Psycological causes of Bulimia

Practically, too little or too much food will result in a change in weight. This input-output formula is HOW a person gets thin or fat. The bulimic eats too much food and then tries to compensate for the binge by purging, excessive exercise, or the use of laxatives, diuretics and enemas Remember that certain high-grained cereals have a laxative effect. (See identifying bulimia nervosa). The bulimic binge-purge pattern is a manifestation of deeper problems and which are caused by psychological and/or historical factors. Psychological "causes", refer to an individual's personal dynamics which contribute to how s/he uses food. Historical causes refer to practical events in a person's life, such as the loss of a parent, the birth of a sibling, changes in schools, sexual abuse, etc.

If you wish to understand how the psyche sets up a coping mechanism such as bulimia nervosa, or purging your food, please click here before or after you have read the following:

1.	They have difficulty with adolescent demands. Bulimia nervosa is quite often a reaction to the demands that are required of adolescents such as the need to behave more independently and to incur social and sexual functioning. Usually an individual with bulimia nervosa seeks help at a certain stage in her life where she is required to be more independent, to have different kinds of social skills and is developing sexually. For example, at the age of 12 or 13 when she has just started menstruating or there is a change from junior school to high school. Most often though they come when there is also a change from leaving school to go into university. Any life experience or transition that taps into separation anxieties, such as leaving home, leaving a structure that they know such as school and going to university may manifest itself in an eating disorder.
2.	They are often outgoing, angry and impulsive.
3.	There may be alcohol dependence, shoplifting and emotional instability, including suicide attempts.
4.	They are more ready to seek help than the anorexic because they feel uncomfortable with uncontrolled eating.
5.	They lack superego control (e.g. the ability to tell right from wrong).
6.	They have difficulty separating from the mother.

7.	They are high achievers.
8.	They respond to social pressures to be slender.
9.	They are often depressed.
10.	There is often a history of depression in the family.
11.	The family is not as close as the family of the anorexic. There is more conflict.
12.	Parents are described as neglectful and rejecting.

1.

A lack of coping skills: This means that there is an inability to manage life in a practical way. Often there is an inability or lack of skill to deal with an emotion, to process it, to work with it and to cope with it. Individuals with eating disorders only know how to deal with their problems through food and exercise. Most of us lack coping skills for at least some areas in our lives. I have indicated that they are stuck at a very primitive way of dealing with the world. We could call them orally fixated (Freud's theory). That is, they are stuck at an oral point of coping with the world. This means that everything in terms of how they cope with the world is done around the mouth. Besides eating, other oral fixations include smoking and drinking. The other important concept that goes with this phase is "instant gratification". This is the sense of time urgency of wanting everything now! There is an inability to wait. My clinical experience with this group of individuals confirms this concept.

2.

They fail to recognize and respond adequately before it is too late because they do not have the appropriate skills. For example, in a stressful situation, the obese person reaches for and eats the doughnut before she even thinks about any other options. This brings us to the next point.

3.

They cannot stop and think because the appropriate skill is often inhibited by fear, anxiety or deeper issues.    Any emotion can prevent an individual from actually using a practical skill to deal with the situation. Emotions are trigger factors which can either get in the way or they can signal that an action is required. Let us look at the inverted U hypothesis.

Up to point X you have a positive experience and you are able to take action. Thereafter there is a decrease in your ability to take action. For example, if a student is studying for an exam, enough anxiety will motivate him/her to study but too much anxiety will prevent this. Any stress, emotion, experience, etc, can be a beneficial experience. However, too much of anything can overload your ability to cope. People stuck in the oral phase have a very low tolerance level which they deal with through instant gratification. Compare to the curve above, theirs would look like this. (Note the smaller curve indicating the lower tolerance level).

We all vary in terms of how our own curve would look and this can affect how well we function. Try and think about what your curve would look like for say anxiety, anger, pain, frustration, etc.

