The article, “Experiences of shame and guilt in anorexia and bulimia nervosa" is written by Blythin, Nicholson , Macintyre , Dickson , Fox, and Taylor and was peer-reviewed and published in 2018. The intended audience of the article is health practitioners and researchers who could consider their proposal on examination of evidence as regards to the relationship that shame and guilt have and establish approaches to be considered to enhance physical fitness and reduce the risk of non-communicable diseases among people with bulimia nervosa (BN) and binge eating disorder (BED). Individuals with bulimia nervosa and binge eating themselves could also use such recommendations of approaches as done by the authors. Therefore, they could also form part of the intended audience (Goldstein & Gvion, 2019). As a definition, BN is an eating disorder in the Diagnostic and Statistical Manual of Disorders (5th ed.; DSM 5; American Psychiatric Association [APA], 2013), that has characteristics such as constant binge eating behavior together with disproportionate compensatory actions intended to avoid weight gain (Naor-Ziv & Glicksohn, 2016). This paper explores an article that talks about bulimia and risk factors for eating disorders and examines evidence as regards the relationship that shame and guilt have on people with anorexia and bulimia nervosa.
Summary of the Article
People with bulimia have a heightened risk of non-communicable diseases (NCD). The authors further expound that experiences of shame and guilt in individuals with bulimia are some of the risk factors leading to the eating disorder. The authors recognized that emotive states play a significant role in the development and persistence of anorexia and bulimia nervosa. The authors did a systematic review intended to establish the relationship between shame and guilt with eating disorders. Mathisen et al. (2018) gathered recent sources that have examined the elements of shame and guilt to eating disorders. They established that shame was more evidenced among individuals with eating disorders. They could have a clear determination of whether shame is more of a risk factor in the development of bulimia or an outcome of these disorders. Shame was more frequent but varied with the behaviors of eating disordered behaviors such as binging, purging, or limited eating. Among the studies reviewed, few of them were consistent with establishing the relationship between guilt and eating disorders. Also, reducing the risks is scarcely considered in standard cognitive-behavioral treatment (CBT).
Delegate your assignment to our experts and they will do the rest.
The objective of the article was the establishment of the relationship between shame, guilt, and eating disorders symptomatology. The reviewed sources collectively established that increased levels of shame and guilt would be linked with eating disorders when compared to non-clinical groups. People with eating disorders also show increased shame levels compared to other clinical populations such as depression and anxiety (Mathisen et al., 2018). Increased acuteness of eating disorders was directly proportional to reported levels of shame and guilt. Momentary feelings of shame and guilt appeared to rise before and then reduce after eating behaviors (Goldstein & Gvion, 2019). It is an indication that the eating disorder behaviors had a role in limiting feelings of shame. Shame that comes up because of body appearance has been most linked with eating disorders. The likelihood of feeling shameful revealed a relationship that was more inconsistent with eating disorders. Therefore, it may be significant theoretically and clinically to differential the concentration or source of feelings of shame.
Critical Analysis and Application of the Article to the Course
The portrayed occurrence of body-related shame and guilt in individuals with eating disorders suggests the likelihood to entertain global self-devaluations on the grounds of physical appearances. Bodily shame was maintained even after an individual recovered from an eating disorder. Further study is needed since there should be a possibility of bodily shame and guilt reducing if one gets the desired shape that was brought about by one devaluing himself or herself (Mathisen et al., 2018). The review reinforces findings that there is a positive relationship between eating disorder symptom acuteness and shame in subclinical groups. Shame could be reduced as an individual begin expressing an eating disorder (Goldstein & Gvion, 2019). This is because the linked behaviors could be efforts to be far from negative feelings towards oneself. The challenge of ensuring efforts to control dietary intake and weight could amount to increased shame and consequently lead to a maladaptive shame - eating disorder cycle.
An evident application of the study is that by implementing certain approaches eating disorders can be effectively reduced or eliminated. Thus, the study contributes to learning as well as interventional measures to disorders. Guided physical exercise and dietary therapy should be complemented by integrating CBT with a motivating interview to help patients with eating disorders (Mathisen et al., 2018). CBT is key in reacting to dysfunctional cognitions, whereas motivating interview helps to internalize treatment goals in the patient's mind (Smink et al., 2016). Indeed, it is evident that there are undue concerns regarding one's body, weight and shape, and the requirement to regulate eating as well as ambivalence towards change.
