Association between Puberty , Bulimia Nervosa and Depression

Background: Anorexia Nervosa (AN) and Bulimia Nervosa (BN) are diseases characterized by an eating disorder, distorted weight regulation and distorted perception of one’s body. In the period of puberty adolescents are becoming increasingly vulnerable to eating disorders. Objective: The target of this study was to examine the prevalence of possible eating disorder (bulimia nervosa) and depression in the period of puberty. Methods: The study group included 233 students from secondary schools, of whom 128 were boys and 105 girls, with an average mean age of 14 years. The Eating Attitude Test (EAT-26) and Children’s Depression Inventory (CDI) were applied to the entire study population. Also we calculate the Body Mass Index (BMI); a parameter defines as the ratio of human body weight and height. Results: According to the EAT, 73 (32%) students had a EAT score indicating a possible diagnosis of bulimia nervosa. The authors observed statistically significant increased frequency of depressive thoughts in the study group. 188 (81%) students had emotional symptoms of depression Correlation results indicated that depressed mood scores positively correlated with bulimia scores. Conclusions: We observed high prevalence of bulimia nervosa and depression in the period of puberty.


Introduction:
Adolescence is a period which is characterized by significant physical, emotional and intellectual changes.This is a period of growth which is characterized by the change in body proportion, size, weight and body image, development of sexuality and reproductive functions.These changes are a normal transition from childhood to adulthood.But adolescents are experiencing these changes in different ways.During puberty, most of the adolescents feel out of control with their body.At this stage, they are no children, but they are young people who keeping up with the transition can be a change.This is not new that more development changes occur during puberty, that in only other life stage.Also the puberty starts earlier now than ever before.The young person thinks:"What is happening with my body?"To answer of this question will help him/her to know about and understand these changes before they occur.Also it is very important to recognize that no two people are exactly alike, puberty comes at different times for everyone 1 .In this period of their life many adolescents, because of their stage of cognitive development, lack the psychological capacity to express abstract concepts such as self -awareness, motivation to lose weight or feeling depression 2 .Depression always goes hand -in -hand with some kind of eating disorders, like anorexia nervosa and bulimia nervosa 3 .Eating problems are common in children and adolescents, and eating disorders typically have their onset during these developmental periods.Anorexia nervosa is a serious and potentially lifethreatening disorder associated with food restriction, malnutrition and distorted thinking about body shape and weight.On the other side bulimia is more frequent than anorexia, with prevalence at 90 to 95% among females 4 .Bulimia nervosa is complex illness affecting adolescent with increasing frequency.It is characterized by period of restriction followed by binge eating and purging behaviors (vomiting, laxative use) and often begins during early adolescence (ages 15 to 17 years).This kind of eating disorder is associated with serious biological, psychological and sociological morbidity 5 .
There are several psychological hypotheses that attempt to explain indication as an etiologic factor of bulimia nervosa.Psychiatrists and psychologists think that this kind of eating disorder is more prevalent in industrial countries, in the family with conflicts, social isolation and emotional deficit.
In the last few years, many researchers have focused their attention on the study of the relationship between depressive symptoms and eating disorder in period of adolescents [6][7][8] .Studies emphasize a frequent association between bulimia nervosa and depression as psychiatric conditions.The young person feels sad, lonely, empty and isolated.To our knowledge this is one of the first studies in which the relationships between the bulimia nervosa and symptoms of depression have been investigated in our population.

