bulimarexia in Medicine
Eating Disorders and Self-control
The current view of orthodoxy is that the eating disordered patient is attempting to reassert control over her life by ritually regulating her food intake and her body weight. In this respect, eating disorders resemble obsessive-compulsive disorders.
One of the first scholars to have studied eating disorders, Bruch, described the patient’s state of mind as “a struggle for control, for a sense of identity and effectiveness.” (1962, 1974).
In Bulimia Nervosa, protracted episodes of fasting and purging (induced vomiting and the abuse of laxatives and diuretics) are precipitated by stress (usually fear of social situations akin to Social Phobia) and the breakdown of self-imposed dietary rules. Thus, eating disorders seem to be life-long attempts to relieve anxiety. Ironically, binging and purging render the patient even more anxious and provoke in her overwhelming self-loathing and guilt.
Eating disorders involve masochism. The patient tortures herself and inflicts on her body great harm by ascetically abstaining from food or by purging. Many patients cook elaborate meals for others and then refrain from consuming the dishes they had just prepared, perhaps as a sort of “self-punishment” or “spiritual purging.”
The Diagnostic and Statistical Manual (DSM) IV-TR (2000) (p. 584) comments on the inner mental landscape of patients with eating disorders:
“Weight loss is viewed as an impressive achievement, a sign of extraordinary self-discipline, whereas weight gain is perceived as an unacceptable failure of self-control.”
But the “eating disorder as an exercise in self-control” hypothesis may be overstated. If it were true, we would have expected eating disorders to be prevalent among minorities and the lower classes – people whose lives are controlled by others. Yet, the clinical picture is reversed: the vast majority of patients with eating disorders (90-95%) are white, young (mostly adolescent) women from the middle and upper classes. Eating disorders are rare among the lower and working classes, and among minorities, and non-Western societies and cultures.
Refusing to Grow Up
Other scholars believe that the patient with eating disorder refuses to grow up. By changing her body and stopping her menstruation (a condition known as amenorrhea), the patient regresses to childhood and avoids the challenges of adulthood (loneliness, interpersonal relationships, sex, holding a job, and childrearing).
Below are a few images: