Bulimia, Anger, and Aggression in Teens

Gender was one area of difference in this Russian study.

Extensive research has tied bulimia nervosa to difficulties with emotion regulation as well as impulse control. These problems may increase the risk for affective and anxiety disorders, and can also lead to suicidal behavior, binge-drinking, and obsessive-compulsive disorders. Previous studies have reported that impulsivity and negative affect underly aggression in adolescents with BN (Compr Psychiatry. 2008. 49:364).

Gender has been one of the main predictors of differences in the forms of aggression. Boys are known to use direct aggression significantly more often than girls (Aggress Behav. 2006. 32:68), but results from studies evaluating social aggression among both genders have been mixed. Authors have reported either greater or no gender differences between girls and boys with BN (Curr Opin Psychol. 2018. 19:39). Dr. Roman Koposov and researchers from Northern State Medical University in Arkhangelsk, Russia, designed a self-assessment study to examine the relationship of aggression to “clinical level of bulimia symptoms” (CLBS) in adolescents (BMC Public Health. 2023. 23:833).

A study of BN, anger, and aggression

The final study group included a representative sample of 2613 adolescents 13 to 17 years of age from northwestern Russia. Slightly more than half (59.5% ) were female, which reflected the local public school population. The participants were students in the 6th to 10th grades, from Arkhangelsk, a city of about 39,000, where approximately 30,00 adolescents are in the 13- to 17-year-old age range. Aggression and anger were assessed with the Trait Anger Scale of the State Trait Anger Expression Inventory, the Anger Ruination Scale, and scales that weighed physically and verbally aggressive behavior.

Gender differences

CLBS were higher among girls than boys. Mean aggression ratings were higher among those with CLBS than those without; this was true across genders. Anger and aggression were significantly higher among boys on all scales, except for anger rumination. While boys scored higher on verbal and physical aggression in both the study and control groups, the research team noted only slight differences in social aggression. Other studies have shown the same pattern.

In both groups, there was a relationship between age and anger and aggression; higher scores were associated with increasing age. The subject of bullying raised the possibility that age might play a role among individuals with eating disorders. Because of conflicting results in similar studies, the authors point to the need for further studies to clarify this connection between bullying and eating disorders.

Limitations. The researchers also listed a few limitations. The cross-sectional design precluded drawing inferences, and a longer study might better define the observed associations. Because the study was conducted in northwestern Russia, the results shouldn’t be generalized to other populations, including clinical groups, say the authors—but this is a relatively unique aspect of the study, as research samples of those with ED from Russian are uncommon. Ideally, direct observations and reports from parents and teachers might have strengthened the findings.

The study results underscore the potential relevance of anger in understanding and treating those with symptoms of bulimia.

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