Aims of research:
The aim of the present study is to investigate the correlation between bulimia nervosa and depression in period of adolescence.To achieve this aim, the following goals are pursued: 233 100 On the other hand most of the students in our study had negative emotions not only about their weight.In the study group the following results we obtained using the BDI survey: 45 students scored under 24 points indicating no clinically significant depressive symptoms, 188 students scored above 24 points showing the presence of clinically significant depressive symptoms (Table 3).Among the mental disorders, eating disorders have gained exceptional importance in recent decades, as evidenced by the numerous studies related to these diseases.This interest is stimulated by the need to prevent; to early detect and to effectively threat a group of disorders that affect a large population sector.A variety of factors including personality, genetic inheritance, neurobiological alteration and the mass media's portrayal of thinness as an attractive quality, all play a role 12,13 .However the number of adolescents displaying eating disorder decreased from the beginning of the year to the end.Anorexia nervosa and bulimia nervosa often are chronic eating disorders associated with high co morbidity.Researchers found increase disordered eating behaviors and depression among adolescents who had bulimic problems 14 .There is inconsistent findings concerning the relationship between obesity and depression.Some studies included that there was no relation between obesity and depression 15 , while others reported that obese people had higher risk of depression 16 .Goodman and Whitaker showed that depressed adolescents are at increased risk to the development and persistence of obesity later in their life.They concluded that depression in adolescence was positively associated with body mass index during adulthood.Also they thought that psychological distresses caused by obesity may lead to depression.
In this paper we tried to find the relation between BMI, EAT-26 and CDI in a sample of 233 boys and girls in period of puberty.We found that overweight and obesity in adolescents of secondary school are on the increase.Research among students has suggested that the EAT-26 is an internally consistent scale with an alpha coefficient of 0.765.A score greater than 20 is considered to be an indicator of a possible eating disorder.Also results of our analyses indicate that BMI and depression are associated.In general, it can be concluded that higher BMI may result in more severe forms of depression.The depression of adolescents refers to a set of emotions and behaviors such as sadness, unhappiness, blue feelings, poor appetite, insomnia 18,19 .It is known that adolescent depression in this case is associated with their psychological difficulties about their overweight and obesity.Adolescents may present significant difficulties related to eating, body image and weight control habits.The young people who believe they are overweight prior to puberty may be at risk for the development of disordered eating, related problems and depression mood.
The family often plays a big role in whether a person develops an eating disorder.Negative family influences such as being teased about appearance, overly critical parents and siblings and pressure to be thin are all risk factor.Studies and research also show that eating disorders (anorexia nervosa or bulimia nervosa) are more prevalence in people who had one or more parents who were overprotective, detached and critical with their children.Given that adolescents with eating disorder usually live at home and interact with their families on a daily basis, the role of family should be explored during both evaluation and treatment, with particular given to the issues of control and responsibility for the adolescent within the family context.

Conclusion:
From the results of this research this paper can be considered among the first works of its kind in the region of the Republic of Macedonia and it connection with determining the correlation between obesity and depression.The results indicate a high level of depressed emotions and dissatisfaction with their figure among adolescents.Further research is needed to better understand the structure of such complexity.This research showed that obesity and depression are associated, but maybe the form of the relation is different among boys and girls.

Table 2 :
10andardized self-report measure of symptoms and concerns characteristic of eating disorder9.This test is good at detecting clinical cases in high-risk populations and identifying individuals with an abnormal occupation with their diet and weight10.EAT-26 is a 26-item self-report instrument.bulimia nervosa From table 2 we can see that a great number of our participants are young subjects with excessive intake of food, with a sense of loss of control ever eating.Prevalence of students according to EAT-26 scores.
To classify adolescents by their Body mass Index (BMI) -how BMI varies in period of puberty; To estimate the magnitude of bulimic problems among boys and girls; To find out the relation between bulimia nervosa ad level of depression in period of puberty.Material and methods: ParticipantsThe participants in this study were 233 8 th -grade basic general education students, of whom 128 were boys and 105 girls with an average mean age of 14, 6 years.The undergraduate students who volunteered to participate in the study were explained about the purpose of the study and implications.The students were assured anonymity and were told to respond honestly.The questionnaires were administered collectively in the participants' classrooms.Finally, height and weight measurements were taken of all participants.InstrumentsThe Eating Attitudes Test (EA-26) is probably the most widely used

Table 3 :
Prevalence of students according to CDI

Table 4 .
The mean average of BMI among students was 22.5 kg/m 2 .The average total score obtained on the EAT-26 was 20.8 points, with values ranging between 0 and 76 points.The mean CDI scores was 32 with range of 54 (0-54).The correlation of statistical significance by Pearson between BMI, bulimic symptoms and depression is at the level of 0.01.

Table 4 :
The correlation between BMI, EAT-26 and **. Correlation is significant at the 0.01 level Discussion: