... bulimia is, and the person's response to treatments: Support groups may be helpful for mild bulimia without other health problems. Counseling, such as talk therapy and nutritional therapy are the first treatments for bulimia that ...
... weight gain. Many people with bulimia also have anorexia nervosa . Causes Many more women than men have ... to go to the hospital, unless they: Have anorexia Have major depression Need medicines to help them ...
Muuss, Rolf E.
Defines bulimia and lists associated features of bulimia, physical side effects, and cognitive disturbances related to binging and purging. Asserts that bulimics resist treatment; but that such methods as cognitive, group, family, behavior, and drug therapy, and hospitalization appear promising. (Author/ABB)
de Tournemire, R
Binge eating, bulimia nervosa, binge eating disorder, anorexia-bulimia are terms often used without really knowing what precisely one is referring to. Otherwise, there are many articles concerning anorexia nervosa in medical literature, a disease, which can be seen and fascinates. These eating disorders are frequent in today's society; medical, psychological and social consequences are important. PMID:24090668
Weinstein, Harvey M.; Richman, Ann
Bulimia has become an increasing problem in the college population. This article describes a group psychotherapeutic treatment approach to the problem. A theoretical formulation of the psychodynamics that may underlie the development of bulimia is offered. (Author/DF)
Santomango, Gloria Jean
There are three known diseases of eating disorders: compulsive overeating, anorexia nervosa, and bulimia. All three affect various body systems, are pathological in nature, and are addictive behaviors that mainly affect females. All can be fatal if not treated or under-treated. Compulsive overeating is the most known of the three disorders. The…
Johnson, Craig; And Others
Describes a treatment approach for the symptom management of bulimia that is a synthesis of various techniques, including cognitive-behavioral therapy, response prevention, relapse training, and psychodynamic therapy. The model has been a useful teaching tool for staff and patients in both group and individual formats. Addresses the challenges of…
Roberto, Laura Giat
Within families with bulimia, certain interactional patterns enable and perpetuate the patient's binge-eating and purging symptoms. A transgenerational treatment method is proposed, which intervenes in ongoing dysfunctional patterns, and provides a frame for creating a therapeutic metaphor ("legacy") to direct the therapy. Rationale and stages of…
The article reviews the literature on anorexia nervosa, with or without bulimia, and presents a comprehensive picture of this eating disorder, focusing on terminology, historical references, prevalence, prognosis, classification, diagnostic criteria, physical and psychological characteristics, evolution of the disability, etiology, treatment, and…
Vindreau, C; Ginestet, D
We report the psychopathological study of 20 subjects with the Bulimia syndrome (DSM III criteria) specifying affective, emotional state and psychiatric symptoms associated with the eating disorder. Evaluation was made using self-rating questionnaires, anxiety and depression rating scales and specific rating scales for various clinical dimensions (impulsivity and mood). Two groups of subjects differing from one another on their elective appetite and taste for two types of food (sweet versus salty) are distinguished. Clinical characteristics of each group are different: Carbohydrate bulimics are more impulsive, dysphoric, make much greater use of medications, drugs, and alcohol than salted food bulimics do. Patients of the second group are more anxious and emotionally blunted. Anorexia nervosa was more often present in their past. The two groups differ also in their responses to serotoninergic and noradrenergic medications used here in open trial. These results are consistent with literature data on carbohydrate metabolism, impulsivity disorders, depression and cerebral serotonin. PMID:3109875
Muuss, R E
Bulimia, an eating disorder, recently has emerged as a major mental health problem, especially among adolescent females. The bulimic experiences periods of compulsive binge eating followed by purges to rid the body of unwanted calories. Binges are triggered by intense emotional experiences, such as loneliness, anger, rejection, or stress. Associated features of bulimia are secretiveness, depression, drug abuse, preoccupation with body image and sexual attractiveness, and an awareness that the behavior is abnormal. The physical side effects include dental problems, inflamed esophagus, EEG abnormalities, abdominal or urinary disturbances, and changes in blood sugar level. Cognitive disturbances related to binging and purging are perfectionistic, egocentric, and distorted thinking, misconceptions about nutritional requirements, unreasonable goals and expectations, and disturbed affect. Bulimics resist treatment; however, such methods as cognitive, group, family, behavior, and drug therapy, and hospitalization appear promising. PMID:3461693
Hoste, Renee Rienecke; Labuschagne, Zandre; Le Grange, Daniel
Onset of bulimia nervosa (BN) typically occurs in adolescence and is frequently accompanied by medical and psychiatric sequelae that may have detrimental effects on adolescent development. Potentially serious medical consequences and high comorbid rates of mood disorders and suicidality underscore the need for early recognition and effective treatments. Research among adolescents with BN has lagged behind that of adults, although evidence is accumulating to support the efficacy of family-based interventions and cognitive behavioral treatments that are adapted for use with adolescent populations. The aim of the current article is to provide an overview of recent research on epidemiology, risk factors, diagnostic issues, and treatment interventions focusing on adolescent BN, and to highlight areas for future research. PMID:22614677
López-Ibor Aliño, J J; Cervera Enguix, S
Anorexia nervosa and bulimia nervosa are at the present moment, two well defined clinical entities among the group of the eating disorders. The psychopathological differentiation of both syndromes has a great importance for diagnosis and therapy. The authors make a phenomenological description, based on case histories of patients with diagnostics of anorexia and bulimia nervosa, and try to establish an approach to the essential symptomatology of those disorders. The presence of affective symptomatology--depressive, but not exclusively--in the eating behaviour disorders in general and particularly in bulimia nervosa, is nowadays interpreted as an unspecific emotional lability as a response to stressing situations. That is to say, it is a secondary depressive symptomatology, more than a primary mood disorder preceding or underlying bulimia. There is strong evidence in favour of a dysregulation of serotonin metabolism in patients with bulimia nervosa, in the sense of a reduced activity, which manifest itself clinically by binges with food with a high content in carbohydrates. High levels of 5-HT seem to induce increasing feelings of safety, fullness and lead to an interruption of eating. Fluoxetine and this active metabolite are selective inhibitors of the reuptake of 5-HT and their antibulimic effect could be mediated by this mechanism. PMID:1687234
Getzfeld, Andrew R.
This paper reviews the literature on the physiological causes of bulimia and investigates the rationale behind the usage of antidepressant medication in the treatment of bulimia nervosa. No definite conclusions can be stated regarding the physiology of bulimia, but a number of hypotheses are suggested. It appears that the hypothalamus is involved…
Rushing, Jona M.; Jones, Laura E.; Carney, Caroline P.
Bulimia nervosa is a psychiatric condition that affects many adolescent and young adult women. The disorder is characterized by bingeing and purging behavior and can lead to medical complications. Thus, patients with bulimia nervosa commonly present in the primary care setting. Physical and laboratory examinations reveal markers of bulimia nervosa that are useful in making the diagnosis. Treatment is beneficial, and outcomes of early intervention are good. This article discusses the history, presentation, and tools needed for recognizing and treating bulimia nervosa in primary care. PMID:15213788
Westmoreland, Patricia; Krantz, Mori J; Mehler, Philip S
Anorexia nervosa and bulimia nervosa are serious psychiatric illnesses related to disordered eating and distorted body images. They both have significant medical complications associated with the weight loss and malnutrition of anorexia nervosa, as well as from the purging behaviors that characterize bulimia nervosa. No body system is spared from the adverse sequelae of these illnesses, especially as anorexia nervosa and bulimia nervosa become more severe and chronic. We review the medical complications that are associated with anorexia nervosa and bulimia nervosa, as well as the treatment for the complications. We also discuss the epidemiology and psychiatric comorbidities of these eating disorders. PMID:26169883
Typical DSM-III-R bulimia nervosa with self-induced vomiting was found in 2 women of Hong Kong Chinese origin and a Chinese man from Malaysia. All 3 cases had a family history of obesity. In 2 of the cases a period of weight gain and in the third case frank obesity preceded the onset of the eating disorder. Cultural transition seemed to play an important part in the onset and maintenance of the eating disorder. PMID:8293034
Ruhl, Berenice; McCanne, Thomas R.
It has been suggested that a lack of assertiveness may be an important component of the psychological make-up of bulimic women, and that bulimic women may experience particular difficulties in asserting themselves in interactions with men. In this study, 23 women reporting the symptoms of bulimia by high scores on the Bulimia Test (BULIT) and 21…
Thompson, G. Sue
Anorexia nervosa and bulimia are currently being studied with great intensity by the medical profession. Anorexia nervosa was first described in the medical literature in 1868, but was considered a rarity until the late 1930's. Bulimia was not identified in the medical literature until 1979. Recent studies suggest that approximately five percent…
Copeland, P M; Herzog, D B
The increased prevalence of bulimia has received great publicity by the news media. Such publicity predisposes individuals to self-diagnosis. A 57-year-old man with a 10-year history of food regurgitation presented to an eating disorder clinic complaining of bulimia, which he had heard discussed on a television talk show. He proved not to have bulimia but a large pharyngoesophageal (Zenker's) diverticulum. The diagnosis of bulimia may be misattributed to various symptoms by patients. The differential diagnosis of chronic regurgitation and vomiting must be considered in such patients. PMID:3086293
Describes bulimia, a disorder involving binge eating and purging increasingly prevalent in young women. Reviews the literature and describes symptoms, etiological factors, and treatment considerations and approaches for the disorder. (Author)
Sweeten, Mary K.
The eating disorders called anorexia nervosa and bulimia are examined in terms of their symptomatology, etiology, and treatment, and in terms of how the extension home economist or teacher can help. Resources for additional information or help are listed. (CT)
Goldbloom, D S; Kennedy, S H; Kaplan, A S; Woodside, D B
No definitive therapy exists for anorexia nervosa (AN) or bulimia nervosa (BN). Nevertheless, biologic and psychologic research into these disorders has increased over the last decade. We examine the various drugs available for treatment. Advances in pharmacotherapy for AN have been modest and have reflected efforts either to stimulate hunger and weight gain or to control complications of the starvation process. Food remains the "drug" of choice. Antidepressants have been found to be beneficial in the treatment of BN. The meaning of this in the context of a relation between BN and mood disorders remains unclear, since coexistent depression does not predict a positive response to these drugs. Pharmacotherapy represents a single but important dimension of the management of patients with eating disorders. The optimal integration of drug therapy and psychotherapy and the identification of predictors of a positive response to drugs have yet to be addressed by clinical research. PMID:2565759
Segal, Shirley Ann; Figley, Charles R.
Surveyed 160 college women to examine the incidence of bulimia and its relationship to shyness. Results indicated 23 percent of the participants were bulimic. A significant relationship was found between bulimia and fear of rejection (private shyness). (JAC)
Outlines a sociocultural perspective of bulimia. Notes that since bulimia occurs in a sociocultural context, which includes a socialized developmental path with concomittant norms and values, effective treatment must address those norms and values. Recommends group therapy. (ABB)
Cesari, Joan P.
Differences between fad bulimia and clinical bulimia are presented using Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria, personality assessment measures, and responses to counseling. (Author)
Zimpfer, David G.
Reviews descriptive and experimental research relating to the eating disorder known as bulimia nervosa. Reviews outcome studies of group treatment of bulimia to examine the effectiveness of group intervention. Provides recommendations for practice and future research. (Author/PVV)
Chen, Eunice Y; Le Grange, Daniel
Cluster analyses of eating disorder patients have yielded a "dietary-depressive" subtype, typified by greater negative affect, and a "dietary" subtype, typified by dietary restraint. This study aimed to replicate these findings in an adolescent sample with bulimia nervosa (BN) from a randomized controlled trial and to examine the validity and reliability of this methodology. In the sample of BN adolescents (N=80), cluster analysis revealed a "dietary-depressive" subtype (37.5%) and a "dietary" subtype (62.5%) using the Beck Depression Inventory, Rosenberg Self-Esteem Scale and Eating Disorder Examination Restraint subscale. The "dietary-depressive" subtype compared to the "dietary" subtype was significantly more likely to: (1) report co-occurring disorders, (2) greater eating and weight concerns, and (3) less vomiting abstinence at post-treatment (all p's<.05). The cluster analysis based on "dietary" and "dietary-depressive" subtypes appeared to have concurrent validity, yielding more distinct groups than subtyping by vomiting frequency. In order to assess the reliability of the subtyping scheme, a larger sample of adolescents with mixed eating and weight disorders in an outpatient eating disorder clinic (N=149) was subtyped, yielding similar subtypes. These results support the validity and reliability of the subtyping strategy in two adolescent samples. PMID:17949682
Tillmann, Lisa M.
In 1996, the author published "A Secret Life in a Culture of Thinness: Reflections on Body, Food, and Bulimia" (Tillmann-Healy, 1996), an account of her struggle with binging and purging from ages 15 to 25. She came to understand bulimia as a communicative act, expressing fear, anxiety, and grief. From 25 to 35, her recovery from bulimia involved…
Quadflieg, Norbert; Fichter, Manfred M
We reviewed the literature on the course and outcome of bulimia nervosa. Longer-term outcome is associated with a considerable degree of relapse and chronification. Diagnostic crossover to anorexia nervosa and binge eating disorder is low. Mortality in bulimia nervosa is considerably lower than in anorexia nervosa. Social adjustment and sexuality apparently normalizes in quite a few bulimic women over the course of time. A large group of bulimic patients, however, chronifies and suffers from severe bulimic symptoms and social and sexual impairment. Assessments using more systematic categories and standardized reporting procedures are required in order to make the results of studies comparable and to allow generalized conclusions. PMID:12567221
Cummings, Anne L.
Written responses of three women with bulimia were analyzed for instances of metaphoric understanding of their difficulties with food during 20 to 24 therapy sessions. Results show a gradual deepening of the metaphoric understanding of what the troubled eating represented for each client. Metaphoric understanding included ways of dealing with self…
Bauer, Barbara G.
Bulimia, an eating disorder characterized by binge eating followed by purging and intense feelings of guilt and failure, is increasing among young women. The eating behavior is only a symptom of more complex underlying problems such as feelings of inadequacy, social isolation, depression, rigid thinking, self-defeating thoughts, and perfectionism.…
Describes bulimia, its symptoms, characteristics and bulimic's family profile. Disorder may be more difficult to hide at camp. Camp staff could be first to recognize symptoms. Describes behavior indicators of bulimics. Suggests appropriate responses and counseling techniques for helping bulimic campers. (TES)
Katzman, Melanie; Weiss, Lillie
In spite of growing attention to the negative psychological and physiological consequences of bulimia, little has been written on its treatment. A comprehensive group treatment program was developed to increase the bulimic's comfort with herself and her body. Subjects were five single females (four college students and a nurse) who participated in…
Kirkley, B G
Bulimia is characterized by recurrent episodes of binge eating and severe self-deprecation, often accompanied by self-induced vomiting and/or laxative abuse. It is most often found among young women in their late teens to mid-30s. Estimates of the disorder's prevalence vary widely, depending on the diagnostic criteria used, but usually range from 5% to 20% of college age women. Binge eating typically begins in late adolescence, frequently after a period of dieting to lose weight. Self-induced vomiting usually follows the onset of binge eating by about a year. To date, theories of the disorder's etiology have included several biological models, a psychosocial model, and a biopsychosocial model. The biological models proposed have viewed bulimia as a form of biological depression, neurological disturbance, or metabolic disturbance. The psychosocial model suggests that society's pressure on young women for extreme thinness leads to excessive dietary restraint, deprivation, and, paradoxically, binge eating. The presence of anxiety or depression exacerbates the process. The biopsychosocial model appears to be the most promising. It proposes that young women with biological predispositions toward overweight, depression, or metabolic disturbance are particularly vulnerable to social pressure for thinness, the binge eating that may result from excessive dieting, and, hence, bulimia. The complex nature of bulimia suggests that a multidisciplinary team approach treatment is appropriate. PMID:3514731
Bauer, Barbara G.; And Others
This book was written for practitioners working with bulimic clients and for clients themselves. Bulimia is presented as a multidimensional problem requiring a multidisciplinary team approach to treatment. An introductory chapter presents six treatment sessions with a bulimic client which provide an overview of the experiences and attitudes of the…
Bulimia Nervosa (BN) is a chronic disorder that results in a high degree of psychological impairment for many women. This article presents a description of Interpersonal Therapy for Group (IPT-G), an evidence-based approach for the treatment of BN. The author presents a rationale for the use of IPT-G, an outline of the group model, and provides…
Freeman, C P L; Barry, F; Dunkeld-Turnbull, J; Henderson, A
In a randomised controlled trial of different types of psychotherapy for bulimia 92 women were assigned to receive cognitive-behaviour therapy (n=32), behaviour therapy (30), or group therapy (30) for 15 weeks and a further 20 (controls) assigned to remain on a waiting list for 15 weeks. Eating behaviour and psychopathology were assessed by standard methods. At the end of the trial the controls had significantly higher scores than the treated groups on all measures of bulimic behaviour. In terms of behavioural change all three treatments were effective, 71 (77%) of the 92 women having stopped bingeing. In addition, scores on eating and depression questionnaires were reduced and self esteem improved. Follow up was continuing, but of 24 women available at one year, 21 were not bingeing and had maintained their improved scores on psychometric scales. Bulimia nervosa is amenable to treatment by once weekly structured psychotherapy in either individual or group form. PMID:3126890
Bonne, O B; Gur, E; Berry, E M
Phosphorus abnormalities among patients suffering from eating disorders, although cited, have received relatively little attention. Studies generally report decreased concentrations of phosphorus for both bulimia and anorexia nervosa. We have recently noted hyperphosphatemia in several consecutive hospitalized bulimic patients who appeared to have normal renal function and calcium levels. Case files of 30 inpatient and outpatient female bulimic patients and 30 sex- and age-matched physically healthy psychiatric inpatients and outpatients were reviewed. Phosphorus and electrolytes related to phosphorus metabolism were compared between the two groups. Twenty-four of 30 bulimic patients (80%) were found to have at least one elevated serum phosphorus concentration, whereas all but one of 30 age-matched controls had values within normal limits. Elevated phosphorus levels were generally in the mild to moderate range. No correlation was found between phosphorus levels and any of the other electrolytes examined in both patients and controls. No correlation was found between phosphorus levels and the reported frequency of bingeing and vomiting or the number of laxatives ingested. Since bulimic patients are generally of normal weight and tend to deny their disturbed eating habits, diagnosis is often delayed. However, bulimia may be suspected from biochemical abnormalities such as hypokalemia, hypochloremia, elevated amylase, and acid-base disturbances. This preliminary study indicates that elevated serum phosphorus levels may serve as an additional objective marker for the presence of bulimia nervosa. PMID:7648849
Bayer, Alan E.; Baker, Daniel H.
This document presents an overview of anorexia nervosa and bulimia in adolescents. A brief review of the historical background of these eating disorders is included. Causes of anorexia and bulimia are discussed and physical, behavioral, emotional, and perceptual characteristics of the disorders are listed in a section on symptoms. The need for a…
Sandberg, Katie; Erford, Bradley T.
Six commonly used instruments for assessment of eating disorders were analyzed. Effect size results from Erford et al.'s (2013) meta-analysis for the treatment of bulimia nervosa were used to compare each scale's ability to measure treatment outcomes for bulimia nervosa. Effect size comparisons indicated higher overall effect sizes using…
Whitner, Phillip A.; Shetterly, Arminta
The eating disorder known as bulimia is a relatively new and baffling phenomenon. This paper raises questions that college and university counseling center professionals need to address regarding this phenomenon. The first section focuses on defining the term "bulimia" and its evolution. The second section identifies numerous symptoms that need to…
Glasofer, Deborah R; Devlin, Michael J
Cognitive-behavioral therapy (CBT) is a first-line psychotherapeutic treatment for bulimia nervosa (BN). This article outlines three specific interventions--introducing and using the CBT model of BN, self-monitoring of eating and related experiences, and psychoeducation regarding various aspects of BN--representative of CBT overall but unique in their application to individuals with BN. The theoretical basis and supporting research relevant to each technique are highlighted. Clinical vignettes are provided to illustrate how these interventions might be integrated into the psychotherapy. PMID:24295463
Yu, Jessica; Agras, W Stewart; Bryson, Susan
To examine how different definitions of recovery lead to varying rates of recovery, maintenance of recovery, and relapse in bulimia nervosa (BN), end-of-treatment (EOT) and follow-up data were obtained from 96 adults with BN. Combining behavioral, physical, and psychological criteria led to recovery rates between 15.5% and 34.4% at EOT, though relapse was approximately 50%. Combining these criteria and requiring abstinence from binge eating and purging when defining recovery may lead to lower recovery rates than those found in previous studies; however, a strength of this definition is that individuals who meet this criteria have no remaining disordered behaviors or symptoms. PMID:24044595
Pedrolli, Carlo; Sacchi, Manuela C; Togni, Michele; Cereda, Emanuele
Bulimia nervosa is an eating disorder defined by recurrent episodes of binge eating followed by compensatory behaviors, primarily self-induced vomiting. Most common complications are due to purge behaviors and are frequently responsible for hospitalization. These include electrolyte disturbances, dehydration, hypovolemia, stomatitis, esophageal diseases, and functional impairment of the colon. However, an obstruction-like syndrome has never been reported. We report the case of a middle-age woman suffering from bulimia nervosa and referring at the emergency department with a 7-day story of hyperemesis responsible for an acute renal failure. During hospitalization, after the most important and common medical causes of hyperemesis were excluded, an upper gastrointestinal endoscopy was performed. The endoscopist reported the presence of an impressive bezoar, which underwent to mechanical fragmentation and biopsy sampling, revealing it was made up exclusively of liquorice wheels. An endoscopy performed few days after showed the complete dissolution of the bezoar, and the patient was discharged without any further gastrointestinal complaint. PMID:24902945
Andersen, A E
Anorexia nervosa or bulimia in adolescent males occurs ten times less frequently than in adolescent females. When they occur, however, they can be clearly identified and differentiated from disorders also associated with weight loss such as swallowing phobias. Early diagnosis and treatment leads to improved outcome. While the formal psychopathology of male anorectics is similar to that of females, there is often a different motivation for the initial weight loss in males. They are more often concerned with attaining an idealized male body and avoiding teasing or criticism about their appearance. When males become ill, they tend to develop the full anorectic syndrome or not to become ill at all. Recognition of the special needs of adolescent males for individualized treatment increases the change of optimal outcome. Anorexia nervosa and bulimia in the teenage male should be seen as an ineffective method of dealing with developmental crises by gaining a sense of effectiveness and control through weight reduction and food restriction. Treatment seeks to improve quickly the starvation-related aspects of the illness while attempting to find more appropriate methods of dealing with the life crises prompting the illness. The real goal of treatment is to make the anorectic or bulimic illness unnecessary by encouraging the patient to continue the work of individuation and separation so that challenges in development and problems in living are resolved in a direct rather than an indirect way through an eating disorder. PMID:6596548
Criquillion-Doublet, S; Samuel-Lajeunesse, B
The multiplicity of actual studies about a possible correlation between eating disorders and affective disorders is found on clinical and family studies, biological, genetic and therapeutic studies. As depressive symptoms are associated to eating disorders in 30 to 88% of the cases according to the authors, family studies suggest the existence of a relationship between eating and affective disorders but no causal link between the two can be proved. Biological tests are difficult to interpret (the dexamethasone suppression test, the TRH stimulation test, a study of platelet MAO activity, of the metabolism of neurotransmitters). The imbrication of metabolic and neuroendocrine disorders being a characteristic of both affective and eating disorders. On the level of therapy, if the results of antidepressants--essentially tricyclics and IMAO--on bulimia are effective on a short-term basis, this is not enough to prove the dysthimic nature of eating disorders. Moreover, their efficiency on the long term (over 6 months) is very controversial. It is the research on genetic and biological index which will allow the precise characterization of the nature of the relationship between eating (bulimia) and affective disorders. PMID:2667951
Mines, Robert A.; Merrill, Cheryl A.
Discusses the use of group approaches when treating bulimia and outlines recommendations for more efficacious group treatment. Recommends a comprehensive approach to assessment and treatment. Notes that a cognitive-behavioral approach seems viable. (Author/ABB)
Garner, David M.; Davis, Ron
Outlines a cognitive-behavioral approach to treating bulimia, focusing on the client's eating behavior, physical condition, and dysfunctional attitudes responsible for deficiencies in self-concept. (Author/ABB)
Lavender, Jason M.; Wonderlich, Stephen A.; Peterson, Carol B.; Crosby, Ross D.; Engel, Scott G.; Mitchell, James E.; Crow, Scott J.; Smith, Tracey L.; Klein, Marjorie H.; Goldschmidt, Andrea B.; Berg, Kelly C.
The goal of this study was to examine associations between dimensions of emotion dysregulation and eating disorder (ED) symptoms in bulimia nervosa (BN). This investigation used baseline data from a BN treatment study that included 80 adults (90% women) with full or subthreshold BN. Participants completed the Difficulties in Emotion Regulation Scale (DERS) and the Eating Disorders Examination (EDE) interview. The EDE global score was significantly correlated with the DERS total score, as well as several DERS subscales: Nonacceptance, Impulse, and Strategies. Further, the DERS Goals subscale was found to be uniquely associated with frequency of purging and driven exercise, although none of the subscales were associated with frequency of objective binge eating. Findings indicate that emotion dysregulation is associated with ED symptoms in BN, suggesting the utility of interventions that address emotion regulation skills deficits in the treatment of the disorder. PMID:24619484
Alex Sánchez, María Dolores
The Information and Communication Technologies (ICT) have an increasing influence on the way we relate and in shaping personal identity. The phenomenon of online social networking emerges strongly and contributes to the development of new spaces breaking with the official discourse that marks the scientific evidence on health. This paper analyzes the impact of ICT in relation to the identity of the digital natives and eating disorders (ED). Particular attention to how the network society determines the response of young people in situations of social tension is dedicated. To do this, provides a perspective on the concept of interaction from the analysis of the discourse on anorexia and bulimia in the network, and how to care nurses should consider these factors to improve efficiency and quality in clinical care and patient care. PMID:26448996
Gutiérrez-Maldonado, José; Ferrer-García, Marta; Riva, Giuseppe
Several approaches to the treatment of bulimia nervosa have proved effective, including cognitive-behavioral therapy; however, not all patients improve. It is therefore necessary to explore the possibilities of increasing the efficacy of such treatments. One way to attempt this is to incorporate new technologies. This review explores the possibility of developing a new, empirically validated procedure for the treatment of bulimia nervosa patients that involves cue exposure via virtual reality. PMID:23792835
Mehler, Philip S; Krantz, Mori J; Sachs, Katherine V
Inherent to anorexia nervosa and bulimia nervosa are a plethora of medical complications which correlate with the severity of weight loss or the frequency and mode of purging. Yet, the encouraging fact is that most of these medical complications are treatable and reversible with definitive care and cessation of the eating-disordered behaviours. Herein, these treatments are described for both the medical complications of anorexia nervosa and those which are a result of bulimia nervosa. PMID:25874112
Brown, Michael H.
Written for counselors who must help clients deal with bulimia, this article reviews bulimia's most obvious physical signs and symptoms, etiology, and behavioral characteristics. Considers innovative counseling approaches including Transpersonal Psychology, relaxation training, imagination, fantasy, hypnosis, myths, and rituals. (Author)
The neuro-transmitter serotonin seems to be important in the treatment of disturbed eating behaviour. In Anorexia Nervosa (AN) a serotonin antagonist has been proposed, whereas in Bulimia Nervosa (BN) serotonin agonists have been used with success, e.g. fenfluramine. A new generation of antidepressants has been introduced. that selectively have a serotonergic effect. The previous tricyclic and particularly the tetracyclic antidepressants had a noradrenergic effect as well. Fluoxetine belongs to the new generation. A total of 30 females with BN were treated with fluoxetine in an open study. Clinical effect was observed after 2 to 6 weeks. One patient discontinued after 3 weeks, the other were treated for 3 to 10 months. A moderate effect with 75% reduction of bingeing and purging was observed in 15 patients, 14 stopped bingeing and purging. There was no serious side effects. However, drug treatment alone had no significant effect. The fluoxetine treatment is not instead of, but in addition to the traditional behavioral treatment with strict limits regarding food and meals. PMID:2291423
Anorexia nervosa (AN) and bulimia nervosa (BN) are eating disorders characterized by an aberrant pattern of eating behavior, relentless pursuit of thinness, an intense fear about weight gain and an altered perception of body shape. The pathobiology of eating disorders is complex. Several social, psychological and developmental phenomena are proposed to contribute to the etiology of eating disorders. The role of neuropeptide Y, corticotropin releasing hormone and leptin has also been investigated to understand the pathogenesis of eating disorders. However, most of the neuropeptide alterations noted in eating disorders are secondary to starvation. Several nonpharmacological approaches such as cognitive and behavior-based therapy and interpersonal therapy have been developed to assist weight gain and to modify the behavioral impairment associated with eating disorders. Pharmacotherapy serves as an adjunct in AN, whereas it plays a more significant role in the management of BN. Antidepressants are effective in a limited number of AN patients with comorbid depression. On the other hand, the efficacy of fluoxetine in BN patients in reducing the frequency of binge eating and in the severity of behavioral abnormalities is quite impressive. Several adjunct therapies such as prokinetics and anxiolytics have also been used in AN and BN to assist eating behavior. An insight into genetic and neurochemical abnormalities occurring in eating disorders will help to find better therapeutic agents for these disorders. (c) 2001 Prous Science. All rights reserved. PMID:12768223
Tolstoi, L G
The purpose of this article is to review the basic pharmacology and the role of drugs that are used to treat anorexia nervosa and bulimia. The pharmacological treatment of eating disorders is based upon theoretical principles. The theoretical models include: (a) an illness secondary to other psychiatric disorders, (b) a disorder in the hypothalamic control of food intake, (c) a disorder of hypothalamic endocrine regulation, (d) a syndrome secondary to depressive illness, and (e) a disorder in the hypothalamic regulation of food intake. Theoretical models a, b, and c govern the choice of drug therapy for anorexia nervosa, and models d and e govern the choice of drug therapy for bulimia. Drugs used to treat anorexia nervosa and bulimia include tricyclic antidepressants and lithium carbonate. Chlorpromazine, metoclopramide, cyproheptadine, and clomiphene citrate have also been prescribed for the treatment of anorexia nervosa. Monoamine oxidase inhibitors are commonly prescribed to treat bulimia. Fenfluramine has the potential to be of therapeutic value in patients with bulimia. Although drug therapy plays a limited role in the treatment of eating disorders, drugs are commonly prescribed. Therefore, the nutritionist should be familiar with the basic pharmacology and the side effects related to drug therapy. PMID:2572619
Coull, Charles Edward
This paper presents a dynamic perspective of some of the major issues surrounding the eating disorder of bulimia. The focus is specifically on the relationship of the bulimia nervosa syndrome to the historical dynamics of the developmental process of the individual. Three major aspects of bulimia are discussed. First, there is a discussion of…
Richards, P. Scott
This paper defines the eating disorders of anorexia nervosa, bulimia, and bulimia nervosa, a bulimic subtype of anorexia nervosa. The diagnosis of these disorders is discussed and similarities and differences among the three disorders are reviewed. Etiological factors are considered and current trends in treatment of anorexia nervosa, bulimia, and…
Fairburn, Christopher G; Stice, Eric; Cooper, Zafra; Doll, Helen A; Norman, Patricia A; O'Connor, Marianne E
Bulimia nervosa shows a marked tendency to persist, suggesting that powerful maintaining mechanisms operate. Using data from a prospective, 5-year, study of the natural course of 102 people with bulimia nervosa, the authors sought to identify predictors of persistence and to test specific hypotheses derived from the cognitive-behavioral theory of the persistence of bulimia nervosa. The results of both sets of analyses were consistent with the theory, with the degree of overevaluation of shape and weight and a history of childhood obesity predicting a persistent course. There was also support for the central prediction of the cognitive-behavioral theory. These findings suggest that the mechanisms specified by the theory influence its longer term natural course. PMID:12602430
Ordman, Arnold M.; Kirschenbaum, Daniel S.
Examined the efficacy of a cognitive-behavioral therapy for bulimia. Assigned 20 bulimic women to full- or brief-intervention therapy programs. Results indicated that full-intervention clients, relative to brief-intervention clients, substantially reduced the frequency of their bingeing-vomiting; improved their psychological adjustment; and…
Phillips, Elaine L.; Greydanus, Donald E.; Pratt, Helen D.; Patel, Dilip R.
Reviews the current literature on psychological and psychopharmacologic treatments for bulimia nervosa in the adolescent population. Describes the two most researched psychological treatments--cognitive behavior therapy and interpersonal therapy--in terms of treatment protocols and outcome research. Reviews psychopharmacologic treatment, including…
Gross, Karen B. W.; And Others
Dentists and dental hygienists are in a unique position to identify an eating disorder patient from observed oral manifestations and to refer the patient for psychological therapy. The inclusion of information on general and oral complications of bulimia and anorexia nervosa in dental and dental hygiene curriculum was examined. (MLW)
Leitenberg, Harold; And Others
Evaluated exposure plus response-prevention treatment of bulimia nervosa among 47 women. Subjects were assigned to either exposure plus response-prevention in one setting, exposure plus response-prevention in multiple settings, cognitive-behavioral therapy, or waiting-list control conditions. Found three treatment groups improved significantly on…
Lowe, Michael R.; Berner, Laura A.; Swanson, Sonja A.; Clark, Vicki L.; Eddy, Kamryn T.; Franko, Debra L.; Shaw, Jena A.; Ross, Stephanie; Herzog, David B.
Objective: To investigate whether, at study entry, (a) weight suppression (WS), the difference between highest past adult weight and current weight, prospectively predicts time to first full remission from bulimia nervosa (BN) over a follow-up period of 8 years, and (b) weight change over time mediates the relationship between WS and time to first…
Cullari, Salvatore; Redmon, William K.
This paper presents a theoretical model for a primary prevention program for bulimia and anorexia nervosa to be used with adolescents and young women considered most at risk of developing these eating disorders. Characteristics of potential anorexics and bulimics are identified to aid in the selection of target groups for the program. It is…
Kaplan, Allan S.; Woodside, D. Blake
Reviews biological factors relevant to the understanding of anorexia nervosa and bulimia nervosa. Considers the physical presentation of these disorders; the medical complications of starvation, binging, and purging; and the cognitive and behavioral effects of starvation. Reviews neurophysiological and neurochemical aspects of these illnesses and…
Mallick, M. Joan
School personnel can have a vital role in the early detection and treatment of anorexia nervosa and bulimia by understanding certain signs and symptoms. This article provides specific information about early detection, approaches to use when confronting the student, and methods to facilitate treatment. (Author/DF)
... to treat children and teens with anorexia and bulimia. In family-based therapy, parents play an important and active role in a child's treatment. Additionally, a study is starting to see how this type of ... eating disorders are complex and affect a variety of people ...
Miller, Debra A. F.; And Others
Examined relationship of early mealtime experiences to later bulimia in 128 female college students. Found significant group differences among bulimics, nonbulimics, and repeat dieters on early meal experience questionnaire, with bulimic group reporting most negative and unusual experiences. Found significant differences among groups on depression…
Davis, Ron; And Others
Investigated parameters of eating behavior in subjects with bulimia nervosa (BN). BN and female comparison (FC) subjects monitored hourly over several days their food intake, mood, hunger, social circumstances, and experiences of unpleasant events. BN subjects reported more positive moods prior to consuming a meal, and more negative moods prior to…
Gupta, M A; Gupta, A K; Haberman, H F
The dermatologic changes in anorexia nervosa and bulimia nervosa may be the first signs to give the clinician a clue that an eating disorder is present, as many of these patients either deny their symptoms or secretly refuse to comply with treatment. The dermatologic signs are a result of (1) starvation or malnutrition, eg, lanugolike body hair, asteatotic skin, brittle hair and nails, and carotenodermia; (2) self-induced vomiting, eg, hand calluses, dental enamel erosion, gingivitis, and a Sjögrenlike syndrome; (3) use of laxatives, diuretics, or emetics and their dermatologic side effects; and (4) other concomitant psychiatric illness, eg, hand dermatitis from compulsive handwashing. Further, as most of the cutaneous signs are not specific to anorexia nervosa and bulimia nervosa, failure to include eating disorders in the differential diagnosis may lead to misdiagnosis of the cutaneous symptoms. PMID:3310913
Wallace, Laurel M; von Ranson, Kristin M
As psychology has moved toward emphasizing evidence-based practice, use of treatment manuals has extended from research trials into clinical practice. Minimal research has directly evaluated use of manuals in clinical practice. This survey of international eating disorder professionals examined use of manuals with 259 clinicians' most recent client with bulimia nervosa. Although evidence-based manuals for bulimia nervosa exist, only 35.9% of clinicians reported using a manual. Clinicians were more likely to use a manual if they were younger; were treating an adult client; were clinical psychologists; were involved in research related to eating disorders; and endorsed a cognitive-behavioral orientation. Clinicians were less likely to use a manual if they provided eclectic psychotherapy that incorporated multiple psychotherapeutic approaches. We conclude that psychotherapy provided in clinical practice often does not align with the specific form validated in research trials, and "eclecticism" is at odds with efforts to disseminate manuals into clinical practice. PMID:21939960
Stewart, Catherine; Voulgari, Stamatoula; Eisler, Ivan; Hunt, Katrina; Simic, Mima
Existing randomized controlled trials of family therapy for treatment of bulimia nervosa in adolescence highlight the need for further development of treatments. This article describes the development of multi-family treatment for bulimia nervosa in adolescents aged 13-18. It outlines the theory guiding this development, the areas of need identified by previous studies, and the treatment that has been designed to meet these needs. Particular attention is given to the need to increase communication between family members, strategies to reduce high levels of criticism or hostility, and skills to manage emotion dysregulation and low tolerance for negative emotions. To these ends the program draws on the multi-family treatment for anorexia nervosa, cognitive behavioral therapy techniques, and dialectical behavior therapy. PMID:26010166
Huang, Chiu-Min; Hsieh, Chia-Jung
This paper focused on the experience of the authors in providing nursing care to a patient with bulimia nervosa who sought psychiatric assistance upon her first episode. The nursing period spanned a period from April 21, 2008 to June 16, 2008. After primary diagnosis, relevant data was collected by observation, interview, and a review of medical records. The patient's disease was assessed from five dimensions. Care problems faced for this patient included: altered nutrition profile, abnormal eating patterns, ineffective individual coping, and body image disturbance. The authors adopted a three-stage nursing intervention based on cognitive behavior theory (CBT). First, a caring attitude was employed to establish a good nurse-patient relationship, after which the patient was instructed to maintain a diet diary, which could be used to help identify the underlying causes of her bulimia nervosa condition. Secondly, we assisted the patient to express her emotions and feelings in order to help her disentangle herself from unhealthy perceptions regarding body image and weight. Thirdly, we assisted the patient to develop critical problem-solving abilities and coping skills that would help avoid symptom recurrence. We followed up on patient progress by telephone for one month after treatment. The treatment had successfully stabilized her emotions and bulimia nervosa did not recur. Her body weight was kept within a satisfactory range. Furthermore, she applied cognitive behavior skills in daily life continuously, and she did exercise and kept company with an individual who helped reinforce appropriate behavior. It is hoped that this report can help nurses better understand bulimia nervosa and be used as a reference in clinical care. PMID:20405392
Coffey, Janet I.; Oakley, Suzanne J.
This paper discusses bulimia among college women, and describes a workshop utilizing structured short-term group treatment for these bulemic women. An overview and definitions of bulimia are given, and research supporting the theory that binge eating is a reaction to excessive dietary restraint is reviewed. Treatment goals and techniques used in…
The use of the MMPI and MMPI-2 to assist in the understanding of individuals with bulimia nervosa is examined. DSM-IV criteria for diagnosis of bulimia nervosa are reviewed. It is also important to understand the personality variables or psychological correlates associated with this disorder. The structure and history of the MMPI and MMPI-2 are…
Halasz, Hisako, Comp.
This bibliography is intended to help readers locate material on anorexia nervosa and bulimia in the collections of the Library of Congress. A scope note briefly defines the terms "anorexia nervosa" and "bulimia" and discusses similarities and differences between the two eating disorders. Four references are included as introductions to the topic…
Higgins, Gerald L.
This paper offers a brief review of recent literature on the incidence and age of onset of bulimia in the light of a 17th century description of a female centenarian with bulimia, together with a brief account of the physician, Sir Thomas Browne (1605-1682), and the etymology and early usage of the term. PMID:21248899
Getzfeld, Andrew R.
Bulimia represents a major health problem in the United States, especially in high schools, colleges, and universities. This paper reviews literature on the definition, etiology, and therapeutic approaches for bulimia. The literature points to potential physiological bases for the disorder since some researchers reported similarities between it…
Killian, Kyle D.
Reviews literature examining family variables associated with anorexia nervosa and bulimia nervosa and family systems treatments for these eating disorders. Presents definitions of and diagnostic criteria for anorexia and bulimia, and discusses prevalence of these disorders. Reviews role played by psychopathological, sociological, and…
Anderson, Drew A.; Simmons, Angela M.
