Academic journal article Journal of Eating Disorders

Uncontrollable Behavior or Mental Illness? Exploring Constructions of Bulimia Using Q Methodology

Academic journal article Journal of Eating Disorders

Uncontrollable Behavior or Mental Illness? Exploring Constructions of Bulimia Using Q Methodology

Article excerpt

Author(s): Kate Churruca[sup.1], Janette Perz[sup.1] and Jane M Ussher[sup.1]


Clinically diagnosable bulimia nervosa can be identified in approximately one in every hundred young women in Western societies [1,2]. There is evidence that the behaviors that characterize this condition, such as binge eating and purging, are becoming increasingly common, with a more than twofold rise in prevalence for both men and women between 1995 and 2005 [1]. Despite this general increase, bulimic behaviors still occur more commonly in women than in men [1,3,4]; as such, bulimia is viewed as predominately a woman's problem [5]. However, most women exhibiting bulimic behaviors do not seek help or treatment [6-8]. This is a matter of serious concern, given the numerous associated health risks, such as cardiovascular and gastrointestinal problems [9,10], as well as psychological distress and reduced quality of life [11-13]. As such, there is a need for research that examines factors that may influence help-seeking for bulimic behaviors.

A variety of factors have been implicated in the development and maintenance of bulimia, which can be broadly characterised as biological [14], psychological [15,16] and sociocultural [5,17]. However, bulimia is a complex problem, and is not easily explained through one particular factor, or type of factor [18]. Instead, integrating factors together within a multifactorial bio-psycho-social model is considered necessary to more fully understand eating disorders [18-21]. For such an approach to be truly integrative, however, it should not only focus on the way social, psychological and biological factors intersect to determine eating disordered behaviors. Rather, as is recommended in the study of all categories of health and illness [22,23], it should also examine the way social meanings of eating disorders affect subjective experience. Research into bulimia has generally focused on the multifactorial aetiology of the behavior [24], rather than the social meaning [25]. This is typical for investigations into psychiatric diagnostic categories [26], as causal pathways and behaviours are more readily observed and quantified than meaning [22], and statistical analysis of such pathways is highly valued in psychological and medical research [27]. However, social constructionism provides a theoretical basis from which to explore the variety of social meanings of bulimia, and the implications that these different understandings have for those involved.

Proponents of social constructionist theory argue that meaning and knowledge are constructed in ongoing processes of social interaction [28]. As such, one's perspective on a concept, such as bulimia, is always socially and historically situated, and open to being contested by competing understandings [28]. Bulimia might therefore be understood in terms of a number of alternate constructions: these are coherent accounts, representations, or ways of thinking about a topic, that circulate widely in our culture [29]. This includes biomedical, psychological and many social theories of eating disorders, that despite their differences, reflect a dominant construction that circulates in research, popular culture, and self-help resources, in which bulimia is positioned as an individual pathology and categorically distinct from normal eating behaviors [30-32].

These different constructions have different real-world implications for the subjectivity of those individuals engaging in bulimic behaviors; social constructionism suggests that they frame feelings, experiences, sense of self and perceptions of one's own behavior, making certain actions possible, while simultaneously closing down others [23,29,33]. For instance, the construction of bulimia as a mental illness, a common conceptualisation in the research literature [18,34], positions individuals with a bulimic diagnosis as not responsible for the abnormal and distressing condition they experience, and opens up the possibility for particular forms of treatment. …

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