and tension and thus creating a vicious binge-purge cycle (1).

Anorexia and bulimia are mental illnesses that can be cured. One approach is cognitive therapy, which deals with the thoughts, beliefs, and the assumptions of individuals that affect their feelings and behaviors (6). Recently, scientists have found a decreased level of neurotransmitters such as serotonin and norepinephirne in bulimic and anorexic patients. Depression and irregular menstrual cycle are other factors that are usually associated with an eating disorder. So, the other approach is medical treatment that addresses these issues.

Cognitive therapy teaches you how certain thinking patterns are causing your symptoms (7). Anorexic and Bulimic people are constantly thinking about their body weight and shape. This is mainly due to the image of a woman in our culture today. The cultural pressure of the ideal woman seems to play a large role in affecting the female adolescent age group. A woman goes through a lot of physical and mental changes during the time period and so it is obvious that eating disorders would mainly affect this age group. Thinking patterns can be distorted as soon as a person begins to give into the ideal image of a man or woman that is portrayed in the media as well as other factors combining to worsen the thought process.

The medical approach involves recognizing other behaviors that are related to eating disorders such as depression and treating her in terms of depression. Also, it has been discovered that there are certain neurotransmitters that may cause such a behavior. Serotonin is a neurotransmitter that helps regulate mood (8). When levels of serotonin are low, the bulimic will binge on carbohydrate-rich foods, which increases tryptophan in the blood. The high levels of tryptophan stimulates the brain the synthesis and release of serotonin. Serotonin allows her to feel relaxed and drowsy, however this only lasts for a short time, which leaves her in the same place as before with low levels of serotonin (1). Dexfenfluramine and fluoxetine are two drugs that cause the release of serotonin and have shown some improvement in behavior.

Nonetheless, it is very unlikely to use one or the other method for the treatment of eating disorders. These two methods are combined to get the best possible result. The brain and the behavior of a person are related and therefore these two aspects cannot be separated from one another when treating a mental illness. It is quite clear that people who suffer from anorexia nervosa and bulimia nervosa have similar distorted thought processes and similar behavior. Since each individual is unique in his/her own way, their behavior will differ and may be triggered by different reasons. Two people can both be bulimic and have different factors that have led them to behave in similar fashions. This is where cognitive therapy is useful. Once the root of the problem is recognized, medical treatment can be administered if needed.

Anorexia and bulimia are eating disorders that are rapidly growing and affecting a large number of adolescents mainly women. The causes are for the most part due to the cultural standards of a woman and can also be due to chemical imbalances. Treatment for this mental illness usually entails cognitive therapy and medical attention. The main problems lies within the brain and thought process of body image, which seems to develop in the early teens. An excerpt from Scottís Anorexia and Bulimia Nervosa says it best:

"Adolescence is one of the most crucial periods in a personís life for the development or personality, and if this time of growth, challenge and integration is not made proper use of, the individual will be unable to cope efficiently with normal adult life. In particular, the development of a healthy mind and body identity, the establishment of adequate psychological and sexual intimacy and the development of normal stress-management skills suffer." (4)


Works Cited:

1) Abraham, Suzanne. Eating Disorders, the Facts. Oxford University Press, 1992.
2)Anorexia Nervosa/Bulimia: Adolescent Self Image
3)Anorexia and Bulimia Nervosa
4) Scott, Derek. Anorexia and Bulimia Nervosa. New York University Press, 1988.
6) Mitchell, James E. Anorexia Nervosa & Bulimia, Diagnosis and Treatment. University of Minnesota, 1985.
7)Cognitive Behavior Therapy: The Basics
8)Health: Brain chemicals may cause Bulimia

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