Bulimia and Anorexia Nervosa :
An Examination of the Two
According to some estimates, as many as 85% of American women are dissatisfied with their weight. Few, if any, think that they are "too thin." Those estimates were revealed at the American Psychological Association's conference on women's health in May 1994 (Driedger, 1994). According to my reading, the consensus is quite clear that we are witnessing an epidemic of sub-clinical eating disorders. The term applies to women who do not meet the strict criteria for anorexia or bulimia, but nonetheless have a preoccupation with weight control that can set the stage for alternating between fasts and food binges and reliance on diet pills, laxatives, and diuretics. Such nutritional and pharmacological abuses increase the risk of infertility, osteoporosis, and electrolyte imbalances. They also erode self-esteem and set the stage for depression.
Many of the data relevant to this subject seems to reinforce conventional wisdom. One survey revealed that women of Asian or African descent are less likely than American women to have eating disorders, but that as they assimilate into American culture they become increasingly prone to anorexia or bulimia. Another determined that only 30% of eighth-grade girls were content with their bodies, compared to 70% of their male classmates (Schnur, 1995). A third found that anorexia and bulimia were more prevalent among college students concentrating in fields that emphasize body image, such as dance, acting, or gymnastics, than among those majoring in English or political science.
According to my research, few psychologists hesitate to attribute the increasing incidence of eating disorders and distortions of body image to our weight-obsessed culture that with each decade has offered a progressively pared-down icon of female self-obsession. The wasting away of the ideal woman was documented recently by one study I read about that determined that department-store dummies, which had once represented the statistically average female form, would now, if brought to life, be too thin to menstruate (Bower, 1993). For many of us, mannequins, models, and movie stars have become annoying reminders of our own imperfections, creating a background of low-level anxiety against which we make our decisions about eating. However, an estimated 15-30% of women are free of such concerns.
They eat when they are hungry, stop when they are full, and, according to one study are no heavier than habitual dieters (Brownwell & Foreyt, 1986). This fact lends logical reason to think that common eating disorders such as bulimia and anorexia should be almost non-existent through education, but unfortunately, this is not reality in our society.
Every morning when she wakes up, Jane, who is 22, takes a deep breath and then another one. She says to herself, "OK, Jane, today you're going to take care of yourself. You're going to eat." fixes herself a bowl of cereal, eats it, and then wills herself to keep it down.
Jane is recovering from bulimia, an eating disorder that she has lived with for nine years. Jane's cycle of bingeing on large amounts of food, then making herself vomit, is a central trait of bulimia. Jane has also suffered from a related eating disorder, anorexia, which is an intense fear of becoming fat that leads to starvation. Many women suffer from both. Often bulimic females are not underweight because their bodies do retain some of the large quantities of food they eat. An anorexic, though, is often clearly emaciated and malnourished. According to the American Psychiatric Association, both disorders are increasing in this country, affecting up to 4 percent of young and adult white women (Driedger, 1994). The diseases do not occur as frequently among minorities. More than 90 percent of those diagnosed with eating disorders are women, because men do not seem to be as vulnerable to society's fixation on thinness (Driedger, 1994).
There is no one exclusive thing that causes bulimia or anorexia. Culture messages that glamorize thinness play an essential role, and the disorders can run in families. Many women who develop an eating disorder have been sexually abused or are depressed. They can have a lack of self-confidence, low self-esteem, or a tendency to be compulsive, which is then channeled into dieting and exercise. Jane says after she first began to purge her food, she started to do it every day, throwing up her breakfast,