Bulimia Nervosa: Pathogenesis and Risk Factors

Biological Risk Factors

 • Gender: F > M

 • Genetics: Some familial transmission

 • Possible link to excessive ghrelin production (ghrelin stimulates appetite, promotes fat storage)

 • Early pubertal maturation (hormones modulating brain in way that is out of sync with typical adolescent brain development, causing disordered feeding patterns)

Environmental Risk Factors

 • Promotion of the thin ideal (concept of ideal female body as having a small waist and very little body fat) as the definition of femininity and measure of self worth - varies across cultures and can be Of higher value in particular occupations (ex. professional athletics)

Psychosocial Risk Factors

 • History of childhood physical or sexual abuse

 • Family dysregulation

 • Often from families with obese individuals

 • Childhood obesity (body image concerns from young age)

Neurobiological Risk Factors

• Reward Pathway Hypothesis: Dysregulated response of reward pathways in the brain in relation to eating

 • Altered brain structure and function = hunger and satiety states not accurately interpreted



PREMORBID CHARACTERISTICS

Emotional Dysfunction:

 - Poor ability to handle negative emotional arousal

 - Emotion Dysregulation - Labile mood

 - Lack of Interoceptive Awareness: Inability to identify internal physiological/emotional states

Cognitive Dysfunction:

 - Appearance over-evaluation

 - Cognitive biases when processing information related to food, weight and shape

 - Internalization of the "thin ideal"

 - Rigid and obsessive thinking patterns related to eating

Personality Traits:

 - Obsessionality, compulsivity and rigidness

 - Neuroticism: High tendency to worry and experience anxiety

 - Impulsivity: Related to purging, high rates of substance use

 - Perfectionism: Self-criticism, fear of failure, excessive concern over mistakes



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