Posted: June 17th, 2022

Literature Review on Bulimia Nervosa and its Relation to the Personality Trait Introversion

Bulimia nervosa (BN) is among the three main consuming issues generally addressed within the discipline of psychology. The dysfunction is primarily characterised by an irregular consuming conduct that normally entails binging on meals for a sure time period as a response to private stressors. Sometimes called a binge/purge syndrome, the consuming dysfunction might contain such behaviors as induced vomiting, laxative and diuretic abuse, extreme train and pointless fasting. The illness normally has an onset age between 15 and 18 years and is claimed to have an effect on 1-5% of (younger) girls normally.

The dysfunction is usually exhausting to detect as a result of a number of causes. These causes embrace: a) bulimics are good at hiding their rituals; b) most weigh inside regular vary for his or her top, intercourse and age and just a few are underneath or obese; and c) they display acceptable and regular consuming habits in public circumstances. Moreover, “consuming issues have for a very long time been considered a culture-bound syndrome regarding white, center class girls, and sometimes haven’t been thought to exist in different societies or cultures.

Nonetheless, research present that consuming issues are current additionally in non-western societies, although not as prevalent” (Ekeroth, 2005, p. 19). Some indicators and signs bulimics might exhibit embrace dental and gum illnesses as a result of gastric acid publicity; irregular menstrual durations; swollen parotid glands; gastrointestinal issues akin to bloating, constipation, and ulcers (gastric and duodenal); and electrolyte imbalances on account of dehydration with accompanying signs akin to hypotension, dizziness and lightweight headedness (Sewell, 2000 ,p. 5-6).
The prognosis of BN is primarily achieved by the willpower of the next standards: “: a) recurrent episodes of binge consuming (speedy consumption of a considerable amount of meals in a discrete time period); b) a sense of lack of management over consuming conduct in the course of the consuming binges; c) usually participating in self-induced vomiting, the usage of laxatives or diuretics, strict weight-reduction plan or fasting, or vigorous train with a view to forestall weight achieve; d) a minimal of two binge-eating episodes every week for a minimum of three months; and e)
persistent over concern with physique form and weight” (Sewell, 2000, p. 6). Within the paper written by Tracy Sewell (2000), she discusses the prevalence of consuming issues (ED) as affecting an estimated 2-Three% of put up pubertal women and girls with an extra 5-10% of whom have “subclinical” consuming issues. Apparently, a big variety of women are psychologically distressed struggling in quiet disturbance which makes their cries for assist more durable to listen to and simpler to disregard.
Because it have been, women are likely to understand their our bodies, because it strikes away from the skinny prepubertal look, as obese – leading to sad emotions and the event of maladaptive strategies of coping akin to excessive dietary measures (p. 98-99). Sewell (2003) discusses a number of variables as affecting the incidence of the dysfunction. One such variable researchers have usually related to the dysfunction is the vanity ranges/values of girls.
Points usually surrounding the dysfunction embrace physique form dissatisfaction which have been discovered to be extremely correlated with the dysfunction as having each a mediating and moderating impact relying on consequence measures used. Moreover, she notes that “disordered consuming could be conceptualized alongside a continuum, starting from concern with weight and regular consuming, to “normative discontent” with weight and reasonably deregulated/restrained consuming, to anorexia nervosa and bulimia nervosa” (Three).
“Normative discontent,” nevertheless, doesn’t essentially imply a psychiatric prognosis or categorization, the situation itself – in its personal proper – may cause appreciable misery and thus is a possible threat issue for creating BN syndrome (Three). Notion performs an important function within the pathology of the dysfunction. Most research achieved on the topic reveal that bulimic girls are likely to report important distortion of their physique components. They’re tremendously dissatisfied with their our bodies which make them understand themselves as bigger than they are surely and thus need to grow to be a lot smaller (Sewell, 2000, p.
102). Apparently, there’s a excessive connection between despair, physique esteem, physique picture pre-occupation (Sewell, 2000, p. 103); Baigrie & Giraldez, 2008, p. 173; Watson, 2008, p. 6-7) teasing, anxiousness, hostility, boredom, dietary restraint (Baigrie & Giraldez, 2008), neuroticism, obsessive compulsive issues [OCD], borderline character dysfunction [BPD] and extroversion (Watson, 2008, p. 6-7) with the event of consuming disturbances in younger girls with low vanity.
Sewell’s (2000) analysis into the topic of BN reveals that there are a number of correlated elements within the growth of the dysfunction. One such issue is the onset of adolescence which is seen as a turbulent time of “storm and stress” because the younger lady’s household values come into battle with societal, peer and media-espoused values. Quite a few research have established that adjustment issues peak throughout this time and thus contribute to the wrestle for identification and independence (p. 6-7). Moreover, she discovered that sure predictive signs of BN could be discovered as quickly as early childhood.
These embrace consuming and digestive issues akin to issues with self-control of consuming behaviors in addition to eating-related household struggles. Notably, it was found that folks of bulimics – most particularly the daddy – demonstrated character profiles suggestive of disturbed have an effect on, weak inside controls, unmodulated expression of hostile impulses and absent emotionally satisfying intrafamilial ties. It was additionally discovered that kinfolk of bulimics have been extra prone to endure ceaselessly from affective issues, alcoholism and drug use issues (p.
eight). Moreover, it was found that the households of people with bulimia and bulimia-like signs have been characteristically missing in dedication, assist, help, and stuffed with anger, aggression and battle. Moreover, they have been additionally discovered to be “disengaged, chaotic, conflictual, and missing in expressive communication” (p. 9-10). It was additionally mentioned in the identical analysis that female and masculine traits have been additionally correlated with the event of the dysfunction, particularly in the direction of the event of a distorted body-image.
Apparently within the case of consuming issues, female traits have been valued negatively in comparison with masculine traits and this has led girls to have extra damaging self-concepts than males do (Sewell, 2000, p. 11). In truth, it was discovered that: each masculine and female gender-typed girls who strongly adhered to a superwoman splendid have been at larger threat for consuming issues than androgynous superwomen have been. In distinction, androgynous superwomen had comparatively low potential for disordered consuming and appeared corresponding to girls who no matter gender typing rejected the superwoman splendid.
(Sewell, 2000, p. 13). One other space of correlation, in response to the identical analysis, is within the space of vanity. Apparently, low vanity is linked to indicators of psychological misery akin to despair, neuroticism, anxiousness, poor normal adjustment and consuming issues. In response to research, it’s typically accepted that those that have low self worth have a larger threat of creating consuming issues (Sewell, 2000, p. 14). The problem of physique picture in bulimics has been discovered to have distinctions between body-size distortion and physique dissatisfaction.
The previous is described to be a “perceptual” disturbance the place the affected person seems unable to evaluate private measurement precisely. The latter, alternatively, has a extra attitudinal (cognitive and affective) nature and has no disturbed measurement consciousness. To cite: “ [in] this sort sufferers assess their bodily dimensions precisely however they react to their our bodies with excessive types of disparagement or occasional[] aggrandizement” (Sewell, 2000, p. 15). These two varieties are additionally identified to function individually or conjointly, relying on the complexity of the dysfunction.
Despair was additionally discovered to be extremely correlated to the event of bulimia. Analysis signifies that round 60% of all bulimics endure from a type of despair and that these emotions could also be rooted in troubles with socialization. Research have proven that socialization encourages the event of female traits in younger girls, nevertheless, the identical exercise additionally predispose them to develop “realized helplessness” – a type of maladaptation sample in the direction of stress.
This can be as a result of imposition of the “skinny splendid” totally on girls which ends up in the upper frequency of despair within the group (Sewell, 2000, p. 16). In truth it was discovered that “despair was associated to consuming attitudes in fifth and sixth grade women [which] counsel that preoccupation with meals and weight-reduction plan in women begins within the fifth and sixth grades and will increase within the seventh and eighth grades, a time when most women are finishing puberty” (Sewell, 2000, p. 18).
Moreover, Sewell (2000) described in her analysis two units of variables which the writer predicted to have both predisposing results (variables A) or precipitating results (variables B) on the event of consuming issues. Findings for the analysis indicated that variables designated as B (which included self worth and physique form dissatisfaction) had a extra direct relationship in predicting consuming dysfunction threat (p. 50-51). Apparently, it was additionally discovered that weight-reduction plan could be an entree into an consuming dysfunction particularly if it have been accompanied by sure threat elements and intensified by sure points (p.
51). Different findings mentioned by the writer included a number of psychological measures designed to estimate the presence of threat elements such because the Rosenberg Self-Esteem Stock, Physique Form Questionnaire, endorsed intercourse roles, Social Insecurity Subscale and the Interoceptive Consciousness Subscale (Sewell, 2000, p. 52-53, 57, 106, 108). In response to the analysis, those that are susceptible to creating consuming issues normally rating excessive within the Rosenberg Self-Esteem Stock – a measure indicating the presence of lowered vanity.
Scoring excessive within the Physique Form Questionnaire check, alternatively, signifies larger physique form dissatisfaction. These two measures mixed point out a larger threat for respondents falling throughout the medical prognosis vary (p. 52-53). When it comes to reported intercourse function, those that endorsed an androgynous intercourse function orientation have been discovered to have increased physique mass indices (BMI) and scored lowest within the Consuming Attitudes Check (EAT), supporting findings in literature which state that these people with a extra androgynous sex-role orientation typically rating highest in vanity (p.
57). In the meantime, excessive scores on the Social Insecurity Subscale displays the extent of perceived rigidity, insecurity, disappointment, unrewarding and usually poor high quality of social relationships whereas the Interoceptive Consciousness Subscale, alternatively, measures confusion and apprehension in recognizing and precisely responding to emotional states.
It additionally displays one’s insecurity in recognizing and precisely figuring out sensations of starvation and satiety (p. 108). Deciphering these varied information led Sewell (2000) to the next conclusions: quite a few literatures point out decreased vanity results in a larger chance of being identified with an consuming dysfunction.
Equally, elevated physique form dissatisfaction and poor physique picture are strongly associated to consuming issues and people people who indicated they “all the time” train have been extra prone to be identified with an consuming dysfunction than those that indicated they exercised much less ceaselessly. This additionally agrees with findings within the literature that signifies people who’ve an consuming dysfunction are inclined to interact in nice quantities of train, moderately than train carefully. (p. 52-53).
These, due to this fact, are the gist of Sewell’s findings on BN and different consuming issues: a) the dysfunction is very predisposed by despair; b) a number of complicated co-morbidities precipitate the event of consuming issues; c) failed, defective or maladaptive social and familial interactions can have an effect on the likeliness of creating the consuming issues; and d) BN and different consuming issues show excessive ranges of physique distortion and dissatisfaction which all level in the direction of lowered physique and self esteems.
In a separate research performed by Kerstin Ekeroth (2005) the place the writer tackled psychological issues in adolescents and younger girls, she discovered that “sufferers with bulimia nervosa (BN) scored increased than each sufferers with anorexia nervosa (AN) and people with an consuming dysfunction not in any other case specified (EDNOS) on most drawback scales,” supporting the findings of Sewell and different literatures. Moreover, the writer additionally mentions that AN-bingers/purgers (an AN subclass related in conduct with bulimics) scored increased in externalizing behaviors than pure restrictors (p. four).
When it comes to co-morbidity, the writer additionally discovered robust relations with despair. Nonetheless, the writer additionally warns that hunger might trigger signs just like main depressive dysfunction and thus has a possible to affect preliminary despair rankings. Equally, it was additionally discovered that there are elevated frequencies of social phobia in each AN and BN sufferers. In truth, an estimated 75% of AN and 88% of BN sufferers had anxiousness issues predating the consuming dysfunction (Ekeroth, 2005, p. 25-26). Moreover, the writer described a number of character dysfunction clusters normally present in individuals with consuming issues.
In response to this description, BN sufferers mostly display cluster B character issues. Cluster B character issues embrace borderline, delinquent, histrionic, and narcissistic character issues. Amongst these, it was discovered that borderline character dysfunction is probably the most ceaselessly reported. Moreover, BN sufferers additionally categorize underneath a cluster labeled C which incorporates issues akin to avoidant, dependent and obsessive-compulsive character issues. Apparently this cluster is usually reported equally in each BN sufferers and AN sufferers (Ekeroth, 2005, p.
27-28). A number of research have additionally reported that a increased frequency of suicidal conduct, drug use, and stealing are present in women with BN indicating impulsivity issues. Because the writer writes: Bulimic conduct is commonly considered an expression or manifestation of a failure to manage impulses to eat, and to do away with the meals afterwards. As well as, earlier research have discovered that women with bulimia not solely have decrease impulse management and elevated charges of impulsive conduct but in addition specific extra aggression in comparison with women with AN.
(Ekeroth, 2005, p. 29). That is additional supported by the truth that many sufferers with BN appear to have disinhibitory issues. A attainable clarification for that is that weight-reduction plan and hunger has been discovered to not solely affect temper lability however can be disruptive to the completely different psychoneuroendocrinological methods (Ekeroth, 2005, p. 30). The writer additionally mentioned that sufferers with consuming issues usually expertise conflicted relations with family and friends, and normally withdraw from social interplay.
Regardless of this normal characterization nevertheless, AN sufferers have been discovered to be energetic in class and in sports activities. In full distinction, BN women have been reported to have acquired much less help from family and friends, skilled damaging interactions and conflicts extra ceaselessly, and have much less social competence (Ekeroth, 2005,p. 32). Moreover, correlations recognized by the writer revealed the next information: [C]orrelations between the internalizing and externalizing dimensions have been zero. 51/zero.
