young women have developed abnormal eating-related behavior. The
preoccupation with thinness has caused girls and young women to feel
or fat, even if they are of normal weight. Now thinness, which is seen
synonymous with self-discipline and control, is the desired goal.
Bulimia Nervosa is
characterized by binge eating accompanied by a loss of control over
attempts to prevent weight gain by extreme dieting, vomiting, misuse of
laxatives and diuretics and excessive exercise (Kaltiala-Henino,
Rimpelae, and Rantanen, 2003). Many
times, patients also show an over concern with their body weight and
shape. This disorder is fairly new. It was first described only twenty years ago
and classified in the Diagnostical and Statistical Manual of Mental
III in 1980 (Kaltiala-Henino, et al., 2003).
Bulimia nervosa primarily affects white Western
females in late
adolescence (Kaltiala-Henino, Rissanen, Rimpelae, and
Rantanen, 2001). Most
of these females are well educated and
are at their normal weight for their height (Johnson, 1984). This disease is rare among males.
Throughout the years, the disorder seems to
affect children at a younger age (Kaltiala-Henino, Rissanen, Rimpelae,
Rantanen, 2001). The disease has been
seen as a chronic disorder that may last for several years (Singer,
White, Song, 1993).
et al., (2003), examined bulimia and impulsive behavior in middle
adolescence. The researchers studied the
associations between bulimic type eating pathology with a number of age
specific uncontrolled behaviors such as bullying, truancy, excessive
and sexual activity. The participants
were taken from a random sample from the 8th and
9th grades of all
secondary school in Middle Finland.
There were a total of 4,453 girls, and 4,334 boys
participating in the
study. The participants were given a
self-report questionnaire. The questions
concerning bulimic eating pathology were formulated around the
DSM-III-R. The questionnaire asked
frequent drinking by asking, “Did you ever drink so much alcohol that
really drunk? How many times?” Truancy was measured by the absences from
school. Bullying was measured by a few
questions concerning the amount of times a person had been bullied. Sexual activity was addressed by two
questions concerning whether or not the participant had ever had sexual
intercourse and with how many people.
Results from the study showed that bulimic behavior
was associated with
bullying, truancy, excessive drinking and sexual activity between both
and females. Researchers also found that
the more uncontrolled behaviors occurring at the same time, the more
participant was to show bulimic type eating pathology.
Johnson (1984) did
a study on the incidence and correlation between bulimia and the female
school population. This study, in
particular focused on the estimated incidences of bulimic behavior
high school students. The study also
investigated the differences between bulimic and non bulimic students
demographics, body perceptions, weight concerns, dieting, exercise,
behavior, and frequency of bingeing and purging behavior.
The study took a sample of 1268 adolescent
females between the ages of 13 and 19, which represented 98.1% of the
female population. The girls came from a
diverse ethnic and socioeconomic mix.
The participants were split up into two different
consisted of bulimic vs. non-bulimic students.
They were compared over four content areas. The participants were given a survey during
their gym class, all on the same day.
They were told that the survey would be anonymous. This survey was used to identify the students
who met the DSM-III criteria for bulimia nervosa. After
the survey, a presentation was given
about dieting behavior, anorexia, and bulimia.
Results showed that 4.9% of the students met the
criteria for the
diagnosis of bulimia. Of the 4.9%, 21%
of the total sample admitted to weekly or greater episodes of binge
eating. 4% of the sample used
self-induced vomiting, and 3% used laxatives as a way of evacuation
techniques. When researchers compared
the bulimic and the non-bulimic groups, results indicated that the
group had a much poorer body perception, even though they were at
weight. They also had a larger desire to
be thin. The bulimic group also started
to diet at an earlier age and more frequently and over a longer period
than the non-bulimic group.
et al., (2001) conducted a
study about early puberty and the early sexual experiences that are
with bulimia in middle adolescence. The
purpose of this study was to explore further the associations between
timing and early advanced sexual development with bulimic type eating
in middle adolescents. The study took a
total of 19,321 males and 19, 196 female students from the ages of
old. The participants were given the
School Health Promotion Study. This was
a survey for adolescents about health, health behavior, and school
experiences. The survey was geared
toward the DSM-IV criteria for meeting the bulimia nervosa disorder. The onset of menstruation was simply
determined by asking, “How old were you when you had your first
menstruation?” Sexual activity was
measured by asking several questions referring to kissing, petting, and
intercourse. Age was measured by
calculating the date of birth on the survey.
Researchers found in their results that bulimic type
eating pathology in
girls were associated with early menstruation, early sexual
higher in age. For the male respondents,
the onset of ejaculation was at the normative age with little risk of
but early sexual experiences were associated with bulimic type eating
pathology. Researchers concluded that in
order to help prevent the onset of bulimia nervosa, there should be
opportunities for early intervention. Special attention should be given
early maturing girls and off time maturing boys. Attention
to early onset of sexual activity
should be made.
adolescence find themselves under a severe amount of stress. Going though puberty can be a very a
demanding yet rewarding experience. For
most adolescents, they need a way to release their stress and cope with
problems though the help of social support.
Social support can be found though friends, family,
and the school, such
as guidance counselors and teachers.
conducted a study of adolescent bulimic behavior and its relation to
adolescents develop, cope, and use social support.
The study examined whether there were any
relationships between adolescent bulimia and coping, social support or
maturation timing. The study consisted
of 388 adolescent females from the 9th through 12th
grades. These were girls who were
attending two different schools but were attending their physical
classes. Four different self-report
measures were taken:
The Ways of Coping
Social Support From Family,
Perceived Social Support
from Friends, and
The Bulimia Test.
also had questions regarding
demographics and pubertal timing.
Results showed that female adolescences that
reported having stronger
symptoms of bulimia were not as likely to use useful forms of coping
dealing with stress. As well, those
girls who had more bulimic symptoms showed lower reports of support
friends and family. These adolescents
also reported that they were going to reach puberty before their peers. Researchers found an unexpected finding that
any of the girls, regardless of whether or not they show signs of
experienced similar stressful events.
Also, those adolescents who showed more symptoms of
bulimia were less likely
to find social support when experiencing a stressful event and instead
themselves. Researchers suggest through
their findings that early intervention should take place and
programs should focus on teaching appropriate coping and social skill.
Reichert (1990), conducted a study on extreme dieting behaviors
early adolescence. There were multiple
purposes for the study. One purpose of
the study was to find a better understanding of the ages of possible
extreme dieting and the patterns in early adolescence.
A second purpose was to obtain a pilot
screening procedure that has not been used by other researchers. Students use these procedures to try to
overcome the problems with “false-positive” statements of bingeing. The participants taken for this study were
235 fourth, fifth, and sixth graders from two elementary schools in North Dakota. Almost all of the students were Caucasian and
the majority of them had at least one parent who had a college degree. The participants were shown a slide show with
audio taped narration of two case stories involving eating disorders. After they watch the show, they were asked to
complete a series of questions about their eating behaviors and to
their eating habits to that of the case participants.
The case participants were seen to be those
of bingers. Results showed that between
3 and 4% of girls reported that they had either self induced vomiting,
secretly thrown away food to avoid gaining any weight.
There were 6 students from the fifth and
sixth grade that reported that they had skipped more than two meals a
order to lose weight. The fifth and
sixth grade girls scored much higher than any other group on Food
Dieting. This study should alert
teachers and other professionals to the fact that a lot of fifth and
graders are experimenting with extreme dieting behaviors.
Educators should become more familiar with
the risk factors and signs and symptoms of eating disorders. Such risk factors include mood instability,
low self-esteem, and sudden weight gain in adolescence, peer modeling
influences, and internalization of society’s values of thinness in
society, women are expected to ideally be thin.
Early on in life females are taught to comply with
of beauty. At the age of six, girls have
an internalized perception of what is attractive and how is relates to
popularity as well as the negative insights of an overweight person.
Girls who are
bulimic show signs of body dissatisfaction.
These girls see themselves as being bigger than what
they really are and
they wish that they were smaller in size (Dacey, Nelson, Clark, and
Dacey, Nelson, et al.,
did a study of
how bulimia relates to how adolescents view their body image and how
dissatisfied they are with their body’s. The purpose of the study was
examine the body image dissatisfaction in bulimic girls in their
years. The participants for this study
were taken from an all-girl, middle to upper level income, and private
high school in the Midwest. Fifty-four percent of the students returned
their consent forms, which equaled out to be 260 students.