With the view of applying the components of CBT in this study in the field of psychology, it is evident through the study that individuals have not been able to exercise self-control in their lifestyle. This has predisposed them to poor eating behaviors. Thus, the article is more of creating awareness on how the risk factors (of shame and guilt) are contributing to eating disorders among patients. Patients and practitioners alike can benefit from it by understanding what causes eating disorders and how to prevent the same. In the field of psychology, someone can better the neurological factors and other risk factors that surround an individual so that they are inclined to eat abnormally. Consequently, there have increased cases of bulimia among people. The study lays a foundation for further studies in the field on better integration of Motivating Interview, and CBT on the treatment of eating disorders and other disorders that could cause poor health to individuals, predisposing them to non-communicable diseases. Thus, shame and guilt cause self-esteem issues and the way one views himself or herself. Indeed, they are risk factors that amount to bulimia among individuals.
The article is relevant since it helps in the understanding of mental processes inherent that pertain to patients with eating disorders. That is, a psychologist can recognize the underlying responses that determine the behavior of patients suffering from bulimia. With a proper understanding of the risk's impact, health care practitioners can come up with frameworks that can help people have proper responses to crave for unhealthy eating habits. People can make sound decisions in light of risks, but this with a proper understanding of the psychological issues that cause the behaviors.
Neurological Factors of Bulimia
Research alludes to a genetic link to eating disorders that have been linked with abnormal neurotransmitter frameworks comprising serotonin and dopamine. As neuro-scientific and biological factors of eating disorders are explained, several patients have been able to limit their confusion and self-blame (Goldstein & Gvion, 2019). They have come to realize the genetics and brain biology involved with the disorder. Several functional and anatomical variations in the brain itself are key in explaining the variations as they occur.
Thoughts emanate from the brain. It can be determined when a person is thinking or processing something in the brain through the electrochemical signals using medical equipment like EEGs, MRIs, and many others. When individuals have bulimia, their thoughts are extremely distressful, all-consuming, and, most of the time, distorted. Individuals with eating disorders have specific ways in which they hear, say things, perceive, or even do things (Naor-Ziv & Glicksohn, 2016). According to Smink et al. (2016), neuroscientists have been coming with substantial determinations on how and why the brain works differently. Several factors and brain determinations have revealed similar effects. Estonian researcher established that specific changes in brain chemistry with a particular serotonin neurotransmitter determined in people with eating disorders could be the cause of a strong thirst-for-thinness. Certain manner of thinking and the resultant behaviors and indications are most frequently an outcome of several biological aspects that join and cause eating disorder pathology.
It is well recognized that gut and hypothalamic frameworks lead to the regulation of energy processes and eating tendencies. Nonetheless, lately, studies in humans have shown that higher-order corticolimbic mechanisms probably determine the pathophysiology of eating disorders. The beginning of these networks entails the perceived significance of a food stimulus and the insula and anterior cingulate (Goldstein & Gvion, 2019). The insula, together with the frontal operculum, also produces fundamental sensory information regarding food. The second network entails the nucleus accumbens, putamen, and caudate, plus the orbitofrontal cortex and amygdala. Such sections explain the rewarding and stimulating aspect of eating and lead to strategy or avoidance of behavior.
The brain shows varied reaction to the anticipation and taking of food. Persons with bulimia or even binge eating disorder show decreased response when stimulating food reward in the insula and ventral striatum. Hay et al. (2020) established that such individuals would also show a heightened reaction to the reception of food in the same regions. On the other hand, people with bulimia show heightened and nervous sweet-taste expectations in the insula, striatum, and prefrontal cortex, as well as fewer responses in the insula and striatum to the tastes themselves. Disparities in the manner in which the brains of people with present or past eating conditions expect and process food rewards probably stimulate their attitude to food.
Dispensation of other significant stimuli also appears to be challenged with bulimia cases, which indicates a generalized deficit. In healthy people, the ventral striatum and dorsal caudate normally indicate increased reactions to reward as compared to punishment. On the other hand, imaging research in bulimia shows a dysfunctional neural assessment of reward and punishment. For instance, when coming up with decisions about monetary rewards, the women's brains with a history of bulimia does not provide a difference between victories and losses in the ventral striatal regions. Women that have reduced symptoms of bulimia also depict decreased reward response to money (Goldstein & Gvion, 2019). This is an indication that people with eating disorders could have the challenge of assessing rewards. With that, they do not exercise self-control when it comes to indulging in unhealthy eating habits.