49 (boys/women), and for anxious/depressed, and aggressive conduct the correlations have been zero. 49/zero. 45 (boys/women). Furthermore, self-destructive/identification issues correlated excessive with anxious/depressed (r = zero. 78/zero. 82 boys/women) in addition to with the internalizing dimension (r = zero. 77/zero. 78 boys/women) (Ekeroth, 2005, p. 40), revealing that a excessive correlation exists between self-destructive/identification issues with anxiousness/despair and internalizing dimensions of individuals with consuming issues.
Different findings included within the paper additionally reveal that BN sufferers rating increased on somatic complaints, consideration issues, delinquent conduct, aggressive conduct, externalizing, and whole issues in comparison with AN and EDNOS sufferers. This was supported by the truth that BN sufferers report increased levels of drawback externalization particularly regarding delinquent behaviors in comparison with AN patints (Ekeroth, 2005, p. 43). Moreover, BN sufferers have been additionally reported to have extra issues in contrast with AN sufferers.
Equally, BN sufferers have been additionally reported to have extra issues “than EDNOS sufferers on anxious/depressed, self-destructive/identification issues and internalizing” (Ekeroth, 2005, p. 41). These findings have been in step with earlier experiences that women with ED rating considerably decrease on competence, interpersonal sensitivity, despair, anxiousness, and psychoticism (Ekeroth, 2005, p. 48) – reinforcing the concept that “[f]eelings of self-competence and having shut and good relations to household and friends is perhaps necessary elements influencing coping potential and remedy consequence” (Ekeroth, 2005, p.
43) of sufferers with consuming issues. Evidently, lack of competence is on of the widespread options in individuals with consuming issues. Nonetheless, like most constructs, this facet shouldn’t be simply outlined (Ekeroth, 2005, p. 58). Moreover, the writer discusses: Bulimic conduct has been linked to impulsivity…[h]owever, the definition of impulsivity shouldn’t be clear-cut and easy. Impulsivity consists of two completely different elements, lack of planning and urgency (the tendency to behave rashly when experiencing damaging have an effect on), and that it’s urgency, which is linked to bulimic conduct.
Others have pointed on the distinction between internally and externally directed impulsive conduct, and counsel that normal psychopathology is said to internally directed impulsivity (e. g. self-harm), whereas bulimic pathology is extra particularly related to externally directed impulsivity (e. g. theft). (Ekroth, 2005,p. 53). Nonetheless, regardless of all these data, it’s nonetheless typically regarded that there’s nonetheless giant uncertainty concerning the related distinction between AN-r (restrictive sort), AN-b/p (binging/purgative sort), and BN.
(Ekeroth, 2005, p. 33). The findings in each Sewell’s and Ekeroth’s analysis have been additionally supported by a 3rd research performed by Baigrie and Giraldez (2008). The main focus of this research nevertheless was with regards to binge consuming and its relation to coping methods employed by [Spanish] in any other case regular adolescents. Within the mentioned research, it was discovered that amongst respondents for the research, those that reported binge consuming characteristically had increased BMIs, decrease self worth, depressive signs and have been much less glad with their physique picture (p. 173).
Moreover, the research additionally decided that those that scored increased within the Consuming Problems Stock (EDI) have been extra prone to have decrease self worth, extra irrational pondering, decreased use of cognitive and behavioral coping methods and elevated use of avoidance coping (p. 174). When it comes to coping methods, the research discovered that the binge-eating group scored highest in three of the 4 areas of coping (introversion, optimistic hedonist coping, and avoidance coping) with introversion and avoidance coping garnering increased imply scores (Baigrie and Giraldez, 2008, p.
177). Because the writer’s mentioned: it was anticipated that the adolescents who binge eat would use extra avoidance coping methods (unproductive coping) and fewer problem-focused methods (optimistic coping) in comparison with the adolescents who don’t binge eat. The outcomes confirmed [that] adolescents who binge eat use avoidance coping extra ceaselessly than those that don’t binge eat. (Baigrie and Giraldez, 2008, p. 177). A number of research additionally targeted on the facet of extraversion and introversion in correlation with consuming issues (Miller et al.
, 2005; Hitti, 2008; Watson, 2008[? ], p. 6-10,23; Carmo and Leal, 2007, p. 1). In these research, it was discovered that decrease extraversion (i. e. introversion) was associated to disordered consuming particularly in girls who rating excessive in neuroticism – indicating that neuroticism and introversion could also be threat elements in creating consuming issues (Miller et al. , 2005). That is supported by all beforehand mentioned literature and by Miranda Hitti (2008) in her article the place she states “shyness and introversion are threat elements for anxiousness issues, particularly social anxiousness dysfunction.
” As beforehand mentioned, anxiousness issues are widespread co-morbidities amongst individuals with consuming issues. An assumption can due to this fact be made that since neuroticism and introversion are threat elements for creating anxiousness issues, they’re due to this fact oblique elements in the direction of the event of consuming issues akin to bulimia. Moreover, within the research performed by Isla Watson (2008), it was decided that extroversion has a damaging relation with consuming issues.
Extroversion is outlined as being markedly engaged with the world and coping with exterior elements in an lively, optimistic method such that extroverted people achieve pleasure from consideration and their actions are sometimes spontaneous and lack regard for others. Moreover, “[c]ompelling proof has proven that extroversion will increase after weight is restored throughout restoration from an consuming dysfunction” and that it’s usually not expressed in anorexic people due to this fact calling for a must be careful for the polar trait introversion (Watson, 2008, p.
10) as a result of the truth that introversion is a typical function of consuming issues (Watson, 2008, p. 23). This concept is additional strengthened by the findings of Claudia Carmo and Isabel Leal the place the authors negatively correlated extroversion and consciousness with the Consuming Problems Stock (EDI) subscales, permitting the authors to conclude that extroversion and consciousness are protecting elements in opposition to the event of consuming issues (p. 1).
In abstract of all of the literature mentioned to this point, the topic of BN and consuming issues normally appear to be extremely correlated and related to anxiousness and character issues. Additionally it is identified that these psycho-behavioral issues are a possible results of a number of contributing elements akin to households which can be disengaged, chaotic, conflictual, and missing in expressive communication, damaging self ideas, and poor high quality of social relationships.
These elements contribute to the event of despair, neuroticism, anxiousness, poor normal adjustment and lowered self worth. Moreover, these talked about traits additionally outline character clusters present in individuals with consuming issues akin to BN. Although BN sufferers are typically extra aggressive and demonstrative of delinquent conduct, distinctions between BN, AN-r, AN b/p and EDNOS shouldn’t be very clearly outlined. Subsequently, findings about extroversion and introversion might typically apply to all of those consuming issues.
If something, the truth that extroversion is confirmed to be negatively associated to consuming issues, the inverse thus can be believable: introversion is positively associated with consuming issues. How this impacts BN nevertheless remains to be unclear since many of the literature mentioned right here to this point characterize BN as particularly related to externally directed impulsivity – a conduct that considerably mirrors extroversion. Nonetheless, since BN sufferers even have co-morbid anxiousness and character issues it can’t be dominated out mechanically that these people wouldn’t have introvertive traits.
The mere undeniable fact that the traits lowered self worth, avoidant coping, decreased social competence, and social phobia ceaselessly come up as descriptive traits of the anxiousness and depressive issues present in these people all level to the chance that these people might have some type of introversion and that BN sufferers most likely compensates for this by “performing out” with a view to cowl for the insecurity that may be very definitive of consuming issues. References
Baigrie, S. S. , Giraldez, S. L. (2008). Analyzing the connection between binge consuming and coping methods and the definition of binge consuming in a pattern of Spanish adolescents. The Spanish Journal of Psychology vol. 11 no. 1:172-180. Carmo, C. , Leal, I. (2007). Dimnsions of character and consuming issues. College of Algarve Portugal, Division of Psychology. Ekeroth, Okay. (2005). Psychological issues in adolescents and younger girls with consuming disturbances.
Doctoral Dissertation for Goteborg College, Division of Psychology. Hitti, M. (2008). Variations in RGS2 Gene Linked to Shyness in Children, Introversion in Adults. WebMD Well being Information Reviewed by Louise Chang, MD. Retrieved March 17, 2009 from http://www. webmd. com/mental-health/information/20080303/shyness-gene-teased-out Miller, J. L. , Schmidt, L. A. , Vaillancourt, T. , McDougall, P. and Laliberte, M. (2005).
Neuroticism and introversion: A dangerous mixture for disordered consuming amongst a non-clinical pattern of undergraduate girls. Elsevier Ltd. Sewell, T. (2000). Creating threat issue profiles for Anorexia and Bulimia Nervosa in younger adults. Thesis for the College of Manitoba for the College of Graduate Research. Nationwide Lirary of Canada. Watson, I. (2008). Persona elements & their relation with attentional bias to meals phrases. Rsearch for the College of Wales, Bangor.

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