Bulimia Nervosa in Women’s Health Context

📄 Words:	1391
📝 Subject:	Healthcare Research
📑 Pages:	6
📚 Topics:	Eating Disorders

Plenty of women suffer from eating disorders (ED), one of which is bulimia nervosa (BN). This women’s health topic becomes rather important in terms of rapidly increasing number of overweight and obese women all over the world. Synthesizing the existing evidence, it is possible to note that there are various research studies exploring BN from biological, psychological, psychopathological, genetic, and emotional stances.

Bulimia can be regarded as a disease based on a neuropsychiatric disorder manifested in an uncontrolled consumption of food and high concentration on weight and food. The female patients suffer from attacks of unquenchable hunger, use some means to lose weight, take laxatives, and even induce vomiting and practice binge eating. Bulimics are characterized by a low self-esteem, a sense of guilt, excessive self-criticism, and they have a distorted view of their own weight. Most often, bulimia that is not associated with organic disorders has a psychological nature, occurring when eating becomes a factor of the correction of the emotional state. At the same time, the patient tries to escape from objective reality in a subjectively assessed and unpleasant reality by means of a change in consciousness through overeating. During the outbreak of negative emotions, including anger, irritation, fear, uncertainty, etc., a person perceives food as a way to get positive emotions, address challenges, and force out bad emotions into the subconscious.

As for the prognosis for bulimia, it is related to a patient’s psychological state and the effectiveness of treatment. If the therapy is ineffective and rejected, the prognosis is unfavorable, since complications develop and the cardiovascular system is affected. With regular therapy and correction of psychological disorders, the prognosis is favorable. Spontaneous cures are possible due to strong positive emotions. It should also be stressed that constant dissatisfaction with the body pushes women to extreme measures. Tough diets and grueling workouts are the key behavioral disorders affecting female patients. On the one hand, tight restriction in food gives short-term results. On the other hand, there is an obsession to lose weight regardless of the real proportions of one’s body, which can be lean even with a clear deficit in weight. Therefore, there is a cognitive dissonance: a woman wants to eat deliciously, but there is an independent ban. During a nervous breakdown, there is an attack of overeating with a brief feeling of euphoria followed by a self-flagellation that lead a sense of guilt is formed. The latter, in turn, causes stress, which aggravates the situation, and the process develops further along the cycle. Some scholars regard bulimia as a mild variant of anorexia, in which a person does not completely abandon the food. However, for all the similarities in the causes of the development of the disease, bulimia and anorexia have different courses and consequences, and it is logical to treat them as separate diseases.

This paper summarizes five scholarly articles published in peer-reviewed journals within the last five years (see Table 1). They consider bulimia nervosa from different angles and present significant theoretical information. Along with behaviors and emotions specific to women diagnosed with the identified disease, they focus on childhood issues as one of the causes of BN. In particular, one of the factors contributing to the development of bulimia is hunger in infancy: not only malnutrition, which is unlikely in developed countries, but also insufficiently frequent feeding that forms a feeling of hunger as a big problem.

Table 1. Evaluation Table

Citation	Conceptual Framework	Design / Method	Sample / Setting	Major Variables	Measurement	Data Analysis	Findings	Appraisal
Aspen, Darcy, and Lock (2013), A review of attention biases in women with eating disorders	Fairburn’s cognitive model	A systematic literature review regarding BN as cognitive issue	Data from several recent research studies, attrition rate – total follow-up for analysis purpose	Independent variables: BN cases in women and dependent variables: eating disorders (ED) neurological concepts such as amygdale, facial expressions, etc.	Dot-probe and modified Stroop tasks	Evidence observation and interpretation data analysis methods were used to answer the research questions	Authors propose a new integrated model for BN and attention bias (AB) and a treatment option based on attention bias modification (ABM)	Limitation: patients’ resistance to change, strength: relevant problem solution, risk: not significant, feasibility: high
Klabunde, Acheson, Boutelle, Matthews, and Kaye (2013), Interoceptive sensitivity deficits in women recovered from bulimia nervosa	Research studies exploring a biological aspect of BN	Structured Clinical Interview for the DSM-IV	Nine women recovered from BN (experimental group) and 10 healthy women (control group) aged between 18 and 45 years, attrition rate – total follow-up	Independent variables: stable weight and food restriction and dependent variables: interoceptive sensitivity levels	Heart Beat Perception Task (HBPT)	Statistical analysis via Statistical Package for the Social Sciences (SPSS) 15.0. Accuracy and mean values were also specified	SPSS analysis showed the following findings: HBPT ((F 1,19) = 7.78, p =.013, Cohen’s d = 1.16)	Women recovered from BN present interoceptive sensitivity deficits; limitation: small sample size, age mismatch, and non-compliance with psychiatric diagnoses, strength: the first study evaluating interoceptive sensitivity, risk: not significant, feasibility: high. This study seems to be of great importance to understand stimuli produced by organism of female patients diagnosed with BN
Anestis et al. (2012),Predicting nonsuicidal self‐injury episodes over a discrete period of time in a sample of women diagnosed with bulimia nervosa: An analysis of self‐reported trait and ecological momentary assessment based affective lability and previous suicide attempts	Recent data regarding rates of nonsuicidal self-injury (NSSI) in women with BN	Analysis of self-reported trait and ecological momentary assessment	127 adult females with BN, the number of women in experimental and control groups is not identified, attrition rate – total follow-up	Independent variables: episodes reported by respondents and dependent variables: ED and self-destructive behavior checklist	Dimensional assessment of personality pathology-basic questionnaire (DAPP-BQ) and diagnostic interview for borderlines-revised (DIB-R)	Affective lability calculation by the positive affect–negative affect scale (PANAS)	Female respondents diagnosed with BN reported higher affective lability compared to the control group that showed low lability rates	Past suicidal behavior is likely to cause greater self-injury; limitations: inability to generalize and unclear definition of suicidality, strength: emphasize the risk for NSSI, risk: not significant, feasibility: provide essential insights for future research. The key implication of this article is that it may be helpful in anticipating potential suicidal behavior in women suffered from BN
Groleau (2014),Methylation of the dopamine D2 receptor (DRD2) gene promoter in women with a bulimia-spectrum disorder: Associations with borderline personality disorder and exposure to childhood abuse	Previous research regarding genetic factors and gene-environment relation	Quantitative research based on blood samples for methylation analyzes	206 women with BN and 102 females with no eating disorder (NED), attrition rate – total follow-up	Independent variables: BN symptoms and dependent variables: methylation in the promoter region of the DRD2 gene	Eating Disorders Examination, Childhood Trauma Interview, and Structured Clinical Interview for DSM-IV-TR for Axis II	Analysis of variance (ANOVA) statistical tool was used to understand the relations between the identified variables and either support or reject the hypothesis stated by the authors	BSD and NED groups showed no significant difference in DRD2 promoter methylation, while women with BN revealed higher methylation	In women with BN,higher methylation of the DRD2 may be a sign of comorbid psychopathology; limitation: small sample size, strength: important theoretical implications, risk: not significant, feasibility: moderate
Selby et al. (2012), Momentary emotion surrounding bulimic behaviors in women with bulimia nervosa and borderline personality disorder	Review of the existing literature related to (BN) and borderline personality disorder (BPD)	Mixed method research including both qualitative and quantitative analysis	133 female respondents diagnosed with BN, attrition rate – total follow-up	Independent variables: emotions and behaviours such as binge eating and vomiting of respondents and dependent variables: BPD symptoms	Ecological Momentary Assessment (EMA) and Revised diagnostic interview for borderlines	Mixed module of Statistical Package for the Social Sciences (SPSS) 19.0.0	BPD group showed more negative behaviours rather than the control group, while both groups experienced increased positive emotions after ED	Addictive effects were detected in BPD group members, especially during pre- and post-binge eating characterized by positive emotions; limitation: non-compliance with BPD group that makes it difficult to determine whether comorbidity is critical to the given disease or not; strength: this study is one of the first that focuses on emotional pathology of ED in women and outlines the need for future research; risk: not significant, feasibility: high

References

Anestis, M. D., Silva, C., Lavender, J. M., Crosby, R. D., Wonderlich, S. A., Engel, S. G., & Joiner, T. E. (2012). Predicting nonsuicidal self‐injury episodes over a discrete period of time in a sample of women diagnosed with bulimia nervosa: An analysis of self‐reported trait and ecological momentary assessment based affective lability and previous suicide attempts. International Journal of Eating Disorders, 45(6), 808-811.

Aspen, V., Darcy, A. M., & Lock, J. (2013). A review of attention biases in women with eating disorders. Cognition & Emotion, 27(5), 820-838.

Groleau, P., Joober, R., Israel, M., Zeramdini, N., DeGuzman, R., & Steiger, H. (2014). Methylation of the dopamine D2 receptor (DRD2) gene promoter in women with a bulimia-spectrum disorder: Associations with borderline personality disorder and exposure to childhood abuse. Journal of Psychiatric Research, 48(1), 121-127.

Klabunde, M., Acheson, D. T., Boutelle, K. N., Matthews, S. C., & Kaye, W. H. (2013). Interoceptive sensitivity deficits in women recovered from bulimia nervosa. Eating Behaviors, 14(4), 488-492.

Selby, E. A., Doyle, P., Crosby, R. D., Wonderlich, S. A., Engel, S. G., Mitchell, J. D., & Le Grange, D. (2012). Momentary emotion surrounding bulimic behaviors in women with bulimia nervosa and borderline personality disorder. Journal of Psychiatric Research, 46(11), 1492-1500.

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