People with eating disorders have experienced challenges with their inhibitory regulation. Persons with bulimia nervosa and binge eating disorders, in particular, in most cases, show decreased inhibition that goes beyond food. They indulge in deviant activities such as substance use, self-injuries, shoplifting). Neuroimaging reports indicate that this could only indicate failure to involve properly frontostriatal circuits that control behavior (Naor-Ziv & Glicksohn, 2016). Other functional MRI (fMRI) outcomes indicate that adults and teenagers with bulimia have decreased inhibitory activation. Other outcomes have revealed reduced activation of frontostriatal sections in teenagers with binge-purge syndromes. Inadequate or adequate activation in such control-based areas may clinically evidence as strain in preventing eating during binge moment, as well as challenge in stopping impulses to purge.
Increased cognitive control in individuals with bulimia may be led to a likelihood to restrain intake even when emaciated. Recent studies by fMRI of people with bulimia show heightened activity with dorsolateral cognitive circuitry linked with decision-making and inhibitory regulation (Goldstein & Gvion, 2019). Even though further research is necessary, the previous findings show that heightened activation in control-linked regions during the postponement of satisfaction may trigger the extreme or dietary restriction characteristic, as an abnormal eating habit.
Risk Factors Related to Eating Disorders
The term risk factor constitutes a measurable element that leads to the beginning of a disorder. Besides the many biological risk factors like genetic elements, eating disorders are caused by psychosocial risk factors such as environmental elements. There are general variable risk factors that could lead to the onset of eating disorders Stressing moments of life such as being exposed to physical and sexual abuse, specifically familial events (e.g., challenging parenting) and negative affectivity are not different between people with eating disorders or other psychiatric disorders (Smink et al., 2016). There are also shape and weight linked concerns, dietary limitations, and family history are some of the established risk factors that have led to eating disorders. Other risk factors could include health problems, bodily organ interference, and deficient bone mass development (Hay et al., 2020). Genetic factors have been discussed in detail above. Some people are susceptible to developing eating disorders because they have inherited such genes that are wired for the same from biological parents. There some evidence that confirms that some eating disorders are a constituent of the genetic makeup of a person. Nonetheless, not much has been established regarding the biological causes of eating disorders.
Psychological factors are those behaviors and personality elements that predispose a person to eating disorders. A person can be at a greater risk of showing some disordered eating habits because of several things that he or she does not take charge of (Naor-Ziv & Glicksohn, 2016). One of the psychological factors is reduced self-esteem. This is a case when an individual feels that he or she is inadequate and demeans himself or herself. She might not be happy about her body such that she indulges in binge eating to fit in society or some preferences that she has. There are also perfectionism and obsessive-compulsiveness or neuroticism perspectives. That is, an individual would think of herself or himself as a model. In that way, such individuals develop wrong eating habits to attain perfect bodies that they feel others could admire (Goldstein & Gvion, 2019). The individual also overvalues her body image to describe her self-worth. Such a person would always see herself negatively or be discontent about her body shape. In response, she indulges in eating abnormally.
Another aspect is negative emotions or pessimism, coupled with stress and depression. Negative emotions breed negative tendencies and desires in an individual. They become aggressive in things that harm their bodies because they endeavor to encounter negative emotions. People should be optimistic about themselves and take their body shapes positively, without allowing internal and external pressures to the challenge their impression about themselves (Smink et al., 2016). The negative energies could be one that takes the form of bad eating habits. Stress and depression are factors that also contribute to negative energies. Thus, an individual would eat a lot as a way of distancing himself or herself from the stressing agent.
Some characteristics could cause someone to develop eating disorders such as harm avoidance, excessive worries, anxiety, fear, cynicism, mentalities, and others. Such traits would only push somebody to other negative energies that cause them to eat abnormally. To avoid harm, they spend on food stores and have poor eating habits as their focus. Such individuals also would avoid interacting with others (Naor-Ziv & Glicksohn, 2016). Avoidance of social interaction only makes one mindful of himself and lose control of oneself. In loneliness, a person would indulge in junks and other unhealthy foods since that is craving that he or she may have, because of guilt and shame (Mathisen et al., 2018). Such individuals are also insensible to negative evaluations. Hay et al. (2020) elaborate that if someone comments negatively about their bodies, they became destabilized mentally, and their self- esteem is reduced. As such, by unhealthy eating habits, it would be the only way to counter negative evaluations about themselves.
