Bulimia Nervosa (BN) is defined as a type of eating disorder in which repetitive binge eating episodes are followed by compensatory attempts like self-induced vomiting, purging, misuse of various medicines like diuretics, fasting or excessive exercise. The self-evaluation of people suffering from BN are seriously influenced from their body image and weight (American Psychiatric Association, 2015).
It’s well known that many women suffer from BN. However, the literature indicates that it’s more common among adolescents, probably because the rates of seeking for professional help among adult women are less (Grilo & Mitchell, 2010). Kayrooz (2001) indicated that young women are more concerned with ‘size zero’ as compared to adult women and men, and this might explain why adolescents develop BN more frequently than adults. It’s obvious that ‘size zero’ image pumped by media disproportionately affects young women. However, when cultural definitions of success and beauty strongly refer to slimness, this also leads adult women to develop a self-image preoccupied with body shape and eating disorders. Another reason why we know less about adult women suffering from BN as compared to youth is the ‘secretive’ nature of the disorder (Stavrou, 2009). The fact that binge eating episodes and successive compensatory behaviors are mostly conducted secretly and that the person usually conceals these behaviors from significant others result in avoiding from seeking for professional help unless the person cannot hide these behaviors anymore due to a serious health problem. It’s already rare among housewives to seek for professional help. Thus, what we know about housewives suffering from BN rest upon only a few case studies (Cooper, 2004; Van den Broucke & Vandereycken, 1988). The present article will also mention about cases of two housewives suffering from BN.
Hatice is 48 years old and her education level is primary school. Songül is 53 years old. She discontinued her secondary school education. Both women got married at young ages and they dedicated all their lives to household chores and to their children. As long as they had to deal with the problems of the children, they could avoid their own problems in their marriages. However, the children were grown up and were at the age of leaving the house. Hatice and Songül were feeling somewhat successful and important after doing house cleaning and cookery. That’s why overrated neighbor and relative visits and festive seasons. But in the other times, they were left to themselves and their unhappiness due to problems in their marriages.
Imposing slimness as a beauty criteria is the most significant acknowledged factor that contributes to the development of eating disorders (Grilo & Mitchell, 2010). Pumping the perception of ‘ideal body’ in the media, social circles, and in the family, praising weight loss while being critical about weight gain, making the weight gain/loss issue the primary topic in the social gatherings (after saying ‘hello’) while ignoring other important issues in one’s life (activities, concerns or successes) and several other examples show the extent to which people are preoccupied with the body shape issue today. Having an ideal body shape is internalized by many people regardless of gender, age, education level and economic background. It’s the crucial part of the self that has a significant impact on relating to other people. Many would accept that the ‘ideal body’ is not actually realistic. But still they would feel displeased about their body shape. The reason is that, slimness does not only mean being attractive, but it also indicates social status, will power, and being successful. A slim woman is also perceived as mentally stable, physically healthy, and having high self-respect. Therefore, the social construction of attractiveness is shaped by the meanings attributed to slimness and a woman who displays these qualities gains more positive social attention as compared to other women (Kayrooz, 2001). On the other hand, a woman who receives criticisms about her body shape might consequently develop a perception of self as being unattractive, unsuccessful, and unacceptable. The issue occasionally interferes with other problems between the couples and the woman feels herself guilty for not being attractive enough. The emotional distance between the couples and their inability to support each other are attributed to the woman’s unattractiveness. Problems become more complicated when the man behaves offensively, implies that he does not like his wife anymore, that she is ugly and old, when he compares his wife to other women, cheats on his wife and rationalizes his behavior by blaming her, makes her feel guilty about her body shape, etc. Eventually the woman develops eating disorder as a coping strategy to deal with the negative emotions experienced because of diminished self- worth.
Hatice, while looking at the mirror, thought that her husband was right. In the weekend family meeting, the conversation came around to how she and her husband married each other. While her husband was talking about how beautiful she was in the past, he laughed and mocked about her physical appearance today. The children laughed too and none of them realized that Hatice scowled. In the evening, when she told her husband how her heart was broken, her husband said: ‘Isn’t it true? You don’t take care yourself anymore.’ ‘Do you think you are young?’ ‘Other women who also gave birth to three children never look like you.’ ‘Sometimes I don’t even feel to come home’. ‘I don’t think we look good together’... Recently, Hatice began to hear these kinds of remarks too often. These remarks were too offensive for her. But she thought ‘if the man thinks like that, the woman should feel responsible’.
Lately, Songül was struggling with breast cancer. She defeated the cancer, but they took one of her breasts. Cancer put an end to the sex life with her husband. Before, they were occasionally having sex, though it was generally a sense of duty. However, the treatment lasted very long and her husband fell out of step with their relationship during this period. Songül didn’t want her breast to be taken, but the doctor said that they had to. Since the surgery, she was thinking to herself that she has been a ‘deficient woman’. In fact, her fears eventually got real. Her husband wasn’t coming home for days and they weren’t having sex if he came.
Why does a woman continue an unhappy marriage despite all problems? One reason might be not being able to return to her own family and fear of being exposed to social pressures imposed on divorced women. Additionally, ‘being anxious about living entirely on one’s own’ might lead to a woman to lock herself up in a marriage in which she feels more and more unhappy every day. There are studies indicating that women suffering from BN commonly report a conflict between being either dependent and passive or gaining their independence (Kayrooz, 2001). The woman thinks that she doesn’t have adequate resources (i.e., education, profession, carrier) to continue entirely on her own. On the other hand, if someone reminds her about her skills and tells her that she can make money, she generally feels anxious and fearful rather than feeling happy and proud. This conflict, that the woman locks her up in an unhappy life due to feeling anxious about living entirely on one’s own, leads to a thinking style characterized by themes of weakness and helplessness. Within this perplexity, BN becomes a coping strategy. When the woman cannot engage in active coping strategies for her problems, she avoids from her negative feelings through being preoccupied with her body and through bulimic behaviors. In this way, a woman who wants to divorce and leave the house, but cannot do, at least escapes from her emotions and problems in her marriage (Stavrou, 2009).
Seeing oneself as overweight, inability to lose weight, and binge eating behavior significantly lower the self-worth of people with BN, which in turn leads to a depressive mood (Kayrooz, 2001). Internalizing the ‘slim and beautiful’ ideal too much results in a relentless attitude toward one’s self, despite the absence of others that impose pressures. Self- evaluations generally rely upon body shape, body weight, and the extent to which one can control her eating behavior. If it’s controllable, she is happy; otherwise she is unhappy. When something goes wrong with her life, she falls back on bulimic behaviors. Binge eating provides a temporal relief. In this way, she avoids from thinking about more distressful problems for a while. But after that, she feels more guilty and unhappy for not being able to control her eating behavior. This vicious circle explains how BN is maintained (Grilo & Mitchell, 2010).
Kitchen was the place where Hatice felt herself successful and important, the place where she felt almost self-actualized. Hatice loved to cook. Her neighbors used to say that there wasn’t any meal that she couldn’t cook. Being aware of her neighbors’ admiration, she liked to invite them at least once a weak to eat and chat. Everyone should have acknowledged how skillful, gifted, and hard-working she is as a housewife. Hatice also loved to eat, as much as she loved to cook. But lately, when she invited her neighbors, she wouldn’t eat with them. She talked all the time, telling about this and that to her neighbors. However, she was thinking about the food at the table. When her neighbors asked, she said she was dieting. She said, in an extravagant manner, that it wasn’t difficult for her to diet, she just didn’t want to eat anything, and that she was taking long walks in the evenings. However, this wasn’t the truth. She would prepare many things for the dinner and then she would wait for her husband to come home until late. As hours passed, it would be more difficult to bear with the thought that her husband might be cheating on her. Finally, she would start eating. As she was alone at home there were nobody to see her eating. So, she would eat more. But after that she would feel guilty and think why she ate that much after spending the whole day starving. But there were hours to the evening. She was watching her neighbors out of the tail of her eye while talking about her dieting. The neighbors were looking at her, admiring. Hatice was feeling slightly relieved when she saw these looks.
Secrecy has an important contribution to the maintenance of BN: It almost completely isolates the person, who is already feeling alone. Instead of relating to other people or actively solving the problems in the relationships, the person estranges herself. In addition to this, secrecy also indicates problems about feeling accepted and trust. The person doesn’t share with other people the situations in which she lost control and she detested herself. This in turn reinforces the thought that other people wouldn’t accept her as she is, wouldn’t support her or even would feel disgust for her if they knew about her behaviors (Kayrooz, 2001). This thought reminds the person how unlovable she is. For a person who doesn’t trust others or doesn’t feel that she is in an accepting environment, it’s not possible to show genuiness to others. In fact, sometimes the person reflects negative emotions towards herself to other people around her.
Ever since she had binge eating episodes, Songül isolated herself from her children and her neighbors more and more. She was trying to spend the whole day outside. She was taking long walks and was going to shopping so that she could distract herself thinking about the food. She was buying unnecessary items and she didn’t care. After all, she was spending the whole day without eating. On the other hand, when she was with her children she couldn’t refrain from binge eating. Her children were looking at her dreadfully, and she was feeling so embarrassed that she didn’t want to visit or invite her children. She was afraid that, like her husband, her children would completely leave her or wouldn’t look after her when she needed care. She thought her children weren’t concerned about her to the slightest degree. They had no idea about her suffering.
People suffering from BN generally receive less social support. They lack emotionally supportive and accepting relationships in which they can share their pain and worry in confidence (Cooper, 2004). Moreover, they usually feel detest for themselves for their bulimic behaviors like binge eating/vomiting cycle. It’s very difficult for a person whose self-respect became so vulnerable to effectively cope with the threats toward her self-esteem that come from spouse, family, or social circle. So, bulimic behaviors are maintained as a coping strategy. Being unable to control her spouse and social circle, to re-gain her self-esteem, the person heads for her own body, on which she can use absolute control.
Objectification theory mentions about how women’s bodies are perceived separately from their identities (who she is, her personality, what she is doing with her life, etc.) (Fredrickson & Roberts, 1997). BN is only one type of disorder that is apparent among women whose self-evaluations are locked in a struggle to control their bodies. It’s suggested to develop therapeutic strategies focusing on the marital and social problems as well as to support effective coping skills. Additionally, while studying with housewives suffering from BN, it’s crucial to attend the woman’s thoughts about independent living and to take steps for strengthening her resources. However, the fundamental factor that will liberate women from BN is certainly struggling against the societal point of view that defines women’s value in terms of body shape.