These students were screened for bulimia by
using the Bulimia Test and the Eating Disorders Inventory.
After determining whether or not the girls
had bulimia, they were interviewed by the Russell’s criteria. The remaining girls were matched with
controls accordingly to their age, height, weight, and year in high
school. The participants next were given
the Color-A-Person Test and were asked to indicate their level of body
satisfaction by using five different colors.
Red represented very dissatisfied, yellow for
dissatisfied, black for neutral,
green for satisfied, and blue for very satisfied. Results
showed that the bulimic participants
were more dissatisfied with their hips, buttocks, and thighs compared
non-bulimic participants. There was an
overall dissatisfaction of all body parts with the bulimic participants. But, there was no significant difference
between either of the groups when it came to the dissatisfaction of
front view body part discriminations.
Studies have been
known to show significant relationship between those people who are
those who engage in alcohol or drug use.
Research shows that there are three similarities
that both the bulimic
and binge drinkers in alcohol share.
They characteristics are 1) a loss of control and
feelings of compulsion,
2) bingeing to sedation or drinking to intoxication to forget about
interpersonal problems, and 3) feelings of degradation, powerlessness,
self-loathing, and/or depression following the binge eating or drinking
behavior (Singer, Nutter, White, and Song, 1993).
Singer, et al.,
(1993) examined though a study the problem behaviors, such as substance
and sexual abuse, currently being experienced by hospitalized
were diagnosed with bulimia nervosa.
There were twenty eight adolescents who were
experiencing the bulimic
disorder were compared to 201 psychiatrically hospitalized patients who
not suffering from an eating disorder.
Of the 28 eating disorder patients, 29% were
identified as substance
abusers. 75% of those patients were
experiencing depression as well. Those
patients who were not experiencing an eating disorder were found to be
aggressive, delinquent, and undercontrolled than those patients with
It was also found
that sexual abuse was less likely to be prevalent among those
bulimia nervosa compared to the hospitalized patients.
There were no significant differences in any
aspect of alcohol or drug abuse among any of the patients.
As well, there were similar behavioral
profiles of substance abuse bulimics and non-eating disordered patients. Bulimia and substance abuse has been shown to
have many similarities that may be related to family functioning.
months, researchers did a follow up on the bulimic patients. Researchers found that the patients were less
depressed, had less somatization, and were less overcontrolled. On the other hand, they did not show any
signs of improvements in their eating attitudes or behaviors or with
and/or alcohol use. Researchers have a
few reasons why those patients who showed no improvement:
Both substance abuse and
bulimia nervosa are
more resistant to change than other behaviors;
There is a “lag effect”
for improvement in both
bulimia nervosa and substance abuse.
Other behavior problems may need to be improved for
a period of time
before improvement in eating or substance use attitudes/behaviors.
sociological factors are of great importance in understanding the
on eating disorders. Studies show that
stress in one’s life leads to a dysregulation of the monoamine,
and neuropeptide systems which normally relates the feeding behavior. Patients with eating disorders have reported
separation and attachment
difficulties. This is related to the
importance of separation from primary attachment figures and bulimia
(Horesh, Apter, Ishai, and Danziger,
Horesh, et al.,
(1996) conducted a study on the abnormal psychosocial situations and
are related to eating disorders in adolescence.
The purpose of this study was to determine the
abnormal psychosocial situations and eating disorders in adolescents. The study picked twenty girls with eating
disorders, which were patients of an eating disorder program, 20 girls
psychiatric conditions, such as mood disorders, and 20 healthy girls. The participants were given a semistructured
interview to complete which was designed by the World Health
Organization. This is used to diagnose the
situations. Along with the interview,
all the participants were given the Eating Attitudes Test.
According to the results, many life events
and psychosocial situations showed significant differences between the
and the controls. In particular,
inappropriate parental pressure contributed to the participants who had
eating disorder. Correlations between
hostility toward the child, sibling disability, parental
inappropriate parental pressures, and negative changes in family
were significant with the Eating Attitudes Test scores.
Thus, the results support the evidence on the
interrelationship between abnormal family relationships and eating
Even though social
pressures for thinness is exposed to adolescence, only about 4-14% of
adolescent girls will have bulimia nervosa.
The frequency of boys with bulimia is 0.8-2.1%. Boys are just as likely as girls to indulge
in the binge eating habits, but the full range of bulimic symptoms is
likely to show up in girls (Price, Desmond,
Price and Mossing, 1990).
Price, et al.,
(1990) conducted a study of the knowledge that school counselors had
eating disorders. The researchers wanted
to examine the knowledge that school counselor have had of adolescence
disorders, including bulimia nervosa.
The main questions that were being examined
specifically were: How do
school counselors discover which students have eating disorders? What actions do the counselors take? What do they know about eating
disorders? Does their knowledge vary by
age, sex, number of years as a counselor, or level of formal education? Where have school counselors received most of
their information about eating disorders?
The participants for the study were a random sample
of 500 participants
drawn from the American Association of School Counselors.
They received an anonymous and confidential
questionnaire on eating disorders. There
were 16 questions on the signs and symptoms of bulimia and anorexia,
16 questions of general knowledge questions on the participant, and one
question listing 8 potential sources of information.
Of the 500 counselors asked to fill out the
questionnaire, 337 returned it. There
were 220 female and 117 males ranging from the age of 22 to 65 years of
age. On a scale of 0-10 (not competent,
extremely competent), respondents were to rate themselves on how
believed they were in helping students with eating disorders. 40% of the respondents rated themselves as
not very competent, 49% rated themselves that they were moderately
and 11% rated themselves as very competent.
75% of the participants did not believe it was their
role to treat
students with eating disorders, they instead would refer them to eating
disorder programs, their parents, or a physician. The
majorities of respondents had encountered
bulimic students and were very knowledgeable of signs and symptoms of
bulimia. The two main sources of eating
information used by most
counselors were professional journals and workshops and conferences.
seems to be a lack of research dedicated to the study of bulimia in a
social and school setting. Most of the
research focuses on the stress, contributing factors, and dieting
than how the issue is related to schools and education.
In order to help solve the problem of
bulimia, initiative needs to be taken from all points of the spectrum,
includes the help from schools. Teacher,
guidance counselors, and fellow schoolmates need to take a stand and
further educate students, as well as the staff, on the warning signs
symptoms of bulimia.
Bulimia nervosa is
recognized as being multi-determined with several factors involved in
aetiology. These are factors in such
areas as genetics, biological, familial, psychological and social
influences. Patients who suffer from
eating disorders are usually found to be suffering from some sort of
psychological problems at the current time.
But studies have found that there are recollections
of cognitive social
experiences, which include such things as loneliness, shyness and
inferiority in childhood and early adolescence (Troop, and Bifulco,
Troop, and Bifulco
(2002), conducted a study of the childhood social arena and the
in eating disorders. The researchers were
interested in finding out whether women with eating disorders who
difficulties in the social aspect of life as children involved
factors before the eating disorder developed.
A sample of 43 women with an eating disorder and a
sample of 20 women
without an eating disorder were interviewed.
Of the 43 women recruited for the study, 16 of them
were of the
binge/purge subtype and 12 were of normal weight bulimia nervosa. At the time of the interview, the women were
asked about their experiences with such feelings as loneliness, shyness
inferiority in childhood and adolescence.
The period that they were told to recall was up to
age 17. Researchers found that the women
bulimic experienced a higher level of loneliness, shyness and feelings
inferiority in adolescence than of those women who did not have an
disorder. However, when the women were
asked about earlier childhood experiences, there was not a significant
difference between the two groups. Researchers drew the conclusion that
women, who experienced higher levels of negative cognitive factors in
adolescence, may have led to the development of bulimia.
conclusion, for all these reasons, it is becoming
more important to educate young adolescents
that dieting is not a gentle
process. Students should know that
symptoms such as persistent irritability,
sleep difficulties, poor
concentration, menstrual irregularities and impulses to binge eating
calorie deprivation and subnormal body weights. Health
educators should be faced with the
informing the community that an importance on thinness and weight
for some young
adolescents may result in the development of bulimia or other
eating disorders. School counselors
should become more knowledgeable about eating disorders and school
should take the time
to prepare them for these situations, as well as the
students. More health promotions should
available for students who are struggling with their body
and should always have a place
to turn, whether it be family, peers, counselors
or teachers, rather than turn away and indulge in more
negative eating habits.