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 #BulimiaNervosa #pathophysiology #diagnosis #signs #symptoms #psychiatry #RiskFactors