4.

Poor self-esteem: The entire sense of self is invested in how the individual looks and how much she weighs. She cannot give herself credit if she has lost a kilogram of weight because she is still 15 kgs overweight. Her mood will depend on how she looks or feels that day. A slight increase or decrease in weight as reflected on a scale, can change her whole outlook despite how she may have felt just prior to weighing. These are all manifestations of a poor self-esteem.

5.

They lack confidence but this is often body specific. These individuals can be quite high functioning in other areas of their lives but they are not confident about their bodies.   They feel particularly threatened in situations which require that they look physically good e.g. going out to a function.

6.

There is a poor body image and the body mage itself is often distorted. A distorted body image is a very specific phenomenon. It means that you look in the mirror and when you weigh 45kgs you believe that you weigh 65kgs. It is a distortion, not a slight maladjustment. When these individuals look in the mirror they do not see the reality. The fat person seldom realizes how big s/he is, while the anorexic always thinks she is overweight.

7.

There is an obsession with weight/food and the approach to this is often extreme or all-or-nothing. They constantly think about food. Being obsessive as well as being all-or-nothing are both defense mechanisms. All-or-nothing behaviour can be assessed by the "diet mind-set". E.g. "I am either on diet or off diet", "I will be 100% compliant when I'm on the diet, but will eat as much as possible when I am not on diet". This all-or-nothing thinking is also applied to other areas of the person's life.

The negative effects of dieting and the media play a prevalent role in poor self-esteem, the lack of confidence, a poor and/or distored body image, as well as obsessions with food. On is constantly bombarded with new fad diets or emaciated looking models. The average woman tries to model herself on this and loses touch with how she wants to look and what is realistic for her size and shape.

8.

They feel isolated. There is a lack of understanding from friends, family and society. They are quite often rejected by spouse, family, friends and society, which results in feelings of loneliness and isolation. Even some professionals do not understand the phenomenon. There are ardent attempts to change the symptom and a tendency to ignore the deeper dynamics. There is often employment discrimination and they are labelled as lazy, sloppy, out of control, self-destructive. Unfortunately, these indiviudals also tend to internalize these labels and then live up to the label.

9.

Emotions. This is a bit of a chicken and an egg situation. Is the emotion that is being expressed a result of the problem, or the cause of the problem? What comes first, the cause or the effect? Was this person anxious, frustrated, bored, etc before they started having an eating disorder or has the emotion been exacerbated by the eating disorder?

All emotions may contribute to, or be the result of the eating disoder.   Depression, anger, boredom, emptiness, loneliness, feeling devalued, helpless, inadequate, stressed, frightened etc.   These emotions need to be controlled and because the person with an eating disorder does not have the coping skills (point 1) s/he resorts to the eating disorder pattern. Emotions that are not dealt with are shut off, but do not go away. They come back when you least want them or expect them to. Food or purging or exercise is merely a comforter which restores the equilibrium. Food is also a tool for expressing emotions or feelings as a reward or punishment. For people with an eating disorder, food does not equal food.   Food is not eaten for sustenance. Food is a comforter, a friend or a dummy.   In summary, their relationship with food is quite abnormal.

10.

There is denial of and poor communication with regards to feelings and needs. Poor communication often causes other problems in relationships and issues are not dealt with as they happen.

11.

There is an inability to trust in themselves, their needs, their wants, their feelings and in others.

12.

Boundaries. They cannot say no to themselves or to anyone else.

13.

There is an inability to make choices. The ability to make choices is something we learn from a young age. Someone who is functioning at a very primitive level (point 1), cannot make choices in general, let alone about food.

14.

Personality Disorder: It is enevitable that some people will have found different ways of coping with their personal issues, even to the point of developing a personality disorder. Personality disorders are difficult to treat as they become fixed, ingrained patterns of coping. The assessment of a personality disorder can only be made by a psychologist or a psychiatrist.