Socio-cultural influences also lead to eating disorders. They include external and environmental experiences that would influence how a person perceives his or her body image. The socio-cultural factors are construed through platforms such as television, social media, magazines, advertisements, as well as film. Nonetheless, socio-cultural impacts can also be linked to experiences including peers, family, teachers, and other mentors or influence. Some people have been directed to eating disorders because of how they perceive the western beauty of ideal slimness, muscularity, and leanness. They afterward aspire to have the bodies that they saw on the television or other platforms. Particularly, when they consider the music and movie stars that they admire. They will also be under pressure to develop bodies like they have seen or even eat the foods that they have been seen eating.
There is also societal pressure to attain and be successful. The pressure causes stress to an individual who will develop an eating disorder because he wants to cope and fit in society. There is also the pressure to engage in a sport or industry that emphasizes on some type of a body (Naor-Ziv & Glicksohn, 2016). For instance, a model or athlete would always be expected to have some kind of body shape and size. For a gymnast, a person could be needed to be well-built. As such, the person would be under pressure to eat more but fails to indulge in enough exercise to balance the calories he or she is taking (Goldstein & Gvion, 2019). Peer pressure is also a factor that causes eating disorders. Adolescents will be under pressure since they are pushed by friends to be like another person. The person can be teased or bullied by friends regarding their body shape and weight, causing them to demonstrate poor eating habits to be accepted.
Social media plays a significant role in the lives of people, especially young persons. Social media is accessible and a perfect toolkit for getting information about their expectations in life. Through social media platforms, people get to create relationships as well as have a sense of identity and belonging (Naor-Ziv & Glicksohn, 2016). Some people are under pressure to develop body shape and weight that they saw on social media platforms. They do this without knowing that people give a false image of themselves based on their self-esteem. Images of thin, attractive individuals can widely be accessed through online platforms. Such images provide unrealistic standards of beauty that cause a profound impact on the body image of others to feel depressed about their bodies. Some images on the online platforms enhance body dissatisfaction by causing viewers to make a comparison of their bodies to the images they see, feeling less attractive themselves (Hay et al., 2020). Thus, people end up having eating disorders because they want to match up and develop a slimmer physique.
Conclusion
Various risk factors predispose individuals to bulimia and other eating disorders. The neurological factors of bulimia directly explain the other risk factors. Anxious disposition and harm avoidance are aspects of neurology that precede eating disorders among individuals. The mixture of heightened anxiety in desiring food and increased brain reward reaction to receiving it could be what makes it more challenging for individuals with bulimia to eat more. Genetic factors, psychological and social-cultural differences are major predisposing risk factors to eating disorders. Predominantly though, the psychological factors play a huge role since if one has a better view of himself or herself, he or she may not be under pressure to change his body shape. Shape and weight linked concerns, dietary limitation, and family history are some of the established risk factors that have led to eating disorders. Other risk factors could include health problems, bodily organ complications, and deficient bone mass development. Some people are susceptible to developing eating disorders because they have inherited genetic factors from their biological parents. Social media also puts a lot of pressure on young people who would want to be like the models they see about others.
References
Goldstein, A., & Gvion, Y. (2019). Socio-demographic and psychological risk factors for suicidal behavior among individuals with anorexia and bulimia nervosa: A systematic review. Journal Of Affective Disorders , 245 , 1149-1167.
Hay, P., Ghabrial, B., Mannan, H., Conti, J., Gonzalez ‐ Chica, D., Stocks, N., & Touyz, S. (2020). General practitioner and mental healthcare use in a community sample of people with diagnostic threshold symptoms of bulimia nervosa, binge ‐ eating disorder, and other eating disorders. International Journal of Eating Disorders, 53 (1), 61-68.
Mathisen, T. F., Sundgot-Borgen, J., Rosenvinge, J. H., & Bratland-Sanda, S. (2018). Managing risk of non-communicable diseases in women with bulimia nervosa or binge eating disorders: A randomized trial with 12 months follow-up . Nutrients , 10 (12), 1887.
Naor-Ziv, R., & Glicksohn, J. (2016). Investigating cognitive deficits as risk factors for developing eating disorders during adolescence. Developmental Neuropsychology, 41 (1-2), 107-124.
Smink, F. R., van Hoeken, D., Donker, G. A., Susser, E. S., Oldehinkel, A. J., & Hoek, H. W. (2016). Three decades of eating disorders in Dutch primary care: Decreasing incidence of bulimia nervosa but not of anorexia nervosa . Psychological Medicine, 46 (6), 1189-1196.