This paper describes the initial development of a treatment for bulimia nervosa using a functional contextual treatment approach. Seven women (6 with a diagnosis of bulimia nervosa and 1 with a diagnosis of eating disorder not otherwise specified) completed 12 sessions of functional contextual treatment. Participants were assessed with the Eating…
Rorty, Marcia; And Others
This study compared childhood parental physical punishment among 80 women with and 40 women without a lifetime history of bulimia nervosa. Although the women with bulimia reported more and harsher physical punishment than the control group, they did not differ in the extent to which they believed the punishment was deserved or whether they were…
Rodríguez, Sonia; Mata, José L; Lameiras, María; Fernández, M Carmen; Vila, Jaime
The present study examined the emotional reactivity to erotic and food images of women with and without bulimia nervosa using the picture-viewing paradigm. A non-clinical student sample made up of 48 women, 24 diagnosed with bulimia nervosa and 24 healthy controls, aged between 18 and 27 years (M=21.79), participated in the study. Diagnosis was based on questionnaires and a structured interview following DSM-IV criteria. Participants assessed a set of food, erotic, neutral and unpleasant pictures using the Self-Assessment Manikin scales of valence, arousal and control. The women with bulimia nervosa rated as less pleasant the erotic and food pictures, which evoked greater dyscontrol, in comparison with the women without bulimia nervosa. No significant differences were found in the ratings for the remaining pictures. These results suggest that women with bulimia nervosa experience reduced pleasure and control over both food and sexual impulses. PMID:17676693
Mandal, Piyali; Arumuganathan, S; Sagar, Rajesh; Srivastava, Pakhi
A classic case of the bulimia nervosa in a young Indian female is reported. This is in the context of the impression that due to increasing western influence, and change in cultural concepts of beauty and thinness among women, illnesses previously considered rare in Indian subcontinent might be becoming more prevalent. Many of the established pre-disposing factors such as female gender, metropolitan domicile, family history of depressive disorder have conglomerated in this case. Rapid and sustained improvement with the low-dose Fluoxetine and the Cognitive Behavioral Therapy is also worth paid attention. PMID:24249937
Hunt, Jennifer S; Rothman, Alexander J
Knowledge about eating disorders influences lay people's ability to recognize individuals with anorexia nervosa (AN) and bulimia nervosa (BN) and refer them to professional treatment. We assessed mental models (stored knowledge) of AN and BN in 106 college students. Results indicated that most students have general, but not specific, information about AN and BN's symptoms, consequences, causes, duration, and cures. They also believe that people with eating disorders tend to be young, White women. These findings suggest that lay recognition of eating disorders may be based primarily on observations of dysfunctional eating behaviors and therefore facilitated by additional knowledge. PMID:17241690
Giles, G M
In recent years, there has been a growing trend away from a dogmatic adherence to any one approach in the treatment of eating disorders. This paper adds the new element of practice in relation to cognitive change. The activity-oriented approach outlined here stresses that patients with anorexia nervosa or bulimia must maintain responsibility for their own food intake throughout treatment. The key role of the occupational therapist in the treatment team is outlined, and suggestions for assessment and management of this type of patient are given. PMID:3862340
Lunn, Susanne; Daniel, Sarah I F; Poulsen, Stig
This case study presents the progress of one patient with bulimia nervosa who was originally very compromised in psychological domains that are the focus of analytic treatment, and includes in-session therapeutic process and a range of outcomes, for example, eating disorder symptoms, attachment status, and reflective functioning. Nested in a study showing more rapid behavioral improvement in subjects receiving cognitive behavior therapy than in subjects receiving psychoanalytic psychotherapy, the case highlights the importance of supplementing RCTs with single case studies and the need of adapting the therapeutic approach as well as the current therapeutic dialogue to the individual client. (PsycINFO Database Record PMID:27267505
Bulik, Cynthia M.; Marcus, Marsha D.; Zerwas, Stephanie; Levine, Michele D.; Via, Maria La
Case Ms. Z, a 35-year-old African-American single woman with a body mass index (BMI) of 37.8 kg/m2 (height 5 feet, 5.5 inches, weight 238 lb.), presents for an evaluation for bulimia nervosa. She was referred to the eating disorders program by her primary care physician who knew about her eating disorder, but was primarily concerned about her weight and blood pressure. Ms. Z has an advanced degree and is employed full time. She has struggled with her eating, weight, and body image since childhood and began binge eating regularly (1–2× week) at age 15. Fasting and self-induced vomiting began in her early twenties, when she achieved her lowest adult BMI of 21.6 kg (weight 130 lb. at age 23). She gained 100 pounds in the past 7 years and currently binges and purges 1–2 times a day. A typical binge consists of a box of cookies, a pint of ice cream, 7 oz. of cheese, two bowls of cereal with 2 cups of milk, and 4 pickles. Ms. Z has seen five therapists to address her eating behaviors and weight concerns and participated in numerous commercial weight loss programs. She states binge eating has always served a self-soothing purpose for her. Ms. Z has a demanding university-related job that absorbs most of her time. She has few friends and has not been in a romantic relationship for the past five years believing that no one would be interested in a woman of her size. She also claimed that food is more reliable than any man because “it’s always there when you need it and you don’t have to take care of it or stoke its ego.” She spends evenings at home working until she is completely exhausted, heads to the kitchen for an all-out binge, vomits everything up, and then cries herself to sleep. She has never smoked and does not drink alcohol. Current medications prescribed by her primary care physician include Fluoxetine (20 mg), Norvasc (5 mg), and Clonazepam (prn). What are Ms. Z’s treatment goals? What are her primary care physician’s? Is her medication for
Spangler, D L
Cognitive-behavioral therapy for bulimia nervosa (BN) is a well-developed, theoretically grounded treatment for BN with the strongest empirical support for its efficacy of any form of treatment for BN. The treatment package comprises three distinct phases typically delivered over 20 weeks. Incorporating a variety of specific interventions, these three phases of treatment focus systematically on (i) dietary restraint, (ii) dysfunctional beliefs about body weight and shape, and (iii) reactions to recurrence of symptoms, which are thought to be the primary operative mechanisms that cause and maintain BN symptoms. Case material is presented to illustrate cognitive-behavioral treatment principles. PMID:10445861
Carvalho, Maria Bernadete de; Val, Alexandre Costa; Ribeiro, Maria Mônica Freitas; Santos, Lúcia Grossi Dos
The scope of this study is to identify and contextualize aspects of the therapeutic itineraries of patients treated at a university medical clinic specialized in nervous anorexia and bulimia. For this purpose, an attempt was made to reconstitute the succession of events triggered in 20 respondents and their families with the classification of anorexia and bulimia as "health problems." The narratives were analyzed in order to link the individual experiences and the social context of their occurrence (organization of health services, characteristics of treatment and medical knowledge and characteristics of contemporary subjectivity), in light of the theoretical studies of Public Health and Psychoanalysis. Data analysis revealed that these itineraries arise from connections and disconnections between two distinct approaches: one that organizes the management of patients and the other governing the conduct of health institutions and families. If the latter presuppose a quest for health, this is not what primarily concerns the individuals in question. Their refusal to moderate their own eating disorders is notable on their itineraries, and indicates the functionality of those practices. Such practices play a part in the reconstruction of their self-images. PMID:27557019
Pook, Martin; Tuschen-Caffier, Brunna
Measures employed in a therapy study with a pre-post design must be sensitive to the detection of treatment-related changes. In the present study, the treatment sensitivity of 12 internationally established scales that assess bulimia-relevant aspects of eating and body concern is analyzed. The scales can be sorted along three dimensions (Disturbed Eating, Restrictive Eating Behaviors and Body Dissatisfaction). Measures of the same dimension were compared in a sample of 45 women with the diagnosis of bulimia nervosa. Patients completed the scales before and 6 weeks after the end of cognitive-behavioral therapy. Significant differences between scales with respect to treatment sensitivity occurred in all three dimensions. Post hoc analysis revealed that scales are particularly sensitive to change if they include disorder-relevant aspects beyond the main dimension of a scale. Implications of the findings for meta-analytical treatment research, for designing effectiveness studies, and for future research on the treatment sensitivity of outcome measures are discussed. PMID:15450916
Schlesier-Carter, B; Hamilton, S A; O'Neil, P M; Lydiard, R B; Malcolm, R
This study assessed the link between bulimic and depressive cognitions. Twenty-nine bulimics and 16 controls from the general population were first assessed on levels of depression using the Schedule for Affective Disorders and Schizophrenia-Change Version and the Beck Depression Inventory (BDI). Bulimics were significantly more depressed than controls. Bulimics differed significantly from controls on all cognitive measures associated with depression (Automatic Thoughts Questionnaire, Dysfunctional Attitude Scale, and Attributional Style Questionnaire), but differences on these measures were nonsignificant when depression, as measured by the BDI, was controlled. Bulimics differed from controls regardless of level of depression on the three scales of the Restraint Inventory, the Rationalization and All-or-None scales of the Thoughts About Eating Inventory, and most of the eight scales of the Eating Disorders Inventory. Bulimics showed more maladaptive thinking associated with depression, but these differences likely reflect the levels of depression for each group. The differences on the measures of cognitive and behavioral symptoms of bulimia remained when the level of depression was controlled statistically. This suggests that although depression can be frequently diagnosed in a bulimic sample, specific maladaptive cognitions and behaviors reflect a distinct disorder (bulimia) and are not simply the expression of an affective disorder. PMID:2768669
McLean, Siân A; Paxton, Susan J; Massey, Robin; Hay, Phillipa J; Mond, Jonathan M; Rodgers, Bryan
Addressing stigma through social marketing campaigns has the potential to enhance currently low rates of treatment seeking and improve the well-being of individuals with the eating disorder bulimia nervosa. This study aimed to evaluate the persuasiveness of health messages designed to reduce stigma and improve mental health literacy about this disorder. A community sample of 1,936 adults (48.2% male, 51.8% female) from Victoria, Australia, provided (a) self-report information on knowledge and stigma about bulimia nervosa and (b) ratings of the persuasiveness of 9 brief health messages on dimensions of convincingness and likelihood of changing attitudes. Messages were rated moderately to very convincing and a little to moderately likely to change attitudes toward bulimia nervosa. The most persuasive messages were those that emphasized that bulimia nervosa is a serious mental illness and is not attributable to personal failings. Higher ratings of convincingness were associated with being female, with having more knowledge about bulimia nervosa, and with lower levels of stigma about bulimia nervosa. Higher ratings for likelihood of changing attitudes were associated with being female and with ratings of the convincingness of the corresponding message. This study provides direction for persuasive content to be included in social marketing campaigns to reduce stigma toward bulimia nervosa. PMID:26383053
Walters, E E; Neale, M C; Eaves, L J; Heath, A C; Kessler, R C; Kendler, K S
A genetic analysis of the co-occurrence of bulimia and major depression (MD) was performed on 1033 female twin pairs obtained from a population based register. Personal interviews were conducted and clinical diagnoses made according to DSM-III-R criteria. Additive genes, but not family environment, are found to play an important aetiological role in both bulimia and MD. The genetic liabilities of the two disorders are correlated 0.456. While unique environmental factors account for around half of the variation in liability to both bulimia and MD, these risk factors appear to be unrelated, i.e., each disorder has its own set of unique environmental risk factors. Thus, the genetic liability of bulimia and MD is neither highly specific nor entirely non-specific. There is some genetic correlation between the two disorders as well as some genetic and environmental risk factors unique to each disorder. Limitations and directions for future research are discussed. PMID:1410087
Wagner, Angela; Aizenstein, Howard; Venkatraman, Vijay K.; Bischoff-Grethe, Amanda; Fudge, Julie; May, J. Christopher; Frank, Guido K.; Bailer, Ursula F.; Fischer, Lorie; Putnam, Karen; Kaye, Walter H.
Objective It is possible that disturbances of systems modulating reward may contribute to a vulnerability to develop an eating disorder. Method This hypothesis was tested by assessing functional magnetic resonance brain imaging response to a monetary reward task known to activate the anterior ventral striatum (AVS), a region implicated in motivational aspects toward stimuli. To avoid the confounding effects of malnutrition, 10 women who had recovered from bulimia nervosa (BN) were compared with 10 healthy comparison women (CW). Results For the AVS, CW distinguished positive and negative feedback, whereas recovered BN women had similar responses to both conditions. In addition, these groups had similar patterns of findings for the dorsal caudate. Discussion We have previously shown that individuals recovered from anorexia nervosa (AN) also had altered striatal responses and difficulties in differentiating positive and negative feedback. Thus BN and AN individuals may share a difficulty in discriminating the emotional significance of a stimulus. PMID:19434606
Beneke, Johannes; Koerner, Michael; de Zwaan, Martina
Erythema ab igne (EAI) is a skin lesion, which is characterized by a localized netlike erythema. For the occurrence of the dermatosis a continuous or regular heat exposure and infrared radiation to a skin area is necessary. The reticulated maculae could fade after stopping the heat exposure, persist as hyperpigmentation and in single cases a malignant transformation is possible. We present a patient with bulimia nervosa (BN), who developed an EAI after consequent use of a hot-water bottle. In the context of the eating disorder the patient reported a general feeling of cold. She avoided the contact with the abdomen to prevent a stimulation of the digestion. Therefore the EAI was located predominantly on the medial thighs. After stopping the heat application the EAI faded slightly in the periphery und turned browner. PMID:24504523
Espíndola, Cybele Ribeiro; Blay, Sérgio Luís
A systematic literature review published between 1990 and 2006 using a qualitative approach was conducted to explore family members' perception of anorexia and bulimia nervosa patients. Articles were critically reviewed and a meta-synthesis analysis was carried out based on a meta-ethnographic method to analyze and summarize data. Of a total of 3,415 studies, nine met the study inclusion and exclusion criteria. Reciprocal translation was used for data interpretation allowing to identifying two concepts: disease awareness and disease impacts. Feelings of impotence were often described in family reorganization. The study results point to distortions in the concept of disease associated with family involvement, resulting in changes in communication, attitudes, and behaviors in a context of impotence. PMID:19503976
van Rijn, C A
In anorexia nervosa and bulimia nervosa, cachexia and deficient nourishment cause various physical abnormalities, especially of the endocrine and digestive systems and the heart. Disorders in the serotoninergic and dopaminergic systems contribute to development of an eating disorder, whereas an acquired deficiency of tryptophan impairs the serotoninergic system. Any problems of nutritional deficiencies, low blood sugar levels and gastrointestinal disorders disappear after normal nourishment is resumed. Hypotension and sinus bradycardia are manifestations of a physiological adjustment to a lower basal metabolism and need no treatment. Osteoporosis occurs from two years after the onset of weight loss; oestrogen supplementation may protect against this. In patients with infections, symptoms such as fever, leukocytosis and high BSE may be lacking. Hypoglycaemia incidentally leads to coma and death, and a lengthened QT interval to acute cardiac death. During restoration of the nutritional status, the intake of fluid and calories should initially be limited. During the first two weeks, the risk of cardiovascular complications is increased. PMID:9856167
Starr, Taylor B; Kreipe, Richard E
Recent research has modified both the conceptualization and treatment of eating disorders. New diagnostic criteria reducing the "not otherwise specified" category should facilitate the early recognition and treatment of anorexia nervosa (AN) and bulimia nervosa (BN). Technology-based studies identify AN and BN as "brain circuit" disorders; epidemiologic studies reveal that the narrow racial, ethnic and income profile of individuals no longer holds true for AN. The major organs affected long term-the brain and skeletal system-both respond to improved nutrition, with maintenance of body weight the best predictor of recovery. Twin studies have revealed gene x environment interactions, including both the external (social) and internal (pubertal) environments of boys and of girls. Family-based treatment has the best evidence base for effectiveness for younger patients. Medication plays a limited role in AN, but a major role in BN. Across diagnoses, the most important medicine is food. PMID:24705938
Palmer, T A
Anorexia nervosa and bulimia nervosa are eating disorders characterized by gross disturbances in eating behavior. Recently these disorders have reached near-epidemic proportions, affecting approximately 1.2 million adolescent and young adult females in the United States. The incidence in males is considerably less, and the prevalence rate has remained fixed at 5 percent during the last five years. The estimates of mortality range between 1 and 15 percent and are equally divided between medical complications (electrolyte disturbance, acute kidney failure, cardiac complications) and suicide. Successful treatment requires a combination of aggressive medical management, psychotherapy, behavioral management, food-intake management and nutritional counseling. This requires health care providers to understand 1) the psychological ramifications of these disorders, 2) the types of depression associated with them, 3) antidepressants used and therapeutic dosages, 4) correction of nutritional deficiencies, 5) outpatient management and 6) indications for hospitalization (inpatient management). PMID:2183095
Ram, A; Stein, D; Sofer, S; Kreitler, S
The purpose of this study was to compare bulimia nervosa (BN) and substance use disorders (SUD) in cognitive-motivational terms. The cognitive orientation theory was used as a framework for testing the hypothesis that the commonality between BN and SUD consists of a similar motivational disposition for eating disorders, rather than for addiction, as was previously claimed. It was expected that BN and SUD patients would differ from controls but not from each other. The participants were 31 BN, 20 SUD, and 20 healthy controls. They were administered questionnaires for assessing anxiety, depression, addiction and the cognitive orientation for eating disorders. On most parameters BN and SUD scored higher than controls but did not differ from each other except in norm beliefs. Treatment of BN should consider the similarity of BN to SUD in the pathological tendency for eating disorders. PMID:18443981
Bulik, C M; Sullivan, P F; Joyce, P R; Carter, F A
In a sample of 76 women participating in a clinical treatment trial for bulimia nervosa, we examined the clinical differences between subjects with and without concurrent personality disorders and the ability of "self-directedness" (a character scale of Cloninger's Temperament and Character Inventory) to predict the presence of personality disorder. Sixty-three percent of the sample had at least one personality disorder diagnosis. Fifty-one percent of personality disorders were in cluster C, 41% were in cluster B, and 33% were in cluster A. The presence of personality disorder was associated with greater depressive symptoms, worse global functioning, laxative use, greater body dissatisfaction, higher harm avoidance, and lower self-directedness. As hypothesized, low self-directedness scores were associated with a markedly increased probability of a personality disorder. PMID:7561822
Pollatos, Olga; Georgiou, Eleana
Previous studies suggest that patients suffering from bulimia nervosa (BN) have difficulties in perceiving internal bodily signals, mostly assessed by self-report questionnaires. Whether interoception is, in this case, attenuated or not remains an open question. Therefore, interoceptive processes were examined in twenty-three patients with current BN and were compared to healthy participants. We investigated Interoceptive Accuracy (IAc) assessed by the heartbeat detection task and Interoceptive Awareness (IA) assessed by the Eating Disorder Inventory-2. Patients with BN and healthy participants did not differ in terms of IAc when controlling for BMI, depression and anxiety, whereas IA among BN patients was found to have decreased. Although IAc and IA were not related among controls, we observed an inverse correlation in BN, suggesting that an abnormal overlap between these two levels of interoceptive signal processing is present in BN. The current study introduces a new perspective concerning the role of interoceptive processes in BN and generates further questions regarding the therapeutic utility of methods targeting the interaction between different levels of interoception in the treatment of BN. PMID:27138826
Steiger, H; Koerner, N; Engelberg, M J; Israël, M; Ng Ying Kin, N M; Young, S N
Studies have linked bulimia nervosa (BN) to alterations in brain serotonin (5-hydroxytryptamine: 5-HT) activity and to heightened propensity for parasuicidality and self-injuriousness. The coincidence of self-destructiveness and 5-HT abnormality in BN is of interest, given documentation (in various populations) of an inverse association between 5-HT activity and potential for self-harm. The present study examined the connection between 5-HT status and self-destructiveness in BN. Structured interviews and self-report questionnaires were used to assess 40 bulimic and 21 normal-eater women for: (a) history of parasuicidal or self-injurious acts; and (b) mood and impulse-regulation problems. We then applied tests, presumed to reflect 5-HT function, of serial prolactin (PRL) and cortisol (CORT) responses after oral administration of the partial 5-HT agonist, meta-chlorophenylpiperazine (m-CPP). Relative to non-bulimic women, bulimic women (on average) showed blunting of PRL and CORT following m-CPP. The blunting of neuroendocrine responses was, however, most remarkable in bulimic women with a history of self-destructiveness. These findings suggest that some serotonergic anomalies reported in BN sufferers (i.e. reduced neuroendocrine response after m-CPP) may be most characteristic of individuals in the population showing clear-cut self-destructive potential. PMID:11472787
Bodell, Lindsay P; Keel, Pamela K
Bulimia nervosa (BN) is a serious eating disorder that can persist for years and contribute to medical complications and increased mortality, underscoring the need to better understand factors maintaining this disorder. Higher levels of weight suppression (WS) have been found to predict both the onset and maintenance of BN; however, no studies have examined mechanisms that may account for the effects of WS on BN. We hypothesized that high WS would lead to reduced leptin levels, which may increase risk of binge eating by modulating reward responses to food. The current study examined the relationship between WS, leptin levels, and the reinforcing value of food in women with BN (n = 32) and noneating disorder controls (n = 30). Participants provided information on WS, completed a fasting blood draw to obtain serum leptin, and completed a progressive ratio task to measure the reinforcing value of food. Individuals with BN had greater WS (p < .01) and reinforcing food value (p < .05) compared with controls. Additionally, higher WS was associated with both lower leptin (p < .05) and increased reinforcing value of food (p < .05). Contrary to hypotheses, BN and control participants did not differ on leptin levels, and leptin levels were not significantly associated with the reinforcing value of food. Findings support that efforts to conform to the thin ideal may alter drive to consume rewarding foods and leave women vulnerable to binge episodes. However, mechanisms through which WS contributes to food reward and binge eating remain unknown. PMID:26191637
Freeman, C P
Bulimia nervosa is a fascinating but challenging disorder to treat. There is no single treatment approach that suits all patients. Some patients make it clear that they would never consider taking drugs, others that group therapy is totally unacceptable and some, however hard they try, just never seem to get the hang of a cognitive behavioural approach. The principles that I have described above relate specifically to bulimic behaviour and attitudes. It is self-evident that other aspects of the patient functioning must not be ignored. Interpersonal, work and social problems may all need to be addressed at some stage during the treatment process and individual therapists will have their own therapeutic style and techniques for tackling these problems. In our experience it is best to tackle the presenting complaint, the bulimic behaviour, as energetically as possible and then to review the other problem areas. Many patients feel that once they have tackled their eating problem they can begin to tackle other problem areas in their life with relatively little outside help. Tackling things in the reverse order, addressing the underlying or background interpersonal difficulties first and paying little or no attention to the presenting behaviour appears to be less acceptable to patients, leads to lengthier and therefore more costly treatment and makes it difficult to distinguish between problems which are causes and those which are effects of the bulimic behaviour. (ABSTRACT TRUNCATED AT 250 WORDS) PMID:2030486
Mettler, Lisa N.; Shott, Megan E.; Pryor, Tamara; Yang, Tony T.; Frank, Guido K.W.
Objective To investigate brain white matter (WM) functionality in bulimia nervosa (BN) in relation to anxiety. Method Twenty-one control (CW, mean age 27±7 years) and 20 BN women (mean age 25±5 years) underwent brain diffusion tensor imaging (DTI) to measure fractional anisotropy (FA; an indication of WM axon integrity) and the apparent diffusion coefficient (ADC; reflecting WM cell damage). Results FA was decreased in BN in the bilateral corona radiata extending into the posterior limb of the internal capsule, the corpus callosum, the right sub-insular white matter and right fornix. In CW but not BN trait anxiety correlated negatively with fornix, corpus callosum and left corona radiata FA. ADC was increased in BN compared to CW in the bilateral corona radiata, corpus callosum, inferior fronto-occipital and uncinate fasciculus. Alterations in BN WM functionality were not due to structural brain alterations. Discussion WM integrity is disturbed in BN, especially in the corona radiate, which has been associated with taste and brain reward processing. Whether this is a premorbid condition or an effect from the illness is yet uncertain. The relationships between WM FA and trait anxiety in CW but not BN may suggest that altered WM functionality contributes to high anxious traits in BN. PMID:23354827
Berner, Laura A.; Marsh, Rachel
Bulimia nervosa (BN) is characterized by both recurrent episodes of binge eating that are, in part, defined by a sense of loss of control and compensatory behaviors to avoid weight gain. Impulsive behaviors are also common in individuals with BN, indicating more pervasive difficulties in behavioral self-regulation. Findings from functional and anatomical neuroimaging studies of individuals with BN suggest dysfunction in the dorsal frontostriatal circuits that support self-regulatory capacities and habit learning and in overlapping ventral circuits that support reward processing and reward-based learning. In this review, we describe the normal development of frontostriatal circuits and then present behavioral and neuroimaging data from adolescents and adults with BN. These data suggest that the abnormal maturation of frontostriatal circuits may contribute to the habitual binge-eating and purging behaviors of BN. Future longitudinal imaging studies will improve understanding of how these circuits contribute to the developmental trajectory of BN and will inform novel interventions that could target or prevent the impulsive and habit-like features of this disorder. PMID:25452718
Milano, W; Petrella, C; Sabatino, C; Capasso, A
Bulimia nervosa (BN) is one of the most frequently encountered eating disorders in industrialized societies. It has been suggested that reduced serotonin activity may trigger some of the cognitive and mood disturbances associated with BN. Thus, pharmacologic treatment of BN is mainly based on the use of selective serotonin reuptake inhibitors, which have proved effective. At present, the biological basis of this disorder is not completely clear. The aim of this randomized, controlled trial was to verify the efficacy of sertraline, a selective serotonin reuptake inhibitor, in a group of patients with a diagnosis of BN. Twenty female outpatients, with an age range of 24 to 36 years and a diagnosis of purging type BN as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV), were assigned randomly to two treatment groups. The first group received sertraline 100 mg/day for 12 weeks; the second group received placebo. The study was conducted for 12 weeks, with weekly clinical assessments. At the end of the observation period, the group treated with sertraline had a statistically significant reduction in the number of binge eating crises and purging compared with the group who received placebo. In no case was treatment interrupted because of side effects. This study confirms that sertraline is well tolerated and effective in reducing binge-eating crises and purging in patients with BN. PMID:15605617
Bulimia nervosa (BN) and binge-eating disorder (BED) are separate entities with the common denominator of binge eating. In this chapter, Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for BN are reviewed, including both recurrent episodes of binge eating and inappropriate compensatory behaviors to prevent weight gain in one whose self-evaluation is unduly influenced by body weight and shape. Two percent of adolescent females and 0.3% of adolescent males fulfill criteria for BN. Risk factors, medical complications of binge eating (vomiting, use of ipecac, diet pills, diuretics, and laxatives), physical and laboratory findings, and treatment options and outcome are discussed. BED is seen in 1-2% of adolescents. The DSM-IV lists BED under Eating Disorder Not Otherwise Specified. DSM-IV research criteria for BED is reviewed, including binge eating, distress over binge eating, and absence of regular extreme compensatory behaviors. The mean age of onset is 17.2 years. Up to 30% of obese patients have BED. Risk factors are discussed. Because most patients with BED are obese, medical evaluation is similar to that for obesity. Treatment goals must be geared not only toward decreased binge eating but toward weight loss. Outcome is discussed. PMID:12529196
Milano, W; Siano, C; Putrella, C; Capasso, A
Bulimia nervosa (BN) is one of the most common eating disorders in industrialized societies. It has been suggested that reduced serotonin activity triggers some of the cognitive and mood disturbances associated with BN. For this reason, the pharmacologic treatment of BN consists mainly of selective serotonin reuptake inhibitors (SSRIs), which have been proven effective. At present, the physiologic bases of this disorder are not yet completely understood. We conducted a randomized controlled trial to verify the efficacy of the SSRI fluvoxamine in patients with a diagnosis of BN. Twelve female outpatients aged 21 to 34 years with a diagnosis of BN-binge purging (as defined by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM IV]) were randomly assigned to 2 treatment groups: the fluvoxamine 200 mg/day group and the placebo group. The patients underwent weekly clinical assessments for 12 weeks. At the end of the observation period, there was a statistically significant reduction in the number of binge-eating crises and purging episodes in the fluvoxamine group compared with placebo. In no case was treatment interrupted because of emergent side effects. These findings support the hypothesis that fluvoxamine is well tolerated and effective in reducing binge-eating crises and purging episodes in patients with BN. PMID:16236688
Peschel, Stephanie K V; Feeling, Nicole R; Vögele, Claus; Kaess, Michael; Thayer, Julian F; Koenig, Julian
Eating disorders are associated with alterations of the autonomic nervous system (ANS). Among other indices, heart rate variability (HRV) provides a readily available index of ANS function. While ANS dysfunction indexed by HRV in Anorexia Nervosa has been addressed in previous reviews, here we aimed to review the current evidence on HRV in Bulimia Nervosa (BN). A systematic literature search in Web of Science, PsycInfo, Scopus, and PubMed identified 17 studies reporting HRV in patients with BN. Studies described (i) differences in resting state HRV in patients compared to controls, (ii) alterations in the stress response in BN indexed by HRV, and (iii) treatment effects on HRV in patients with BN. Despite a number of conflicting results, we conclude that BN is characterized by increased resting state vagally-mediated HRV and an impaired stress-response. Intervention-studies suggest that altered ANS-activity in BN is at least partially reversible. Future studies on the complex relation between BN and HRV should investigate the effect of comorbid disorders, subtypes of BN, and mechanisms affecting treatment outcome. PMID:26828568
Lester, Regan; Petrie, Trent A.
Disordered eating behaviors and bulimia nervosa were examined in a sample of female Mexican Americans. Results showed that 1.45% to 4.3% could be classified with bulimia. Just over 11% indicated regular binge eating. Dieting and exercising were the primary techniques used for weight control. Implications for intervention are briefly discussed.…
This document provides teachers with information on the identifying features of anorexia nervosa and bulimia and suggests steps which teachers can take to encourage individual children in more positive behavior. The paper makes clear distinctions between anorexia nervosa, bulimia, and bulimarexia, describing the symptoms of each disorder. It is…
Laser, Eleanor; Sassack, Michael
This case report describes an effort to control bulimia nervosa by combining low-level laser therapy (LLLT)-the application of red and near-infrared light to specific body points-and hypnosis. A 29-year old female with a 14-year history of bulimia received one session of LLLT combined with hypnosis. Two weeks later, following a measurable decrease in bulimic episodes (purging), a session of psychotherapy and hypnosis was administered. Six months post-treatment, the patient has experienced a complete cessation of purging activities without recurrence. LLLT, when used in conjunction with hypnosis and psychotherapy, was effective in managing bulimia and may prove useful in treating other eating disorders.
Historical changes in psychological symptoms are analysed not only from a social causation approach but also from a labelling perspective. Modern eating disorders lend themselves to such an analysis because of their historical variability. Effects of the introduction and dispersion of the psychiatric concept of 'bulimia nervosa' at normal body weight and its propagation through the mass media are examined (relying on Devereux's model of 'ethnic disorders'). Data of an exploratory interview study with 39 bulimic patients evaluated along these lines (a) indicate that the recognition of bulimia has facilitated seeking of professional and non-professional help, (b) invite categorization of bulimic behaviour implying less self-blame, (c) render imitation of bulimia more probable, and (d) covary with less secretive illness behaviour indicating a broadening of underlying motivations. PMID:1571308
Wu, J.C.; Hagman, J.; Buchsbaum, M.S.; Blinder, B.; Derrfler, M.; Tai, W.Y.; Hazlett, E.; Sicotte, N. )
Eight women with bulimia and eight age- and sex-matched normal control subjects were studied with positron emission tomography using (18F)-fluorodeoxyglucose (FDG) as a tracer of brain metabolic rate. Subjects performed a visual vigilance task during FDG uptake. In control subjects, the metabolic rate was higher in the right hemisphere than in the left, but patients with bulimia did not have this normal asymmetry. Lower metabolic rates in the basal ganglia, found in studies of depressed subjects, and higher rates in the basal ganglia, reported in a study of anorexia nervosa, were not found. This is consistent with the suggestion that bulimia is a diagnostic grouping distinct from these disorders.
Tuschen-Caffier, B; Pook, M; Frank, M
In the present study manual-based cognitive-behavioral therapy for bulimia nervosa was evaluated on an unselected sample of an out-patient service facility. A total of 73 female patients who asked for treatment received the primary diagnosis of bulimia nervosa. Of these, 67 took up treatment. Treatment was completed by 66 patients. Outcome variables were the number of binge episodes along with questionnaire scores for restraint eating, emotional eating, body dissatisfaction and depressiveness. At the end of treatment and 1 year after the end of treatment significant improvements were found in all outcome variables. Effect sizes for outcome variables were within the range of those of controlled research. Therefore, the present study delivered empirical evidence that manual-based cognitive-behavioral therapy is an effective treatment for bulimia nervosa not only within the restricted area of research. PMID:11227811
Oleĭnikov, A N
65 patients were examined. They were divided into three groups. Group 1 consisted of patients with anorexia nervosa (AN) without bulimia, complicated by cachexia and amenorrhea. Epileptoid personality masculinous body built and behaviour, essential disturbances of sexual self-identification prevailed in this group. 3 patients had homoerotic tendencies, while a syndrome of sex negation developed in 5 cases. In group 2 bulimia was a stage of AN development. The patients had frequently initial endocrinopathy (obesity, dysmenorrhea), experiences of phobia and anxiety, asynchronous disharmonious type of psychosexual ontogenesis. Group 3 of patients was characterized by predomination of bulimia symptoms as a variation of the disease course. Normostenic body built, normal somatoendocrine and psychosexual development were combined with hysteric personal characteristics, mood and sexual fluctuations. PMID:10849961
Gonidakis, Fragiskos; Kravvariti, Vasilliki; Varsou, Eleftheria
The cross-sectional study aimed at examining the sexual function of young adult women suffering from eating disorders. The authors interviewed 53 women (26 with anorexia nervosa and 27 with bulimia nervosa) and 58 female students. Each participant was administered the Female Sexual Function Index, the Eating Attitudes Test, the Body Shape Questionnaire, and the Beck Depression Inventory. Comparisons among the 3 groups showed that patients with anorexia nervosa scored lower in each Female Sexual Function Index subscale than did healthy controls. There was no significant difference between bulimia nervosa and healthy controls. Sexual functionality of patients with anorexia nervosa was correlated only with body mass index (r = 0.5, p =.01). Sexual functionality of patients with bulimia nervosa was correlated only with the Beck Depression Inventory (r = -0.4, p =.03) Patients with anorexia nervosa had more disturbed sexual function than did controls. Sexual function can be related to the level of starvation and symptoms of depression. PMID:24779385
Bulimia nervosa is an eating disorder characterised by recurrent episodes of binge eating and associated efforts to purge the ingested calories through self-induced vomiting, laxative or diuretic abuse, fasting or intensive exercise. The aetiopathogenesis and pathophysiology of the disorder are currently unclear. Biological bases have been proposed repeatedly, based on several lines of evidence: hunger, satiety and food choice are regulated by neurotransmitters and neuropeptides, and impairment of eating habits may be related to alterations in the secretion of these chemicals; genetic studies suggest that these neurotransmitter systems are dysfunctional in individuals with bulimia nervosa; and the frequent comorbidity of bulimia nervosa with major depressive and obsessive-compulsive disorders, conditions in which multiple alterations of brain biochemical functions have been demonstrated. Data in the literature suggest that levels of noradrenaline (norepinephrine) and serotonin (5-hydroxytryptamine; 5-HT) are lower in individuals with bulimia nervosa than in healthy controls. Levels of dopamine are similar to, or lower than, those in controls. After remission of the disorder, noradrenergic function returns to that seen in controls, whereas dopaminergic and serotonergic function rebound to levels higher than in controls. Among the neuropeptides, alterations in the levels of neuropeptide Y, peptide YY, beta-endorphin, corticotrophin-releasing hormone, somatostatin, cholecystokinin and vasopressin have been found in the symptomatic phase of bulimia nervosa, with a return to levels seen in controls after remission. Pharmacological treatment of bulimia nervosa that is directed at correction of the neurochemical alterations observed is difficult because of the complexity of the impairments. However, such treatment is necessary and should be continued long after symptomatic remission to ensure reinstitution of cerebral biochemical homeostasis. PMID:11460890
Accurso, Erin C.; Fitzsimmons-Craft, Ellen E.; Ciao, Anna; Cao, Li; Crosby, Ross D.; Smith, Tracey L.; Klein, Marjorie H.; Mitchell, James E.; Crow, Scott J.; Wonderlich, Stephen A.; Peterson, Carol B.
Objective This study examined the temporal relation between therapeutic alliance and outcome in two treatments for bulimia nervosa (BN). Method Eighty adults with BN symptoms were randomized to 21 sessions of integrative cognitive-affective therapy (ICAT) or enhanced cognitive-behavioral therapy (CBT-E). Bulimic symptoms (i.e., frequency of binge eating and purging) were assessed at each session and post-treatment. Therapeutic alliance (Working Alliance Inventory) was assessed at sessions 2, 8, 14, and post-treatment. Repeated-measures analyses using linear mixed models with random intercepts were conducted to determine differences in alliance growth by treatment and patient characteristics. Mixed-effects models examined the relation between alliance and symptom improvement. Results Overall, patients in both treatments reported strong therapeutic alliances. Regardless of treatment, greater therapeutic alliance between (but not within) subjects predicted greater reductions in bulimic behavior; reductions in bulimic behavior also predicted improved alliance. Patients with higher depression, anxiety, or emotion dysregulation had a stronger therapeutic alliance in CBT-E than ICAT, while those with more intimacy problems had greater improvement in therapeutic alliance in ICAT compared to CBT-E. Conclusions Therapeutic alliance has a unique impact on outcome, independent of the impact of symptom improvement on alliance. Within- and between-subject effects revealed that changes in alliance over time did not predict symptom improvement, but rather that individuals who had a stronger alliance overall had better bulimic symptom outcomes. These findings indicate that therapeutic alliance is an important predictor of outcome in the treatment of BN. PMID:25894667
Albert, U; Venturello, S; Maina, G; Ravizza, L; Bogetto, F
The present study was performed in a group of bulimic (BN) females (1) to assess prevalence rates of comorbid obsessive-compulsive phenomena; (2) to investigate whether BN patients display a characteristic cluster of obsessive-compulsive symptoms; and (3) to determine whether obsessive-compulsive symptoms influence the clinical picture of BN. Thirty-eight DSM-IV BN females were interviewed by means of the Structured Clinical Interview for DSM-III-R (SCID) to assess the prevalence rate of obsessive compulsive disorder (OCD); the Yale-Brown Obsessive-Compulsive Symptom Scale (Y-BOCS) Symptom Check-List was also used to evaluate the presence of obsessive-compulsive symptoms. The phenomenology of BN females with obsessive-compulsive syndromes (OCS) as detected by the Y-BOCS was compared to that shown by a "control" group of nonbulimic OCD females. Finally, the eating-related psychopathology of BN women with and without OCS was compared. The current prevalence rates of OCD and of subthreshold obsessive-compulsive syndrome (sOCS) in our sample were 10.5% and 15.8%, respectively. Thus, a total of 26.3% of BN females had a current OCS that comprised both clinical disorders and subthreshold syndromes. No differences were detected between obsessive-compulsive symptoms of these females and those of the control group of nonbulimic OCD females. BN females with OCS had higher ratings on the Eating Disorder Inventory (EDI) total score and on the "drive for thinness" and the "bulimia" items of the scale, as compared to BN females without OCS. In conclusion, it appears that a considerable proportion of BN females display OCS, which sometimes are not severe enough to fulfill diagnostic criteria for OCD. Moreover, in these patients, obsessive-compulsive symptoms are undistinguishable from those of OCD females, and exert a negative influence on the clinical picture of the bulimic disorder. PMID:11704935
Arnow, B A
Empirically supported therapies for bulimia nervosa, as well as for other disorders, are rarely utilized. Underutilization is frequently attributed to doubts among psychotherapists about the value of randomized controlled trials and professional resistance to the perceived constraints of manualized therapy. However, controversies about the usefulness of empirically supported therapies have been shaped by lack of access to adequate training and inexperience in delivering these treatments. A proposal for expanding training opportunities is presented along with discussion about how more intensive training for the practicing therapist would affect current controversies regarding the value and relevance of empirically supported therapies for bulimia nervosa and other disorders. PMID:10445866
Guiffrida, Douglas A.; Barnes, Kristin L.; Hoskins, Christine M.; Roman, Lisa L.
Presents an overview for college counselors of the literature on bulimia treatment outcomes for purposes of screening, treatment, and referral. Outlines pretreatment characteristics that seem amenable to success in brief therapy, as well as those that do not lead to a positive outcome. (Contains 37 references and 2 tables.) (Author/GCP)
Le Grange, Daniel; Crosby, Ross D.; Lock, James
The predictors and moderators of treatment outcome for adolescents with bulimia nervosa (BN) are explored among those who participated in family based treatment or individual supportive psychotherapy. It is concluded that family-based treatment of BN may be most effective in those cases with low levels of eating disorder psychopathology.
Sullivan, Keri A.
Compares the clinical characteristics of binge eating disorder (BED) and the related syndrome bulimia nervosa (BN). Findings suggest individuals with BED are distinguishable from those with BN on a number of traits, including higher rates of obesity and lower levels of eating concern and dietary restraint. (Contains 29 references and 2 tables.)…
Sim, Leslie; Zeman, Janice
This study examined emotion-identification skills in 19 adolescent girls (M age = 16 years, 8 months) diagnosed with a Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994) diagnosis of bulimia nervosa or eating disorder not otherwise specified in the bulimic spectrum, 19 age-matched girls…
Furber, Gareth; Steele, Anna; Wade, Tracey D.
A previous case-series evaluation of a six-session guided self-help (GSH) approach with 15 people with bulimia nervosa (BN) showed significant reductions across all measures, including binge eating, self-induced vomiting, weight concern, shape concern and dietary restraint. However, the reduction of binge eating and self-induced vomiting was…
Bulimia and other eating disorders are coping strategies to avoid or mask distressing emotions. Outdoor adventure activities can be intense emotional experiences that help young women find new strategies to deal with their "trigger" emotions in the absence of food. Metaphors are consciously built into adventure activities to facilitate…
Baird, Pryor; Sights, Judith R.
Observation has indicated that low self-esteem is pervasive in clients with anorexia and bulimia. Possible origins of the self-esteem deficit, its relationship to eating problems, and psychotherapeutic strategies to counteract the deficits are explored. (Author/BL)
Strober, Michael; Humphrey, Laura Lynn
Discusses familial influences in anorexia nervosa and bulimia. Reviews descriptions of family interaction, familial correlates of course and phenomenology of symptoms, and studies of familial transmission. Concludes that certain personality factors, possibly genetically determined, predispose the individual to greater sensitivity and vulnerability…
Spangler, Diane L.; Baldwin, Scott A.; Agras, W. Stewart
Cognitive-behavioral therapy (CBT) for bulimia nervosa (BN) has received considerable empirical support for its efficacy. However, few investigators have examined the mechanisms proposed to account for the reduction of BN symptoms during CBT. The current study examined the associations between therapist interventions, client mechanisms, and…
Craighead, Linda W.; Agras, W. Stewart
Summarizes data pertaining to separate and combined effects of cognitive-behavioral and psychopharmacologic treatments for obesity and bulimia nervosa. Anorexiant medication appears to enhance restraint and facilitates weight loss with behavioral interventions in the treatment of obesity, but relapse occurs once medication is withdrawn.…
Our Children, 1998
Examines facts about eating disorders, which typically affect females in their teens, discussing the causes of anorexia and bulimia, describing their effects on the body, and explaining available treatment. Though eating disorders are very serious and potentially fatal, they are treatable. Treatment includes physician evaluation, possible…
Levine, Michael P.
This book presents a comprehensive review of anorexia nervosa and bulimia and the roles that schools can have in preventing, identifying, and treating these disorders. Chapter 1 provides an overview of student eating disorders and presents a case study of a high school student with an eating disorder. Chapter 2 discusses the nature of anorexia…
Agras, W. Stewart; And Others
Assessed treatment for bulimia nervosa among 77 female patients assigned to wait-list control, self-monitoring of caloric intake and purging behaviors, cognitive-behavioral treatment, and cognitive-behavioral treatment plus response prevention of vomiting. All treatment groups showed significant improvement; control group did not.…
Oakley, Suzanne J.
Although long-term treatments have successfully reduced or eliminated the binging and purging of bulimia patients, there is a critical need for effective short-term treatments since many bulimics are college students who are not available for lengthy treatment. Seven female university students participated in an eight session individual…
Zimmer, Marc A.
Prevention and early intervention in cases of anorexia and bulimia require that both professionals and the general public have knowledge about these eating disorders. A study was conducted to identify the questions about these disorders most often asked by the general public and to develop a guide to answer those questions for individuals of…
Binford, Roslyn B.; Mussell, Melissa Pederson; Crosby, Ross D.; Peterson, Carol B.; Crow, Scott J.; Mitchell, James E.
This study's purpose was to examine the extent to which participants (N = 143) receiving cognitive-behavioral therapy for bulimia nervosa (BN) reported implementing therapeutic strategies to abstain from BN behaviors, and to assess whether use of specific strategies predicts outcome at treatment end and 1-and 6-month follow-up. Frequency of…
Salbach-Andrae, Harriet; Bohnekamp, Inga; Pfeiffer, Ernst; Lehmkuhl, Ulrike; Miller, Alec L.
The aim of this study was to describe a case series of adolescents (mean age = 16.5 years, SD = 1.0) with anorexia nervosa (AN) and bulimia nervosa (BN) who received dialectical behavior therapy (DBT). Twelve outpatients with AN and BN took part in 25 weeks of twice weekly therapy consisting of individual therapy and a skills training group.…
Michel, Deborah Marcontell; Willard, Susan G.
This book about anorexia and bulimia is written for patients and the people who care about them. It describes the symptoms and warning signs of eating disorders, explains their presumed causes and complexities, and suggests effective treatments. The book emphasizes the critical role of psychotherapy and family therapy in recovery, explains how…
The purpose of this literature review is to examine prevalence and incident rates of both anorexia nervosa and bulimia nervosa. In addition, this article will review the psychological and sociological factors that contribute to the development and maintenance of an eating disorder. Finally, different treatment approaches will be discussed in…
Peters, Carole; And Others
Anorexia nervosa and bulimia are major concerns for high school students, especially females. These syndromes interfere with normal functioning and social development and can be life-threatening. Definitions, characteristics, symptoms, and treatment approaches for these two eating disorders are discussed, and suggestions for involvement of the…
Delinsky, Sherrie S.; Wilson, G. Terence
Cognitive behavior therapy (CBT) is an effective treatment for bulimia nervosa (BN). However, among patients with BN, symptom improvement is more pronounced for behavioral eating symptoms (i.e., bingeing and purging) than for body image disturbance, and the persistence of body image disturbance is associated with relapse. The need for more…
Harrington, Brian C; Jimerson, Michelle; Haxton, Christina; Jimerson, David C
Eating disorders are life-threatening conditions that are challenging to address; however, the primary care setting provides an important opportunity for critical medical and psychosocial intervention. The recently published Diagnostic and Statistical Manual of Mental Disorders, 5th ed., includes updated diagnostic criteria for anorexia nervosa (e.g., elimination of amenorrhea as a diagnostic criterion) and for bulimia nervosa (e.g., criterion for frequency of binge episodes decreased to an average of once per week). In addition to the role of environmental triggers and societal expectations of body size and shape, research has suggested that genes and discrete biochemical signals contribute to the development of eating disorders. Anorexia nervosa and bulimia nervosa occur most often in adolescent females and are often accompanied by depression and other comorbid psychiatric disorders. For low-weight patients with anorexia nervosa, virtually all physiologic systems are affected, ranging from hypotension and osteopenia to life-threatening arrhythmias, often requiring emergent assessment and hospitalization for metabolic stabilization. In patients with frequent purging or laxative abuse, the presence of electrolyte abnormalities requires prompt intervention. Family-based treatment is helpful for adolescents with anorexia nervosa, whereas short-term psychotherapy, such as cognitive behavior therapy, is effective for most patients with bulimia nervosa. The use of psychotropic medications is limited for anorexia nervosa, whereas treatment studies have shown a benefit of antidepressant medications for patients with bulimia nervosa. Treatment is most effective when it includes a multidisciplinary, teambased approach. PMID:25591200
Buchanan, J. A.; Fortune, F.
An unusual case of bulimia nervosa in a post-adolescent male is reported. The clinical presentation was one of painless parotid swelling of 3 years duration with marked weight loss and underlying metabolic alkalosis. The diagnostic significance of parotid salivary gland swellings is discussed. Images Figure 1 Figure 2 PMID:8140014
Grob, Simona; Milos, Gabriella; Schnyder, Ulrich; Eckert, Anne; Lang, Undine; Hasler, Gregor
Background: A relationship between bulimia nervosa and reward-related behavior is supported by several lines of evidence. The dopaminergic dysfunctions in the processing of reward-related stimuli have been shown to be modulated by the neurotrophin brain derived neurotrophic factor (BDNF) and the hormone leptin. Methods: Using a randomized, double-blind, placebo-controlled, crossover design, a reward learning task was applied to study the behavior of 20 female subjects with remitted bulimia nervosa and 27 female healthy controls under placebo and catecholamine depletion with alpha-methyl-para-tyrosine (AMPT). The plasma levels of BDNF and leptin were measured twice during the placebo and the AMPT condition, immediately before and 1 hour after a standardized breakfast. Results: AMPT–induced differences in plasma BDNF levels were positively correlated with the AMPT–induced differences in reward learning in the whole sample (P=.05). Across conditions, plasma brain derived neurotrophic factor levels were higher in remitted bulimia nervosa subjects compared with controls (diagnosis effect; P=.001). Plasma BDNF and leptin levels were higher in the morning before compared with after a standardized breakfast across groups and conditions (time effect; P<.0001). The plasma leptin levels were higher under catecholamine depletion compared with placebo in the whole sample (treatment effect; P=.0004). Conclusions: This study reports on preliminary findings that suggest a catecholamine-dependent association of plasma BDNF and reward learning in subjects with remitted bulimia nervosa and controls. A role of leptin in reward learning is not supported by this study. However, leptin levels were sensitive to a depletion of catecholamine stores in both remitted bulimia nervosa and controls. PMID:25522424
Woodside, D B; Field, L L; Garfinkel, P E; Heinmaa, M
This study examines the prevalence of anorexia nervosa and bulimia nervosa in relatives of probands, and examines the probandwise specificity of any familial clustering. Data were collected from probands using the family history method. Probands were recruited in a sequential cohort fashion. Information collected from probands was rated semiblindly by two of the authors, and a diagnostic hierarchy applied to arrive at a diagnosis for each of the relatives assessed. Data are reported on 2,125 family members, collected from 93 probands. Diagnostic agreement between raters was high, with serious disagreement present in three of 167 possible cases of an eating disorder. Rates of anorexia nervosa, bulimia nervosa, major depression, and substance abuse declined from first- to third-degree relatives, which is consistent with genetic clustering, and there was evidence of a cohort effect operating for anorexia nervosa and bulimia nervosa. The rates of anorexia nervosa and bulimia nervosa in all family members were 5.1%, and 4.3% respectively. An analysis of maternal and paternal descent showed no evidence for X-linked dominant transmission in these families. Preliminary analysis of the clustering of diagnoses in relatives showed a tendency (chi 2 = 14.47, P = .006) for family members to be affected by the same diagnosis as was the proband. This trend was strongest for anorexia nervosa, but there was overlap when the proband had a lifetime diagnosis of bulimia nervosa, with or without anorexia nervosa. These results are compatible with the existence of genetic factors influencing predisposition to eating disorders, but do not prove such. PMID:9777277
Oberndorfer, Tyson A.; Frank, Guido K.W.; Simmons, Alan N.; Wagner, Angela; McCurdy, Danyale; Fudge, Julie L.; Yang, Tony T.; Paulus, Martin P.; Kaye, Walter H.
Objective Recent studies suggest that altered function of higher-order appetitive neural circuitry may contribute to restricted eating in anorexia nervosa and overeating in bulimia nervosa. This study used sweet tastes to interrogate gustatory neurocircuitry involving the anterior insula and related regions that modulate sensory-interoceptive-reward signals in response to palatable foods. Method Subjects recovered from anorexia and bulimia were studied to avoid confounding effects of altered nutritional state. Functional magnetic resonance imaging measured brain response to repeated tastes of sucrose and sucralose to disentangle neural processing of caloric and non-caloric sweet tastes. Whole-brain functional analysis was constrained to anatomical regions of interest. Results Compared to matched control women (n=14), women recovered from anorexia (n=14) had diminished (F(1,27)=7.79, p=0.01) and women recovered from bulimia (n=14) had exaggerated (F(1,27)=6.12, p=0.02) right anterior insula hemodynamic response to tastes of sucrose. Furthermore, anterior insula responses to sucrose compared to sucralose was exaggerated in recovered subjects (lower in women recovered from anorexia and higher in women recovered from bulimia). Conclusions The anterior insula integrates sensory/reward aspects of taste in the service of nutritional homeostasis. For example, one possibility is that restricted eating and weight loss occur in anorexia nervosa because of a failure to accurately recognize hunger signals, whereas overeating in bulimia nervosa could represent an exaggerated perception of hunger signals. This response may reflect the altered calibration of signals related to sweet taste and the caloric content of food and may offer a pathway to novel and more effective treatments. PMID:23732817
Ioannidis, Konstantinos; Serfontein, Jaco; Müller, Ulrich
There is increasing literature suggesting a link between attention-deficit hyperactivity disorder (ADHD) and eating disorders (EDs), especially bulimia nervosa. ADHD is under-diagnosed in girls and children of high intelligence are typically missed. We identified a case of a 23-year-old woman suffering from severe bulimia nervosa and previously unsuspected ADHD in adulthood; we diagnosed and treated her with extended-release methylphenidate. We performed a literature review on the ADHD and bulimia nervosa comorbidity. We discuss the reasons why her ADHD remained undiagnosed and the difficulties in diagnosing ADHD in patients with EDs. We suggest that identifying comorbid ADHD is crucial for these patients and argue for the use of a structured interview, collateral history and investigation of onset of symptoms to establish a diagnosis of ADHD in adults with bulimia nervosa. Comorbidities and overlap of symptomatology need to be taken into account. PMID:24311027
Freudenberg, Cara; Jones, Rebecca A; Livingston, Genvieve; Goetsch, Virginia; Schaffner, Angela; Buchanan, Linda
The effectiveness of an individualized outpatient program was investigated in the treatment of bulimia nervosa (BN) and anorexia nervosa (AN). Participants included 151 females who received outpatient eating disorder treatment in the partial hospitalization program, the intensive outpatient program, or a combination of the two programs. Outcome measures included the Eating Disorder Inventory (EDI-2), Beck Depression Inventory (BDI-II), frequency of binge eating and purging, and mean body weight. Findings included significant increases in weight for the AN group, reductions in binge eating frequency for the BN group, and reductions in EDI-2 and BDI-II scores and purging frequency for both groups. This study provides preliminary support for the efficacy of a multimodal program for the treatment of both anorexia nervosa and bulimia nervosa. PMID:26467107
Chakraborty, Kaustav; Basu, Debasish
Anorexia nervosa and bulimia nervosa are primarily psychiatric disorders characterized by severe disturbances of eating behavior. Eating disorders are most prevalent in the Western culture where food is in abundance and female attractiveness is equated with thinness. Eating disorders are rare in countries like India. Despite a plethora of management options available to the mental health professionals, no major breakthrough has been achieved in recent years. Nutritional rehabilitation along with some form of re educative psychotherapy remains the mainstay of management of anorexia nervosa. In bulimia nervosa, both fluoxetine and cognitive behavior therapy have been found to be effective. Although the above-mentioned management options have been in use for decades, the active ingredient is still to be ascertained. PMID:20838508
Rodgers, Rachel Florence; Paxton, Susan J; McLean, Siân A; Massey, Robin; Mond, Jonathan M; Hay, Phillipa J; Rodgers, Bryan
Widely held stigmatizing attitudes and beliefs toward bulimic eating disorders may lead to self-blame and reduced treatment seeking. Knowledge and familiarity with mental disorders may help decrease associated stigma. However, these relationships are not well understood in bulimia nervosa (BN). A community sample of 1828 adults aged 18 to 70 years completed a survey assessing stigmatizing attitudes and beliefs toward BN, knowledge and familiarity with the disorder, as well as levels of eating disorder symptoms. Knowledge of BN was negatively associated with three dimensions of stigmatization, personal responsibility (ρ = -0.28), unreliability (ρ = -0.19), and advantages of BN (ρ = -0.23). Familiarity revealed no association with stigmatization. Both men and women with high levels of eating disorder symptoms perceived BN as less serious than the participants with low levels of symptoms. Increasing community knowledge about bulimia may help mitigate stigmatization and perceived barriers to treatment. PMID:25751709
Reich, Günter; Horn, Hildegard; Winkelmann, Klaus; Kronmüller, Klaus-Thomas; Stefini, Anette
A manual for a disorder oriented psychodynamic treatment of bulimia nevosa and atypical bulimia nervosa of female adolescents and young adults is presented. This manual is applied in a therapy project, which started in 2007. The work on conflicts and structural dysfunctions is meant to lead to the removal or alleviation of the symptoms and an improvement of eating behavior and body image. The bulimic symptoms are contextualized and focussed according to the conflicts and ego-structural deficits of the patients. Typical patterns of interpersonal relationships, transference, conflict, defence and structural problems as well as therapeutic steps are described. The typical psychosocial situation of female adolescence and young adult age is taken into account. Special emphasis is laid on the limitedness of the therapy to 60 sessions and the active structuring of the final phase of he therapy by the therapist. PMID:24693801
Gleaves, D H; Williamson, D A; Fuller, R D
To investigate the hypothesis that problems characteristic of eating disorders may often be associated with distance running, 20 women who had lost weight through distance running were compared with a control group who did not exercise and had not lost weight and a comparison group of bulimia nervosa patients. Dependent variables were measures of depression, bulimia nervosa symptomatology, and body image disturbance. No differences were found between the runner group and the normal controls. Bulimics differed from runners and controls on most measures. Thus, the results did not support the proposition that weight loss through running leads to problems related to eating and body image. The failure to find disturbances in body image in runners suggests that body image disturbances are not a direct result of weight loss, as suggested by some theorists. PMID:1422651
Background Empirically supported therapies for bulimia nervosa include cognitive behaviour therapy and interpersonal therapy. Whilst these treatments have been shown to be effective in multiple randomised controlled trials, little research has investigated how they are perceived by patients who receive them. This study investigated whether empirically-supported psychological therapies (ESTs) are associated with superior self-rated treatment outcomes in clients with Bulimia Nervosa (BN). Results 98 adults who had received psychological therapy for BN in the United Kingdom completed a questionnaire which retrospectively assessed the specific contents of their psychological therapy and self-rated treatment outcomes. Around half the sample, fifty three participants reported receiving an EST. Fifty of these received Cognitive Behaviour Therapy (CBT) and three Interpersonal Therapy (IPT). Where therapy met expert criteria for Cognitive Behaviour Therapy for Bulimia Nervosa (CBT-BN, an EST) participants reported superior treatment outcomes than those who appeared to receive non-specialist cognitive-behavioural therapy. However, self-rated treatment outcomes were similar overall between those whose therapy met criteria for ESTs and those whose therapy did not. Conclusions The findings offer tentative support for the perceived helpfulness of CBT-BN as evaluated in controlled research trials. Cognitive-behavioural therapies for BN, as they are delivered in the UK, may not necessarily be perceived as more beneficial by clients with BN than psychological therapies which currently have less empirical support. PMID:24999419
Deb, Koushik Sinha; Gupta, Rishab; Varshney, Mohit
Eating disorders like bulimia nervosa, generally considered to be rare in Asian countries, are currently on the rise among the youth, probably secondary to rapid westernization and globalization of the orient. Clinical manifestations of these disorders, which were previously thought to be different in the oriental countries, are now also often seen to parallel their western counterparts. However, detailed clinical descriptions of such cases from Asian countries, documenting the societal change, are missing. In addition, the possibility of abuse of various anti-obesity drugs as a part of bulimic compensatory behavior is high in this population, given the easy and unsupervised access of these drugs over the counter. We report a case of bulimia nervosa in a female medical graduate from India, presenting with classic bulimic symptomatology and with a compensatory behavior consisting almost exclusively of Orlistat abuse. This case sensitizes health professionals to the abuse liability of new medications like Orlistat and also documents the changing symptomatology of bulimia nervosa in India. PMID:24953260
Dalle Grave, R
Seventeen patients meeting the DSM-IV criteria for bulimia nervosa were treated in a specialist setting according to the "guided self-help" approach as outlined in the self-help handbook "Overcoming Binge Eating" by Fairburn. This self-help manual is essentially a condensed version of the cognitive-behavioural therapy for bulimia nervosa developed by the same author. Every patient took part in 8 bimonthly sessions each lasting 20 minutes. All subjects were evaluated both before and after the treatment through a semi-structured interview. Overall, 10 patients (58.8%) did well; 6 of these 10 patients (35.3%) stopped binge-eating and vomiting altogether. Although the conclusions arising from this pilot study have yet to be confirmed by a controlled study, the preliminary findings seem to suggest that "guided self-help" in a specialist setting could, indeed, be not only sufficient in some cases but may also be the most accessible approach in treating many patients affected by bulimia nervosa. PMID:14655843
Individuals with bulimia nervosa and binge eating disorder commonly report co-occurring interpersonal problems, and treatment that focuses on relationships and relational functioning has shown benefit relative to other forms of treatment. Relational psychotherapy for eating disorders can vary on several important dimensions, such as how structured and symptom-focused versus exploratory and patient-directed it is, whether it focuses on past relationships and patterns in relationships over time versus focusing on current relationships, and whether it includes the relationship with the therapist as an explicit topic of conversation and mechanism for relational change. The cases in this special section provide the opportunity to closely compare 3 therapeutic approaches on each of these dimensions. Psychoanalytic Psychotherapy for Bulimia Nervosa, Integrative Dynamic Therapy for Bulimia Nervosa, and Interpersonal Psychotherapy for the Prevention of Weight Gain and Eating Disorders are each highly distinct approaches. The authors of each case explain the intended mechanisms of treatment response, the measures that assess changes in eating disorder symptoms as well as the mechanisms of change, and provide extensive excerpts from case material to demonstrate and illustrate the particular evidence-based treatment. Therapists and researchers may usefully consider the process and outcome variables described in these interpersonal approaches. (PsycINFO Database Record PMID:27267502
Mitchell, J E; Fletcher, L; Hanson, K; Mussell, M P; Seim, H; Crosby, R; Al-Banna, M
A randomized, placebo-controlled study was conducted examining the singular and combined effects of fluoxetine and a self-help manual on suppressing bulimic behaviors in women with bulimia nervosa. A total of 91 adult women with bulimia nervosa were randomly assigned to one of four conditions: placebo only, fluoxetine only, placebo and a self-help manual, or fluoxetine and a self-help manual. Subjects were treated for 16 weeks. Primary outcome measures included self-reports of bulimic behaviors. Fluoxetine and a self-help manual were found to be effective in reducing the frequency of vomiting episodes and in improving the response rates for vomiting and binge-eating episodes. Furthermore, both factors were shown to be acting additively on the primary and secondary efficacy measures in this study. Results are discussed in relation to previous research and the implications for treatment of bulimia nervosa. PMID:11386493
McAdams, Carrie J.; Krawczyk, Daniel C.
Self-evaluation closely dependent upon body shape and weight is one of the defining criteria for bulimia nervosa (BN). We studied 53 adult women, 17 with BN, 18 with a recent history of anorexia nervosa (AN), and 18 healthy comparison women, using three different fMRI tasks that required thinking about self-knowledge and social interactions: the Social Identity task, the Physical Identity task, and the Social Attribution task. Previously, we identified regions of interest (ROI) in the same tasks using whole-brain voxel-wise comparisons of the healthy comparison women and women with a recent history of AN. Here, we report on the neural activations in those ROIs in subjects with BN. In the Social Attribution task, we examined activity in the right temporoparietal junction (RTPJ), an area frequently associated with mentalization. In the Social Identity task, we examined activity in the precuneus (PreC) and dorsal anterior cingulate (dACC). In the Physical Identity task, we examined activity in a ventral region of the dACC. Interestingly, in all tested regions, the average activation in subjects with bulimia was more than the average activation levels seen in the subjects with a history of anorexia but less than that seen in healthy subjects. In three regions, the RTPJ, the PreC, and the dACC, group responses in the subjects with bulimia were significantly different from healthy subjects but not subjects with anorexia. The neural activations of people with BN performing fMRI tasks engaging social processing are more similar to people with AN than healthy people. This suggests biological measures of social processes may be helpful in characterizing individuals with eating disorders. PMID:24065928
Favaro, A; Santonastaso, P
A specific link between self-injurious behavior and bulimia nervosa has been observed. In affective spectrum disorders, some authors propose a distinction between impulsive and compulsive self-injurious behavior. One of the aims of the present study is to examine how different kinds of self-injurious behavior, including purging behavior, may be classified in bulimia nervosa. The clinical impact of the different types of self-injury will be studied. The subjects of the study were 125 consecutive patients with bulimia nervosa, diagnosed by DSM-IV criteria. Subjects were evaluated by means of a semistructured interview and self-report questionnaires (Eating Disorders Inventory and Hopkins Symptom Checklist). In our sample, the distinction between compulsive and impulsive self-injurious behavior appeared to be confirmed by a principal component analysis. Self-induced vomiting loaded on the compulsive dimension and laxative abuse on the impulsive dimension. To study the clinical impact of the two kinds of behavior, bulimic subjects were divided according to their position in the two dimensions. The presence of impulsive self-injurious behavior is associated with a history of sexual abuse and with higher scores on the Symptom Checklist. The presence of both impulsive and compulsive behavior is associated with greater depression, whereas the presence of impulsive features in the absence of compulsive ones seems to be linked to a longer duration of illness and to a higher dropout rate. Both compulsive and impulsive self-injurious behaviors are associated with a greater lack of interoceptive awareness. PMID:9521351
Esplen, Mary Jane; Garfinkel, Paul E.
Bulimia nervosa (BN) has been described as involving impairment in affect regulation and in self-soothing. Such a conceptualization suggests the need to design treatments that specifically target these problems in order to assist individuals with BN in comforting themselves. A model of guided imagery therapy suggests that imagery therapy has multiple levels of action and can assist these individuals in the regulation of affect by providing an external source of soothing and also by enhancing self-soothing. The authors illustrate the model with a case example and report the results of a study in a clinical sample of BN. PMID:9527955
Weibel, Sébastien; Lalanne, Laurence; Riegert, Myriam; Bertschy, Gilles
High-dose baclofen is a promising treatment for alcohol use disorder, with a specific action on craving. A more general action on craving in other addictive disorders has been suggested based on the hypothesis of a common neurobiological pathway in addictions. We report the case of a woman with both alcohol use disorder and bulimia nervosa. There was a positive response to high-dose baclofen on alcohol craving, but no response on food craving. The case illustrates that craving could be differentially responsive to anti-craving drugs. PMID:26457456
Vaz-Leal, Francisco J; Ramos-Fuentes, María I; Rodríguez-Santos, Laura; Flores-Mateos, Isabel S; Franco-Zambrano, Andrés; Rojo-Moreno, Luis; Beato-Fernández, Luis
The study was aimed at analysing the reciprocal relationships of several clinical and neurobiological items in order to predict alcohol misuse in patients with bulimia nervosa (BN). Seventy BN patients and 70 healthy controls were assessed for depression, impulsivity, borderline personality traits and self-defeating behaviours using specific scales; serum cortisol and 24-hour urinary excretion of serotonin and 5-hydroxiindolacetic acid were also assessed. The study confirmed the implications of these clinical factors for alcohol misuse in BN patients, but the results suggested that depressive symptoms and hypercortisolism could lie behind these relationships. PMID:25766414
Kasper, Siegfried; Tauscher, Johannes; Willeit, Matthäus; Stamenkovic, Mara; Neumeister, Alexander; Küfferle, Bernd; Barnas, Christian; Stastny, Jürgen; Praschak-Rieder, Nicole; Pezawas, Lukas; de Zwaan, Martina; Quiner, Sylvia; Pirker, Walter; Asenbaum, Susanne; Podreka, Ivo; Brücke, Thomas
Considerable progress has been achieved over the past 15 years in uncovering the biological basis of major psychiatric disorders. To determine patterns of brain dysfunction and to uncover the mechanism of action of centrally active compounds we used single photon emission computerized tomography (SPECT) as well as positron emission tomography (PET) in patients diagnosed with schizophrenia, depression, bulimia and Tourette's disorder. Striatal D2 and 5-HT1A receptors were studied in schizophrenia and 5-HT transporters (5-HTT) in depression and bulimia. Patients were either drug-naïve or drug free, or we studied the influence of specifically acting compounds on receptor/transporter occupancy. We could demonstrate that atypical antipsychotics have a dose-dependent (with the exception of clozapine and quetiapine) lower striatal D2 receptor occupancy rate compared with typical neuroleptics, paralleling the more favourable extrapyramidal side effects of atypical antipsychotics. However, no association between striatal D2 receptor occupancy rates and antipsychotic efficacy has been found. The measurement of 5-HT1A receptors in drug-naïve schizophrenic patients using the in vivo PET methodology revealed an increase of cortical 5-HT1A receptor binding potential in schizophrenia. beta-CIT as a ligand for measurement of 5-HT transporter densities (5-HTT) revealed lower rates in depression compared to age- and sex-matching healthy controls, a measurement that has also been obtained for bulimia. We also documented seasonal variations in brain serotonergic function by our finding of reduced brain 5-HTT availability in winter (compared to summer) in healthy controls. Furthermore, displaceable [123I] beta-CIT binding in the area corresponding to the left striatum (representing predominantly the density of dopamine transporters) was significantly reduced in SAD patients compared to healthy controls. In depression as well as in bulimia, selective serotonin reuptake inhibitors
Allen, Karina L; Byrne, Susan M; Crosby, Ross D
Binge eating disorder and purging disorder have gained recognition as distinct eating disorder diagnoses, but risk factors for these conditions have not yet been established. This study aimed to evaluate a prospective, mediational model of risk for the full range of binge eating and purging eating disorders, with attention to possible diagnostic differences. Specific aims were to determine, first, whether eating, weight and shape concerns at age 14 would mediate the relationship between parent-perceived childhood overweight at age 10 and a binge eating or purging eating disorder between age 15 and 20, and, second, whether this mediational model would differ across bulimia nervosa, binge eating disorder, and purging disorder. Participants (N = 1,160; 51 % female) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, which has followed children from pre-birth to age 20. Eating disorders were assessed via self-report questionnaires when participants were aged 14, 17 and 20. There were 146 participants (82 % female) with a binge eating or purging eating disorder with onset between age 15 and 20 [bulimia nervosa = 81 (86 % female), binge eating disorder = 43 (74 % female), purging disorder = 22 (77 % female)]. Simple mediation analysis with bootstrapping was used to test the hypothesized model of risk, with early adolescent eating, weight and shape concerns positioned as a mediator between parent-perceived childhood overweight and later onset of a binge eating or purging eating disorder. Subsequently, a conditional process model (a moderated mediation model) was specified to determine if model pathways differed significantly by eating disorder diagnosis. In the simple mediation model, there was a significant indirect effect of parent-perceived childhood overweight on risk for a binge eating or purging eating disorder in late adolescence, mediated by eating, weight and shape concerns in early adolescence. In the conditional process model
Alloway, R; Reynolds, E H; Spargo, E; Russell, G F
Two adolescent patients with eating disorders and severe weight loss presented with neuromyopathy. The first was female and had a twenty months' history of bulimia nervosa with weight loss and episodic gorging and vomiting. The second was male with a two-year history of anorexia nervosa characterised by vegetarianism and increasing food restriction. Both had severe wasting and asymmetrical weakness of proximal limb muscles. The first patient deteriorated on refeeding and became temporarily paralysed. Both had a purpuric rash and haematological abnormalities. They made a complete recovery on a mixed diet: vitamin supplements were given to the first but not to the second patient. PMID:3863893
Lacey, J H; Gowers, S G; Bhat, A V
Family size, sex of siblings and birth order were examined in 225 bulimic patients of normal weight, all stemming from the same circumscribed catchment area. Although bulimia can occur in any size family, all-female sibships were significantly over-represented. In small families at least, the bulimic patient was highly likely to be the only or eldest daughter. In small sibships, a bulimic who was first-born was significantly more likely to have a younger sister; if second-born she was more likely to have an elder brother. Despite the very large sample size, no final conclusion can be made on birth order. PMID:2054564
Simpson, W S; Ramberg, J A
The immediacy of anorexia and bulimia nervosa tends to obscure the adjunct problems of eating-disordered patients. The literature records no data pertaining to the treatment of concomitant psychosexual dysfunctions. The authors report the cases of five young married women referred for psychosexual therapy from eating disorders programs. The therapists found that each of the women was suffering from at least one additional disorder. Basic issues of control, grounded in these patients' early lives, generated intense resistance to treatment. The authors emphasize the need for accelerated research to gather the data from which to develop an effective treatment program for eating-disordered patients with associated sexual dysfunctioning. PMID:1556757
Weigel, Angelika; Gumz, Antje; Kästner, Denise; Romer, Georg; Wegscheider, Karl; Löwe, Bernd
The "Health care network anorexia and bulimia nervosa", a subproject of psychenet - the Hamburg network for mental health - aims to decrease the incidence of eating disorders as well as the risk for chronic illness courses. One focal project, therefore, evaluates a school-based prevention manual in a randomized controlled trial. The other one examines the impact of a systemic public health intervention on early treatment initiation in anorexia nervosa. The present article provides an overview about study design and interventions in both focal projects as well as preliminary results. PMID:26135276
Tasegian, Anna; Curcio, Francesco; Dalla Ragione, Laura; Rossetti, Francesca; Cataldi, Samuela; Codini, Michela; Ambesi-Impiombato, Francesco Saverio; Beccari, Tommaso; Albi, Elisabetta
Vitamin D3 has been described to have different extraskeletal roles by acting as parahormone in obesity, diabetes, cancer, cognitive impairment, and dementia and to have important regulatory functions in innate immunity. There are no studies showing extraskeletal changes associated with hypovitaminosis D3 in eating disorders. Methods. We have analyzed the blood of 18 patients affected by anorexia nervosa and bulimia nervosa collected over a 15-month period. We performed a panel of chemical and clinical analyses: the assay of vitamin D3, the immunoblotting of vitamin D receptor and peroxisome proliferator-activated receptor gamma, and the genotyping of 5-hydroxytryptamine transporter linked polymorphic region. Results. We choose 18 patients with a normal blood test profile such as thyroid hormones, hepatic and renal parameters, triglycerides, proteins, vitamin B12, and folic acid. Among these emerged the case of a woman with long-term anorexia nervosa and the case of a woman with long-term bulimia nervosa both complicated by anxiety and depression, severe hypovitaminosis D3, decrease of vitamin D receptor, leukopenia, and 5-hydroxytryptamine transporter linked polymorphic region short allele. Conclusion. The results induce hypothesising that the severe hypovitaminosis D3 might be responsible for the lack of the inflammatory response and the depressive symptoms in patients with long-term eating disorders. PMID:26903713
Tasegian, Anna; Curcio, Francesco; Dalla Ragione, Laura; Rossetti, Francesca; Cataldi, Samuela; Codini, Michela; Ambesi-Impiombato, Francesco Saverio; Beccari, Tommaso; Albi, Elisabetta
Vitamin D3 has been described to have different extraskeletal roles by acting as parahormone in obesity, diabetes, cancer, cognitive impairment, and dementia and to have important regulatory functions in innate immunity. There are no studies showing extraskeletal changes associated with hypovitaminosis D3 in eating disorders. Methods. We have analyzed the blood of 18 patients affected by anorexia nervosa and bulimia nervosa collected over a 15-month period. We performed a panel of chemical and clinical analyses: the assay of vitamin D3, the immunoblotting of vitamin D receptor and peroxisome proliferator-activated receptor gamma, and the genotyping of 5-hydroxytryptamine transporter linked polymorphic region. Results. We choose 18 patients with a normal blood test profile such as thyroid hormones, hepatic and renal parameters, triglycerides, proteins, vitamin B12, and folic acid. Among these emerged the case of a woman with long-term anorexia nervosa and the case of a woman with long-term bulimia nervosa both complicated by anxiety and depression, severe hypovitaminosis D3, decrease of vitamin D receptor, leukopenia, and 5-hydroxytryptamine transporter linked polymorphic region short allele. Conclusion. The results induce hypothesising that the severe hypovitaminosis D3 might be responsible for the lack of the inflammatory response and the depressive symptoms in patients with long-term eating disorders. PMID:26903713
Cooper, P J; Coker, S; Fleming, C
Eighty two patients with bulimia nervosa were managed by providing them with supervision in the use of a highly structured cognitive behavioral self-help manual. Their progress was assessed in an open clinical trial. The 67 patients who completed the course of self-help experienced considerable benefit; the frequency of bulimic episodes and self-induced vomiting decreasing by 80% and 79%, respectively. Compared to those who benefited, those who had a poor outcome or dropped out of treatment were more than twice as likely to have had anorexia nervosa in the past and were somewhat more likely to have a personality disorder. Three-quarters of those who persisted with the programme of supervised self-help were followed up a year after commencing treatment. Clinical gains were well maintained: almost two thirds were abstinent with respect to both bulimic episodes and self-induced vomiting. It would seem appropriate that, as part of a stepped care approach to the management of bulimia nervosa, supervised cognitive behavioral self-help should routinely be the first line treatment. PMID:8861124
Clients suffering from the fasting and gorging syndromes of anorexia and bulimia nervosa are at significant risk of self-harm even if treated with apparent success in hospital. Two major issues (not inevitably co-existing) appear to be at work in these illnesses; distorted perception by the sufferer of his or her own body appearance and stressful interpersonal relationships originating in one of a variety of groups of which the sufferer is a member. (Fear of psychosexual maturity, that is, the clients' inability to develop an age-appropriate sexual identity, is treated in this paper as being the product of faulty interactional patterns; it is also a less clear-cut issue in bulimia nervosa than in anorexia.) A supervised hospital in-patient treatment regime concentrating upon weight gain, effective discouragement of purgation and vomiting, possible drug treatment and perhaps dual or independent usage of individual or group psychotherapy with focused cognitive-behavioural task-oriented approaches, will not realize effective change unless these issues are resolved. Community psychiatric nurses (CPNs) are well-placed to observe and supervise people with eating disorders who are potentially vulnerable to relapse following discharge from hospital. Strategies for effective CPN interventions in the community care of anorectic and bulimic clients are suggested in the paper. PMID:8450130
Cooper, P J; Steere, J
In an effort to elucidate the role of cognitive factors in the maintenance of bulimia nervosa, the efficacy of two psychological treatments was examined in a randomised control trial: cognitive behaviour therapy in the absence of explicit exposure instructions was compared with exposure and response prevention treatment in the absence of cognitive restructuring procedures. In the short term both treatments were successful at effecting substantial improvement in both the specific and the non-specific psychopathology of the disorder. However, at a one year follow up, whilst improvements were well maintained for those who had received the cognitive-behavioural treatment, virtually all of those who had responded to the purely behavioural treatment had relapsed. This provides some support for the cognitive model of the maintenance of bulimia nervosa. Nevertheless, the two treatment groups could not be distinguished on post-treatment measures of cognitive disturbance and neither was it the case that residual levels of cognitive disturbance, as assessed, predicted relapse. This may suggest that the level at which the necessary cognitive change takes place may not be accessible by conventional assessment procedures. PMID:7487847
Loeb, Katharine L.; Wilson, G. Terence; Labouvie, Erich; Pratt, Elizabeth M.; Hayaki, Jumi; Walsh, B. Timothy; Agras, W. Stewart; Fairburn, Christopher G.
The relationship between therapeutic alliance, therapist adherence to treatment protocol, and outcome was analyzed in a randomized trial of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy for bulimia nervosa. Independent observers rated audiotapes of full-length therapy sessions. Purging frequency was the primary outcome…
Zaider, Talia I.; Johnson, Jeffrey G.; Cockell, Sarah J.
Conducted a prospective longitudinal study to investigate whether anxiety, depressive, personality, or substance abuse disorders increase risk for onset of bulimia nervosa (BN) or binge eating disorder (BED) during adolescence. Findings for 201 adolescents suggest that adolescents with chronic depressive symptoms may be at elevated risk for the…
Stice, Eric; Bohon, Cara; Marti, C. Nathan; Fischer, Kathryn
Studies have found that individuals with bulimia nervosa can be classified into dietary and dietary-negative affect subtypes and that the latter exhibit greater eating pathology, psychiatric comorbidity, and functional impairment; a more protracted clinical course; and a worse treatment response. In this report, the authors describe 2 prospective…
Zimmer, Marc A.
This report describes the research study involved in developing a document on anorexia and bulimia for the lay population. Chapter I focuses on the basic areas that provided the foundation for the study: (1) the definitions of specific eating disorders; (2) the role of the mass media in affecting anorexics and bulimics, and in educating the public…
Auslander, Beth A.; Dunham, Richard M.
Examines parallels between the findings of empirical studies on bulimia and the findings of empirical studies on the diffusion status of the adolescent identity transition. Results reveal similarities in familial descriptors, personality characteristics, and interpersonal styles for adolescents who are bulimic and those who are identity diffused.…
Gordon, Kathryn H; Simonich, Heather; Wonderlich, Stephen A; Dhankikar, Swati; Crosby, Ross D; Cao, Li; Kwan, Mun Yee; Mitchell, James E; Engel, Scott G
Self-harm and suicide attempts occur at elevated rates among individuals with bulimia nervosa, particularly among those who have experienced childhood abuse. This study investigated the potential mediating roles of emotion dysregulation and affective intensity in the relationship between these variables in 125 women with bulimia nervosa. Analyses revealed that emotion dysregulation mediated the relationship between sexual and emotional abuse with both self-harm and suicide attempts. Negative affective intensity mediated the relationship between abuse and suicide attempts. The findings may advance the understanding of mechanisms underlying suicide-related behaviors in women with bulimia nervosa who experienced abuse and suggest potential clinical targets. PMID:26052753
Monteleone, Alessio Maria; Scognamiglio, Pasquale; Volpe, Umberto; Di Maso, Virginia; Monteleone, Palmiero
Published studies suggested an implication of oxytocin in some temperament characteristics of personality. Therefore, we measured oxytocin secretion in 23 women with anorexia nervosa (AN), 27 with bulimia nervosa (BN) and 19 healthy controls and explored the relationships between circulating oxytocin and patients' personality traits. Plasma oxytocin levels were significantly reduced in AN women but not in BN ones. In healthy women, the attachment subscale scores of the reward dependence temperament and the harm avoidance (HA) scores explained 82% of the variability in circulating oxytocin. In BN patients, plasma oxytocin resulted to be negatively correlated with HA, whereas no significant correlations emerged in AN patients. These findings confirm a dysregulation of oxytocin production in AN but not in BN and show, for the first time, a disruption of the associations between hormone levels and patients' temperament traits, which may have a role in certain deranged behaviours of eating disorder patients. PMID:26259495
Legenbauer, Tanja; Maul, Bärbel; Rühl, Ilka; Kleinstäuber, Maria; Hiller, Wolfgang
This study investigates whether individuals with bulimia nervosa (BN) have a memory bias in relation to explicit memory (cued and free recall vs. verbal and pictorial recognition tasks). Twenty-five participants diagnosed with BN and 27 normal controls (NC) were exposed to body-related, food-related, and neutral TV commercials, and then recall and recognition rates were assessed. Poorer recognition and recall of body-related stimuli was found for BN in comparison to NC, suggesting a memory bias. Results are discussed in relation to previous studies, along with suggestions as to how future studies can gain more insight into dysfunctions in information processing that can lead to the maintenance of eating disorders. PMID:20099307
Fernandez, Senaida; Malcarne, Vanessa L; Malacrne, Vanessa L; Wilfley, Denise E; McQuaid, John
The factor structure of the Bulimia Test--Revised (BULIT-R) was investigated using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). The sample consisted of 2,671 female college students (African American, Asian American, Caucasian American, and Latino American). Reliability coefficients were excellent across groups. African Americans scored significantly lower on the BULIT-R than Caucasian Americans. Across groups, CFA and EFA results suggest a six-factor solution is most appropriate. Consistent across groups were factors representing bingeing, body image, purging, and extreme weight loss behaviors, while few differences were observed across groups. These findings suggest that the measure is reliable and valid for use with diverse ethnic groups. Future research should focus on culturally salient psychological correlates of disordered eating in diverse ethnic groups. PMID:16881746
Lowe, Michael R; Witt, Ashley A; Grossman, Stephanie L
The cognitive behavioral model of bulimia nervosa (BN) suggests that dieting is central to the maintenance of binge eating. However, correlational and experimental studies suggest that additional clarification is needed about the nature of this relationship. Dieting, weight, eating disorder psychopathology, and depression were assessed at admission among 166 patients with BN presenting for residential treatment. As in past research, a significant fraction (43%) of patients with BN reported not currently dieting. A comparison of weight loss dieters and non-dieters found greater food restriction and eating disorder psychopathology among weight loss dieters. However, dieters reported less frequent binge eating. There were no significant group differences in depression. Results suggest that 1) while many individuals with BN are attempting to restrict their food intake, the goal of losing weight fundamentally alters the effect of such restriction on binge eating, and 2) treatment may benefit from helping patients to establish a healthier approach to achieving long-term weight stability. PMID:23910778
Yamada, Hisashi; Yoshimura, Chiho; Nakajima, Takenori; Nagata, Toshihiko
Recent studies have suggested that brain-derived neurotrophic factor (BDNF) is associated with energy balance, eating behaviors, and psychological states such as depression. Although decreased BDNF levels in patients with bulimia nervosa (BN) have been reported, the mechanism is still unclear. Few studies have investigated longitudinal changes of BDNF in BN patients. We investigated changes in the levels of plasma BDNF before and after inpatient treatment. Subjects were 16 female patients with BN and 10 control females. The levels of plasma BDNF were measured. In seven patients who completed a 4-week inpatient treatment program based on cognitive behavior therapy, levels of plasma BDNF were measured twice, before and after inpatient treatment. Plasma BDNF levels were significantly lower in BN subjects than in controls. BDNF levels were significantly higher following inpatient treatment. Increased plasma BDNF after inpatient treatment suggests that lower plasma BDNF levels in BN patients are associated with abnormal eating behaviors, especially binge eating. PMID:22425474
Daniel, Sarah Ingrid Franksdatter; Lunn, Susanne; Poulsen, Stig
The relationship between client attachment and therapist postsession feelings was investigated in a randomized clinical trial of psychoanalytic psychotherapy (PPT) and cognitive behavior therapy (CBT) for bulimia nervosa. Therapists completed feeling word checklists after each session, and client attachment was assessed with the Adult Attachment Interview. A factor analysis identified 3 feeling factors, Happy/Enthusiastic, Overwhelmed/Moved, and Indifferent/Bored. Positive feelings were predominant, but PPT therapists reported more negative and fewer positive feelings than CBT therapists did. Client improvement in terms of frequency of bulimic episodes and general psychiatric distress was related to an increase in Happy/Enthusiastic feelings. Multilevel analyses indicated significant interactions between therapy type and client dismissing versus preoccupied attachment in predicting therapist negative emotional reactions. PPT therapist felt more Indifferent/Bored the more dismissing clients were, whereas CBT therapists felt more Overwhelmed/Moved the more preoccupied clients were. PMID:25985045
Pearson, Carolyn M.; Wonderlich, Stephen A.; Smith, Gregory T.
This paper offers a new model for bulimia nervosa (BN) that explains both the initial impulsive nature of binge eating and purging as well as the compulsive quality of the fully developed disorder. The model is based on a review of advances in research on BN and advances in relevant basic psychological science. It integrates transdiagnostic personality risk, eating disorder specific risk, reinforcement theory, cognitive neuroscience, and theory drawn from the drug addiction literature. We identify both a state-based and a trait-based risk pathway, and we then propose possible state-by-trait interaction risk processes. The state-based pathway emphasizes depletion of self-control. The trait-based pathway emphasizes transactions between the trait of negative urgency (the tendency to act rashly when distressed) and high-risk psychosocial learning. We then describe a process by which initially impulsive BN behaviors become compulsive over time, and we consider the clinical implications of our model. PMID:25961467
Gebhard, S; Dorogi, Y; Giusti, V; Stagno, D; Lanz, M; Schmidt, D; Chaubert, C Monney; Laget, J; Michaud, P-A; Stiefel, F
As psychiatric disorders attacking the body, anorexia and bulimia may have severe psychological, physical and social consequences, often requiring a long-standing interdisciplinary, coordinated and individualized approach. Recently the canton of Vaud has initiated and developed an interinstitutional structure--between the University Hospital (CHUV) and the hospitals of the Northern region of the canton (eHnv)--for the care of patients suffering from eating disorders. This structure, allowing the above mentioned approach for the treatment of eating disorders, consists of an outpatient facility located in the CHUV and an inpatient unit in the hospital of Saint Loup of the eHnv. Within this structure, the general practitioner plays a crucial role in the prevention of the chronification of these disorders by means of their early detection and management. PMID:21416864
Laessle, R G; Kittl, S; Fichter, M M; Wittchen, H U; Pirke, K M
DSM-III lifetime diagnoses were assessed in 52 patients with a lifetime history of anorexia nervosa or bulimia by means of a standardised diagnostic interview. It was found that 44.2% had a lifetime diagnosis of DSM-III major affective disorder, with abstaining anorectics having a lower rate of depression than those with bulimic symptoms. In the great majority of cases, the onset of affective disorder post-dated the onset of the eating disorder by at least one year. In patients whose eating disorder was in remission, the rate of depressive symptoms was lower than in those in the acute stage of their illness. These findings, combined with recent studies on biological changes in eating disorders, and psychological theories of depression, suggest that in most cases in which the two conditions are associated, the depression is secondary to the eating disorder. PMID:3502805
Greetfeld, Martin; Bröckel-Ristevski, Nicole; Fumi, Markus; Cuntz, Ulrich; Voderholzer, Ulrich
We give account of a patient, who works in health care, with bulimia nervosa (BN) and a long term abuse of Furosemide. Due to patients' tendency to conceal addictive behavior and symptoms of BN, the prevalence of purging behavior caused by the intake of diuretics is difficult to quantify 10% of BN patients exhibit a long-term harmful abuse. Discontinuation of diuretics causes the development of edema, attributable to pathophysiological changes with hyperaldosteronism. These can lead to renewed escalation of purging behaviour, provoked either by phobia of weight gain or by unbearable feelings of tension in the facial area or in the legs. For an adequate clinical management, it is vital to have thorough knowledge of the pathophysiological context which consists of psychoeducation, provision of information, treatment of water-electrolyte imbalance and, in individual cases, the administration of aldosterone antagonists. PMID:26039368
Moosavi, Mandana; Kreisman, Stuart; Hall, Lacresha
Most cases of eating disorders associated with type 1 diabetes mellitus are categorized as diabulimia, a disorder of withholding insulin treatment to lose weight through sustained hyperglycemia. In this paper, we report a unique case of a patient with both type 1 diabetes and bulimia nervosa who has an atypical way of controlling her bingeing by keeping her blood sugars low. This pattern of intentionally sustained hypoglycemia has not been previously described in the literature to the best of our knowledge. Knowing various presentations of eating disorders in patients with type 1 diabetes can provide healthcare workers with enhanced ability in recognizing and educating at-risk patients, in the hope of preventing serious hypoglycemia or complications. Furthermore, a patient's awareness of complications associated with suboptimal control of diabetes, whether by overdosing or underdosing their insulin regimen, might lead to avoidance of disordered eating behaviours. PMID:25282003
Wilson, G. Terence; Sysko, Robyn
Objective In DSM-IV, to be diagnosed with Bulimia Nervosa (BN) or the provisional diagnosis of Binge Eating Disorder (BED), an individual must experience episodes of binge eating is “at least twice a week” on average, for three or six months respectively. The purpose of this review was to examine the validity and utility of the frequency criterion for BN and BED. Method Published studies evaluating the frequency criterion were reviewed. Results Our review found little evidence to support the validity or utility of the DSM-IV frequency criterion of twice a week binge eating; however, the number of studies available for our review was limited. Conclusion A number of options are available for the frequency criterion in DSM-V, and the optimal diagnostic threshold for binge eating remains to be determined. PMID:19610014
O'Brien, Karina M; Vincent, Norah K
Eating disorders are complex, multifactorially determined phenomena. When individuals with eating disorders present for treatment with comorbid conditions, case conceptualization is further complicated and, as a result, it may be difficult to determine optimal psychological or pharmacological treatment. This article reviews the evidence of the association between eating disorders (anorexia nervosa [AN] and bulimia nervosa [BN]) and Axis I depression, obsessive-compulsive disorder (OCD), substance abuse, and Axis II personality disorders, for the purposes of increasing awareness about the different options for case conceptualization. Although other diagnoses comorbid with eating disorders are of interest to clinicians (e.g., posttraumatic stress disorder [PTSD] and social phobia), their comprehensive review is currently premature due to a lack of empirical scrutiny. Finally, future directions for research, including suggestions for the use of particular assessment tools and more sophisticated research designs, are discussed. PMID:12559994
Vall, Eva; Wade, Tracey D
Set-shifting inefficiencies have been consistently identified in adults with anorexia nervosa (AN). It is less clear to what degree similar inefficiencies are present in those with bulimia nervosa (BN). It is also unknown whether perfectionism is related to set-shifting performance. We employed a commonly used set-shifting measure, the Trail Making Test (TMT), to compare the performance of inpatients with AN and BN with a healthy control sample. We also investigated whether perfectionism predicted TMT scores. Only the BN sample showed significantly suboptimal performance, while the AN sample was indistinguishable from controls on all measures. There were no differences between the AN subtypes (restrictive or binge/purge), but group sizes were small. Higher personal standards perfectionism was associated with better TMT scores across groups. Higher concern over mistakes perfectionism predicted better accuracy in the BN sample. Further research into the set-shifting profile of individuals with BN or binge/purge behaviours is needed. PMID:25966895
Banasiak, Susan J; Paxton, Susan J; Hay, Phillipa J
This study examined perceptions of 36 women who participated in Guided Self-Help (GSH) treatment for bulimia nervosa delivered by general practitioners (GPs) in primary care. Qualitative responses revealed factors perceived to contribute toward treatment effectiveness including: improved eating behaviours, body image and emotional and general well-being; the empathic and practical style of the manual; specific behavioural strategies; GP facilitated positive therapeutic alliance and interventions with program implementation; and accessible treatment. Factors perceived as contributing to treatment ineffectiveness concerned: lack of changes to eating and body image; inadequacies of treatment program and approach; inadequate treatment dose; poor service delivery; and perceptions of low GP competence/professionalism and poor therapeutic alliance. PMID:17162639
Thompson-Brenner, Heather; Westen, Drew
Data from naturalistic samples provide an important complement to findings from randomized trials of psychotherapy. A random national sample of US clinicians provided data on 145 completed treatments of patients with bulimic symptoms. Treatment in the community was substantially longer than treatment prescribed in manuals, with a mean length of cognitive-behavioral therapy of 69 sessions and significantly longer for eclectic and psychodynamic therapies. Most patients treated in the community had substantial comorbidity, and this comorbidity was associated with longer treatments and poorer outcome. Using four common exclusion criteria from randomized controlled trials for bulimia nervosa, approximately 40% of the naturalistic sample would have been excluded from randomized controlled trials. These patients showed higher pretreatment severity and required longer treatments to achieve positive outcomes relative to patients who did not meet these exclusion criteria. PMID:16131940
Latner, J D; Wilson, G T
The goals of manual-based cognitive-behavioral therapy (CBT) and nutritional counseling for eating disorders are similar, namely, eliminating dysfunctional patterns of eating. Modifying these behaviors requires specific therapeutic expertise in the principles and procedures of behavior change that is not typically part of the training of nutritionists and dieticians or mental health professionals without specific expertise. We discuss ways in which principles of behavior change can be applied to eating disorders by non-CBT experts. Specific nutritional rehabilitation programs have the potential to augment CBT in addressing the array of appetitive abnormalities present in eating disorder patients. The dysfunctional appetitive, hedonic, and metabolic characteristics of patients with bulimia nervosa (BN) and binge eating disorder are reviewed. These abnormalities constitute potential target areas that might be more fully addressed by nutritional interventions designed to restore normal appetitive function. PMID:15001063
Hoste, Renee Rienecke; le Grange, Daniel
Expressed emotion (EE), a measure of a relative's attitudes and behaviours towards an ill family member, has been found to be related to treatment outcome for both anorexia nervosa (AN) and bulimia nervosa (BN). Although cultural and ethnic background can influence the way in which family members interact, very little is known about cultural differences in EE among families of an eating disordered adolescent. As part of a treatment study for adolescent BN, 55 patients and 84 parents participated in a structured interview, from which EE ratings were made. White and ethnic minority families were compared on five subscales of EE as well as overall level of EE (high vs. low). No significant differences were found between white and minority families. These findings are consistent with previous studies suggesting that white and minority families of eating disorder patients may share several similarities. PMID:18240126
The author examines the functions of child masturbation in the development of narcissim and distinguishes a demarcation function, a compensation function and a function serving to establish autonomy. In Binswanger's view, certain reactions to child masturbation on the part of parents may affect the interactive relationship between the child and the parent representing the primary object in such a way as to thwart or undermine these functions. The result is the appearance of masturbation substitutes in the form of certain symptoms. Binswanger distinguishes "horrified", "liberal", and "eroticized" reactions by parents, relating the first to compulsion neurosis, the second to obesity, and the third to anorexia/bulimia. The author illustrates his hypotheses with copious references to cases from his own practice. PMID:8766992
... hard to adapt to a new culture (a theory called "culture clash"). The stress of trying to ... U.S. federal government and is in the public domain. This public information is not copyrighted and may ...
Mitchell, James E.; Agras, Stewart; Crow, Scott; Halmi, Katherine; Fairburn, Christopher G.; Bryson, Susan; Kraemer, Helena
Background This study compared the best available treatment for bulimia nervosa, cognitive–behavioural therapy (CBT) augmented by fluoxetine if indicated, with a stepped-care treatment approach in order to enhance treatment effectiveness. Aims To establish the relative effectiveness of these two approaches. Method This was a randomised trial conducted at four clinical centres (Clinicaltrials.gov registration number: NCT00733525). A total of 293 participants with bulimia nervosa were randomised to one of two treatment conditions: manual-based CBT delivered in an individual therapy format involving 20 sessions over 18 weeks and participants who were predicted to be non-responders after 6 sessions of CBT had fluoxetine added to treatment; or a stepped-care approach that began with supervised self-help, with the addition of fluoxetine in participants who were predicted to be non-responders after six sessions, followed by CBT for those who failed to achieve abstinence with self-help and medication management. Results Both in the intent-to-treat and completer samples, there were no differences between the two treatment conditions in inducing recovery (no binge eating or purging behaviours for 28 days) or remission (no longer meeting DSM–IV criteria). At the end of 1-year follow-up, the stepped-care condition was significantly superior to CBT. Conclusions Therapist-assisted self-help was an effective first-level treatment in the stepped-care sequence, and the full sequence was more effective than CBT suggesting that treatment is enhanced with a more individualised approach. PMID:21415046
Thiels, C; Schmidt, U; Treasure, J; Garthe, R
The aim of this follow-up study was to evaluate the longer-term effectiveness of guided self-care for bulimia nervosa. In the original trial, 62 patients with DSM-III-R bulimia nervosa were randomly assigned to: a) a self-care manual plus eight fortnightly sessions of cognitive behavioural therapy (guided self-change); or b) 16 weekly sessions of cognitive behavioural therapy (CBT). Twenty-eight of these patients (45% of the original cohort) were involved in this follow-up study based on personal interviews by experts and self-rated instruments; the majority of the others could not be traced, but their pre- and post-treatment variables were not different from those of the follow-up patients. After an average follow-up of 54.2 months (SD 5.8), significant improvements were achieved or maintained in both groups in terms of the main outcome measures: eating disorder symptoms based on expert ratings (Eating Disorder Examination sub-scores for overeating, vomiting, dietary restraint, and shape and weight concerns), self report (Bulimic Investigatory Test Edinburgh), and a global five-point severity scale. There was also an improvement in the subsidiary outcome variables: Beck's Depression Inventory, the Self-concept Questionnaire, and knowledge of nutrition, weight and shape. During the week before the follow-up examination, 66.7% of the patients in the guided self-change group and 61.5% of those in the CBT group had not binged, vomited or abused laxatives. Guided self-change incorporating a self-care manual is an approach that can be as effective as standard cognitive behavioural therapy in the long-term, and can reduce the amount of therapist contact required. PMID:14649785
Schulze, U M; Pettke-Rank, C V; Kreienkamp, M; Hamm, H; Bröcker, E B; Wewetzer, C; Trott, G E; Warnke, A
The cutaneous signs of anorexia nervosa (AN) and bulimia nervosa (BN) have been described previously in adult patients. For the first time, we present here dermatologic findings in children and adolescents suffering from eating disorders. Thirty consecutive young anorexic and bulimic inpatients (8 to 17 years of age, mean 15.1 years) underwent a standardized dermatologic examination. Patients were checked for abnormalities of the skin including atopic stigmata, dermographism, hair, nails, and oral cavity. Serum was obtained for hemoglobin, iron, zinc, GPT, thyroid, and sex-hormone levels. In 13 patients, the total serum IgE was determined, and a prick test was carried out with defined type I allergens. Findings in order of frequency included xerosis of the skin, white dermographism, diffuse hypertrichosis, acrocyanosis, scars, diffuse effluvium, artifacts, brittle nails, and onychophagia. Significant co-relations were found between the presence of hypertrichosis and the existence of amenorrhea or a body mass index of less than 16. In 22 patients a low T3 level was found. In summary, children and adolescents suffering from AN or BN show dermatologic features similar to those reported in older patients. Special findings in this age group are extensive lanugo hair and signs of autoaggressive behavior. PMID:10337669
Wagner, Angela; Simmons, Alan N; Oberndorfer, Tyson A; Frank, Guido K W; McCurdy-McKinnon, Danyale; Fudge, Julie L; Yang, Tony T; Paulus, Martin P; Kaye, Walter H
Recent studies show that higher-order appetitive neural circuitry may contribute to restricted eating in anorexia nervosa (AN) and overeating in bulimia nervosa (BN). The purpose of this study was to determine whether sensitization effects might underlie pathologic eating behavior when a taste stimulus is administered repeatedly. Recovered AN (RAN, n=14) and BN (RBN, n=15) subjects were studied in order to avoid the confounding effects of altered nutritional state. Functional magnetic resonance imaging (fMRI) measured higher-order brain response to repeated tastes of sucrose (caloric) and sucralose (non-caloric). To test sensitization, the neuronal response to the first and second administration was compared. RAN patients demonstrated a decreased sensitization to sucrose in contrast to RBN patients who displayed the opposite pattern, increased sensitization to sucrose. However, the latter was not as pronounced as in healthy control women (n=13). While both eating disorder subgroups showed increased sensitization to sucralose, the healthy controls revealed decreased sensitization. These findings could reflect on a neuronal level the high caloric intake of RBN during binges and the low energy intake for RAN. RAN seem to distinguish between high energy and low energy sweet stimuli while RBN do not. PMID:26596520
Tuschen-Caffier, Brunna; Bender, Caroline; Caffier, Detlef; Klenner, Katharina; Braks, Karsten; Svaldi, Jennifer
Objective Cognitive theories suggest that body dissatisfaction results from the activation of maladaptive appearance schemata, which guide mental processes such as selective attention to shape and weight-related information. In line with this, the present study hypothesized that patients with anorexia nervosa (AN) and bulimia nervosa (BN) are characterized by increased visual attention for the most dissatisfying/ugly body part compared to their most satisfying/beautiful body part, while a more balanced viewing pattern was expected for controls without eating disorders (CG). Method Eye movements were recorded in a group of patients with AN (n = 16), BN (n = 16) and a CG (n = 16) in an ecologically valid setting, i.e., during a 3-min mirror exposure. Results Evidence was found that patients with AN and BN display longer and more frequent gazes towards the most dissatisfying relative to the most satisfying and towards their most ugly compared to their most beautiful body parts, whereas the CG showed a more balanced gaze pattern. Discussion The results converge with theoretical models that emphasize the role of information processing in the maintenance of body dissatisfaction. Given the etiological importance of body dissatisfaction in the development of eating disorders, future studies should focus on the modification of the reported patterns. PMID:26714279
Ruisoto, Pablo; Cacho, Raúl; López-Goñi, José J; Real Deus, Eulogio; Vaca, Silvia; Mayoral, Paula
Some females are at an increased risk of developing bulimia. However, etiological factors and their interplay remain controversial. The present study analyzed Sticefe Model for eating disorders in a non-clinical population by examining gender differences with respect to the following risk factors: body mass index (BMI), body dissatisfaction, perceived social pressure to be thin, body-thin internalization, and dieting behavior. A sample of 162 American college students (64 males and 91 females) was surveyed, and validated scales were used. The Sticey model was tested using Structural Equation Modeling. Our results supported Stice r Dual Pathway Model of bulimic pathology for females but not for males. Females reported significantly higher body dissatisfaction, perceived pressure to be thin and weight-loss oriented behaviors than males (p .05), a key predictor of body dissatisfaction (r = .33; p .05) although their BMI was significantly lower than males (d = 0,51). The results of this study fail to support the role of BMI as a predictor of dietary restraint in females, the main risk factor of eating disorders. Males may abstain from dietary restraint to gain muscular volume and in turn increase their BMI. Implications are discussed. PMID:26388326
Thompson-Brenner, Heather; Shingleton, Rebecca M; Sauer-Zavala, Shannon; Richards, Lauren K; Pratt, Elizabeth M
Bulimia nervosa (BN) treatment studies consistently observe that substantial reductions in purging frequency after four weeks of treatment predict outcome. Although baseline levels of other variables have been compared to change in purging, measures of early change in other domains have not been examined. This study aimed to compare percentage change in purging, depression, and cognitive eating disorder (ED) symptoms for associations with BN remission post-treatment and at six months follow-up. Data from N = 43 patients with BN in a clinical trial comparing the broad and focused versions of enhanced cognitive behavior therapy (CBT-E; Fairburn, 2008) were utilized. Measures included self-reported purging frequency, Beck Depression Inventory (BDI) score, and a mean of items from the Eating Disorder Inventory Body Dissatisfaction and Drive for Thinness subscales. Results indicated that both percentage change in purging frequency and percentage change in BDI score at week four/session eight were significantly associated with remission at termination. The optimal cutoffs for purging change and BDI score change were 65% decrease and 25% decrease respectively. Only change in BDI score at week four significantly predicted remission at six-month follow-up. These data suggest that change in depressive symptoms may be as important as ED symptom change to predict outcome in some groups. PMID:25462877
Raykos, Bronwyn C; McEvoy, Peter M; Erceg-Hurn, David; Byrne, Susan M; Fursland, Anthea; Nathan, Paula
The present paper assessed therapeutic alliance over the course of Enhanced Cognitive Behavioural Therapy (CBT-E) in a community-based sample of 112 patients with a diagnosis of bulimia nervosa (BN) or atypical BN. Temporal assessment of alliance was conducted at three time points (the start, middle and end of treatment) and the relationship between alliance and treatment retention and outcome was explored. Results indicated that the alliance between patient and therapist was strong at all stages of CBT-E, and even improved in the early stages of treatment when behaviour change was initiated (weekly in-session weighing, establishing regular eating, and ceasing binge-eating and compensatory behaviours). The present study found no evidence that alliance was related to treatment retention or outcomes, or that symptom severity or problematic interpersonal styles interacted with alliance to influence outcomes. Alliance was also unrelated to baseline emotional or interpersonal difficulties. The study provides no evidence that alliance has clinical utility for the prediction of treatment retention or outcome in CBT-E for BN, even for individuals with severe symptoms or problematic interpersonal styles. Early symptom change was the best predictor of outcome in CBT-E. Further research is needed to determine whether these results are generalizable to patients with anorexia nervosa. PMID:24841726
Schebendach, Janet; Broft, Allegra; Foltin, Richard W.; Walsh, B. Timothy
Binge eating is a core clinical feature of bulimia nervosa (BN). Enhanced reinforcing value of food may play a role in this behavioral disturbance, but a systematic behavioral assessment of objective measures of the rewarding value of binge eating is lacking. The purpose of this study was to quantify the reinforcing value of food in BN patients as compared with normal controls. A progressive ratio (PR) computerized work task was completed under binge and non-binge instruction. The task consisted of 12 trials. The first trial required 50 keyboard taps to earn one portion of yogurt shake, and subsequent trials required progressive work increments of 200 taps for each additional portion. Completion of all 12 trials required 13,800 taps to earn 2,100 ml of shake. The breakpoint, defined as the largest ratio completed before a participant stopped working, was the measure of reinforcing efficacy. Ten patients and 10 controls completed the experiment. Under binge instruction, patients completed more trials and taps, and had a higher breakpoint than controls. The non-binge instruction yielded opposite findings; compared to controls, patients completed fewer trials and taps, and had a lower breakpoint. These results support the feasibility and potential utility of a PR task to quantify the reinforcing value of food in patients with BN. PMID:23178173
Amianto, Federico; Siccardi, Sara; Abbate-Daga, Giovanni; Marech, Lucrezia; Barosio, Marta; Fassino, Secondo
The goals of the study were to explore anger correlation with bulimic symptoms and to test the mediation power of anger between personality and eating psychopathology. A total of 242 bulimia nervosa (BN) outpatients and 121 healthy controls were recruited. Assessment was performed using Temperament and Character Inventory (TCI); State-Trait Anger Expression Inventory 2 (STAXI-2); Eating Disorder Inventory-2 (EDI-2); Body Shape Questionnaire (BSQ); Binge Eating Scale (BES); and Beck Depression Inventory (BDI). Mediation was tested on the whole BN group, on controls and on two BN subgroups based on a previous history of anorexia nervosa. Self-Directedness and Cooperativeness extensively relate to anger and psychopathology in bulimic group. Bulimic symptoms are related to Trait Reactive Anger. Trait Anger and Anger Expression fully mediate Cooperativeness effects on binge eating and Impulsiveness in the BN subjects. Anger Expression-In partially mediates between Harm Avoidance and Social Insecurity/Interpersonal Distrust in BN subjects. The comparison with controls and the analysis of subgroups underlines that these patterns are specific for BN. Anger mediation between Cooperativeness, and binge eating and impulsive behaviours confirm the relevance of relational dynamics in the expression of these core eating symptoms. Relational skills may represent a relevant target for the treatment of BN. PMID:22944222
Lampard, Amy M; Byrne, Susan M; McLean, Neil; Fursland, Anthea
The original cognitive-behavioural model of bulimia nervosa (BN) has been enhanced to include four additional maintaining mechanisms: low self esteem, clinical perfectionism, interpersonal problems, and mood intolerance. These models have been used to guide cognitive-behavioural treatment for BN, but the enhanced model has yet to be directly evaluated as a whole in a clinical sample. This study aimed to compare and evaluate the original and the enhanced cognitive-behavioural models of BN using structural equation modelling. The Eating Disorder Examination and self-report questionnaires were completed by 162 patients seeking treatment for BN (N = 129) or atypical BN (N = 33). Fit indices suggested that both the original and enhanced models provided a good fit to the data, but the enhanced model accounted for more variance in dietary restraint and binge eating. In the enhanced model, low self esteem was associated with greater overevaluation of weight and shape, which, in turn, was associated with increased dietary restraint. Interpersonal problems were also directly associated with dietary restraint, and binge eating was associated with increased purging. While the current study provides support for some aspects of the enhanced cognitive-behavioural model of BN, some key relationships in the model were not supported, including the important conceptual relationship between dietary restraint and binge eating. PMID:21724176
Laessle, R G; Platte, P; Schweiger, U; Pirke, K M
The eating disorder bulimia nervosa is characterized by alternating periods of strict dieting and overeating. Patients also report mood fluctuations, frequent eating related thoughts, fear of loss of control over eating, impairment of cognitive abilities such as concentration, and somatic complaints. The present study attempted to clarify to what extent these symptoms are consequences of the dieting behavior. Nine healthy young women, classified as unrestrained eaters, were set on a intermittent dieting schedule over 4 weeks. Four days each week (Tue, Wed, Thu, Fri) they had to reduce their intake below 600 kcal/day, the other 3 days they could eat without restrictions. Psychological variables were assessed by means of a standardized diary. Biological indices of starvation were also measured repeatedly. There was no substantial weight loss after the 4 weeks, although subjects had significantly increased levels of beta-hydroxybutyric acid during the dieting periods, and decreased levels of t3 after 2 weeks. The reported tendency to overeat and the actual calorie intake during the days of unlimited access to food showed a significant increase over the 4-week period. Eating-related thoughts, feelings of hunger, and fear of loss of control were significantly more frequent during periods of dieting, compared to days of normal eating. Subjects also reported worse mood, heightened irritability, difficulties concentrating, and increased fatigue. These results suggest that a substantial part of symptoms of bulimic patients might be associated with the frequent periods of an extremely restrained eating behavior. PMID:8804634
Ciao, Anna C.; Accurso, Erin C.; Fitzsimmons-Craft, Ellen E.; Le Grange, Daniel
This study examined predictors of psychological change among 80 adolescents with bulimia nervosa (BN) participating in a randomized-controlled trial comparing family-based treatment (FBT) to supportive psychotherapy (SPT). Psychological outcomes (cognitive eating disorder pathology, depression, and self-esteem) were explored at baseline, post-treatment, and 6-month follow-up. Multi-level growth models examined predictors of rate of change in psychological outcomes and moderators of treatment effects. All psychological outcomes improved through 6-month follow-up (moderate to large effect sizes) across both treatments. Overall, few significant predictors were identified. Older adolescents had faster change in self-esteem relative to younger adolescents (p=.03). Adolescents taking psychotropic medication at baseline had faster change in eating concerns relative to adolescents not taking medication (p=.02). Age (p=.02) and baseline purging severity (p=.03) moderated the relationship between treatment condition and change in eating concerns, where younger adolescents and individuals with high baseline purging had greater change when treated with FBT relative to SPT. Age and purging did not significantly moderate change in other psychological outcomes. Bulimic symptom improvement did not predict change in psychological symptoms. Generally, FBT and SPT were equally efficacious with respect to psychological improvement, although FBT may be more efficacious in younger adolescents and those with more frequent purging. PMID:25874955
Elran-Barak, Roni; Fitzsimmons-Craft, Ellen E; Benyamini, Yael; Crow, Scott J; Peterson, Carol B; Hill, Laura L; Crosby, Ross D; Mitchell, James E; Le Grange, Daniel
We examined eating disorders in midlife and beyond by comparing frequency of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding or eating disorder (OSFED) among midlife eating disorder treatment-seeking individuals and younger controls. We also compared demographic and eating disorder-related characteristics across diagnoses and age groups. Participants included 2,118 treatment-seeking adults who self-reported their eating-related symptoms on the Eating Disorder Questionnaire. Results showed that percent of patients with BN was significantly lower whereas percent of patients with BED and OSFED was significantly higher among midlife relative to younger patients. Percent of patients with AN did not differ between midlife and younger patients. Additionally, midlife and younger patients with BED and OSFED differed on several demographic (e.g., marital status) and eating disorder-related characteristics (e.g., BMI, compulsive exercising). This study suggests that BN is less common whereas BED and OSFED are more common among midlife eating disorder treatment-seeking individuals relative to younger controls. In addition, AN and BN present fairly similarly whereas BED and OSFED present fairly differently among midlife patients relative to younger controls. Attention to these differences and similarities is necessary to understand eating disorders in midlife. PMID:26164423
Kostopoulou, Myrsini; Varsou, Eleftheria; Stalikas, Anastassios
'Thought-shape fusion' (TSF) is a cognitive distortion specific in patients with eating disorders and occurs when the thought about eating a forbidden food increases a person's estimate of her weight/shape, elicits a perception of moral wrongdoing and makes her feel fat. This study aimed to experimentally induce, study and compare TSF between patients with bulimia nervosa (BN) and patients with anorexia nervosa (AN). 31 patients diagnosed with a current eating disorder, of which 20 met DSM-IV-TR criteria for BN and 11 for AN, participated in a mixed-model experimental design with the aim of eliciting TSF and investigating the effects of corrective behaviors (checking and mental neutralizing). Verbal analogue scales constituted the main outcome measures. TSF was experimentally induced and expressed in a similar way in both clinical groups, apart from 'feeling fat' which was higher in BN patients. TSF induction triggered heightened levels of anxiety, guilt and urges to engage in corrective behaviors in both groups. Body dissatisfaction only increased in the BN patients. Mental neutralizing and to a lesser extent checking reduced most effects of the experimental procedure, but this effect was larger for BN patients. The nature of TSF seems to have similarities between BN and AN patients; however, the precise connection between TSF and different types of eating disorders remains to be explored in future clinical trials. PMID:23881747
He, Xiaofu; Stefan, Mihaela; Terranova, Kate; Steinglass, Joanna; Marsh, Rachel
Previous data suggest structural and functional deficits in frontal control circuits in adolescents and adults with bulimia nervosa (BN), but less is known about the microstructure of white matter in these circuits early in the course of the disorder. Diffusion tensor imaging (DTI) data were acquired from 28 female adolescents and adults with BN and 28 age- and BMI-matched healthy female participants. Tract-based spatial statistics (TBSS) was used to detect group differences in white matter microstructure and explore the differential effects of age on white matter microstructure across groups. Significant reductions in fractional anisotropy (FA) were detected in the BN compared with healthy control group in multiple tracts including forceps minor and major, superior longitudinal, inferior fronto-occipital, and uncinate fasciculi, anterior thalamic radiation, cingulum, and corticospinal tract. FA reductions in forceps and frontotemporal tracts correlated inversely with symptom severity and Stroop interference in the BN group. These findings suggest that white matter microstructure is abnormal in BN in tracts extending through frontal and temporoparietal cortices, especially in those with the most severe symptoms. Age-related differences in both FA and RD in these tracts in BN compared with healthy individuals may represent an abnormal trajectory of white matter development that contributes to the persistence of functional impairments in self-regulation in BN. PMID:26647975
Hatch, Kent A; Spangler, Diane L; Backus, Elizabeth M; Balagna, Jonathan T; Burns, Keven S; Guzman, Brooke S; Hubbard, Matthew J; Lindblad, Stephanie L; Roeder, Beverly L; Ryther, Natalie E; Seawright, Max A; Tyau, Jaymie N; Williams, Dustin
Diagnosis of anorexia nervosa (AN) and bulimia nervosa (BN), while including such physiological data as weight and the reproductive status of the individual, are primarily based on questionnaires and interviews that rely on self-report of both body-related concerns and eating-related behaviors. While some key components of eating disorders are psychological and thus introspective in nature, reliance on self-report for the assessment of eating-related behaviors and nutritional status lacks the objectivity that a physiologically based measure could provide. The development of a more physiologically informed diagnosis for AN and BN would provide a more objective means of diagnosing these disorders, provide a sound physiological basis for diagnosing subclinical disorders and could also aid in monitoring the effectiveness of treatments for these disorders. Empirically supported, physiologically based methods for diagnosing AN and BN are reviewed herein as well as promising physiological measures that may potentially be used in the diagnosis of AN and BN. PMID:18020913
Vitale, Elsa; Lotito, Letizia; Maglie, Rosita Belinda
Recent clinical reports have shown an increasing number of patients afflicted by eating disorders in the western world. There are numerous causes and mechanisms leading to eating disorders that affect the psychoneuroendocrinoimmune system. In this study, we define a novel psychoneuroendocrinoimmune nursing approach for anorexic and bulimic patients' treatment. According to the specific diagnostic items deriving from the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, and clinical guidelines in eating disorders formulated by the National Institute for Clinical Excellence, we carried out a qualitative study on the nursing treatment chosen by 210 international centers considered as a sample. This study was based on a no structured interview via e-mail to better understand the nursing approach in anorexia and bulimia nervosa. Thanks to the selected centers' answers, four different levels of nursing care were identified, that include: the nursing role analyzing the spectrum of patients' problems; the nursing intervention in inpatient care; the nursing intervention in outpatient care; the day hospital treatment. All four prove to be especially useful in the nursing practice. PMID:18618355
Richards, Lauren K; Shingleton, Rebecca M; Goldman, Rachel; Siegel, Deborah; Thompson-Brenner, Heather
Both cognitive-behavioral therapy (CBT) and psychodynamic psychotherapy are commonly used to treat eating disorders. To further investigate the effectiveness of integrative dynamic therapy (IDT) for bulimia nervosa (BN), our research group undertook a randomized, controlled pilot study comparing IDT with CBT for BN. The case described here was selected from a sample of N = 38 female patients with the symptoms of BN who enrolled in the study. IDT incorporated aspects of the first 4-week stage of CBT, including psychoeducation, self-monitoring, and regular eating. Subsequently, the treatment focused on emotional expression, emotion regulation (defenses), intrapsychic conflict, and interpersonal relationships. The objectives of the report are to demonstrate the effectiveness of an integrative approach to the treatment of eating disorders to address the symptoms of BN and personality issues using pre-, mid-, and posttreatment data, and to illustrate the patient and clinician reactions to each approach to treatment using excerpts from session transcripts and alliance data. (PsycINFO Database Record PMID:27267504
Ciao, Anna C; Accurso, Erin C; Fitzsimmons-Craft, Ellen E; Le Grange, Daniel
This study examined predictors of psychological change among 80 adolescents with bulimia nervosa (BN) participating in a randomized-controlled trial comparing family-based treatment (FBT) to supportive psychotherapy (SPT). Psychological outcomes (cognitive eating disorder pathology, depression, and self-esteem) were explored at baseline, post-treatment, and 6-month follow-up. Multi-level growth models examined predictors of rate of change in psychological outcomes and moderators of treatment effects. All psychological outcomes improved through 6-month follow-up (moderate to large effect sizes) across both treatments. Overall, few significant predictors were identified. Older adolescents had faster change in self-esteem relative to younger adolescents (p = 0.03). Adolescents taking psychotropic medication at baseline had faster change in eating concerns relative to adolescents not taking medication (p = 0.02). Age (p = 0.02) and baseline purging severity (p = 0.03) moderated the relationship between treatment condition and change in eating concerns, where younger adolescents and individuals with high baseline purging had greater change when treated with FBT relative to SPT. Age and purging did not significantly moderate change in other psychological outcomes. Bulimic symptom improvement did not predict change in psychological symptoms. Generally, FBT and SPT were equally efficacious with respect to psychological improvement, although FBT may be more efficacious in younger adolescents and those with more frequent purging. PMID:25874955
Roberts, Marion E; Tchanturia, Kate; Treasure, Janet L
Poor set-shifting has been implicated as a risk marker, maintenance factor and candidate endophenotype of eating disorders (ED). This study aimed to add clarity to the cognitive profile of set-shifting by examining the trait across ED subtypes, assessing whether it is a state or trait marker, and whether it runs in families. A battery of neuropsychological tasks was administered to 270 women with current anorexia (AN) and bulimia nervosa (BN), women recovered from AN, unaffected sisters of AN and BN probands, and healthy control women. Set-shifting was examined using both individual task scores and a composite variable (poor/intact/superior shifting) calculated from four neuropsychological tasks. Poor set-shifting was found at a higher rate in those with an ED particularly binge/purging subtypes. Some evidence for poor set-shifting was also present in those recovered from AN and in unaffected sisters of AN and BN. Clinically, poor set-shifting was associated with a longer duration of illness and more severe ED rituals but not body mass index. In sum, poor set-shifting is a transdiagnostic feature related to aspects of the illness but not to malnutrition. In part it is a familial trait, and is likely involved in the maintenance of the illness. PMID:20398910
Bulik, Cynthia M; Devlin, B; Bacanu, Silviu-Alin; Thornton, Laura; Klump, Kelly L; Fichter, Manfred M; Halmi, Katherine A; Kaplan, Allan S; Strober, Michael; Woodside, D Blake; Bergen, Andrew W; Ganjei, J Kelly; Crow, Scott; Mitchell, James; Rotondo, Alessandro; Mauri, Mauro; Cassano, Giovanni; Keel, Pamela; Berrettini, Wade H; Kaye, Walter H
Bulimia nervosa (BN) is strongly familial, and additive genetic effects appear to contribute substantially to the observed familiality. In turn, behavioral components of BN, such as self-induced vomiting, are reliably measured and heritable. To identify regions of the genome harboring genetic variants conferring susceptibility to BN, we conducted a linkage analysis of multiplex families with eating disorders that were identified through a proband with BN. Linkage analysis of the entire sample of 308 families yielded a double peak, with the highest nonparametric multipoint maximum LOD score (MLS), of 2.92, on chromosome 10. Given the high heritability of self-induced vomiting and the reliability with which it can be measured, we performed linkage analysis in a subset (n=133) of families in which at least two affected relatives reported a symptom pattern that included self-induced vomiting. The highest MLS (3.39) observed was on chromosome 10, between markers D10S1430 and D10S1423. These results provide evidence of the presence of a susceptibility locus for BN on chromosome 10p. Using simulations, we demonstrate that both of these scores, 2.92 and 3.39, meet the widely accepted criterion for genomewide significance. Another region on 14q meets the criterion for genomewide suggestive linkage, with MLSs of 1.97 (full sample) and 1.75 (subset) at 62 centimorgans from p-ter. PMID:12476400
Alfano, Lauren; Tricamo, Michelle; Pfaff, Donald W.
Serotonergic dysregulation is thought to underlie much of the pathology in bulimia nervosa (BN). The purpose of this review is to expand the serotonergic model by incorporating specific and nonspecific contributions of estrogens to the development and maintenance of bulimic pathology in order to guide research from molecular genetics to novel therapeutics for BN. Special emphasis is given to the organizing theory of general brain arousal which allows for integration of specific and nonspecific effects of these systems on behavioral endpoints such as binge eating or purging as well as arousal states such as fear, novelty seeking, or sex. Regulation of the serotonergic system by estrogens is explored, and genetic, epigenetic, and environmental estrogen effects on bulimic pathology and risk factors are discussed. Genetic and neuroscientific research support this two-system conceptualization of BN with both contributions to the developmental and maintenance of the disorder. Implications of an estrogenic-serotonergic model of BN are discussed as well as guidelines and suggestions for future research and novel therapeutic targets. PMID:20554102
Woznica, Andrea; Vickers, Kristin; Koerner, Naomi; Fracalanza, Katie
The inhalation of 35% carbon dioxide (CO₂) induces panic and anxiety in people with panic disorder (PD) and in people with various other psychiatric disorders. The anxiogenic effect of CO₂ in people with eating disorders has received sparse attention despite the fact that PD and bulimia nervosa (BN) have several common psychological and neurobiological features. This study compared CO₂-reactivity across three groups of participants: females with BN, females with PD, and female controls without known risk factors for enhanced CO₂-reactivity (e.g., social anxiety disorder, first degree relatives with PD). Reactivity was measured by self-reported ratings of panic symptomatology and subjective anxiety, analyzed as both continuous variables (change from room-air to CO₂) and dichotomous variables (positive versus negative responses to CO₂). Analyses of each outcome measure demonstrated that CO₂-reactivity was similar across the BN and PD groups, and reactivity within each of these two groups was significantly stronger than that in the control group. This is the first study to demonstrate CO₂-hyperreactivity in individuals with BN, supporting the hypothesis that reactivity to this biological paradigm is not specific to PD. Further research would benefit from examining transdiagnostic mechanisms in CO₂-hyperreactivity, such as anxiety sensitivity, which may account for this study's results. PMID:26141602
Rühl, Ilka; Legenbauer, Tanja; Hiller, Wolfgang
This study investigates whether eating behavior in women with diagnosed bulimia nervosa is influenced by prior exposure to images of ideally thin models. Twenty-six participants diagnosed with bulimia nervosa (BN) and 30 normal controls (NC) were exposed to body-related and neutral TV commercials; then food that typically triggers binge eating was provided, and the amount of food eaten was measured. No significant difference for food intake between NC and BN could be found, but food intake for BN was predicted by the degree of thoughts related to eating behaviors during exposure to the thin ideal. No impact of general body image or eating pathology on food intake could be found. The results emphasize the importance of action-relevance of dysfunctional cognitions for the maintenance of eating-disordered behaviors in women with bulimia nervosa, when exposed to eating-disorder-specific triggers. PMID:21855433
Torres-Bugarín, Olivia; Pacheco-Gutiérrez, Angélica Guadalupe; Vázquez-Valls, Eduardo; Ramos-Ibarra, María Luisa; Torres-Mendoza, Blanca Miriam
The aim of this study is to assess the frequency of micronucleated cell (MNC) and nuclear abnormalities (NA) in the buccal mucosa cells of females with anorexia nervosa (AN) or bulimia nervosa (BN), compared with healthy women. Individuals with AN and BN have inadequate feeding and compensatory behaviour to avoid weight gain. These behaviours can cause extreme body stress, thereby inducing DNA damage. In a cross-sectional study, we assessed the frequency of MNC and NA in the buccal mucosa cells of female participants with AN or BN. All of these patients had been admitted to a private clinic for the treatment of eating disorders after diagnosis with AN (n = 10) or BN (n = 7) according to the DSM-IV. Age-matched healthy female participants (n = 17) composed the control group. Oral mucosa samples were collected, fixed, stained by aceto-orcein/fast green and microscopically examined. Normal cells, MNC and NAs were counted within a 2000 cell sample. The results were analyzed with the Kruskal-Wallis and Mann-Whitney tests. Differences were observed in the frequency of MNC in healthy females (1.2±0.9) versus that of patients with AN (3.4±1.5) (P < 0.0001) and BN (4.1±2.2) (P < 0.001). No differences were found among these groups in terms of NA. AN and BN are related to the loss of genetic material through chromosomal fractures and/or damage to the mitotic spindle (i.e. possibly a result of a deficiency in DNA precursors). Self-imposed compensatory behaviours in AN and BN, such as severe food restriction, potential malnutrition, vomiting, use of diuretics and laxatives and acute exhaustive exercise, are possible inducers of MNC and genotoxic damage. Of these compensatory behaviours, only vomiting has not been linked to genotoxic damage. This is the first report in women with BN, which should be studied in the future. PMID:25232046
Hadad, Natalie A.; Knackstedt, Lori A.
Rationale: Bulimia Nervosa (BN) is highly comorbid with substance abuse and shares common phenotypic and genetic predispositions with drug addiction. Although treatments for the two disorders are similar, controversy remains about whether BN should be classified as addiction. Objectives: Here we review the animal and human literature with the goal of assessing whether BN and drug addiction share a common neurobiology. Results: Similar neurobiological features are present following administration of drugs and bingeing on palatable food, especially sugar. Specifically, both disorders involve increases in extracellular dopamine (DA), D1 binding, D3 mRNA, and ΔFosB in the nucleus accumbens (NAc). Animal models of BN reveal increases in ventral tegmental area (VTA) DA and enzymes involved in DA synthesis that resemble changes observed after exposure to addictive drugs. Additionally, alterations in the expression of glutamate receptors and prefrontal cortex activity present in human BN or following sugar bingeing in animals are comparable to the effects of addictive drugs. The two disorders differ in regards to alterations in NAc D2 binding, VTA DAT mRNA expression, and the efficacy of drugs targeting glutamate to treat these disorders. Conclusions: Although additional empirical studies are necessary, the synthesis of the two bodies of research presented here suggests that BN shares many neurobiological features with drug addiction. While few FDA-approved options currently exist for the treatment of drug addiction, pharmacotherapies developed in the future which target the glutamate, DA, and opioid systems may be beneficial for the treatment of both BN and drug addiction. PMID:24500676
Nagl, Michaela; Jacobi, Corinna; Paul, Martin; Beesdo-Baum, Katja; Höfler, Michael; Lieb, Roselind; Wittchen, Hans-Ulrich
We aimed to assess the prevalence, incidence, age-of-onset and diagnostic stability of threshold and subthreshold anorexia nervosa (AN) and bulimia nervosa (BN) in the community. Data come from a prospective-longitudinal community study of 3021 subjects aged 14-24 at baseline, who were followed up at three assessment waves over 10 years. Eating disorder (ED) symptomatology was assessed with the DSM-IV/M-CIDI at each wave. Diagnostic stability was defined as the proportion of individuals still affected with at least symptomatic eating disorders (EDs) at follow-ups. Baseline lifetime prevalence for any threshold ED were 2.9 % among females and 0.1 % among males. For any subthreshold ED lifetime prevalence were 2.2 % for females and 0.7 % for males. Symptomatic expressions of EDs (including core symptoms of the respective disorder) were most common with a lifetime prevalence of 11.5 % among females and 1.8 % among males. Symptomatic AN showed the earliest onset with a considerable proportion of cases emerging in childhood. 47 % of initial threshold AN cases and 42 % of initial threshold BN cases showed at least symptomatic expressions of any ED at any follow-up assessment. Stability for subthreshold EDs and symptomatic expressions was 14-36 %. While threshold EDs are rare, ED symptomatology is common particularly in female adolescents and young women. Especially threshold EDs are associated with a substantial risk for stability. A considerable degree of symptom fluctuation is characteristic especially for subthreshold EDs. PMID:26754944
Kaye, W; Gendall, K; Strober, M
Anorexia nervosa (AN) and bulimia nervosa (BN) are disorders characterized by aberrant patterns of feeding behavior and weight regulation, and disturbances in attitudes toward weight and shape and the perception of body shape. Emerging data support the possibility that substantial biologic and genetic vulnerabilities contribute to the pathogenesis of AN and BN. Multiple neuroendocrine and neurotransmitter abnormalities have been documented in AN and BN, but for the most part, these disturbances are state-related and tend to normalize after symptom remission and weight restoration; however, elevated concentrations of 5-hydroxyindoleacetic acid in the cerebrospinal fluid after recovery suggest that altered serotonin activity in AN and BN is a trait-related characteristic. Elevated serotonin activity is consistent with behaviors found after recovery from AN and BN, such as obsessionality with symmetry and exactness, harm avoidance, perfectionism, and behavioral over control. In BN, serotonergic modulating antidepressant medications suppress symptoms independently of their antidepressant effects. Selective serotonin reuptake inhibitors (SSRIs) are not useful when AN subjects are malnourished and under-weight; however, when given after weight restoration, fluoxetine may significantly reduce the extremely high rate of relapse normally seen in AN. Nonresponse to SSRI medication in ill AN subjects could be a consequence of an inadequate supply of nutrients, which are essential to normal serotonin synthesis and function. These data raise the possibility that a disturbance of serotonin activity may create a vulnerability for the expression of a cluster of symptoms that are common to both AN and BN and that nutritional factors may affect SSRI response in depression, obsessive-compulsive disorder, or other conditions characterized by disturbances in serotonergic pathways. PMID:9807638
Mauri, M C; Rudelli, R; Somaschini, E; Roncoroni, L; Papa, R; Mantero, M; Longhini, M; Penati, G
1. Eating disorders can be found in several psychiatric pathologies: schizophrenia, delusional disorder (somatic type), bipolar disorders, major depressive disorder, borderline personality disorder, generalized anxiety disorder, body dysmorphic disorder, somatization disorder and conversion disorder. 2. Although their clinical features have been defined, relatively little is known about the role of neurobiological patterns in the pathogenesis of these disorders. Several CNS neurotransmitters and neuromodulators are involved in the regulation of eating behavior in animals and have been implicated in symptoms such as depression and anxiety often observed in patients with eating disorders. The authors will review some studies on NA, DA, 5-HT, beta-endorphins, CRH, VP, OT, CCK, NPY and PYY involved in eating disorders. Furthermore, we will highlight some of the studies on drug therapy of eating disorders taking into account the effects of these agents on neurotransmitters and neuromodulators. 3. Antidepressant drugs have long been used for anorexia nervosa and bulimia, these disorders been claimed to be affective equivalent. Antidepressant agents seem to be effective in reducing the frequency of binge-eating episodes, purging behavior and depressive symptomatology. It is notable that antidepressant agents have been proved to be effective in patients with chronic bulimic symptoms, even in cases persisting for many years and in patients who had repeatedly failed courses of alternative therapeutic approaches. In all of the positive studies, antidepressant agents appeared effective even in bulimic subjects who did not display concomitant depression. 4. Few controlled studies on use of medications for anorexia nervosa have been published. Central serotonergic receptor-blocking compounds such as cyproheptadine cause marked increase in appetite and body weight. Zinc supplementation or cisapride could be a therapeutic option in addition to psychological and other approaches in
Thiels, C; Schmidt, U; Treasure, J; Garthe, R; Troop, N
We compared 8 fortnightly sessions plus a self-care manual (guided self change, GSC) with 16 weekly individual sessions of cognitive behaviour therapy (CBT). There were 31 sufferers of DSM-III-R-bulimia nervosa (BN) in each group. Both treatments resulted in significant improvements regarding self and interviewer based measures of bulimia nervosa as well as depression, self-esteem, quality of life and knowledge about nutrition, weight and shape. There were no significant differences between therapies regarding drop-out rate, compliance with follow-up, and the number of patients receiving additional treatment. At none of the assessments was there a significant difference between GSC and CBT regarding severity of BN, Beck Depression Inventory-score, self-esteem, and quality of life. A significantly higher percentage of CBT-patients were abstinent from bingeing for at least one week at the end of treatment. Three months later, the GSC-group had caught up in this respect and knew more about nutition, weight and shape. Only the sum-scores on a BN self-rating scale were worse for GSC than CBT at the end of therapy and at follow-up. There were no significant differences between the two groups in general treatment satisfaction and judgement about the usefulness of the therapies. Thus, guided self change with a selfcare manual can save therapist time without impinging significantly on treatment satisfaction and effectiveness. PMID:9629559
Somerville, Kate; Cooper, Myra
Women with bulimia nervosa (BN), dieters and non-dieting control participants were questioned about spontaneous imagery linked to concern with food and eating, weight and shape. The downward arrow technique was used to access any associated negative or core beliefs, which were examined for belief, distress and content. A semi-structured interview with open and closed questions was used. Negative self (core) beliefs were successfully accessed, and responses to the interview items had good test-retest and good inter-rater reliability. Patients with BN reported significantly more negative self (core) beliefs than those in the other two groups. Only a very small number of core beliefs about other people or the world in general were reported. Emotional belief ratings appeared to be higher overall than rational belief ratings. Patient's negative self-beliefs contained themes of "self-value", followed by "failure", "self-control" and "physical attractiveness", in descending order of frequency. The findings are discussed in relation to existing research, and implications for cognitive theories of bulimia nervosa and clinical practice are briefly discussed. PMID:17950933
Mond, J. M.; Marks, P.; Hay, P. J.; Rodgers, B.; Kelly, C.; Owen, C.; Paxton, S. J.
This research examined the "mental health literacy" of adolescents concerning eating-disordered behavior. A vignette describing a fictional 16-year old female meeting diagnostic criteria for bulimia nervosa was presented to 522 female high school students, followed by a series of questions concerning treatment of and treatment-seeking for the…
Smyth, Joshua M.; Wonderlich, Stephen A.; Heron, Kristin E.; Sliwinski, Martin J.; Crosby, Ross D.; Mitchell, James E.; Engel, Scott G.
The relation of mood and stress to binge eating and vomiting in the natural environments of patients with bulimia nervosa (BN) was examined using real-time data collection. Women (n = 131; mean age = 25.3 years) with BN carried a palmtop computer for 2 weeks and completed ratings of positive affect (PA), negative affect (NA), anger/hostility (AH),…
Hague, Anne; Kovacich, Joann
The incidence of bulimia nervosa has increased significantly in the second half of the twentieth century and its occurrence is more than twice that of anorexia nervosa. Due to its complex nature, successful treatment requires an interdisciplinary approach with nutritional, psychological, medical, pharmacological and dental therapies. Despite…
Fernandez-Aranda, Fernando; Jimenez-Murcia, Susana; Santamaría, Juan J; Giner-Bartolomé, Cristina; Mestre-Bach, Gemma; Granero, Roser; Sánchez, Isabel; Agüera, Zaida; Moussa, Maher H; Magnenat-Thalmann, Nadia; Konstantas, Dimitri; Lam, Tony; Lucas, Mikkel; Nielsen, Jeppe; Lems, Peter; Tarrega, Salomé; Menchón, José Manuel
Although cognitive behavioral therapy (CBT) has been demonstrated to be the most effective approach for the treatment of bulimia nervosa (BN), there is lack of studies showing whether a combination with a serious video game (SVG) might be useful to enhance patients' emotional regulation capacities and general outcome. The aims of this study were (a) to analyze whether outpatient CBT + SVG, when compared with outpatient CBT - SVG, shows better short-term outcome; (b) to examine whether the CBT + SVG group is more effective in reducing emotional expression and levels of anxiety than CBT - SVG. Thirty-eight patients diagnosed as having BN according to DSM-5 criteria were consecutively assigned to two outpatient group therapy conditions (that lasted for 16 weekly sessions): 20 CBT + SVG versus 18 CBT - SVG. Patients were assessed before and after treatment using not only a food and binging/purging diary and clinical questionnaires in the field of eating disorders but also additional indexes for measuring anger expression and anxiety. Regarding the post-treatment psychometric measures, most of the mean differences (Eating Disorder Inventory-2, Symptom Checklist-Revised, State-Trait Anxiety Index, and partially State-Trait Anger Expression Inventory) achieved moderate to high effect size (d > 0.5), in the sense that CBT + SVG obtained the best results compared with the CBT - SVG group. Regarding therapy outcome (dropout, partial remission, and total remission), CBT + SVG showed better results and a moderate effect size emerged for the comparison of the risk of dropout during the treatment, being higher for CBT - SVG compared with CBT + SVG (44.1 percent versus 20.0 percent, d = 0.54). Although the sample size in our study was low, and consequently results should be considered with caution, we have obtained promising findings suggesting that in the short-term CBT + SVG might be a good option not only for improving
Monteleone, P; Bortolotti, F; Fabrazzo, M; La Rocca, A; Fuschino, A; Maj, M
Leptin is known to regulate body weight, energy balance, and reproduction. Therefore, investigation of its physiology is of obvious interest in bulimia nervosa (BN), an eating disorder characterized by body weight-related psychopathology, acute changes in the energy balance, and reproductive alterations. To date, the few studies that have assessed leptin production in BN have had several limitations, including the measurement of blood leptin levels in treated patients and the lack of normal weight healthy controls, so that the information they provide is not conclusive. As the investigation of leptin dynamics is likely to be more informative, we decided to assess leptin response to acute fasting and refeeding in both untreated patients with BN and healthy controls. Twelve women meeting the diagnostic criteria for BN of the Diagnostic and Statistical Manual of Mental Disorders, and 10 healthy women of the same age range participated in a 3-day study. At 1800 h on day 1, they received a meal of 1088 Cal, with 53% carbohydrates, 17% protein, and 30% fat. Then, they fasted until 1800 h on day 2, when they received the same meal. On day 3, they received a standard hospital diet of 2600 Cal, divided into 3 meals, with the same percentages of nutrients as described above. Blood samples were collected at different time points for plasma leptin, glucose, and insulin measurements. In bulimic patients, plasma leptin values were significantly lower than in healthy women (P < 0.0001) and were positively related to body weight, expressed as body mass index (r = 0.86; P < 0.0001). The leptin response to the fasting/refeeding paradigm significantly differed between patients and controls (time x group interaction, P < 0.0001). In fact, in healthy subjects, acute fasting induced a 58% decline in the plasma leptin concentration, whereas such a decrease was only 7% in bulimic women (P < 0.001). After acute refeeding, plasma leptin increased in both groups, although in the patients it
Tortorella, Alfonso; Brambilla, Francesca; Fabrazzo, Michele; Volpe, Umberto; Monteleone, Alessio Maria; Mastromo, Daniele; Monteleone, Palmiero
A large body of literature suggests the occurrence of a dysregulation in both central and peripheral modulators of appetite in patients with anorexia nervosa (AN) and bulimia nervosa (BN), but at the moment, the state or trait-dependent nature of those changes is far from being clear. It has been proposed, although not definitively proved, that peptide alterations, even when secondary to malnutrition and/or to aberrant eating behaviours, might contribute to the genesis and the maintenance of some symptomatic aspects of AN and BN, thus affecting the course and the prognosis of these disorders. This review focuses on the most significant literature studies that explored the physiology of those central and peripheral peptides, which have prominent effects on eating behaviour, body weight and energy homeostasis in patients with AN and BN. The relevance of peptide dysfunctions for the pathophysiology of eating disorders is critically discussed. PMID:24942507
White, J H
Identifying women at risk for developing bulimia nervosa (BN) is an important area of study for psychiatric-mental health nurses. Of those who develop BN, a large proportion of women have been diagnosed earlier with anorexia nervosa (AN). It has been posited that women who are treated for AN are often only partially recovered. Although their weights become clinically acceptable, they often continue to restrict food; this typically leads to a binge eating and purging cycle and the development of BN. A history of AN is viewed as a possible risk factor for the development of BN. This study compared women seeking treatment for BN with a prior history of AN, and those without this history on selected variables. A profile emerged and is described supporting a distinct subgroup with prior AN. Findings from this study have implications for early detection of and extended follow-up care after treatment for AN. PMID:10783526
Rodríguez, Sonia; Mata, José Luis; Moreno, Silvia; Fernández, Maria Carmen; Vila, Jaime
The aim of the study was to explore the effect of visualizing food images under different mood states and food restriction conditions on the emotional modulation of two defense reflexes (startle reflex and cardiac defense). 72 women at risk of suffering from bulimia nervosa were assigned to two groups: 1) a group under induced positive, neutral, or negative mood state and, 2) a 6-hour-food-deprived group or a non-deprived group. Second-by-second heart rate and electromyogram activity from the orbiculari oculi region were recorded after the auditory stimulus. The results showed that, while viewing food images, non-deprived women under negative mood state potentiated the cardiac defense response and the startle motor reflex. Results are discussed in the context of emotional eating theories and Peter Lang's motivational priming model. PMID:17295980
Anderson, Leslie K; Murray, Stuart B; Ramirez, Ana L; Rockwell, Roxanne; Le Grange, Daniel; Kaye, Walter H
Dialectical behavior therapy (DBT) and family-based treatment (FBT) are two evidence-based interventions that have been applied in the treatment of bulimia nervosa (BN) in adolescents. While DBT focuses on providing skills for coping with emotion dysregulation that often co-occurs with BN, FBT targets the normalization of eating patterns. The purpose of the current article is to introduce an integration of both treatments to provide a more comprehensive approach that targets the full scope of the disorder. We provide a review of the conceptual similarities and differences between FBT-BN and DBT along with strategies to guide a blended treatment approach. Given the strengths and limitations of either independent treatment, DBT and FBT-BN complement one another and together can address the range of symptoms and behaviors typically seen in adolescent BN. PMID:26009868
Background With the imminent publication of the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there has been a growing interest in the study of the boundaries across the three bulimic spectrum syndromes [bulimia nervosa-purging type (BN-P), bulimia nervosa-non purging type (BN-NP) and binge eating disorder (BED)]. Therefore, the aims of this study were to determine differences in treatment response and dropout rates following Cognitive Behavioural Therapy (CBT) across the three bulimic-spectrum syndromes. Method The sample comprised of 454 females (87 BED, 327 BN-P and 40 BN-NP) diagnosed according to DSM-IV-TR criteria who were treated with 22 weekly outpatient sessions of group CBT therapy. Patients were assessed before and after treatment using a food and binging/purging diary and some clinical questionnaires in the field of ED. “Full remission” was defined as total absence of binging and purging (laxatives and/or vomiting) behaviors and psychological improvement for at least 4 (consecutive). Results Full remission rate was found to be significantly higher in BED (69.5%) than in both BN-P (p < 0.005) and BN-NP (p < 0.001), which presented no significant differences between them (30.9% and 35.5%). The rate of dropout from group CBT was also higher in BED (33.7%) than in BN-P (p < 0.001) and BN-NP (p < 0.05), which were similar (15.4% and 12.8%, respectively). Conclusions Results suggest that purging and non-purging BN have similar treatment response and dropping out rates, whereas BED appears as a separate diagnosis with better outcome for those who complete treatment. The results support the proposed new DSM-5 classification PMID:24200085
Fagundo, Ana B; Santamaría, Juan J; Forcano, Laura; Giner-Bartolomé, Cristina; Jiménez-Murcia, Susana; Sánchez, Isabel; Granero, Roser; Ben-Moussa, Maher; Magnenat-Thalmann, Nadia; Konstantas, Dimitri; Lam, Tony; Lucas, Mikkel; Nielsen, Jeppe; Bults, Richard G A; Tarrega, Salomé; Menchón, José M; de la Torre, Rafael; Cardi, Valentina; Treasure, Janet; Fernández-Aranda, Fernando
Although standard psychological treatments have been successful in treating several core features in eating disorders (ED), other characteristics such as emotional regulation or impulsivity appear to be more resistant to change. There is a growing body of evidence to support the efficacy of cognitive remediation for cognitive and emotional difficulties in ED. Playmancer/ Islands is a video game (VG) designed to specifically treat mental disorders, characterized by problems in impulse control. The objective of the game is to increase self-control over emotions, decision making and behaviours. The aim of this study is to describe the results from a consecutive series of nine bulimia nervosa patients who were treated with the VG in addition to cognitive behaviour therapy (CBT). The outcomes included clinical and psychopathological questionnaires, and physiological measures were obtained during the VG. Emotional regulation improved, heart rate variability increased, and respiratory rate and impulsivity measures reduced after the treatment. These findings suggest that VG training may enhance treatment for ED. PMID:24092598
Spielmans, Glen I; Benish, Steven G; Marin, Catherine; Bowman, Wesley M; Menster, Maria; Wheeler, Anthony J
Treatment guidelines state that cognitive-behavioral therapy (CBT) and interpersonal therapy are the best-supported psychotherapies for bulimia nervosa (BN) and that CBT is the preferred psychological treatment for binge eating disorder (BED). However, no meta-analysis which both examined direct comparisons between psychological treatments for BN and BED and considered the role of moderating variables, such as the degree to which psychotherapy was bona fide, has previously been conducted Thus, such an analysis was undertaken. We included 77 comparisons reported in 53 studies. The results indicated that: (a) bona fide therapies outperformed non-bona fide treatments, (b) bona fide CBT outperformed bona fide non-CBT interventions by a statistically significant margin (only approaching statistical significance for BN and BED when examined individually), but many of these trials had confounds which limited their internal validity, (c) full CBT treatments offered no benefit over their components, and (d) the distribution of effect size differences between bona fide CBT treatments was homogeneously distributed around zero. These findings provide little support for treatment specificity in psychotherapy for BN and BED. PMID:23454220
Bulik, Cynthia M; Marcus, Marsha D; Zerwas, Stephanie; Levine, Michele D; Hofmeier, Sara; Trace, Sara E; Hamer, Robert M; Zimmer, Benjamin; Moessner, Markus; Kordy, Hans
Cognitive-behavioral therapy (CBT) is currently the "gold standard" for treatment of bulimia nervosa (BN), and is effective for approximately 40-60% of individuals receiving treatment; however, the majority of individuals in need of care do not have access to CBT. New strategies for service delivery of CBT and for maximizing maintenance of treatment benefits are critical for improving our ability to treat BN. This clinical trial is comparing an Internet-based version of CBT (CBT4BN) in which group intervention is conducted via therapeutic chat group with traditional group CBT (CBTF2F) for BN conducted via face-to-face therapy group. The purpose of the trial is to determine whether manualized CBT delivered via the Internet is not inferior to the gold standard of manualized group CBT. In this two-site randomized controlled trial, powered for non-inferiority analyses, 180 individuals with BN are being randomized to either CBT4BN or CBTF2F. We hypothesize that CBT4BN will not be inferior to CBTF2F and that participants will value the convenience of an online intervention. If not inferior, CBT4BN may be a cost-effective approach to service delivery for individuals requiring treatment for BN. PMID:22659072
Lavender, Jason M; Utzinger, Linsey M; Cao, Li; Wonderlich, Stephen A; Engel, Scott G; Mitchell, James E; Crosby, Ross D
Although negative affect (NA) has been identified as a common trigger for bulimic behaviors, findings regarding NA following such behaviors have been mixed. This study examined reciprocal associations between NA and bulimic behaviors using real-time, naturalistic data. Participants were 133 women with bulimia nervosa (BN) according to the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders who completed a 2-week ecological momentary assessment protocol in which they recorded bulimic behaviors and provided multiple daily ratings of NA. A multilevel autoregressive cross-lagged analysis was conducted to examine concurrent, first-order autoregressive, and prospective associations between NA, binge eating, and purging across the day. Results revealed positive concurrent associations between all variables across all time points, as well as numerous autoregressive associations. For prospective associations, higher NA predicted subsequent bulimic symptoms at multiple time points; conversely, binge eating predicted lower NA at multiple time points, and purging predicted higher NA at 1 time point. Several autoregressive and prospective associations were also found between binge eating and purging. This study used a novel approach to examine NA in relation to bulimic symptoms, contributing to the existing literature by directly examining the magnitude of the associations, examining differences in the associations across the day, and controlling for other associations in testing each effect in the model. These findings may have relevance for understanding the etiology and/or maintenance of bulimic symptoms, as well as potentially informing psychological interventions for BN. PMID:26692122
Ortega-Roldán, Blanca; Rodríguez-Ruiz, Sonia; Perakakis, Pandelis; Fernández-Santaella, M. Carmen; Vila, Jaime
Background Body dissatisfaction is the most relevant body image disturbance in bulimia nervosa (BN). Research has shown that viewing one's own body evokes negative thoughts and emotions in individuals with BN. However, the psychophysiological mechanisms involved in this negative reaction have not yet been clearly established. Our aim was to examine the emotional and attentional processes that are activated when patients with BN view their own bodies. Method We examined the effects of viewing a video of one's own body on the physiological (eye-blink startle, cardiac defense, and skin conductance) and subjective (pleasure, arousal, and control ratings) responses elicited by a burst of 110 dB white noise of 500 ms duration. The participants were 30 women with BN and 30 healthy control women. The experimental task consisted of two consecutive and counterbalanced presentations of the auditory stimulus preceded, alternatively, by a video of the participant's own body versus no such video. Results The results showed that, when viewing their own bodies, women with BN experienced (a) greater inhibition of the startle reflex, (b) greater cardiac acceleration in the first component of the defense reaction, (c) greater skin conductance response, and (d) less subjective pleasure and control combined with greater arousal, compared with the control participants. Conclusion Our findings suggest that, for women with BN, peripheral-physiological responses to self-images are dominated by attentional processes, which provoke an immobility reaction caused by a dysfunctional negative response to their own body. PMID:25036222
Utzinger, Linsey M.; Mitchell, James E.; Cao, Li; Crosby, Ross D.; Crow, Scott J.; Wonderlich, Stephen A.; Peterson, Carol B.
Objective This study examined whether having a history of anorexia nervosa (AN) or bulimia nervosa (BN) is associated with response to treatment in adults with binge eating disorder (BED). Method Data from 189 adults diagnosed with BED who were randomly assigned to one of three group cognitive-behavioral (CBT) treatments were analyzed to compare those with and without a history of AN/BN. Results A total of 16% of the sample had a history of AN/BN. The BED subgroup with a history of AN/BN presented with higher rates of mood disorders and greater eating-related symptom severity at baseline. Participants with a history of AN/BN also had higher global eating disorder (ED) symptoms at end of treatment (EOT), and more frequent objective binge-eating episodes at EOT and 12-month follow-up. Discussion These findings suggest that in adults with BED, a history of AN/BN is predictive of greater eating-related symptom severity following group-based CBT and poorer short- and long-term binge-eating outcomes. These findings suggest that considering ED history in the treatment of adults with BED may be clinically useful. PMID:25959549
Lavender, Jason M.; Wonderlich, Stephen A.; Engel, Scott G.; Gordon, Kathryn H.; Kaye, Walter H.; Mitchell, James E.
Several existing conceptual models and psychological interventions address or emphasize the role of emotion dysregulation in eating disorders. The current article uses Gratz and Roemer’s (2004) multidimensional model of emotion regulation and dysregulation as a clinically relevant framework to review the extant literature on emotion dysregulation in anorexia nervosa (AN) and bulimia nervosa (BN). Specifically, the dimensions reviewed include: (1) the flexible use of adaptive and situationally appropriate strategies to modulate the duration and/or intensity of emotional responses, (2) the ability to successfully inhibit impulsive behavior and maintain goal-directed behavior in the context of emotional distress, (3) awareness, clarity, and acceptance of emotional states, and (4) the willingness to experience emotional distress in the pursuit of meaningful activities. The current review suggests that both AN and BN are characterized by broad emotion regulation deficits, with difficulties in emotion regulation across the four dimensions found to characterize both AN and BN, although a small number of more specific difficulties may distinguish the two disorders. The review concludes with a discussion of the clinical implications of the findings, as well as a summary of limitations of the existing empirical literature and suggestions for future research. PMID:26112760
Lavender, Jason M; Wonderlich, Stephen A; Engel, Scott G; Gordon, Kathryn H; Kaye, Walter H; Mitchell, James E
Several existing conceptual models and psychological interventions address or emphasize the role of emotion dysregulation in eating disorders. The current article uses Gratz and Roemer's (2004) multidimensional model of emotion regulation and dysregulation as a clinically relevant framework to review the extant literature on emotion dysregulation in anorexia nervosa (AN) and bulimia nervosa (BN). Specifically, the dimensions reviewed include: (1) the flexible use of adaptive and situationally appropriate strategies to modulate the duration and/or intensity of emotional responses, (2) the ability to successfully inhibit impulsive behavior and maintain goal-directed behavior in the context of emotional distress, (3) awareness, clarity, and acceptance of emotional states, and (4) the willingness to experience emotional distress in the pursuit of meaningful activities. The current review suggests that both AN and BN are characterized by broad emotion regulation deficits, with difficulties in emotion regulation across the four dimensions found to characterize both AN and BN, although a small number of more specific difficulties may distinguish the two disorders. The review concludes with a discussion of the clinical implications of the findings, as well as a summary of limitations of the existing empirical literature and suggestions for future research. PMID:26112760
Stice, Eric; Bohon, Cara; Marti, C Nathan; Fischer, Kathryn
Studies have found that individuals with bulimia nervosa can be classified into dietary and dietary-negative affect subtypes and that the latter exhibit greater eating pathology, psychiatric comorbidity, and functional impairment; a more protracted clinical course; and a worse treatment response. In this report, the authors describe 2 prospective studies that found that young women with threshold (n = 48) and subthreshold (n = 83) bulimic pathology can be classified into dietary and dietary-negative affect subtypes; that two subtyping approaches produced similar results (mean kappa = .94); that the subtyping distinction showed 4-week test-retest reliability (kappa = .61); and that the dietary-negative affect subtype showed greater eating pathology, emotional distress, functional impairment, treatment seeking, and lower likelihood of recovery over 6-month and 3-year follow-ups than the dietary subtype. The dieting-negative affect subtyping distinction evidenced greater test-retest reliability and concurrent and predictive validity than did the purging-nonpurging subtyping distinction. The additional evidence for the reliability and validity of this subtyping scheme, particularly the prognostic utility, suggests it is worth additional inquiry. PMID:19045970
Mercader, J M; Fernández-Aranda, F; Gratacòs, Mònica; Aguera, Zaida; Forcano, Laura; Ribasés, Marta; Villarejo, Cynthia; Estivill, Xavier
Association studies and rodent models suggest a major role for BDNF (brain-derived neurotrophic factor) in feeding regulation. Altered BDNF blood levels have been associated with eating disorders (ED) and their related psychopathological traits. Since the influence of BDNF on self-reported eating disorder inventory scores (EDI) has not been tested, we investigated the correlation of EDI scales with BDNF plasma levels. BDNF levels were measured by (ELISA), and the EDI questionnaire was administered in a total of 81 ED patients. The relationship between BDNF levels and EDI scores was calculated using a general linear model. After correcting for multiple testing, BDNF plasma levels negatively correlated with the EDI total score (R (2) = 0.26; p = 4.09 x 10(-4)), interoceptive awareness (R (2) = 0.26; p = 1.96 x 10(-4)), and maturity fears (R (2) = 0.13; p = 6.92 x 10(-4)). When subdividing according to the main diagnoses, interoceptive awareness presented significant correlations with BDNF blood levels in both the anorexia nervosa (R (2) = 0.33, p = 0.0026) and bulimia nervosa groups (R (2) = 0.10; p = 0.008). Our data suggest that BDNF levels may influence the severity of the ED by modulating the associated psychopathology, in particular through the impairment of interoceptive awareness. PMID:20195875
Does higher level of individualization increase treatment efficacy? Fifty patients with bulimia nervosa were randomized into either manual-based (focused) or more individualized (broader) cognitive behavioral therapy guided by logical functional analysis. Eating disorders Examination and a series of self-report questionnaires were used for assessment at pre-, and post-treatment as well as at follow-up. Both conditions improved significantly at post-treatment, and the results were maintained at the 6 months follow-up. There were no statistically and clinically significant differences between the two conditions at post-treatment with the exception of abstinence from objective bulimic episodes, eating concerns, and body shape dissatisfaction, all favoring the individualized, broader condition. Both groups improved concerning self-esteem, perceived social support from friends, and depression. The improvements were maintained at follow-up. Ten patients (20%) did not respond to the treatment. Notably, a majority of non-responders (80%) were in the manual-based condition. Non-responders showed extreme dominance of rule-governed behavior, and lack of contact with actual contingencies compared to responders. The study provided preliminary support for the superiority of higher level of individualization (i.e. broader CBT) in terms of the response to treatment, and relapses. However, the magnitude of effects was moderate, and independent replications, with blind assessment procedures, and a larger sample sized are needed before more clear cut conclusions can be drawn. PMID:16389065
Schnicker, Katja; Hiller, Wolfgang; Legenbauer, Tanja
In the present study, drop-out-analyses were carried out for a manual-based cognitive-behavioral therapy for 104 females with anorexia nervosa (AN) and bulimia nervosa (BN), in the service setting of a university outpatient clinic (naturalistic setting). A total of 22.9% of patients with AN terminated therapy prematurely (drop-outs), compared to 40.6% of patients with BN. Group differences between drop-outs and completers show that the group of drop-outs with BN had higher values in the depression score at the start of therapy and was almost two times more likely to have a comorbid disorder (odds ratio 1.69), whereas drop-outs with AN had higher values in the outcome-scale drive for thinness and the odds ratio for being employed or living in a partnership was slightly lower. Completers and drop-outs did not differ significantly within groups in regard to age, body mass index at the start and end of therapy, or the number of comorbid disorders. On the whole, the therapy effect in the group of drop-outs was relatively moderate. For patients with AN, even higher therapy effects were observed among the drop-outs than among the completers. These data suggest that moderate therapy effects and responses can be achieved even among the drop-outs. PMID:23587528
The aim of the study was to assess the efficacy of a 12-week CBT-based pure and guided self-help among 29 patients with full and subthreshold bulimia nervosa, and binge eating disorder. In the intention-to-treat analyses, self-help had a moderately positive and sustained effect on the patients' eating problems. The patients reduced their mean number of objective bulimic episodes and purging behavior by 26% and 22% over the course of treatment. The corresponding reduction levels for the treatment completers (n=21) were 41% and 34%, respectively. As in the previous study, there were no significant differences between the pure and guided self-help mode in terms of outcome, and the results were sustained 6 months after the end of the treatment. The findings are discussed in relation to the shorter duration of the self-help, the lower rate of attrition, and the characteristics of the sample compared to the earlier trial. PMID:17056405
Bulik, Cynthia M.; Marcus, Marsha D.; Zerwas, Stephanie; Levine, Michele D.; Hofmeier, Sara; Trace, Sara E.; Hamer, Robert M.; Zimmer, Benjamin; Moessner, Markus; Kordy, Hans
Cognitive-behavioral therapy (CBT) is currently the “gold standard” for treatment of bulimia nervosa (BN), and is effective for approximately 40–60% of individuals receiving treatment; however, the majority of individuals in need of care do not have access to CBT. New strategies for service delivery of CBT and for maximizing maintenance of treatment benefits are critical for improving our ability to treat BN. This clinical trial is comparing an Internet-based version of CBT (CBT4BN) in which group intervention is conducted via therapeutic chat group with traditional group CBT (CBTF2F) for BN conducted via face-to-face therapy group. The purpose of the trial is to determine whether manualized CBT delivered via the Internet is not inferior to the gold standard of manualized group CBT. In this two-site randomized controlled trial, powered for non-inferiority analyses, 180 individuals with BN are being randomized to either CBT4BN or CBTF2F. We hypothesize that CBT4BN will not be inferior to CBTF2F and that participants will value the convenience of an online intervention. If not inferior, CBT4BN may be a cost-effective approach to service delivery for individuals requiring treatment for BN. PMID:22659072
Gale, Christopher J; Cluett, Elizabeth R; Laver-Bradbury, Cathy
There are disproportionately fewer studies examining the role of the father in the development of child and adolescent psychopathology. This is pertinent in the field of eating disorders, where there is a wealth of research related to family influences and the value of family-based interventions. This article reviews the key themes within the literature around the potential impact of the father-child relationship on the development and maintenance of Anorexia and Bulimia Nervosa in young people. The critical review searched relevant health and social care databases, as well as manually searching key journals in the eating disorder field. In these results, 13 studies met the inclusion/exclusion criteria and were critiqued, with 8 being taken forward for discussion. The 8 studies identified key themes within the relationship of the father and child (particularly daughters) around conflict and communication, parental protection and psychological control, emotional regulation and self-esteem, and self-perfectionism. All of these factors appear to influence the child's level of self-determining autonomy, which in turn can impact maladaptive eating attitudes and psychopathology. Tentative recommendations are made around working with fathers to encourage free expression of ideas and foster a sense of autonomy through compromise and collaboration with their adolescent child. Further research around these themes in relation to other family members is also suggested. PMID:23597275
Murray, Stuart B; Anderson, Leslie K; Cusack, Anne; Nakamura, Tiffany; Rockwell, Roxanne; Griffiths, Scott; Kaye, Walter H
Adolescent bulimia nervosa (BN) remains relatively understudied, and the complex interaction between core eating psychopathology and emotional regulation difficulties provides ongoing challenges for full symptom remission. In an open pilot trial, we aimed to investigate the efficacy of a program integrating family-based treatment (FBT) and dialectical behavior therapy (DBT) in treating adolescent BN, without exclusion criteria. Participants were 35 adolescents who underwent partial hospital treatment for BN, and outcomes included measures of core BN pathology and emotional regulation difficulties, as well as parental measures of self-efficacy, completed at intake and discharge. Results indicate significant improvements in overall eating disorder pathology, t(68) = 4.52, p = .002, and in core BN symptoms, including objective binge episodes, t(68) = 2.01, p = .041, and self-induced vomiting, t(68) = 2.90, p = .005. Results also illustrated a significant increase in parental efficacy throughout the course of treatment, t(20) = .081, p = .001, although no global improvement in difficulties in emotion regulation was noted, t(68) = 1.12, p = .285. These preliminary findings support the utility of this integration of FBT and DBT, although raise interesting questions as to the mechanism of symptom remission. PMID:26009971
Corcos, M; Flament, M F; Giraud, M J; Paterniti, S; Ledoux, S; Atger, F; Jeammet, P
While bulimia nervosa (BN) typically begins in girls during late adolescence, puberty and associated developmental changes have been linked to negative body image and onset of a variety of psychological problems. This study aimed to identify early psychopathological signs, which could have marked the period of puberty in subjects whom later developed BN. In a case control study, we compared 49 girls with BN according to DSM-IV, aged between 18 and 20 years, to 49 girls of the same age, who were free of any past or current psychiatric diagnosis. Psychiatrists or clinical psychologists, using a semi-structured clinical interview including retrospective assessment of the emotional and behavioural changes that had occurred in puberty evaluated both groups. Before the onset of a clinical eating disorder, the subjects with BN presented significantly more often than controls weight related concerns, attitudes of withdrawal and social isolation, and negative changes in their body image and self-image, as well as in their relationships with siblings and peers. The results suggest that early psychological distress precedes the onset of an eating disorder in many cases, and that prevention efforts should be directed towards peripubertal psychopathology. PMID:10926061
Pisetsky, Emily M; Crosby, Ross D; Cao, Li; Fitzsimmons-Craft, Ellen E; Mitchell, James E; Engel, Scott G; Wonderlich, Stephen A; Peterson, Carol B
The current study examined the association between affect and self-reported alcohol intoxication in women with bulimia nervosa (BN; N=133). Participants completed a two-week ecological momentary assessment protocol. Momentary global positive affect (PA) and negative affect (NA), as well as the facets of NA (fear, guilt, hostility and sadness), were measured. Forty-five participants endorsed that they "got drunk" during the study period. Daily mean and variability of global PA and NA were compared between days with self-reported alcohol intoxication and days without self-reported alcohol intoxication. Trajectories of affect were modeled prior to and following episodes of self-reported alcohol intoxication. There were no differences in the mean or variability of PA or NA on days characterized by self-reported alcohol intoxication compared to days with no self-reported alcohol intoxication (ps>0.05). PA decreased significantly prior to self-reported alcohol intoxication and remained stable afterwards. There were no changes in global NA before or after self-reported alcohol intoxication, but an examination of the facets of NA showed that sadness increased following episodes of self-reported alcohol intoxication. These findings showed only partial support for a negative reinforcement model of alcohol use in women with BN. PMID:27111214
Izydorczyk, Bernadetta; Czekaj, Barbara
The article is a review of the selected theoretical concepts of eating disorder etiological factors and the authors' experience in the field of psychotheraphy of women with anorexia and bulimia nervosa. The authors describe various psychological and psychoanalytical concepts, for instance the theory of object relations by R. Spitz, D. Winnicott and H. Bruch's the theory of development. They indicate the importance of primary mother-child relations in the genesis of eating disorders as well as the process of the child's separation, his becoming independent and the basis of forming the child's attitude towards eating. They also show the difficulties during the course of psychotherapy for women with eating disorders. PMID:16756029
Santangelo, Philip; Mussgay, Lutz; Sawitzki, Günther; Trull, Timothy J.; Reinhard, Iris; Steil, Regina; Klein, Christoph; Bohus, Martin; Ebner-Priemer, Ulrich W.
Affective instability is a core feature of borderline personality disorder (BPD). The use of advanced assessment methodologies and appropriate statistical analyses has led to consistent findings that indicate a heightened instability in patients with BPD compared with healthy controls. However, few studies have investigated the specificity of affective instability among patients with BPD with regard to relevant clinical control groups. In this study, 43 patients with BPD, 28 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa (BN), and 28 healthy controls carried e-diaries for 24 hours and were prompted to rate their momentary affective states approximately every 15 minutes while awake. To quantify instability, we used 3 state-of-the-art indices: multilevel models for squared successive differences (SSDs), multilevel models for probability of acute changes (PACs), and aggregated point-by-point changes (APPCs). Patients with BPD displayed heightened affective instability for emotional valence and distress compared with healthy controls, regardless of the specific instability indices. These results directly replicate earlier studies. However, affective instability did not seem to be specific to patients with BPD. With regard to SSDs, PACs, and APPCs, patients with PTSD or BN showed a similar heightened instability of affect (emotional valence and distress) to that of patients with BPD. Our results give raise to the discussion if affective instability is a transdiagnostic or a disorder-specific mechanism. Current evidence cannot answer this question, but investigating psychopathological mechanisms in everyday life across disorders is a promising approach to enhance validity and specificity of mental health diagnoses. PMID:24661176
Yilmaz, Zeynep; Kaplan, Allan S.; Tiwari, Arun K.; Levitan, Robert D.; Piran, Sara; Bergen, Andrew W.; Kaye, Walter H.; Hakonarson, Hakon; Wang, Kai; Berrettini, Wade H.; Brandt, Harry A.; Bulik, Cynthia M.; Crawford, Steve; Crow, Scott; Fichter, Manfred M.; Halmi, Katherine A.; Johnson, Craig L.; Keel, Pamela K.; Klump, Kelly L.; Magistretti, Pierre; Mitchell, James E.; Strober, Michael; Thornton, Laura M.; Treasure, Janet; Woodside, D. Blake; Knight, Joanne; Kennedy, James L.
Objective Although low weight is a key factor contributing to the high mortality in anorexia nervosa (AN), it is unclear how AN patients sustain low weight compared with bulimia nervosa (BN) patients with similar psychopathology. Studies of genes involved in appetite and weight regulation in eating disorders have yielded variable findings in part due to small sample size and clinical heterogeneity. This study: (1) assessed the role of leptin, melanocortin, and neurotrophin genetic variants in conferring risk for AN and BN and (2) explored the involvement of these genes in body mass index (BMI) variations within AN and BN. Method Our sample consisted of 745 individuals with AN without a history of BN, 245 with BN without a history of AN, and 321 controls. We genotyped 20 markers with known or putative function among genes selected from leptin, melanocortin, and neurotrophin systems. Results There were no significant differences in allele frequencies among individuals with AN, BN, and controls. AGRP rs13338499 polymorphism was associated with lowest illness-related BMI in those with AN (p=0.0013), and NTRK2 rs1042571 was associated with highest BMI in those with BN (p=0.0018). Discussion To our knowledge, this is the first study to address the issue of clinical heterogeneity in eating disorder genetics and to explore the role of known or putatively functional markers in genes regulating appetite and weight in individuals with AN and BN. If replicated, our results may serve as an important first step toward gaining a better understanding of weight regulation in eating disorders. PMID:24831852
Lee, Seojung; Ran Kim, Kyung; Ku, Jeonghun; Lee, Jung-Hyun; Namkoong, Kee; Jung, Young-Chul
Cortical areas supporting cognitive control and salience demonstrate different neural responses to visual food cues in patients with eating disorders. This top-down cognitive control, which interacts with bottom-up appetitive responses, is tightly integrated not only in task conditions but also in the resting-state. The dorsal anterior cingulate cortex (dACC) is a key node of a large-scale network that is involved in self-referential processing and cognitive control. We investigated resting-state functional connectivity of the dACC and hypothesized that altered connectivity would be demonstrated in cortical midline structures involved in self-referential processing and cognitive control. Seed-based resting-state functional connectivity was analyzed in women with anorexia nervosa (N=18), women with bulimia nervosa (N=20) and age matched healthy controls (N=20). Between group comparisons revealed that the anorexia nervosa group exhibited stronger synchronous activity between the dACC and retrosplenial cortex, whereas the bulimia nervosa group showed stronger synchronous activity between the dACC and medial orbitofrontal cortex. Both groups demonstrated stronger synchronous activity between the dACC and precuneus, which correlated with higher scores of the Body Shape Questionnaire. The dACC-precuneus resting-state synchrony might be associated with the disorder-specific rumination on eating, weight and body shape in patients with eating disorders. PMID:24300085
Contaldo, F; Di Paolo, M R; Mazzacano, C; Di Biase, G; Giumetti, D
Patient L.A. (f., 20 yrs), affected by bulimia and self-induced vomiting, was hospitalized because of severe malnutrition (BMI 13.1), hypopotassemia (2.8 mEq/l) and prolonged QTc interval (0.469"). Intensive care treatment aimed to normalize mineral balance mainly serum potassium, consisted of administering e.v. potassium (mg 2346/day), magnesium (mg 72/day), calcium (mg 80/day), phosphorus (mg 769/day), chloride (mg 710/day), iron (mg 40/day). Dietary treatment was deliberately chosen to be slightly above minimum energy requirements in order to avoid possible side effects of forced hyperalimentation. The patient, immediately after hospitalization, interrupted vomiting and 2 wks later weight increased by 5 kg (from 34.9 kg to 40.0 kg). On the other hand normalization of serum potassium levels was slow and QTc interval reached normal range only after the 10th day of treatment (0.447"). This case supports the hypothesis that major ECG abnormalities may be present in severe malnutrition due to anorexia nervosa or bulimia with self-induced vomiting. The dangers of these complications were substantiated by the fact that intensive care treatment allowed prompt body weight recovery but normalization of electrolytic balance and cardiac function was very slow. For such patients, electrocardiographic monitoring should be routine. PMID:2377804
Avena, Nicole M.; Bocarsly, Miriam E.
Food intake is mediated, in part, through brain pathways for motivation and reinforcement. Dysregulation of these pathways may underlay some of the behaviors exhibited by patients with eating disorders. Research using animal models of eating disorders has greatly contributed to the detailed study of potential brain mechanisms that many underlie the causes or consequences of aberrant eating behaviors. This review focuses on neurochemical evidence of reward-related brain dysfunctions obtained through animal models of binge eating, bulimia nervosa, or anorexia nervosa. The findings suggest that alterations in dopamine (DA), acetylcholine (ACh) and opioid systems in reward-related brain areas occur in response to binge eating of palatable foods. Moreover, animal models of bulimia nervosa suggest that while bingeing on palatable food releases DA, purging attenuates the release of ACh that might otherwise signal satiety. Animal models of anorexia nervosa suggest that restricted access to food enhances the reinforcing effects of DA when the animal does eat. The activity-based anorexia model suggests alterations in mesolimbic DA and serotonin occur as a result of starvation coupled with excessive wheel running. These findings with animal models complement data obtained through neuroimaging and pharmacotherapy studies of clinical populations. Finally, information on the neurochemical consequences of the behaviors associated with these eating disorders will be useful in understanding these complex disorders and may inform future therapeutic approaches, as discussed here. PMID:22138162
Avena, Nicole M; Bocarsly, Miriam E
Food intake is mediated, in part, through brain pathways for motivation and reinforcement. Dysregulation of these pathways may underlay some of the behaviors exhibited by patients with eating disorders. Research using animal models of eating disorders has greatly contributed to the detailed study of potential brain mechanisms that many underlie the causes or consequences of aberrant eating behaviors. This review focuses on neurochemical evidence of reward-related brain dysfunctions obtained through animal models of binge eating, bulimia nervosa, or anorexia nervosa. The findings suggest that alterations in dopamine (DA), acetylcholine (ACh) and opioid systems in reward-related brain areas occur in response to binge eating of palatable foods. Moreover, animal models of bulimia nervosa suggest that while bingeing on palatable food releases DA, purging attenuates the release of ACh that might otherwise signal satiety. Animal models of anorexia nervosa suggest that restricted access to food enhances the reinforcing effects of DA when the animal does eat. The activity-based anorexia model suggests alterations in mesolimbic DA and serotonin occur as a result of restricted eating coupled with excessive wheel running. These findings with animal models complement data obtained through neuroimaging and pharmacotherapy studies of clinical populations. Information on the neurochemical consequences of the behaviors associated with these eating disorders will be useful in understanding these complex disorders and may inform future therapeutic approaches, as discussed here. This article is part of a Special Issue entitled 'Central Control of Food Intake'. PMID:22138162
Beintner, Ina; Jacobi, Corinna; Schmidt, Ulrike H
There is a growing body of research on manualized self-help interventions for bulimia nervosa (BN) and binge eating disorder (BED). Study and treatment dropout and adherence represent particular challenges in these studies. However, systematic investigations of the relationship between study, intervention and patient characteristics, participation, and intervention outcomes are lacking. We conducted a systematic literature review using electronic databases and hand searches of relevant journals. In metaregression analyses, we analyzed study dropout as well as more specific measures of treatment participation in manualized self-help interventions, their association with intervention characteristics (e.g. duration, guidance, intervention type [bibliotherapy, CD-ROM or Internet based intervention]) and their association with treatment outcomes. Seventy-three publications reporting on 50 different trials of manualized self-help interventions for binge eating and bulimia nervosa published through July 9th 2012 were identified. Across studies, dropout rates ranged from 1% to 88%. Study dropout rates were highest in CD-ROM interventions and lowest in Internet-based interventions. They were higher in samples of BN patients, samples of patients with higher degrees of dietary restraint at baseline, lower age, and lower body mass index. Between 6% and 88% of patients completed the intervention to which they had been assigned. None of the patient, study and intervention characteristics predicted intervention completion rates. Intervention outcomes were moderated by the provision of personal guidance by a health professional, the number of guidance sessions as well as participants' age, BMI, and eating disorder related attitudes (Restraint, Eating, Weight and Shape Concerns) at baseline (after adjusting for study dropout and intervention completion rates). Guidance particularly improved adherence and outcomes in samples of patients with bulimia nervosa; specialist guidance led
Fitzsimmons-Craft, Ellen E; Ciao, Anna C; Accurso, Erin C; Pisetsky, Emily M; Peterson, Carol B; Byrne, Catherine E; Le Grange, Daniel
This study investigated the importance of the distinction between objective (OBE) and subjective binge eating (SBE) among 80 treatment-seeking adolescents with bulimia nervosa. We explored relationships among OBEs, SBEs, eating disorder (ED) symptomatology, depression, and self-esteem using two approaches. Group comparisons showed that OBE and SBE groups did not differ on ED symptoms or self-esteem; however, the SBE group had significantly greater depression. Examining continuous variables, OBEs (not SBEs) accounted for significant unique variance in global ED pathology, vomiting, and self-esteem. SBEs (not OBEs) accounted for significant unique variance in restraint and depression. Both OBEs and SBEs accounted for significant unique variance in eating concern; neither accounted for unique variance in weight/shape concern, laxative use, diuretic use, or driven exercise. Loss of control, rather than amount of food, may be most important in defining binge eating. Additionally, OBEs may indicate broader ED pathology, while SBEs may indicate restrictive/depressive symptomatology. PMID:24852114
Sutoh, Chihiro; Koga, Yasuko; Kimura, Hiroshi; Kanahara, Nobuhisa; Numata, Noriko; Hirano, Yoshiyuki; Matsuzawa, Daisuke; Iyo, Masaomi; Nakazato, Michiko; Shimizu, Eiji
Previous studies showed that food craving in eating disorders can be weakened with high-frequency repetitive transcranial magnetic stimulation (rTMS) on the left dorsolateral prefrontal cortex (DLPFC). The aims of this study were to assess cerebral oxygenation change induced with rTMS and to assess the short-term impact of rTMS on food craving and other bulimic symptoms in patients with bulimia nervosa (BN). Eight women diagnosed with BN according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria participated in this study. We measured haemoglobin concentration changes in the DLPFC with near-infrared spectroscopy during cognitive tasks measuring self-regulatory control in response to food photo stimuli, both at baseline and after a single session of rTMS. Subjective ratings for food cravings demonstrated significant reduction. A significant decrease in cerebral oxygenation of the left DLPFC was also observed after a single session of rTMS. Measurement with NIRS after rTMS intervention may be applicable for discussing the mechanisms underlying rTMS modulation in patients with BN. PMID:26481583
Kaye, Walter H; Wierenga, Christina E; Bailer, Ursula F; Simmons, Alan N; Wagner, Angela; Bischoff-Grethe, Amanda
Is starvation in anorexia nervosa (AN) or overeating in bulimia nervosa (BN) a form of addiction? Alternatively, why are individuals with BN more vulnerable and AN protected from substance abuse? Such questions have been generated by recent studies that suggest that there are overlapping neural circuits for foods and drugs of abuse. In order to determine whether a shared neurobiology contributes to eating disorders (EDs) and substance abuse, this review focused on imaging studies that investigated response to tastes of food and tasks designed to characterize reward and behavioral inhibition in AN and BN. BN and those with substance abuse disorders may share dopamine D2 receptor related vulnerabilities, and opposite findings may contribute to “protection” from substance abuse in AN. Moreover, imaging studies provide insights into executive cortico-striatal processes related to extraordinary inhibition and self-control in AN and diminished inhibitory self-control in BN that may influence the rewarding aspect of palatable foods and likely other consummatory behaviors. AN and BN tend to have premorbid traits, such as perfectionism and anxiety that make them vulnerable to employing extremes of food ingestion which serve to reduce negative mood states. Dysregulation within and/or between limbic and executive cortio-striatal circuits contributes to such symptoms. Limited data support the hypothesis that reward and inhibitory processes may contribute to symptoms in ED and addictive disorders, but little is known about the molecular biology of such mechanisms in terms of shared or independent processes. PMID:23380716
Downar, Jonathan; Sankar, Ashwin; Giacobbe, Peter; Woodside, Blake; Colton, Patricia
A woman with severe, refractory bulimia nervosa (BN) underwent treatment for comorbid depression using repetitive transcranial magnetic stimulation (rTMS) of the dorsomedial prefrontal cortex (DMPFC) using a novel technique. Unexpectedly, she showed a rapid, dramatic remission from BN. For 5 months pre-treatment, she had reported two 5-h binge-purge episodes per day. After rTMS session 2 the episodes stopped entirely for 1 week; after session 10 there were no further recurrences. Depression scores improved more gradually to remission at session 10. Full remission from depression and binge-eating/purging episodes was sustained more than 2 months after treatment completion. In neuroimaging studies, the DMPFC is important in impulse control, and is underactive in BN. DMPFC–rTMS may have enhanced the patient’s ability to deploy previously acquired strategies to avoid binge-eating and purging via a reduction in her impulsivity. A larger sham-controlled trial of DMPFC–rTMS for binge-eating and purging behavior may be warranted. PMID:22529822
Fitzsimmons-Craft, Ellen E.; Ciao, Anna C.; Accurso, Erin C.; Pisetsky, Emily M.; Peterson, Carol B.; Byrne, Catherine E.; Le Grange, Daniel
This study investigated the importance of the distinction between objective (OBE) and subjective binge eating (SBE) among 80 treatment-seeking adolescents with bulimia nervosa (BN). We explored relationships among OBEs, SBEs, eating disorder (ED) symptomatology, depression, and self-esteem using two approaches. Group comparisons showed that OBE and SBE groups did not differ on ED symptoms or self-esteem; however, the SBE group had significantly greater depression. Examining continuous variables, OBEs (not SBEs) accounted for significant unique variance in global ED pathology, vomiting, and self-esteem. SBEs (not OBEs) accounted for significant unique variance in restraint and depression. Both OBEs and SBEs accounted for significant unique variance in eating concern; neither accounted for unique variance in weight/shape concern, laxative use, diuretic use, or driven exercise. Loss of control, rather than amount of food, may be most important in defining binge eating. Additionally, OBEs may indicate broader ED pathology while SBEs may indicate restrictive/depressive symptomatology. PMID:24852114
Daniel, Sarah Ingrid Franksdatter; Poulsen, Stig; Lunn, Susanne
In the context of a randomized clinical trial of psychoanalytic psychotherapy (PPT) versus cognitive behavior therapy (CBT) for bulimia nervosa (BN), this study performed secondary analyses of (a) the relation between attachment and pretreatment symptom levels, (b) whether client pretreatment attachment moderated treatment outcome, (c) whether change in client attachment was associated with symptomatic change, and (d) whether client attachment changed differently in the 2 treatments. Sixty-nine women and 1 man of a mean age of 25.8 years diagnosed with BN were randomly assigned to either 2 years of weekly PPT or 5 months of CBT. Assessments at intake, after 5 months, and after 2 years included the Eating Disorder Examination to assess eating disorder symptoms, the Adult Attachment Interview to assess client attachment, and the Symptom Checklist 90-R to assess general psychiatric distress. Repeated measures were analyzed using multilevel analysis. Higher scores on attachment insecurity and attachment preoccupation were associated with more frequent binging pretreatment. Pretreatment attachment did not predict treatment outcome. In PPT, but not in CBT, reduction of binging was associated with an increase in attachment security. The 2 treatment types were not associated with significantly different patterns of attachment-related change. Degree and type of attachment insecurity is related to the frequency of binging in BN. Increase in attachment security may be a treatment-specific mechanism of change in PPT for BN. (PsycINFO Database Record PMID:26950692
Steiger, Howard; Gauvin, Lise; Joober, Ridha; Israel, Mimi; Badawi, Guilaine; Groleau, Patricia; Bruce, Kenneth R; Yin Kin, N M K Ng; Sycz, Lindsay; Ouelette, Anne Sophie
We recently documented a gene-environment interaction suggesting that individuals with Bulimia Nervosa (BN) differed from normal eaters as to the combined presence of the low-function allele of the glucocorticoid receptor polymorphism, BcII, and childhood abuse. The present study examined the extent to which any such interaction effect may have been attributable to behavioral impulsivity, sensation seeking, affective instability or depression. We had 174 bulimic and 130 nonbulimic women provide blood for genetic assays, and measured psychopathological traits and childhood abuse using structured interviews and self-report questionnaires. As expected, we observed a significant BcII × abuse interaction indicating genetic and environmental susceptibilities to co-occur significantly more often in bulimic than in nonbulimic individuals. The BcII × abuse interaction was attenuated when levels of depression were accounted for, but was surprisingly unaffected by controls for motoric impulsivity, sensation seeking or affective instability. Our findings suggest that stress-induced alterations in glucocorticoid sensitivity contribute to BN and depressive disturbances--without being associated with the behavioral/affective dysregulation seen in many BN sufferers. We discuss theoretical and clinical implications of these observations. PMID:22088926
Bailer, Ursula F.; Bloss, Cinnamon S.; Frank, Guido K.; Price, Julie C.; Meltzer, Carolyn C.; Mathis, Chester A.; Geyer, Mark A.; Wagner, Angela; Becker, Carl R.; Schork, Nicholas J.; Kaye, Walter H.
Objective Because altered serotonin (5-HT) function appears to persist after recovery from bulimia nervosa (RBN), we investigated the 5-HT1A receptor, which could contribute to regulation of appetite, mood, impulse control, or the response to antidepressants. Method Thirteen RBN individuals were compared to 21 healthy control women (CW) using positron emission tomography and [carbonyl-11C]WAY100635 ([11C]WAY). Results RBN had a 23–34% elevation of [11C]WAY binding potential (BP)P in subgenual cingulate, mesial temporal, and parietal regions after adjustments for multiple comparisons. For CW, [11C]WAY BPP was related negatively to novelty seeking, whereas for RBN, [11C]WAY BPP was related positively to harm avoidance and negatively related to sensation seeking. Discussion Alterations of 5-HT1A receptor function may provide new insight into efficacy of 5-HT medication in BN, as well as symptoms such as the ability to inhibit or self-control the expression of behaviors related to stimulus seeking, aggression, and impulsivity. PMID:20872754
Giner-Bartolomé, Cristina; Fagundo, Ana B.; Sánchez, Isabel; Jiménez-Murcia, Susana; Santamaría, Juan J.; Ladouceur, Robert; Menchón, José M.; Fernández-Aranda, Fernando
Background: Several studies have highlighted the implications of impulsivity and novelty seeking for both the maintenance and the process of recovery from bulimia nervosa (BN). Cognitive behavioral therapy (CBT) is the treatment of choice for BN, but for some cases, this treatment alone might not be sufficient for reducing the high levels of impulsivity. The paper presents a case report of a patient with BN, examining the effectiveness of using a videogame (VG; Playmancer) as an additional intervention designed to address impulsivity. Design: Psychometric and neuropsychological measures were collected at baseline. After this assessment, Playmancer was applied prior to CBT, following an “A-B-A-C-A” single case experimental design. Impulsivity levels were assessed with the Conner’s Continuous Performance Test II (CPT-II). After the Playmancer treatment, the patient started CBT, and the levels of impulsivity were recorded again. Finally, psychometric and neuropsychological measures were collected after treatment. Weekly frequency of binges and vomiting were also recorded during the entire procedure. Results: After the VG intervention, psychometric measures such as anxiety levels, impulsivity and novelty seeking decreased. Regarding the neuropsychological measures, impulsivity levels (measured with the CPT-II) progressively decreased throughout the intervention, and an improvement in decision making capacities was observed. Furthermore, the frequency of binges also decreased during and after the VG intervention. Discussion: This case report suggests that using the Playmancer VG to reduce impulsivity prior to CBT may enhance the final results of the treatment for BN. PMID:26236261
Bruce, Kenneth R; Steiger, Howard; Joober, Ridha; Ng Ying Kin, N M K; Israel, Mimi; Young, Simon N
Separate lines of research suggest that the functional alterations in the serotonin (5-HT) 2A receptor are associated with 5-HT tone, behavioral impulsiveness, and bulimia nervosa (BN). We explored the effect of allelic variations within the 5-HT2A receptor gene promoter polymorphism -1438G/A on trait impulsiveness and serotonin function in women with BN. Participants included women with BN having the A allele (i.e., AA homozygotes and AG heterozygotes, BNA+, N = 21); women with BN but without the A allele (i.e., GG homozygotes, BNGG, N = 12), and normal eater control women having the A allele (NEA+, N = 19) or without the A allele (NEGG; N = 9). The women were assessed for psychopathological tendencies and eating disorder symptoms, and provided blood samples for measurement of serial prolactin responses following oral administration of the post-synaptic partial 5-HT agonist meta-chlorophenylpiperazine (m-CPP). The BNGG group had higher scores than the other groups on self-report measures of non-planning and overall impulsiveness and had blunted prolactin response following m-CPP. The bulimic groups did not differ from each other on current eating symptoms or on frequencies of other Axis I mental disorders. Findings indicate that women with BN who are GG homozygotes on the -1438G/A promoter polymorphism are characterized by increased impulsiveness and lower sensitivity to post-synaptic serotonin activation. These findings implicate the GG genotype in the co-aggregation of impulsive behaviors and alterations of post-synaptic 5-HT functioning in women with BN. PMID:15999344
Fagundo, Ana Beatriz; Via, Esther; Sánchez, Isabel; Jiménez-Murcia, Susana; Forcano, Laura; Soriano-Mas, Carles; Giner-Bartolomé, Cristina; Santamaría, Juan J; Ben-Moussa, Maher; Konstantas, Dimitri; Lam, Tony; Lucas, Mikkel; Nielsen, Jeppe; Lems, Peter; Cardoner, Narcís; Menchón, Jose M; de la Torre, Rafael
Background PlayMancer is a video game designed to increase emotional regulation and reduce general impulsive behaviors, by training to decrease arousal and improve decision-making and planning. We have previously demonstrated the usefulness of PlayMancer in reducing impulsivity and improving emotional regulation in bulimia nervosa (BN) patients. However, whether these improvements are actually translated into brain changes remains unclear. Objective The aim of this case study was to report on a 28-year-old Spanish woman with BN, and to examine changes in physiological variables and brain activity after a combined treatment of video game therapy (VGT) and cognitive behavioral therapy (CBT). Methods Ten VGT sessions were carried out on a weekly basis. Anxiety, physiological, and impulsivity measurements were recorded. The patient was scanned in a 1.5-T magnetic resonance scanner, prior to and after the 10-week VGT/CBT combined treatment, using two paradigms: (1) an emotional face-matching task, and (2) a multi-source interference task (MSIT). Results Upon completing the treatment, a decrease in average heart rate was observed. The functional magnetic resonance imaging (fMRI) results indicated a post-treatment reduction in reaction time along with high accuracy. The patient engaged areas typically active in healthy controls, although the cluster extension of the active areas decreased after the combined treatment. Conclusions These results suggest a global improvement in emotional regulation and impulsivity control after the VGT therapy in BN, demonstrated by both physiological and neural changes. These promising results suggest that a combined treatment of CBT and VGT might lead to functional cerebral changes that ultimately translate into better cognitive and emotional performances. PMID:25116416
Bürger, Carolina; Schmidt, Luise; Herbst, Nirmal; Voderholzer, Ulrich
Background Previous studies have shown an unmet need in the treatment of eating disorders. In the last decade, interest in technology-based interventions (TBIs) (including computer- and Internet-based interventions [CBIs] or mobile interventions) for providing evidence-based therapies to individuals with different mental disorders has increased. Objective The aim of this review was to systematically evaluate the potential of TBIs in the field of eating disorders, namely for anorexia nervosa (AN) and bulimia nervosa (BN), for both prevention and treatment, and also for carers of eating disorder patients. Methods A systematic literature search was conducted using Medline and PsycINFO. Bibliographies of retrieved articles were also reviewed without date or study type restrictions. Results Forty studies resulting in 45 publications reporting outcomes fulfilled the inclusion criteria: 22 randomized controlled trials, 2 controlled studies, and 16 uncontrolled studies. In total, 3646 patients were included. Overall, the studies provided evidence for the efficacy of guided CBIs, especially for BN patients and for compliant patients. Furthermore, videoconferencing also appeared to be a promising approach. Evaluation results of Internet-based prevention of eating disorders and Internet-based programs for carers of eating disorder patients were also encouraging. Finally, there was preliminary evidence for the efficacy of mobile interventions. Conclusions TBIs may be an additional way of delivering evidence-based treatments to eating disorder patients and their use is likely to increase in the near future. TBIs may also be considered for the prevention of eating disorders and to support carers of eating disorder patients. Areas of future research and important issues such as guidance, therapeutic alliance, and dissemination are discussed. PMID:25840591
Ribasés, Marta; Fernández-Aranda, Fernando; Gratacòs, Mònica; Mercader, Josep M; Casasnovas, Carolina; Núñez, Araceli; Vallejo, Julio; Estivill, Xavier
Eating disorders (ED), such as anorexia nervosa (AN) and bulimia nervosa (BN), are complex psychiatric phenotypes influenced by both genetic and environmental factors. We investigated the genetic contribution of four single nucleotide polymorphisms (SNPs) within the serotonin receptor 5HT2C and two sequence variants within the serotonin transporter SLC6A4 to different ED-related psychopathological symptoms in a total sample of 82 ED patients. All patients were diagnosed according to DSM-IV criteria and underwent diagnostic and psychopathological assessments by means of structured clinical interviews and rating scales. We detected significant evidence of association between the -995A/-759T/-697C/Cys23 haplotype of the 5HT2C gene and different anxious and depressive subscales of the SCL90-R instrument, that included Somatization (p = 0.029), Obsessive-Compulsiveness (p = 0.021), Depression (p = 0.032), Anxiety (p = 0.004), Hostility (p = 0.028), Phobic Anxiety (p = 0.029) and Paranoid Ideation (p = 0.008), in BN patients. We also observed a strong association between the 5HTTLPR polymorphism of the SLC6A4 gene and Anxiety in the same group of BN patients (p = 0.004). However, no epistatic effects between the 5HT2C and SLC6A4 genes on the different anxious and depressive subscales were observed. Our preliminary data suggest that the serotoninergic system contributes to the different psychopathological symptoms that may be partially responsible for the phenotypical variability within the bulimic phenotype. PMID:17055531
Kessler, R C; Shahly, V; Hudson, J I; Supina, D; Berglund, P A; Chiu, W T; Gruber, M; Aguilar-Gaxiola, S; Alonso, J; Andrade, L H; Benjet, C; Bruffaerts, R; de Girolamo, G; de Graaf, R; Florescu, S E; Haro, J M; Murphy, S D; Posada-Villa, J; Scott, K; Xavier, M
Background. Cross-national population data from the WHO World Mental Health surveys are used to compare role attainments and role impairments associated with binge-eating disorder (BED) and bulimia nervosa (BN). Methods. Community surveys assessed 23 000 adults across 12 countries for BED, BN and ten other DSM-IV mental disorders using the WHO Composite International Diagnostic Interview. Age-of-onset was assessed retrospectively. Ten physical disorders were assessed using standard conditions checklists. Analyses examined reciprocal time-lagged associations of eating disorders (EDs) with education, associations of early-onset (i.e., prior to completing education) EDs with subsequent adult role attainments and cross-sectional associations of current EDs with days of role impairment. Results. BED and BN predicted significantly increased education (females). Student status predicted increased risk of subsequent BED and BN (females). Early-onset BED predicted reduced odds of current (at time of interview) marriage (females) and reduced odds of current employment (males). Early-onset BN predicted increased odds of current work disability (females and males). Current BED and BN were both associated with significantly increased days of role impairment (females and males). Significant BED and BN effects on adult role attainments and impairments were explained by controls for comorbid disorders. Conclusions. Effects of BED on role attainments and impairments are comparable with those of BN. The most plausible interpretation of the fact that these associations are explained by comorbid disorders is that causal effects of EDs are mediated through secondary disorders. Controlled treatment effectiveness studies are needed to trace out long-term effects of BED-BN on secondary disorders. PMID:24054053
Lau, DeeAnne Karyl
The purpose of this literature review was to demonstrate that a family systems conceptualization of family dysfunction could be applied to bulimic families. In general, self-report and observational family characteristics studies support the hypothesis that bulimic families, like anorectic families, have significant systemic dysfunction in…
Leclair, Norma J; Berkowitz, Belinda
Presents characteristics, medical concerns, treatment alternatives, and family issues for counselors working with nonhospitalized clients. Emphasis is placed on attending the interaction of the behavioral, cognitive, and affective domains in the client. Counselors should use interventions based on theory and research. (Author/JAC)
Dialectical behaviour therapy and an added cognitive behavioural treatment module for eating disorders in women with borderline personality disorder and anorexia nervosa or bulimia nervosa who failed to respond to previous treatments. An open trial with a 15-month follow-up.
Kröger, Christoph; Schweiger, Ulrich; Sipos, Valerija; Kliem, Sören; Arnold, Ruediger; Schunert, Tanja; Reinecker, Hans
There is evidence from case studies suggesting that adapted dialectical behavior therapy (DBT) for borderline personality disorder (BPD) and eating disorders (ED) might improve disorder related complaints. Twenty-four women with BPD (9 with comorbid anorexia nervosa [AN] and 15 with bulimia nervosa [BN]), who already had failed to respond to previous eating-disorder related inpatient treatments were consecutively admitted to an adapted inpatient DBT program. Assessment points were at pre-treatment, post-treatment, and 15-month follow-up. At follow-up, the remission rate was 54% for BN, and 33% for AN. Yet 44% of women with AN crossed over to BN and one woman additionally met the criteria of AN. For women with AN, the mean weight was not significantly increased at post-treatment, but had improved at follow-up. For women with BN, the frequency of binge-eating episodes was reduced at post-treatment as well as at follow-up. Self-rated eating-related complaints and general psychopathology, as well as ratings on global psychosocial functioning, were significantly improved at post-treatment and at follow-up. Although these findings support the assumption that the adapted DBT inpatient program is a potentially efficacious treatment for those who failed to respond to previous eating-disorder related inpatient treatments, remission rates and maintained eating-related psychopathology also suggest that this treatment needs further improvement. PMID:20444442
The Role of “Mixed” Orexigenic and Anorexigenic Signals and Autoantibodies Reacting with Appetite-Regulating Neuropeptides and Peptides of the Adipose Tissue-Gut-Brain Axis: Relevance to Food Intake and Nutritional Status in Patients with Anorexia Nervosa and Bulimia Nervosa
Papezova, Hana; Vondra, Karel; Hill, Martin; Hainer, Vojtech; Nedvidkova, Jara
Eating disorders such as anorexia (AN) and bulimia nervosa (BN) are characterized by abnormal eating behavior. The essential aspect of AN is that the individual refuses to maintain a minimal normal body weight. The main features of BN are binge eating and inappropriate compensatory methods to prevent weight gain. The gut-brain-adipose tissue (AT) peptides and neutralizing autoantibodies play an important role in the regulation of eating behavior and growth hormone release. The mechanisms for controlling food intake involve an interplay between gut, brain, and AT. Parasympathetic, sympathetic, and serotoninergic systems are required for communication between brain satiety centre, gut, and AT. These neuronal circuits include neuropeptides ghrelin, neuropeptide Y (NPY), peptide YY (PYY), cholecystokinin (CCK), leptin, putative anorexigen obestatin, monoamines dopamine, norepinephrine (NE), serotonin, and neutralizing autoantibodies. This extensive and detailed report reviews data that demonstrate that hunger-satiety signals play an important role in the pathogenesis of eating disorders. Neuroendocrine dysregulations of the AT-gut-brain axis peptides and neutralizing autoantibodies may result in AN and BN. The circulating autoantibodies can be purified and used as pharmacological tools in AN and BN. Further research is required to investigate the orexigenic/anorexigenic synthetic analogs and monoclonal antibodies for potential treatment of eating disorders in clinical practice. PMID:24106499
Webbe, Frank M.; Clontz, Joanne
Most studies of bulimics have used an identified, clinical sample of individuals who have been evaluated and diagnosed by professional mental health workers. In this study, self-reported food addicts completed a questionnaire that assessed demographic as well as behavioral and cognitive factors related to their eating. The intent was to describe…
Gerstein, Lawrence H.; Hotelling, Kathy
Examined effects of 4-month or 9-month multidimensional therapy group on bulimic women. Results suggest that participants altered behaviors, attitudes, feelings, and thoughts related to bingeing, purging, and physical appearance and developed more adaptive life skills. Decreases in bingeing and purging were maintained after treatment; no…
Lock, Andrew; Epston, David; Maisel, Richard; de Faria, Natasha
Foucault's analysis of unseen power as it operates in discourses that construct "practices of discipline" and "technologies of the self" has been a central conceptual resource in the development of narrative therapy. Narrative therapists take the view that ?unseen aspects of power work to construct both how a person understands their situation,…
Kaplan, A S; Garfinkel, P E; Brown, G M
Abnormal neuroendocrine responses have been found in depression and eating disorders. It remains unclear whether these reflect an underlying shared biology or epiphenomena. To evaluate this further, we conducted the 1 mg DST and the TSH response to 500 micrograms i.v. TRH in normal-weight bulimics and controls. Bulimics (n = 18) demonstrated significantly more DST non-suppression (45%) than controls (18%; n = 20). In the bulimic group, non-suppressors were significantly thinner than suppressors, but did not differ from them on any measure of depression. Bulimics (n = 19) and controls (n = 12) responded similarly without blunting on the TSH response to TRH. These data suggest that DST non-suppression may be related to non-specific variables such as weight. Bulimics do not demonstrate TSH blunting as found in some depressed patients. These tests do not support evidence for a biological link between these disorders. PMID:2505882
Didie, Elizabeth R.; Reinecke, Mark A.; Phillips, Katharine A.
Body dysmorphic disorder (BDD) and eating disorders often co-occur and share some clinical features. In addition, the co-occurrence of BDD and an eating disorder may be associated with greater impairment in functioning. Furthermore, clinical impressions suggest that this comorbidity may be more treatment resistant than either disorder alone. The…
Cashel, Mary Louise; Cunningham, Dana; Landeros, Clarinda; Cokley, Kevin O.; Muhammad, Grace
This study evaluated the utility of the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ; L. J. Heinberg, J. K. Thompson, & S. Stormer, 1995) for the assessment of diverse college groups, including men, women, minorities, and sorority members. Scores from the SATAQ were compared with the Eating Disorder Inventory-2 (EDI-2; D. M.…
Background This study aimed to assess differences in Quality of Life (QoL) across eating disorder (ED) diagnoses, and to examine the relationship of QoL to specific clinical features. Results 199 patients with a diagnosed ED completed the Clinical Impairment Assessment (CIA) [Cognitive Behavior Therapy and Eating Disorders, 315–318, 2008] and the Eating Disorders Examination (EDE) [Int J Eat Disord 6:1–8]. Differences between diagnostic groups were examined, as were differences between restrictive and binge-purge subtypes. CIA scores and EDE scores were positively correlated and higher in groups with binge-purge behaviours. CIA scores were not correlated with BMI, illness duration or frequency of bingeing/purging behaviours, except in the binge-purge AN group, where CIA scores negatively correlated with BMI. Conclusions Patients with EDs have poor QoL and impairment increases with illness severity. Patients with binge/purge diagnoses are particularly impaired. It remains unclear which clinical features best predict the degree of impairment experienced by patients with EDs. PMID:24999421
Gutiérrez-Maldonado, José; Ferrer-Garcia, Marta; Pla, Joana; Andrés-Pueyo, Antonio
Carrying out a diagnostic interview requires skills that need to be taught in a controlled environment. Virtual Reality (VR) environments are increasingly used in the training of professionals, as they offer the most realistic alternative while not requiring students to face situations for which they are yet unprepared. The results of the training of diagnostic skills can also be generalized to any other situation in which effective communication skills play a major role. Our aim with this study has been to develop a procedure of formative assessment in order to increment the effectiveness of virtual learning simulation systems and then to assess their efficacy. PMID:24875685
Used a cognitive behavioral treatment approach to eliminate bingeing and purging in a 16-year-old high school female. Results indicated that incidents of purging reduced substantially and that the frequency of purging may continue to remain at zero given occasional booster treatments. (LLL)
Salvini, Alessandro; Faccio, Elena; Mininni, Giuseppe; Romaioli, Diego; Cipolletta, Sabrina; Castelnuovo, Gianluca
Starting from the critical review of various motivational frameworks of change that have been applied to the study of eating disorders, the present paper provides an alternative conceptualization of the change in psychotherapy presenting a single-case study. We analyzed six psychotherapeutic conversations with a bulimic patient and found out narratives “for” and “against” change. We read them in terms of tension between dominance and exchange in I-positions, as described by Hermans. These results indicate that the dialogical analysis of clinical discourse may be a useful method to investigate change from the beginning to the end of therapy. PMID:23233845
Thompson-Brenner, Heather; Westen, Drew
Data from naturalistic samples provide an important complement to findings from randomized trials of psychotherapy. A random national sample of US clinicians provided data on 145 completed treatments of patients with bulimic symptoms. We attempted to characterize the nature of treatments in the community and to examine the relation between treatment variables and outcome. Clinicians of all theoretical orientations report using interventions with polysymptomatic cases designed to address clinically significant personality characteristics and interpersonal patterns. Whereas cognitive-behavioral therapy is associated with more rapid remission of eating symptoms, psychodynamic interventions and increased treatment length predict better global outcome across treatment modalities, suggesting the importance of integrative treatments for the broad range of pathology seen in patients with bulimic symptoms. PMID:16131941
Schwartz, Richard C.
Presents case report of the treatment of a bulimic young woman and her family to illustrate method for working with the family's interactions and the client's internal processes. Includes guidelines and caveats for use of the method, which conceptualizes both levels and systems similarly. (Author/NB)
Scott, Ronald L.; Baroffio, James R.
Employed the Minnesota Multiphasic Personality Inventory to study similarities and differences of mean profiles of anorexic patients, bulimic patients, morbidly obese outpatients, and subjects in a matched control group. The results indicated that there was no significant difference in the overall profiles of the three experimental groups, but…
Lavender, Anna; Startup, Helen; Naumann, Ulrike; Samarawickrema, Nelum; DeJong, Hannah; Kenyon, Martha; van den Eynde, Frederique; Schmidt, Ulrike
Objective There is a need to improve treatment for individuals with bulimic disorders. It was hypothesised that a focus in treatment on broader emotional and social/interpersonal issues underlying eating disorders would increase treatment efficacy. This study tested a novel treatment based on the above hypothesis, an Emotional and Social Mind Training Group (ESM), against a Cognitive Behavioural Therapy Group (CBT) treatment. Method 74 participants were randomised to either ESM or CBT Group treatment programmes. All participants were offered 13 group and 4 individual sessions. The primary outcome measure was the Eating Disorder Examination (EDE) Global score. Assessments were carried out at baseline, end of treatment (four months) and follow-up (six months). Results There were no differences in outcome between the two treatments. No moderators of treatment outcome were identified. Adherence rates were higher for participants in the ESM group. Discussion This suggests that ESM may be a viable alternative to CBT for some individuals. Further research will be required to identify and preferentially allocate suitable individuals accordingly. Trial Registration ISRCTN61115988 PMID:23118850
Dolan, B M; Evans, C; Lacey, J H
Many theories of the etiology of eating disorders focus on the role of the family. However, these theories are based on clinical experience and uncontrolled clinical case series. We report a study comparing 50 bulimic women with 40 non-eating-disordered women all from the same clinical catchment area. This study revealed no significant differences in social class, family size, birth position, or sibling sex ratio between the two groups. However, the parents of bulimic women were found to have been significantly older than those of the control group at the time of birth of their daughter. These findings are discussed with reference to previous family studies of eating disorders. PMID:2651557
Constantino, Michael J.; Arnow, Bruce A.; Blasey, Christine; Agras, W. Stewart
The therapeutic alliance is an established predictor of psychotherapy outcome. However, alliance research in the treatment of eating disorders has been scant, with even less attention paid to correlates of alliance development. The goal of this study was to examine the relation between specific patient characteristics and the development of the…
Vailati, Francesca; Carciofo, Sylvain
Due to an increasing awareness about dental erosion, many clinicians would like to propose treatments even at the initial stages of the disease. However, when the loss of tooth structure is visible only to the professional eye, and it has not affected the esthetics of the smile, affected patients do not usually accept a full-mouth rehabilitation. Reducing the cost of the therapy, simplifying the clinical steps, and proposing noninvasive adhesive techniques may promote patient acceptance. In this article, the treatment of an ex-bulimic patient is illustrated. A modified approach of the three-step technique was followed. The patient completed the therapy in five short visits, including the initial one. No tooth preparation was required, no anesthesia was delivered, and the overall (clinical and laboratory) costs were kept low. At the end of the treatment, the patient was very satisfied from a biologic and functional point of view. PMID:26835523
Duarte, Cristiana; Ferreira, Cláudia; Pinto-Gouveia, José
This study examined the similarities and differences in eating psychopathology symptoms, overvaluation of body shape, weight and eating, general psychopathology, social comparison, self-criticism and shame, between AN, BN and BED patients. Also, the mediator effect of self-criticism and social comparison on the association between overvaluation and shame, was tested. Participants were 119 patients (34 AN, 34 BN and 51 BED) diagnosed through the Eating Disorder Examination. Results indicated that BED patients are older and present higher BMI. The groups differed regarding eating disorders' symptomatology, but no significant differences were observed in overvaluation, self-criticism, shame and overall psychopathology symptoms. The path model confirmed that overvaluation has a significant indirect association with shame, which is mediated by severe self-criticism and negative social comparisons. The model was fond to be invariant between the clinical groups. These findings contribute for the understanding of the common processes that feed the perpetual cycle of eating psychopathology. Thus, these data have potential implications for transdiagnostic approaches to treatment. PMID:26995245
... spider veins Body dysmorphic disorder (BDD) Eating disorders Anorexia nervosa Binge eating disorder Bulimia nervosa Over-exercising ... conditions? Visit our Mental health section. Fact sheets Anorexia nervosa Binge eating disorder Bulimia nervosa Cosmetics and ...
... brain injury, tumors, and radiation. Other causes include: Anorexia nervosa or bulimia Bleeding Genetic disorders that cause ... believe you have an eating disorder, such as anorexia or bulimia, get medical attention. These conditions can ...
Korte, Kelli L.; Horton, Connie Burrows; Graybill, Daniel
The co-occurrence of child sexual abuse and the development of bulimia was studied in a nonclinical sample (N=391). Results are discussed, including consideration of possible linkage between the experience of sexual abuse and bulimia. ANOVA analysis is presented briefly. The hypothesis of dissociation as a link was not supported. (EMK)
Engler, Patricia A.; Crowther, Janis H.; Dalton, Ginnie; Sanftner, Jennifer L.
The purpose of this research was to examine and extend portions of the sociocultural model of bulimia nervosa (Stice, E. (1994). Review of the evidence for a sociocultural model of bulimia nervosa and an exploration of the mechanisms of action. "Clinical Psychology Review," 14, 633-661; Stice, E., & Agras, W. S. (1998). Predicting onset and…
Snyder, Francine; Levy, Karen Gorbitz
Bulimia is an eating disorder often referred to as the binge-purge syndrome. The bulimic usually functions well at work and often holds a top-level position. Reasons for bulimia include feelings of inadequacy, societal pressures to be thin, and high parental expectations. Low self-esteem is a common characteristic of the bulimic. (RM)
McCanne, Lynn P. Fisher
Recent research indicates that a significant number of college-age women suffer from bulimarexia (also called the gorging-purging syndrome, the binge-purge cycle, bulimia or bulimia nervosa). To examine the relationship of three personality variables (anxiety, assertiveness, and locus of control) to eating disorders, 46 college students…
Cooper, Zafra; Fairburn, Christopher G.
In recent years there has been widespread acceptance that cognitive behavior therapy (CBT) is the treatment of choice for bulimia nervosa. The cognitive behavioral treatment of bulimia nervosa (CBT-BN) was first described in 1981. Over the past decades the theory and treatment have evolved in response to a variety of challenges. The treatment has…
Buser, Juleen K.; Gibson, Sandy
The authors examined the relationship between avoidant and anxious attachment to God/Higher Power and bulimia symptoms among 599 female college student participants. After controlling for body mass index, the authors found a positive association between both attachment variables and bulimia. When entered together in a regression, anxious…
Moor, Sasha; Vartanian, Lenny R.; Touyz, Stephen W.; Beumont, P. J. V.
Do the levels of psychopathology displayed by patients with an eating disorder not otherwise specified (EDNOS) more closely resemble those displayed by full-criteria anorexia and bulimia nervosa patients than they do those of non-eating-disorder controls? Three groups of eating disorder patients (anorexia nervosa, n = 27; bulimia nervosa, n = 23;…
Moriarty, Dick; And Others
This document reports on the quantitative and qualitative evaluation of "A Preventive Curriculum for Anorexia Nervosa and Bulimia" (Carney and Veilleux, 1986) which was published by the Bulimia Anorexia Nervosa Association-Canadian/American (BANA-Can/Am), an organization which was formed in 1983 by parents, professionals, and patients in…
Bailey, Carol A.
Family variables derived from the Family Environment Scale are examined using data from 174 college women at a Pacific Northwest university and 2 universities in Houston (Texas) with varying degrees of bulimia. Subjects' self-reports indicate family dysfunctions, but the study illustrates the complexity of the family's role in bulimia. (SLD)
Wilkins, Victoria; Urban, Greg; Zanotti, Mary; Chambliss, Catherine
In recent years, bulimia nervosa has plagued young women and become a major issue in mental health care. Strategies for training counseling students so as to acquaint them with clinical research on treatments for bulimia are presented in this report. It reviews empirically supported treatments (ESTs) concerning eating disorders in order to…
Herbert, Deborah, Comp.
This digest describes the characteristics and extent of anorexia and bulimia, and provides psychosocial and family profiles of the victims. The role of counseling programs in treating these disorders is discussed. (BH)
Holleran, Paula R.; And Others
Examined relationships between bulimia and the personality characteristics of assertiveness, masculinity, femininity, masculinity-femininity, and externality in 205 female college students, 15 of whom were classified as bulimic. Found low but statistically significant negative relationships between assertiveness, masculinity, and…
... your medications or monitor you carefully for side effects.tell your doctor if you have or have ever had seizures, anorexia nervosa (an eating disorder) or bulimia (an eating disorder). Also tell your ...
Lucas, Alexander R.
Eating disorders than may beset teenagers and seriously affect their health are discussed. Facts about causes, symptoms, and treatments for anorexia nervosa and bulimia, a disorder which involves overeating, followed by self-induced vomiting or purging, are presented. (PP)
... or vomiting Using too much laxative, which can cause diarrhea Chronic kidney disease Diuretic medicines (water pills), used to treat heart failure and high blood pressure Eating disorders (such as bulimia ) Low magnesium level Sweating
... excessive vomiting or diarrhea or other conditions that cause low blood levels of potassium or sodium. These conditions include the eating disorders anorexia nervosa and bulimia, as well as some ...
This article addresses dangerous dieting techniques used by athletes and provides coaches and teachers specific strategies to aid in preventing eating-related disorders among athletes. Symptoms of anorexia and of bulimia are described. (JL)
... disorders? Where can I find more information? Share Eating Disorders: About More Than Food Download PDF Download ePub Order a free hardcopy What are eating disorders? The eating disorders anorexia nervosa, bulimia nervosa, and ...
... periods (women). Compulsive exercise may be associated with eating disorders, such as anorexia and bulimia . It can cause ... see a counselor who treats compulsive exercise or eating disorders. Your provider or counselor may use one or ...
... become obese. No single factor or behavior causes obesity . Obesity is caused by many things, including a person’s ... image. Examples of eating disorders are: Anorexia Bulimia Obesity and eating disorders often occur at the same ...
... chap 125. Schwaab JL, Bravender T, Rund DA. Anorexia nervosa and bulimia nervosa. In: Tintinalli JE, Stapczynski JS, ... McGraw-Hill; 2011:chap 286. Tanofsky-Kraff M. Eating disorders. In: Goldman L, Schafer AI, eds. Goldman's Cecil ...
Oldis, Katherine O.
Presents a bibliography of books on anorexia nervosa that are appropriate for young adults. Includes fiction, autobiographies, informational books, and books on the related topics of bulimia, bulimarexia, and therapy. (EL)
Wu, Kevin D
The purpose of this research was to investigate the specificity of purported relations between symptoms of eating disorders (ED) and obsessive-compulsive disorder (OCD). Whereas most research has focused on diagnostic comorbidity or between-groups analyses, this study took a dimensional approach to investigate specific relations among symptoms of anorexia, bulimia, and OCD, as well as panic, depression, and general distress in a student sample (N=465). Results were that all symptoms showed significant zero-order correlations, including all ED-OCD pairings. After removing general distress variance, however, none of three OCD scales significantly predicted anorexia; only compulsive washing among OCD scales significantly predicted bulimia. Hierarchical multiple regression demonstrated that panic and depression out-performed OCD in predicting bulimia symptoms. Overall, symptoms of ED and OCD did not show unique relations at the level of core dimensions of each construct. A possible link between bulimia and compulsive washing is worth further study. PMID:18396006
... urinary problems and bulimia. Depression expert Dr. Peter Kramer said antidepressants have a wide range of potential ... these are not necessarily best called antidepressants," said Kramer, a clinical professor emeritus of psychiatry and human ...
Mayes, Susan Dickerson; Fernandez-Mendoza, Julio; Baweja, Raman; Calhoun, Susan; Mahr, Fauzia; Aggarwal, Richa; Arnold, Mariah
This is the first study determining correlates of suicide behavior in children with eating disorders using multiple sleep, psychological, and demographic variables. Mothers rated suicide ideation and attempts in 90 children ages 7-18 with bulimia nervosa or anorexia nervosa. Suicide ideation was more prevalent in children with bulimia nervosa (43%) than children with anorexia nervosa (20%). All children with bulimia nervosa who experienced ideation attempted suicide, whereas only 3% of children with anorexia nervosa attempted suicide. Correlates of ideation were externalizing behavior problems and sleep disturbances. Correlates of attempts were bulimia nervosa, self-induced vomiting, nightmares, and physical or sexual abuse. These problems should be assessed and targeted for intervention because of their association with suicide behavior. PMID:24842006
... nervosa or bulimia may also develop delayed gastric emptying. Gastric emptying may resume and symptoms improve when food ... intestine reattached to the remaining stomach to improve emptying of stomach contents. Rarely the stomach is completely removed. Electrical ...
Fairburn, C G; Cooper, P J
Following a television documentary on bulimia nervosa, people who thought that they had this type of eating problem were asked to complete a confidential questionnaire. 579 women who fulfilled self-report diagnostic criteria for bulimia nervosa were thereby identified. These women closely resembled patients with bulimia nervosa, although the age range was wider. They had grossly disturbed eating habits and almost half vomited at least daily. Laxative abuse was also common. Although almost two-thirds had been overweight in the past, the majority had a weight within the normal range. A minority had previously fulfilled diagnostic criteria for anorexia nervosa. On standardized measures, these women had abnormal attitudes to their weight and shape, as well as significant levels of psychiatric symptomatology. Nearly three-quarters thought that they definitely needed professional help, yet only a third had ever been referred for psychiatric treatment. Using data from this sample and an independent sample of 499 probable bulimia nervosa cases, the significance of three issues relating to the diagnosis of bulimia nervosa were examined: laxative abuse, the frequency of self-induced vomiting, and a history of anorexia nervosa. PMID:6588399
Bruce, Kenneth R.; Steiger, Howard; Young, Simon N.; Kin, N.M.K. Ng Ying; Israël, Mimi; Lévesque, Mélissa
Background Previous research has shown that many people experience a temporary worsening of mood following acute tryptophan depletion (ATD) and that concurrent use of serotonergic medications may influence such mood responses. We investigated mood and other consequences of ATD in women with bulimia nervosa who were or were not using concurrent serotonergic medications compared with women without bulimia. Methods Women self-referred for treatment of bulimia who were either not currently using psychoactive medications (n = 26) or who were using serotonin reuptake inhibitor medications exclusively (n = 13), as well as medication-free normal-eater control women (n = 25) completed interviews and questionnaires assessing eating and comorbid psychopathology and then participated in an ATD procedure involving balanced and tryptophan-depleted conditions. Results In the tryptophan-depleted condition, the groups displayed similar and significant decrements in plasma tryptophan levels and mood. Women with bulimia who were using serotonin reuptake inhibitors, but not the other groups, also reported an increased urge to binge eat in the tryptophan-depleted condition. Limitations Application of medication in participants with bulimia was not random. Conclusion Acute reductions in serotonin availability produced similar mood-reducing effects in bulimic and nonbulimic women. To the extent that ATD affected subjective experiences pertinent to eating (i.e., urge to binge eat), such effects appeared to depend upon ATD-induced competition with the therapeutic effects of serotonergic medications. PMID:19721848
Whitehouse, A M; Cooper, P J; Vize, C V; Hill, C; Vogel, L
The aims of this study were to investigate the prevalence of anorexia nervosa, bulimia nervosa and partial syndromes in women general practice attenders to establish the relative proportions of 'conspicuous' and 'hidden' morbidity. A consecutive series of 540 women patients aged 16-35 years attending their family doctor were screened using a specially devised questionnaire, the weight and dietary practices survey. A total of 115 patients were selected for further assessment and of these 101 patients were interviewed using a standardized diagnostic interview for DSM III-R eating disorders. The prevalence of anorexia nervosa was 0.2% (one case), of bulimia nervosa 1.5% (eight cases) and of partial syndrome bulimia nervosa 5.4% (29 cases). Half of the cases of bulimia nervosa had not been identified by the general practitioner and two of these patients had been referred to specialists for treatment of secondary complications of the eating disorder. Hidden cases of bulimia nervosa or partial syndromes are relatively common in general practice. Certain key questions could be used by general practitioners in order to identify women with eating disorders. PMID:1493006
Menatti, Andrew R.; Weeks, Justin W.; Levinson, Cheri A.; McGowan, Maggie M.
Previous findings indicate that social anxiety and bulimia co-occur at high rates; one mechanism that has been proposed to link these symptom clusters is perfectionism. We tested meditational models among 167 female undergraduates in which maladaptive evaluative perfectionism concerns (MEPC; i.e., critical self-evaluative perfectionism) mediated the relationship between social anxiety and bulimic symptoms. Results from a first model indicated that MEPC mediated the relationship between fear of public scrutiny and bulimia symptoms. This indirect effect was significant above and beyond the indirect effects of maladaptive body-image cognitions and perfectionism specific to pure personal standards. A second model was tested with MEPC mediating the relationship between social interaction anxiety and bulimia symptoms. Similar results were obtained; however, in this model, a significant direct effect remained after partialing out the indirect effect of the mediators. Theoretical implications are discussed. PMID:24932054
Muyan, Mine; Chang, Edward C; Jilani, Zunaira; Yu, Tina
We examined the relationships between intimate partner violence (IPV), perfectionism, and eating disturbances, namely, excessive dieting and bulimia, in a sample of 149 Turkish female college students. Results of conducting hierarchical regression analyses indicated that IPV accounted for significant variance in both excessive dieting and bulimic symptoms. The inclusion of perfectionism was found to predict additional variance in eating disturbances, beyond IPV. Specifically, we found parental expectations to be a significant predictor of dieting, and personal standards, doubts about actions, and parental criticism to be significant predictors of bulimia. Some implications for understanding eating disturbances in Turkish women are discussed. PMID:26276707
Eating disorders, including anorexia nervosa, bulimia nervosa, binge-eating disorder, and atypical eating disorder (eating disorder not otherwise specified or NOS), are estimated to occur in 5-10 million young and adult women and one million males in the United States. The etiology of eating disorders is complex and appears to include predisposing genetic factors and serotonin dysregulation, as well as psychological factors that include a history of trauma and childhood sexual abuse. Both anorexia nervosa and bulimia nervosa are medical conditions complicated by multiple neuroendocrine dysfunctions, nutritional deficiencies, and psychiatric diagnoses. Medical complications, specific nutritional deficiencies, and research involving the therapeutic use of inositol and zinc are reviewed. PMID:12126461
Talbot, Ben Edward Michael; Lawman, Sarah H A
We present a case of a 40-year-old woman with a history of ongoing anorexia nervosa and bulimia nervosa who has required multiple admissions to hospital for management of acute kidney injury (AKI) and electrolyte derangement. This case is of interest as recent studies have highlighted the significant prevalence of disordered eating and the major public health implications this may have. We discuss the unusual finding of hypercalcaemia in this case and address the investigation and management of AKI and electrolyte disturbance in a patient with anorexia and bulimia. PMID:24654247
Humphries, L; Vivian, B; Stuart, M; McClain, C J
Decreased food intake, a cyclic pattern of eating, and weight loss are major manifestations of zinc deficiency. In this study, zinc status was evaluated in 62 patients with bulimia and 24 patients with anorexia nervosa. Forty percent of patients with bulimia and 54% of those with anorexia nervosa had biochemical evidence of zinc deficiency. The authors suggest that for a variety of reasons, such as lower dietary intake of zinc, impaired zinc absorption, vomiting, diarrhea, and binging on low-zinc foods, patients with eating disorders may develop zinc deficiency. This acquired zinc deficiency could then add to the chronicity of altered eating behavior in those patients. PMID:2600063
Talbot, Ben Edward Michael; Lawman, Sarah H A
We present a case of a 40-year-old woman with a history of ongoing anorexia nervosa and bulimia nervosa who has required multiple admissions to hospital for management of acute kidney injury (AKI) and electrolyte derangement. This case is of interest as recent studies have highlighted the significant prevalence of disordered eating and the major public health implications this may have. We discuss the unusual finding of hypercalcaemia in this case and address the investigation and management of AKI and electrolyte disturbance in a patient with anorexia and bulimia. PMID:24654247
American Academy of Child and Adolescent Psychiatry, Washington, DC.
Nine fact sheets relevant to children's emotional well-being are presented in this document. The first fact sheet, "Teenagers with Eating Disorders" focuses on anorexia nervosa and bulimia. The second fact sheet, "Children and Grief" describes age-related responses to death, and ways of coping with a death in a family that includes children. The…
Gilbert, Stefanie C.; Crump, Stacey; Madhere, Serge; Schutz, William
This study, conducted at a historically Black university, evaluated the impact of awareness and internalization of the Western thin ideal of beauty on body dissatisfaction, drive for thinness, and bulimia in African-American, African, and Caribbean women. The relationship between internalization of the thin ideal and disordered eating was…
Examined the hypothesis that adolescent girls attending single-sex schools would exhibit greater body dissatisfaction and disordered eating than their coeducational counterparts, reanalyzing data from relevant subscales of an eating disorder inventory (drive for thinness, bulimia, and body dissatisfaction) and a figure rating scale from an earlier…
Perkins, Daniel F.; Luster, Tom; Jank, Wolfgang
Examined relationship between physical abuse and purging through a survey of 100,236 females ages 12 to 18. Investigated other influences on resiliency such as age, ethnicity, family structure and support, parental education, school climate, sexual abuse, religiosity, and other adult support. Found statistical correlations between bulimia and…
Kiziltan, Gul; Karabudak, Efsun; Unver, Sibel; Sezgin, Emine; Unal, Ayse
The eating attitudes and the prevalence of bulimic behaviors in a group of 300 late adolescents were investigated using the key questions from the Bulimia Investigatory Test, Edinburgh (BITE), and additional questions. Only four subjects (1.3%) scored above the cut-off point on the BITE, and prevalence rates of males and females were the same.…
Coffield, Frank; Costa, Cristina; Müller, Walter; Webber, John
Students are bingeing on large amounts of information and then, in government induced bouts of vomiting otherwise known as national tests, they spew it all out. This is how Frank Coffield introduces the term Bulimia Academica, which he treats every bit as seriously as its medical counterpart. Students resort to bulimic learning to cope with a…
Agras, W. Stewart; Bryson, Susan; Hammer, Lawrence D.; Kraemer, Helena C.
Objective: Thin body preoccupation and social pressure to be thin (TBPSP) in adolescence are risk factors for the development of full and partial bulimia nervosa and binge eating disorder. This study examined precursors of these potent risk factors. Method: A prospective study followed 134 children from birth to 11.0 years and their parents.…
Explored the link between development of bulimic eating behavior and suppression of masculine traits in adolescence. German high school students completed a sex role inventory. Among girls, higher risk of developing bulimia appeared to be caused by increasing discrepancies between actual and ideal self-concept on masculine-typed personality…
Ocker, Liette B.; Lam, Eddie T. C.; Jensen, Barbara E.; Zhang, James J.
The study was designed to examine the construct validity and internal consistency reliability of the Eating Attitudes Test (EAT) using a confirmatory factor analysis (CFA). Two widely adopted EAT models were tested: three-factor (Dieting, Bulimia and Food Preoccupation, and Oral Control) with 26 items (Garner, Olmsted, Bohr, & Garfinkel, 1982),…
Moriarty, Dick; Chanko, Cathy
This report describes an eating disorder as a multi-dimensional physiological, psychological, social, and cultural illness. A chart describing the typical anorexic and bulimic is included which has on its horizontal axis the predisposing, precipitating, perpetuating, professional help, and prevention factors of anorexia nervosa and bulimia. On its…
Offers advice to parents of children with eating disorders, focusing on the warning signs of anorexia nervosa and bulimia nervosa. Suggestions for parents who think their children have eating disorders are provided. Parents are encouraged to be positive role models and be sensitive to stress. (SM)
Friedlander, Myrna L.; Siegel, Sheri M.
Tested theoretical link between difficulties with separation-individuation and cognitive-behavioral indicators characteristic of anorexia nervosa and bulimia. Assessed 124 college women using three self-report measures. Results suggest strong relation between 2 sets of variables and support theoretical assertions about factors that contribute to…
Balentine, Margaret; And Others
Study identified African-American low-income adolescents who thought they had bulimia or anorexia nervosa, identified common behaviors, and compared actual and perceived body weight and dieting methods. About 12 percent suspected an eating disorder and perceived themselves as heavier more often than their peers. Fasting was the most common dieting…
Felker, Kenneth R.; Stivers, Cathie
Surveys measured components of family environment and adolescents' risk of developing anorexia nervosa or bulimia. Females displayed a greater risk than males for developing eating disorders. Lower cohesion, expressiveness, independence, and organization in the family implied a higher eating disorder risk, as did greater conflict and control. (RJM)
Moriarty, Dick; Moriarty, Mary
Since sports can sometimes lend themselves to eating disorders, coaches and sports administrators must get involved in the detection and treatment of this problem. While no reliable studies or statistics exist on the incidence of anorexia nervosa and/or bulimia among athletes, some research suggests that such disorders occur frequently among…
White, Jama Leigh
The literature regarding the relationship between sexual abuse and eating disorders was reviewed. Overall, women with anorexia and bulimia seem to have similar to slightly higher incidences of childhood sexual abuse than has the general population. At the same times, rates of abuse among eating disordered women, including those who experienced…
Physician and Sportsmedicine, 1985
A round table discussion by a physician, a psychiatrist, a dietitian, and 3 college coaches reviewed the problem of anorexia nervosa and bulimia in young athletes who are compulsive overachievers. Coaches need to know the symptoms and potential consequences of these illnesses in order to detect them and to counsel athletes properly. (MT)
Field, Tiffany; Schanberg, Saul; Kuhn, Cynthia; Field, Tory; Fierro, Karen; Henteleff, Tanja; Mueller, Cynthia; Yando, Regina; Shaw, Seana; Burman, Iris
Female bulimic inpatients (N=24) were randomly assigned to massage therapy or standard treatment group. Massaged patients showed immediate reductions in anxiety and depression; additional improvements were noted by the last day of therapy. Massage therapy is shown to be effective as an adjunct treatment for bulimia. (Author/EMK)
Kessel, Greer; Chrisler, Joan C.
Trichotillomania (hair-pulling) and delicate self-cutting are self-destructive behaviors which utilize the body as a vehicle for self-expression. Like anorexia and bulimia, these behaviors occur primarily in young women. This study compared groups of women college students who engage in these self-destructive behaviors with those who do not. It…
Lindsey, Billie J.; Janz, Kathleen F.
In response to concern about the prevalence of anorexia and bulimia, several departments of the University of Iowa collaborated to design and implement an inservice training program for dance and physical educators, coaches and athletic trainers. The rationale, planning, program content, and implications of the eating disorders project are…
Osvold, Lise Leigh; Sodowsky, Gargi Roysircar
Considers eating attitudes and behaviors related to anorexia nervosa, bulimia, and obesity of white American, African-American, Native American, and some international women from the point of view of cultural influences such as sex role, the media, socioeconomic class, and acculturation to Western society. (Author/NB)
Shisslak, Catherine M.; And Others
Summarizes current understanding of anorexia nervosa and bulimia (clinical symptoms and outcome, prevalence and risk factors), offering suggestions for the primary prevention of these disorders at the individual, family, and community levels, and emphasizing prevention in the schools. (Author/KS)
Hohlstein, Leigh Anne; Smith, Gregory T.; Atlas, Jana G.
Five eating reinforcement expectancies and one dieting--thinness reinforcement expectancy were identified and their factor structure replicated on an independent sample of 557 women. Expectancies for negative reinforcement from eating characterized bulimia but not anorexia and were correlated with indexes of restraint plus disinhibition in a…
Analysis of questionnaires returned by 395 sophomores reveals that the eating difficulties of college women may be a problem that only partially resembles clinical eating disorders. They displayed the behavioral symptoms but not the psychological traits associated with anorexia and bulimia. Diagnosis and treatment issues, and sociocultural…
Favazza, Armando R.; And Others
Presents evidence from literature review, patient interviews, responses to Self-Harm Behavior Survey, and case reports that patients with eating disorders are at high risk for self-mutilation. In lieu of dual diagnosis, postulates that combination of self-mutilation, anorexia, bulimia, and other symptoms may be manifestations of impulse control…
There continues to be oppression among female athletes, even after the enactment of Title IX in 1972. Female athletes in secondary schools deal with low self-esteem, eating disorders such as anorexia and bulimia, and depression. Female athletes struggle with societal pressures to maintain a model-like figure, while trying to train and perform for…
Wilson, G. Terence; Fairburn, Christopher G.
Sees cognitive-behavioral therapy (CBT) as applicable to all eating disorders but most intensively studied in treatment of bulimia nervosa. Briefly reviews most commonly used cognitive treatments for eating disorders, provides critical evaluation of their effectiveness, and speculates about their mechanisms of action. Notes that CBT has not been…
Moriarty, Dick; Moriarty, Mary
Through a review of the literature, this presentation provides information on eating disorders as they relate to sport and fitness and examines the role of all physical and health education teachers, coaches, administrators, and guidance counsellors in either precipitating or preventing anorexia nervosa or bulimia. These professionals are in a…
Fursland, Anthea; Byrne, Sharon; Watson, Hunna; La Puma, Michelle; Allen, Karina; Byrne, Susan
Eating disorders are serious mental illnesses affecting a significant proportion of women and a smaller number of men. Approximately half of those with an eating disorder (ED) will not meet the criteria for anorexia or bulimia nervosa, and will be diagnosed with an eating disorder not otherwise specified (EDNOS). Until recently, there were no…
Alberta Learning, Edmonton.
This resource manual is designed to assist Alberta teachers in the identification and education of students with emotional disorders and/or mental illnesses. It takes a comprehensive look at six emotional disorders. The first section focuses on eating disorders. It describes the characteristics and symptoms of anorexia nervosa, bulimia nervosa,…
Frederick, Christina M.; Grow, Virginia M.
Findings from a study of the relationships among autonomy deficits, low self-esteem, and eating disorders of 71 college women supported a mediational model in which lack of autonomy was related to decreased global self-esteem, which in turn was associated with bulimia and body dissatisfaction. (SLD)
Bosch, Amanda; Miltenberger, Raymond G.; Gross, Amy; Knudson, Peter; Breitwieser, Carrie Brower
Binge eating is a serious behavior problem exhibited by individuals diagnosed with binge eating disorder and bulimia nervosa. Binge eating is thought to be maintained by automatic negative reinforcement in the form of relief from negative emotional responding. Current treatments produce only moderate abstinence, perhaps because they do not attempt…
Halmi, Katherine A.
Background: Etiological hypotheses of eating disorders, anorexia nervosa and bulimia nervosa have not produced informative research for predictably effective treatment. Methods: The rationale for applying a model of allostasis, a dysregulation of reward circuits with activation of brain and hormonal stress responses to maintain apparent stability,…
Doane, H. Mitzi
This guide, written for therapists and counselors working with eating disordered individuals, focuses on both bulimia and anorexia. A brief historical perspective and comments on epidemiology and etiology are provided. Definitions and clinical characteristics of both disorders are presented as well as psychodevelopmental profiles of male and…
Dicker, Stacy L.; Craighead, Linda Wilcoxon
The first-line treatment for bulimia nervosa (BN), cognitive-behavioral therapy (CBT), uses food-based self-monitoring. Six young women presenting with BN or significant purging behavior were treated with a modification, Appetite-Focused CBT (CBT-AF), in which self-monitoring is based on appetite cues and food monitoring is proscribed. This change…
Nagelberg, Daniel B.; And Others
Classified college women (N=244) into three groups according to bulimic symptoms: (1) binge eating; (2) purging; and (3) controls. Results indicated purging may represent the critical behavior in bulimia assessment. Purgers showed lower self-esteem, lowered will control, and less regard for social demands, suggesting significant differences…
Bulimia is an eating disorder prevalent among young women, characterized by binge eating episodes followed by purging with subsequent depressive moods and self-deprecating thoughts. To determine whether bulimic women exhibit a greater discrepancy between their perceived and ideal selves than do nonbulimics, three samples of women were assessed.…
Cognitive behaviour therapy (CBT) is now suggested to be the treatment of choice for bulimia nervosa. However, it is also known than no more than approximately 50% of patients recover after receiving CBT. When the first-line manual-based treatment fails, the therapist should use other empirically supported treatments, and if they do not work or…
Shealy, Lucinda; And Others
Cultural pressure for thinness has been cited as a contributing factor in the apparent increase in the eating disorders of anorexia and bulimia. Previous research has examined popular periodicals as an indicator of cultural pressure for thinness. This study assessed changes over the past 20 years in numbers of popular magazine articles focusing on…
Because such eating disorders as anorexia and bulimia have been found to be more common in women than in men, much recent research on these disorders has examined their relationship to gender roles. Some evidence exists supporting the existence of two types of eating disorders; one associated with stereotypically feminine concerns, the other…
Price, Joy A.; And Others
Findings from 337 school counselors revealed 11 percent rated themselves as very competent in helping students with eating disorders (anorexia and bulimia nervosa), 49 percent considered themselves moderately competent, 40 percent believed they were not very competent; 75 percent did not believe it was their role to treat students with eating…
Snodgrass, Gregory; And Others
Sociocultural pressures to pursue an unrealistic ideal of thinness have contributed to an increasing number of students seeking help at a university counseling center for the eating disorders of anorexia nervosa and bulimia. To help these students, a group treatment technique was developed using a cognitive-behavioral approach. Treatment…
Myers, Laura L.; Wiman, Allison M.
In 1994, binge eating disorder (BED) was introduced as a disorder requiring further study in the "American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders", fourth edition ("DSM-IV"). It is now listed as a distinct eating disorder in the "DSM-5", along with bulimia nervosa and…
Thomas, Jennifer J.; Vartanian, Lenny R.; Brownell, Kelly D.
Eating disorder not otherwise specified (EDNOS) is the most prevalent eating disorder (ED) diagnosis. In this meta-analysis, the authors aimed to inform Diagnostic and Statistical Manual of Mental Disorders revisions by comparing the psychopathology of EDNOS with that of the officially recognized EDs: anorexia nervosa (AN), bulimia nervosa (BN),…
Wilson, G. Terence; Grilo, Carlos M.; Vitousek, Kelly M.
Significant progress has been achieved in the development and evaluation of evidence-based psychological treatments for eating disorders over the past 25 years. Cognitive behavioral therapy is currently the treatment of choice for bulimia nervosa and binge-eating disorder, and existing evidence supports the use of a specific form of family therapy…
Schaffner, Angela D.; Buchanan, Linda Paulk
This study examined the current issues relevant to implementing evidence-based practices in the context of outpatient treatment for eating disorders. The study also examined the effectiveness of an outpatient treatment program for eating disorders among a group of 196 patients presenting with anorexia nervosa, bulimia nervosa, or eating disorder…
Anorexia nervosa (AN) and bulimia nervosa (BN) are complex disorders that are often perplexing to therapists and difficult to manage. The purpose of this chapter is to review the history, nature, etiology, and treatment of these disorders, as well as to provide a brief introduction to the proposed d...
Moriarty, Dick; And Others
A qualitative and quantitative evaluation of "A Preventive Curriculum for Anorexia Nervosa and Bulimia" is reported. The evaluation, which included teachers, researchers, health professionals, and students, included development of the curriculum as well as pilot testing activities. The curriculum development and evaluation consisted of three…
Pauls, Brian Scott; Daniels, Thomas
Tests explanatory power of a sociocultural model in predicting bulimic symptomatology in a sample of college women (N=141). High scores on the Bulimia Test were negatively correlated with scores on the cohesion subscale of the Family Adaptability and Cohesion Evaluation Scale. Pressures to diet from family and friends were also found to be…
McCabe, Marita P.; Ricciardelli, Lina A.
This study examined changes in extreme weight change attitudes and behaviors (exercise dependence, food supplements, drive for thinness, bulimia) among adolescent boys and girls over a 16 month period. It also investigated the impact of body mass index, puberty, body image, depression and positive affect on these attitudes and behaviors 16 months…
Tsai, Grace; Gray, James
Assesses the prevalence rate of bulimic disorders among 257 female Asian Americans from 18 to 30 years old. Finds that only two of the 257 women met the classification for bulimia nervosa. Contends that the findings illustrate the need for future research among culturally different populations. (CMK)
Reijonen, Jori H.; Pratt, Helen D.; Patel, Dilip R.; Greydanus, Donald E.
Selectively reviews the literature on the diagnostic criteria for eating disorders (anorexia nervosa, bulimia nervosa, and binge-eating disorder) as described in "Diagnostic and Statistical Manual of Mental Disorders" (4th ed.) and "International Classification of Diseases" (10th ed.). Discusses the prevalence and course of eating disorders,…
Scholzman, Steven C.
Describes anorexia and bulimia, two eating disorders that affect adolescent females more frequently than males. Discusses causes, effects, and treatments of these two eating disorders. Describes what teachers can do to identify students with these disorders and help those who suffer from them. (PKP)
This retrospective study explored the experience of recovery from anorexia nervosa and bulimia nervosa without professional treatment. A nine-question open-ended electronic survey was posted for a period of four months at a mid-western university. Sixteen female and two male respondents reported recovery from adolescent-onset full syndrome…
Gowers, Simon; Bryant-Waugh, Rachel
Although eating disorders in children and adolescents remain a serious cause of morbidity and mortality, the evidence base for effective interventions is surprisingly weak. The adult literature is growing steadily, but this is mainly with regard to psychological therapies for bulimia nervosa and to some extent in the field of pharmacotherapy. This…
Latzer, Yael; Lavee, Yoav; Gal, Sharon
This study assesses and compares the relationship between parents' marital quality, parent-child relationship, and severity of eating-related psychopathology in families with and without eating disorders. Data are collected from the mother, father, and daughter of 30 families with a daughter diagnosed with anorexia or bulimia and from 30 matched…
Goodale, Kimberly R.; Watkins, Patti Lou; Cardinal, Bradley J.
Examined symptoms of muscle dysmorphia (MD), a variation of the eating disorders anorexia nervosa and bulimia, among college students. Surveys indicated that MD symptomatology appears in the general population and among both sexes. MD significantly related to eating disorder pathology and depression, and to some degree to impaired social support.…
Stice, Eric; Fisher, Melissa; Martinez, Erin
The authors conducted 4 studies investigating the reliability and validity of the Eating Disorder Diagnostic Scale (HDDS; E. Stice, C. F. Telch, & S. L. Rizvi, 2000), a brief self-report measure for diagnosing anorexia nervosa, bulimia nervosa, and binge eating disorder. Study 1 found that the HDDS showed criterion validity with interview-based…
Manley, Ronald S.; Rickson, Heidi; Standeven, Bill
this article provides an overview of anorexia nervosa and bulimia in children and adolescents, including ages of onset, prevalence, and clinical characteristics. Behavior, cognitive, and affective characteristics are outlined. Strategies are provided for teachers and counselors who are concerned about students who have or may have eating…
Perosa, Linda M.; Perosa, Sandra L.
The authors summarize a study by D. A. Williamson et al. (2002) in which clinical groups with anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, and binge eating disorder were contrasted with nonclinical groups of participants (i.e., obese and normal weight). The eating disorder groups were qualitatively different. Also,…
Jacobi, Corinna; Hayward, Chris; de Zwaan, Martina; Kraemer, Helena C.; Agras, W. Steward
The aims of the present review are to apply a recent risk factor approach (H. C. Kraemer et al., 1997) to putative risk factors for eating disorders, to order these along a timeline, and to deduce general taxonomic questions. Putative risk factors were classified according to risk factor type, outcome (anorexia nervosa, bulimia nervosa,…
Davis, Blair J.
Eating disorders (EDs) are a serious problem in the U.S. due to their rise in prevalence during the 20th century and high morbidity and mortality rates. A relatively new, controversial phenomenon, "pro-Ana" (pro-anorexia) and "pro-Mia" (pro-bulimia) Web sites, came to the public's attention around 2000. These sites are created by and for people…
Moya, Tatiana; Fleitlich-Bilyk, Bacy; Goodman, Robert
A representative sample of 7-14-year-old young people in southeast Brazil (N=1251) was assessed using standardized parent and youth interviews, thereby identifying an "at-risk" group of young people who met one or more DSM-IV criteria for anorexia and/or bulimia nervosa. These young people were compared with an age and gender matched comparison…
Ray, Shannon L.
Research indicates that the primary onset of eating disorders occurs in adolescence and that there is a growing prevalence of adolescent males with eating disorders. This article describes the eating disorders of anorexia nervosa and bulimia nervosa as they relate to adolescent males. Diagnostic criteria, at-risk groups, and implications for…
Malachowski, Colleen C.; Myers, Scott A.
According to the National Eating Disorders Association (NEDA, 2005), 10 million women and one million men struggle with eating disorders, including anorexia and bulimia. Disordered eating is most common in adolescent girls ages 15-19 and is prevalent in a diverse range of populations (NEDA, 2005). For example, African-American girls aged 11-14…
Buck, Tina; Sales, Amos
This paper provides an overview of addiction related to substance abuse. It provides basic information, prevalence, diagnostic criteria, assessment tools, and treatment issues for eating disorders, compulsive gambling, sex addictions, and work addictions. Eating disorders such as anorexia nervosa and bulimia nervosa, especially affect adolescents.…
Engebretson, Darold; Hollander, Barbara
This paper concerns the high incidence of eating disorders, anorexia nervosa and bulimia, among the female population in colleges. It identifies several major issues in attempting to provide counseling services for eating disordered students (limited resources, a large estimated patient pool, length of treatment involved, and policy changes to…
Anderson, Drew A.; Williamson, Donald A.; Duchmann, Erich G.; Gleaves, David H.; Barbin, Jane M.
Developed a brief self-report inventory to evaluate treatment outcome for anorexia and bulimia nervosa, the Multifactorial Assessment of Eating Disorders, and evaluated the instrument in a series of studies involving 1,054 women. Results support a stable factor structure and satisfactory reliability and validity, and establish normative data. (SLD)
Eating disorders involve serious disturbances in eating behavior, such as extreme and unhealthy reduction of food intake or severe overeating, as well as feelings of distress or extreme concern about body shape or weight. Anorexia nervosa and bulimia nervosa are the two main types of eating disorders. Eating disorders frequently co-occur with…
Lewis, Robin Marie
A review was conducted of literature published over the past 15 years pertaining to attachment factors associated with the formation of anorexia and bulimia nervosa. This review first aims to shed light on the connections between disruption in attachment and psychological disturbances underlying eating disorders. The second purpose is to encourage…
Mitchell, James E.; Eckert, Elke D.
Describes the increasing prevalence of anorexia nervosa and bulimia in many industrialized societies, and their association with significant morbidity and mortality. Discusses the genetic risks for the development of anorexia nervosa, and treatment strategies. Of these, pharmacotherapy and psychotherapy, particularly those incorporating…
Phelps, LeAdelle; Bajorek, Ellen
Literature on the prevalence, symptomatology, and etiology of anorexia nervosa and bulimia in adolescents is reviewed. The school psychologist is in an essential position to help the adolescent and family. Assessment, consultation, and intervention strategies are discussed for the school psychologist, and psychological and pharmacological…
Katzman, Melanie A.; Wolchik, Sharlene A.
A controversial issue in the literature on eating disorders is whether or not bulimia is a disorder distinct from anorexia nervosa. To compare the personality and behavioral characteristics of bulimic women with and without prior anorexia nervosa, 14 female college students (mean age 19.6 years, 86 percent white) were divided into two groups…
Hamilton, Kristin L.
Maladaptive eating behaviors are a growing phenomenon which has captured the interest of not only health and psychology professionals, but also the general public. This paper examines the various types of treatment and counseling approaches for treating anorexia nervosa and bulimia nervosa. Definitions for both disorders are provided, followed by…
Pryor, Tamara; Wiederman, Michael W.
Investigates differences between adolescent females diagnosed with either anorexia nervosa (n=26) or bulimia nervosa (n=30) using the Millon Adolescent Personality Inventory. About half of the participants displayed an inhibited personality style. Anorexics scored higher on the Respectful personality scale. Expressed concerns over self-concept,…
Jackson, Todd; Chen, Hong
From a large school-based sample (N = 3,084), 49 Mainland Chinese adolescents (31 girls, 18 boys) who endorsed all DSM-IV criteria for bulimia nervosa (BN) or sub-threshold BN and 49 matched controls (31 girls, 18 boys) completed measures of demographics and sociocultural experiences related to body image. Compared to less symptomatic peers, those…
Omizo, Sharon A.; Omizo, Michael M.
Discusses role of school counselor in providing assistance to students who may be at risk for developing anorexia nervosa and bulimia and students who already display behaviors and physical symptoms of either of these illnesses. Addresses specific concerns regarding intervention strategies used by the school counselor in the student's recovery…
Kansi, Juliska; Wichstrom, Lars; Bergman, Lars R.
The longitudinal stability of eating problems and their relationships to risk factors were investigated in a representative population sample of 623 Norwegian girls aged 13-14 followed over 7 years (3 time points). Three eating problem symptoms were measured: Restriction, Bulimia-food preoccupation, and Diet, all taken from the 12-item Eating…
Yarborough, Bobbi Jo; DeBar, Lynn L.; Firemark, Alison; Leung, Sue; Clarke, Gregory N.; Wilson, G. Terence
Whereas effective treatments exist for adults with recurrent binge eating, developmental factors specific to adolescents point to the need for a modified treatment approach for youth. We adapted an existing cognitive behavioral therapy treatment manual for adults with bulimia nervosa and binge eating disorder (Fairburn, 2008) for use with…
Although commonly associated with girls and women, eating disorders do not discriminate. School nurses need to be aware that male students also can suffer from the serious health effects of anorexia nervosa, bulimia, anorexia athletica, and eating disorders not otherwise specified. Sports that focus on leanness and weight limits can add to a…
Gaskill, Deanne, Ed.; Sanders, Fran, Ed.
The purpose of this publication is to provide discussion of some of the most difficult and controversial issues surrounding body image and eating disorders, specifically, anorexia nervosa and bulimia nervosa. It includes contributions from a number of nationally and internationally recognized clinicians and researchers in the field. It also…
Katzman, Melanie A.; Wolchik, Sharlene A.
Recent studies have indicated that bulimia, characterized by binge eating followed by depressed mood and purging, is increasing. To investigate the behavioral and emotional antecedents and consequences of binge eating in women, 22 female college students (14 diagnosed bulimics, 8 binge eaters) completed self-monitoring forms for four binges.…
Humphrey, Laura Lynn; Stern, Steven
Presents an integration of object relations theory and family systems theory in the conceptualization of bulimia. Proposes that in bulimic families there are transgenerational developmental deficits and adaptations which determine the level and quality of intrapsychic experience within individuals and the interpersonal relationships and dynamic…
Rupp, Gary L.; Jurkovic, Gregory J.
Compared perspective-taking processes in adolescent females displaying signs of bulimia and their mothers (n=17) to control mother-daughter dyads (n=41). The bulimic adolescents and their mothers were less able to predict the responses of the other on personality instruments than were controls. Discusses other findings and their theoretical and…
Dare, Christopher; And Others
Compared family therapy with individual, supportive psychotherapy for management of severe eating disorder. Findings showed family therapy more effective for patients with early onset, short duration disorder but not in other subgroups (early onset, duration more than 3 years; late onset, after age of 18 years; and those with bulimia nervosa).…
Hepp, Urs; Milos, Gabriella
We report three cases of transsexual patients who are suffering from an eating disorder: a biological male patient diagnosed with anorexia nervosa (AN), a biological male patient with bulimia nervosa (BN), and a biological female patient with AN as well as a severe alcohol dependence. The relationship between eating behavior, gender identity, sexual orientation, and body dissatisfaction is discussed. PMID:12386912
Starkey, Karina; Wade, Tracey
Girls with Type 1 diabetes (insulin-dependent diabetes mellitus [IDDM]) have been identified to be at an increased risk for developing bulimia nervosa (BN) and subthreshold eating disorders. The co-occurrence of these conditions can severely compromise the physical health of these individuals and can even accelerate mortality. The use of a unique…
Wilfrey, Denise E.; And Others
Evaluated effectiveness of group cognitive-behavioral treatment (CBT) and group interpersonal psychotherapy (IPT) for binge eating among 56 women with nonpurging bulimia. At posttreatment, both CBT and IPT conditions showed significant improvement in reducing binge eating, compared to waiting-list condition. Binge eating remained significantly…
Feilke, Kim; Chambliss, Catherine
The prevalence of sexual conflicts in many patients with eating disorders has been well documented. A parallel has been found between psychological problems experienced by victims of childhood sexual abuse and patients with anorexia nervosa and/or bulimia. Past studies have used inpatient clinical samples; however, this study extended this area of…
Jimerson, D C; Wolfe, B E; Brotman, A W; Metzger, E D
Effective planning for medication treatment in patients with bulimia nervosa and anorexia nervosa is based on a comprehensive clinical assessment, including a careful review of comorbid psychiatric disorders and response to treatments for previous episodes of the disorder. Although most patients with bulimia nervosa are offered a trial of psychotherapy, significant results of controlled trials have contributed to an increased role for medications in the treatment of patients with this disorder. Pharmacologic treatment of anorexia nervosa has similarities to that of treatment-resistant depression, with the clinician turning to open trials and clinical reports for clues to rational management. As described in this article, considerations of potential side effects and medical complications are likely to play an important role in guiding the choice of medication used for treatment of patients with eating disorders. PMID:8933605
Collins, M E
Though education for healthy body weight traditionally has focused on obesity, the increased incidence of anorexia nervosa and bulimia among young women suggests education also is needed to address the opposite end of the spectrum. Anorexia nervosa and bulimia are complex and multidimensional disorders associated with individual, family, and sociocultural factors. This article examines the cultural pressure for dieting and thinness currently experienced in America and its impact as a possible predisposing factor for developing eating disorders among adolescent females. Literature is reviewed related to the changing American standard of attractiveness for females reflected by 20th century mass media and its subsequent influence on adolescent concerns for dieting and thinness. Preventive strategies are recommended to help adolescents balance the cultural pressure for thinness and their own desires for attractiveness within the larger context of overall good health. PMID:3216626
Vaz, Ana Rita; Conceição, Eva; Machado, Paulo P P
The aim of this study was to test the effectiveness of a cognitive-behavioral guided self-help treatment program for bulimia nervosa and similar disorders. Participants were assessed at the beginning and end of treatment, and at 6 months follow-up, using the Eating Disorder Examination Questionnaire (EDE-Q), the Outcome-Questionnaire-45 (OQ-45), and the Beck Depression Inventory (BDI). Forty-two participants from an eating disorders treatment service participated in this study. This study followed a one-group repeated measures naturalistic design with no control group. Results showed a significant reduction in EDE scores, OQ-45 and BDI. Clinically significant change occurred for the majority of participants. Cognitive-behavioral self-help treatment may be of value as an initial treatment for bulimia nervosa and similar disorders such as binge eating disorder. PMID:23701428
An occupational therapist's role with clients diagnosed with eating disorders, both anorexia nervosa and bulimia nervosa, has been described throughout the literature. However, the frames of reference and treatment approaches that occupational therapists implement have not been clearly established or validated. This paper outlines the symptomatology of anorexia nervosa and bulimia nervosa, and critically reviews the current literature concerning the frames of reference and treatment approaches used by occupational therapists when intervening with this population. The literature reviewed indicates that therapists are using a variety of frames of reference and treatment approaches. There appears to be an emphasis on the psychoanalytical and cognitive-behavioural frames of reference, although there is a lack of empirical evidence in regards to all frames of reference and treatment approaches. Reasons for the lack of current research with this population, and possible future areas of research are suggested. PMID:10462881
Herpertz, S; von Blume, B; Senf, W
Numerous empirical studies indicate a higher frequency of eating disorders such as anorexia or bulimia nervosa in young female diabetic patients compared to the normal population. The comorbidity of the two syndromes usually leads to a continuous metabolic disorder bearing high risks of acute metabolic failure or early microangiopathic lesions. In addition to "restraint eating" as an essential element of diabetic therapy a premorbid neurotic malformation and/or poor coping strategies are further predisposing aspects for the development of an eating disorder. The inpatient treatment of a 22 year old patient suffering from both diabetes mellitus and bulimia nervosa demonstrates the association of neurotic malformation, poor coping style and the directive function of diabetic therapy. PMID:8560950
Eating disorders long-term evolution is good in 50% of cases, middle in 25% (recovery from eating disorders, but still psychological suffering) and bad in 25% of cases, with chronic eating disorders, anxious or depressive comorbid disorder, and bad consequences in social patients' life. Anorexia nervosa has a considerably worse long-term outcome than bulimia nervosa or binge eating disorders. Never the less, purging bulimia nervosa is often associated with other impulsive symptoms, such as addictions and suicide attempts. Chronic undernutrition leads to main long-term medical complications of eating disorders: linear growth in adolescents with anorexia nervosa, infertility, and osteoporosis. These complications need a specific medical follow up, at least once a year, added to the psychiatric and psychotherapist follow-up. PMID:18361276
Stefini, Annette; Reich, Günter; Horn, Hildegard; Winkelmann, Klaus; Ohmes, Ursula; Frost, Ulrike; Kronmüller, Klaus-Thomas
The reliability of the meanwhile widely used Operationalized Psychodynamic Diagnostics in childhood and adolescence (OPD-CA) is only rarely examined. By means of audiovisual recordings of OPD-CA-interviews with 39 adolescents in the context of a randomized-controlled psychotherapy study for the treatment female adolescents with bulimia nervosa and atypical bulimia nervosa the reliability of the axis conflict and the axis structure were examined. This was carried out by the calculation of Intraklassen-correlations of three raters. The rater agreements ranged from good to excellent, except for impulse control in the axis structure, where the results were satisfactory. The relevance of the results for clinical practice is discussed. PMID:23720992
Nagata, Toshihiko; Oshima, Jun; Wada, Akira; Yamada, Hisashi; Iketani, Toshiya; Kiriike, Nobuo
Previous studies consistently reported a link between bulimic behaviors and high Novelty Seeking (NS), as measured by the Temperament and Character Inventory (TCI). However, it remains unclear whether this relationship is universal and occurs in different environments. Subjects of the present study consisted of 66 patients with anorexia nervosa restricting type (AN-R), 59 patients with anorexia nervosa binge eating/ purging type (AN-BP), 101 patients with bulimia nervosa purging type (BN), and 75 controls. NS score in AN-R patients was significantly lower than that in controls, although NS in BN patients did not differ from that in controls. The temperament of AN-R patients seems to be universal, even in different environments. Conversely, something other than temperament might be important in the development of bulimia nervosa in Japan. PMID:12658623
Sundaram, G; Bartlett, D
The preventative techniques suggested to bulimic patients are frequently undervalued and ignored in favour of restorative treatment, possibly because the dentist may not be aware of the eating disorder. Educating bulimic patients about fluoride application, the use of brushing techniques, antacids, cheese, xylitol chewing gum and the possible use of mouth guards may minimise the effect of acids. Together with attempts at improving patient compliance they can be a valuable adjunct to treatment of bulimic patients with dental problems. Monitoring the wear on teeth by comparing study casts is a good way to maintain control but there are circumstances when restorations are indicated, perhaps when further delay may result in the prognosis of the teeth being compromised. Following a brief introduction to causes of bulimia and the consequences to the dentition, this paper, based on a literature review, considers patient-orientated techniques for prevention and provisional management of erosion of dental hard tissues for patients with bulimia nervosa. PMID:11695131
Wilfley, D E; Agras, W S; Telch, C F; Rossiter, E M; Schneider, J A; Cole, A G; Sifford, L A; Raeburn, S D
This study evaluated the effectiveness of group cognitive-behavioral treatment (CBT) and group interpersonal psychotherapy (IPT) for binge eating. Fifty-six women with nonpurging bulimia were randomly assigned to 1 of 3 groups: CBT, IPT, or a wait-list control (WL). Treatment was administered in small groups that met for 16 weekly sessions. At posttreatment, both group CBT and group IPT treatment conditions showed significant improvement in reducing binge eating, whereas the WL condition did not. Binge eating remained significantly below baseline levels for both treatment conditions at 6-month and 1-year follow-ups. These data support the central role of both eating behavior and interpersonal factors in the understanding and treatment of bulimia. PMID:8473584
Hettema, J M; Neale, M C; Kendler, K S
The equal-environment assumption (EEA), upon which twin methodology is based, was examined for the impact of physical similarity on phenotypic resemblance in five common psychiatric disorders: major depression, generalized anxiety disorder, phobia, alcoholism, and bulimia. A population-based sample of 882 female-female twin pairs of known zygosity was rated for similarity of appearance by color photographs. Psychiatric diagnoses were made by clinical assessment of personal interviews of the twins. Structural equation modeling of the data using physical similarity as a form of specified common environment provided no evidence for a significant effect of physical resemblance on concordance for major depression, generalized anxiety disorder, phobia, and alcoholism, thereby supporting the validity of the EEA in twin studies of these disorders. Results for bulimia, on the other hand, suggest, within the limitations of this study, that physical similarity may significantly influence twin resemblance for this disorder. PMID:7575361
Cooper, Zafra; Fairburn, Christopher G.
In recent years there has been widespread acceptance that cognitive behavior therapy (CBT) is the treatment of choice for bulimia nervosa. The cognitive behavioral treatment of bulimia nervosa (CBT-BN) was first described in 1981. Over the past decades the theory and treatment have evolved in response to a variety of challenges. The treatment has been adapted to make it suitable for all forms of eating disorder—thereby making it “transdiagnostic” in its scope— and treatment procedures have been refined to improve outcome. The new version of the treatment, termed enhanced CBT (CBT-E) also addresses psychopathological processes “external” to the eating disorder, which, in certain subgroups of patients, interact with the disorder itself. In this paper we discuss how the development of this broader theory and treatment arose from focusing on those patients who did not respond well to earlier versions of the treatment. PMID:23814455
Cooper, Zafra; Fairburn, Christopher G
In recent years there has been widespread acceptance that cognitive behavior therapy (CBT) is the treatment of choice for bulimia nervosa. The cognitive behavioral treatment of bulimia nervosa (CBT-BN) was first described in 1981. Over the past decades the theory and treatment have evolved in response to a variety of challenges. The treatment has been adapted to make it suitable for all forms of eating disorder-thereby making it "transdiagnostic" in its scope- and treatment procedures have been refined to improve outcome. The new version of the treatment, termed enhanced CBT (CBT-E) also addresses psychopathological processes "external" to the eating disorder, which, in certain subgroups of patients, interact with the disorder itself. In this paper we discuss how the development of this broader theory and treatment arose from focusing on those patients who did not respond well to earlier versions of the treatment. PMID:23814455
Viesselman, J O; Roig, M
The first 95 patients admitted to an inpatient Eating Disorders Program and diagnosed as having bulimia (binge eating only), bulimarexia (binging and purging), and anorexia nervosa (food restriction only) were evaluated for depression, suicidality, and family history. Major depression was found in 80% of patients; 20% had made suicide attempts in their life; and 40% of those attempting suicide made potentially lethal attempts. Patients with anorexia and bulimarexia tended to be younger, single, and Protestant. Patients with bulimarexia had overeating, oversleeping, more preoccupation with suicide, and more depression in their mothers. Patients with anorexia had more relatives with anorexia and bulimarexia, and patients with bulimia had more relatives with obesity. These findings suggest that eating disorders are unique disorders and not variants of affective disorder or alcoholism. PMID:3856565
Willard, S G; McDermott, B E; Woodhouse, L M
Recent cases in our Eating Disorders Clinic suggest that patients diagnosed with bulimia nervosa seeking surgical fat removal may be exhibiting a variant of the purging behavior seen in bulimic patients. These same patients exhibit historical or concurrent abuse of laxatives and/or diuretics or self-induced vomiting in a pathologic attempt to obtain or maintain an idealized body image. This paper presents two case studies that illustrate the bulimic patient's compulsive quest for lipectomy with unrealistic expectations that surgical alteration of the body will be an emotional and physical panacea. Plastic surgeons must be cautioned regarding this potential manifestation of bulimia nervosa and the dangers inherent in colluding with the patient in a pathologic request for surgery. It is important for plastic surgeons to recognize appropriate use of lipectomy as an alternative to traditional purging behavior in the bulimic patient. PMID:8764715
Rabe-Jablonska Jolanta, J; Sobow Tomasz, M
The aim of the study was to search for a body dysmorphic disorder (BDD) period preceding the symptoms meeting the criteria of either anorexia or bulimia nervosa, and an evaluation of the prevalence of BDD symptoms in a control group of girls without any eating disorder. Ninety-three girls (12-21 years old ) were included in the study (36 with anorexia nervosa, 17 with bulimia nervosa and 40 healthy controls). The Structured Clinical Interview (SCID), including the BDD module, and a novel questionnaire (for the presence of preceding life events) were used. We found the symptoms of BDD in 25% of anorexia nervosa sufferers for at least six months before observing a clear eating disorder picture. Moreover, other mental disorders were also present among these patients. The results may support the idea that BDD and anorexia nervosa both belong to either OCD or affective disorders spectra. PMID:10954874
Mayer, L E; Walsh, B T
The introduction of selective serotonin reuptake inhibitors (SSRIs), which are, in general, safer and more easily tolerated than conventional antidepressants, has had a profound effect on the treatment of affective illnesses and obsessive-compulsive disorder (OCD). A number of symptoms associated with eating disorders overlap those of depression and OCD, suggesting a theoretical and practical case for evaluating the SSRIs in the treatment of anorexia nervosa, bulimia nervosa, binge-eating disorder, and obesity. Despite the expectations for SSRIs in the treatment of eating disorders, clinical investigations have yielded mixed results. In this paper, results from clinical studies of SSRIs (with and without concomitant psychotherapy) in the treatment of anorexia and bulimia nervosa, binge eating disorder, and obesity are reviewed, directions for future research are suggested, and practical recommendations for the clinician are provided. PMID:9786308
Matsou, Eirini; Vouroutzis, Nikolaos; Kontonasaki, Eleana; Paraskevopoulos, Konstantinos M; Koidis, Petros
The rehabilitation of eroded teeth in patients suffering from bulimia nervosa generally includes ceramics. This study compared the roughness of three ceramics before and after exposure to simulated vomit solution (SVS) with a pH of 3.8. Surface roughness parameters Ra, RMS, and AH were calculated using atomic force microscopy before and after exposure to SVS (novel peristaltic pump for 24 hours at 37°C) and were analyzed statistically. Apart from the initial high AH values of the glass-ceramic, none of the parameters evaluated were statistically significantly different after acid exposure. Under the limitations of this in vitro study, the investigated ceramics seem suitable for use in bulimia nervosa patients. PMID:21209998
Brown, Tiffany A; Keel, Pamela K
Excessive diet soda intake is common in eating disorders. The present study examined factors contributing to excessive intake in a sample of individuals with lifetime eating disorders based on proposed DSM-5 criteria (n = 240) and non-eating disorder controls (n = 157). Individuals with eating disorders, particularly bulimia nervosa, consumed more diet soda than controls. Eating disorder symptoms that reflect increased appetitive drive or increased weight concerns were associated with increased diet soda intake. Increased weight concerns were associated with increased diet soda intake when levels of appetitive drive were high, but not when they were low. Results highlight the importance of monitoring diet soda intake in individuals with eating disorders and may have implications for the maintenance of dysregulated taste reward processing in bulimia nervosa. PMID:23600556
Elal, G; Sabol, E; Slade, P
The aim of this study was to examine the direct and indirect relationship between abnormal eating attitudes and sexual abuse. The subject sample comprised 532 female Turkish undergraduate and nursing students in Istanbul. The Eating Attitudes Test (EAT), Sexual Abuse Questionnaire, the Setting Conditions for Anorexia Nervosa Scale, the Positive and Negative Perfectionism Scale and the Need for Control Scale (NCS) were the instruments of the study. The results showed that sexual abuse has a direct effect on EAT-Bulimia but not on EAT-Dieting. It also has some indirect effects on both of these through its effects on family functioning. Perfectionism, on the other hand, was independently linked with both EAT-Dieting and EAT-Bulimia but was not associated with sexual abuse. PMID:15656010
Franko, Debra L; Keel, Pamela K
This review summarizes the published studies on suicide and suicide attempts in individuals with eating disorders, highlighting rates of occurrence, clinical correlates, and implications for practitioners. Multiple studies find high rates of suicide in patients with anorexia nervosa (AN) [Standardized Mortality Ratio (SMR) for suicide range from 1.0 to 5.3], whereas suicide rates do not appear to be elevated in bulimia nervosa (BN). In contrast, suicide attempts occur in approximately 3-20% of patients with anorexia nervosa and in 25-35% of patients with bulimia nervosa. Clinical correlates of suicidality in eating disorders include purging behaviors, depression, substance abuse, and a history of childhood physical and/or sexual abuse. Patients with eating disorders, particularly those with comorbid disorders, should be assessed routinely for suicidal ideation, regardless of the severity of eating disorder or depressive symptoms. PMID:16875766
Mitchell, James E.; Roerig, James; Steffen, Kristine
Objective To provide a comprehensive review of pharmacotherapy and other biological treatments for eating disorders. Method Literature on this topic was systematically reviewed. Results The bulimia nervosa literature underscores the utility of antidepressants, particularly SSRIs, in improving the symptoms of the disorder. The literature on binge eating disorder supports efficacy on reduction in binge eating frequency for a variety of compounds. However, such compounds have only modest effects on weight. Certain antiepileptic agents such as topiramate, if tolerated, are probably more useful in terms of weight loss. The number of controlled trials in patients with anorexia nervosa in particular has been quite small, and recent meta-analyses show disappointing results using atypical antipsychotics in anorexia nervosa. Discussion The pharmacological treatment of eating disorders remains an underdeveloped field although drug therapy clearly plays a role in the treatment of those with bulimia nervosa and binge eating disorder. Other biological therapies have not been adequately studied. PMID:23658094
Fosse, Gunilla Klensmeden; Holen, Are
To explore possible relations between maltreatment in childhood and subsequent eating disorders in adult life, 107 consecutive adult psychiatric female outpatients were screened for eating disorders. They also completed questionnaires about harassment by adults and bullying by peers in childhood. The Childhood Trauma Questionnaire measured childhood abuse by parents or other adults, and the Parental Bonding Instrument captured parental coldness and overprotection. Bullying by peers was measured by an inventory used in schools. Outpatients who met the criteria for bulimia nervosa reported far more bullying by peers, more coldness and overprotection from fathers, and more childhood emotional, physical and sexual abuse. The findings suggest associations between childhood maltreatment, especially bullying by peers, and bulimia nervosa. PMID:17056418
Martin, Jessica L; Groth, Gabrielle; Longo, Laura; Rocha, Tracey L; Martens, Matthew P
Excessive alcohol use and disordered eating are considerable health-related problems among college women. The purpose of the present study was to examine how specific patterns of disordered eating (i.e., anorexia, bulimia, binge eating) are related to alcohol use and related problems and the influence of racial group membership and Big Five personality traits on the co-occurrence of these behaviors. Participants were 153 undergraduate women. Results indicated that White women reported more binge drinking, alcohol-related problems, disordered eating, anorexia nervosa symptoms, and bulimia nervosa symptoms than non-White women. Women with higher levels of openness and who engage in extreme exercise, dieting, fasting, or purging were more at risk for heavy and problematic alcohol use. Implications for the treatment of co-occurring disorders among college students and further research are discussed. PMID:25734858
Suzuki, Mari Hotta
This article gives an outline about involvement of eating disorders in metabolic syndrome. Anorexia nervosa and bulimia nervosa become common diseases in woman in Japan. Binge-eating disorder and night eating syndrome are observed in men as well as women. Binge eating is characteristic of bulimia nervosa, binge-eating disorder and night eating syndrome. It should be noted that high energy availability observed in these diseases results in obesity and exacerbate metabolic syndrome. Cognitive-behavioral therapy and medication with selective serotonin reuptake inhibitors(SSRIs) can make patients to control symptoms and improve their QOL. Osteoporosis is one of chief complications and sequelae of anorexia nervosa. Low-birth weight babies born from emaciated patients with eating disorders are subject to metabolic syndrome in the future. PMID:25936153
Price, W A
Treatment of eating disorders is difficult regardless of the methods employed. Pharmacologic management in anorexia nervosa and in bulimia nervosa is especially helpful when it is part of a multimodal treatment approach that includes individual, family and behavioral therapy. Care must be taken to guard against side effects, abuse and noncompliance in a group of patients that tends to be prone to all three. PMID:3284300
Castillo, C; Acharán, X; Alvarez, P; Bustos, P
Physiological, pathological and therapeutic aspect of appetite are reviewed. The importance of developmental alterations originated at early infancy and lack of appropriate interactions between mother and infant in abnormalities of appetite are emphasized. The role of vitamins, minerals and appetite stimulating drugs is analyzed and major disturbances of appetite and feeding conducts are described together with some therapeutic considerations on anorexia nervosa, bulimia, pica and rumination. PMID:2152223
Cartwright, Martina M
Eating disorders are maladaptive eating behaviors that typically develop in adolescence and early adulthood. Psychiatric maladies and comorbid conditions, especially insulin-dependent diabetes mellitus, frequently co-exist with eating disorders. Serious medical complications affecting all organs and tissues can develop and result in numerous emergent hospitalizations. This article reviews the pathophysiologies of anorexia nervosa, bulimia nervosa, and orthorexia nervosa and discusses the complexities associated with the treatment of medical complications seen in these patients. PMID:15571940
An overview is given on the indications and possibilities of estrogen-progestagen medication in girls during childhood and adolescence. The physiological effects of estrogen and progestagen treatment are described, and practical advice is given for the management with estrogens-progestagens of labial adhesions, lichen sclerosus, vulvovaginitis, breast anomalies, the different forms of amenorrhoeas, pubertas tarda, anorexia-bulimia, bleeding anomalies and high stature. PMID:2079940
Gershon, E S; Schreiber, J L; Hamovit, J R; Dibble, E D; Kaye, W; Nurnberger, J I; Andersen, A E; Ebert, M
The most prevalent psychiatric disorders in the families of patients with anorexia nervosa are bipolar and unipolar major affective disorder. The presence of affective disorder, self-induced vomiting, or bulimia in the patient is not predictive of affective illness in the relatives. Thus these features do not define genetic heterogeneity within anorexia nervosa. There may be genetic factors shared between anorexia nervosa and affective disorders. PMID:6496786
Scolnick, Barbara; Mostofsky, David I; Keane, Robert J
Heart rate variability (HRV) biofeedback, a technique which encourages slow meditative breathing, was offered to 25 in-patients with various eating disorder diagnoses-anorexia nervosa, bulimia nervosa and binge eating disorder. We found that this modality had no serious side effects, and was subjectively useful to most participants. An enhanced ability to generate highly coherent HRV patterns in patients with recent onset anorexia nervosa was observed. PMID:24917934
Gucciardi, Enza; Celasun, Nalan; Ahmad, Farah; Stewart, Donna E
Health Issue Eating disorders are an increasing public health problem among young women. Anorexia and bulimia may give rise to serious physical conditions such as hypothermia, hypotension, electrolyte imbalance, endocrine disorders, and kidney failure. Key Issues Eating disorders are primarily a problem among women. In Ontario in 1995, over 90% of reported hospitalized cases of anorexia and bulimia were women. In addition to eating disorders, preoccupation with weight, body image and self-concept disturbances, are more prevalent among women than men. Women with eating disorders are also at risk for long-term psychological and social problems, including depression, anxiety, substance abuse and suicide. For instance, in 2000, the prevalence of depression among women who were hospitalized with a diagnosis of anorexia (11.5%) or bulimia (15.4 %) was more than twice the rate of depression (5.7 %) among the general population of Canadian women. The highest incidence of depression was found in women aged 25 to 39 years for both anorexia and bulimia. Data Gaps and Recommendations Hospitalization data are the most recent and accessible information available. However, this data captures only the more severe cases. It does not include the individuals with eating disorders who may visit clinics or family doctors, or use hospital outpatient services or no services at all. Currently, there is no process for collecting this information systematically across Canada; consequently, the number of cases obtained from hospitalization data is underestimated. Other limitations noted during the literature review include the overuse of clinical samples, lack of longitudinal data, appropriate comparison groups, large samples, and ethnic group analysis. PMID:15345084
Angelini, L; Mazzucchi, A; Picciotto, F; Nardocci, N; Broggi, G
A body with a focal lesion of the right cingulum, subjected to cingulectomy for the removal of a tumour, is the first case of an isolated unilateral cingulum lesion to be reported. The presenting symptoms consisted of serious behavioural abnormalities: lack of social restraint, heightened sexuality, bulimia and aggressiveness, all of which ceased after surgery. Neuropsychological tests, done before and after the operation, provided no evidence that the higher cognitive functions, including memory, were impaired. Images PMID:7241164
Morgan, J F
Eating disorders are common and characteristically affect young women at what would otherwise be their peak of reproductive functioning. Anorexia nervosa and bulimia nervosa impinge on reproduction both behaviourally and physiologically, with effects on menstruation, ovarian function, fertility, sexuality and pregnancy. This review presents a summary of current knowledge and makes suggestions for future research, along with some clinical recommendations for the management of eating disorders in pregnancy. PMID:10755771
Derchi, Giacomo; Peñarrocha, David; Barone, Antonio; Covani, Ugo
The population affected by dental erosion due to bulimia is generally very young. This population group has a high aesthetic requirement; the dentition in these patients is severely damaged, especially in the anterior maxillary quadrant. In terms of treatment, it is still controversial whether an adhesive rehabilitation is preferable to a longer-lasting but more aggressive conventional treatment, such as full-crown coverage of the majority of teeth. This case report describes the prosthetic rehabilitation of a young female patient previously affected by bulimia nervosa and presenting erosion of the maxillary teeth. The prosthetic rehabilitation was performed through indirect adhesive restorations of the anterior teeth and direct restorations of the posterior teeth. A clinical follow-up after 4 years showed that the occlusion remained satisfactorily restored. Posterior direct composite resin restorations and anterior indirect adhesive composite restorations proved to be an effective time and money-saving procedure to rehabilitate patients affected by dental erosion. Adhesive rehabilitation provides a functional and good aesthetic result while preserving tooth structure. Key words:Bulimia, dental erosion, composite resin, veneers. PMID:25810832
Rahal, Collin J; Bryant, Judith B; Darkes, Jack; Menzel, Jessie E; Thompson, J Kevin
The goal of the current investigation was to develop and validate a measure to assess an individual's eating-related behaviors related to alcohol consumption, specifically behaviors intended to compensate for calories so that more alcohol could be consumed or restrict calories to enhance the psychoactive effects of alcohol consumption. Two hundred and seventy four undergraduate students (n=51 males; 75.2% Caucasian) completed a newly developed scale, the Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale (CEBRACS), along with measures of eating restriction, bulimia, and body dissatisfaction. An exploratory factor analysis on the CEBRACS revealed the existence of 4 clear-cut factors: alcohol effects, bulimia, dieting and exercise, and restriction. Internal consistency statistics for all subscales ranged from .79 to .95. Pearson product-moment correlations between the CEBRACS and measures of bulimia, restriction, and body dissatisfaction ranged from .04 to .44. T-tests revealed no gender differences in compensatory eating behaviors. Future research directions and limitations of the current study are discussed. PMID:22365787
Casper, R C
Both depressive disorders and eating disorders are multidimensional and heterogeneous disorders. This paper examines the nature of their relationship by reviewing clinical descriptive, family-genetic, treatment, and biological studies that relate to the issue. The studies confirm the prominence of depressive symptoms and depressive disorders in eating disorders. Other psychiatric syndromes which occur with less frequency, such as anxiety disorders and obsessive-compulsive disorders in anorexia nervosa, or personality disorders, anxiety disorders, and substance abuse in bulimia nervosa, also play an important role in the development and maintenance of eating disorders. Since few studies have controlled for starvation-induced physical, endocrine, or psychological changes which mimic the symptoms considered diagnostic for depression, further research will be needed. The evidence for a shared etiology is not compelling for anorexia nervosa and is at most suggestive for bulimia nervosa. Since in contemporary cases dieting-induced weight loss is the principal trigger, women with self-critical or depressive features will be disproportionately recruited into eating disorders. The model that fits the data best would accommodate a relationship between eating disorders and the full spectrum of depressive disorders from no depression to severe depression, with somewhat higher rates of depression in bulimic anorectic and bulimia nervosa patients than in restricting anorexia nervosa patients, but the model would admit a specific pathophysiology and psychopathology in each eating disorder. PMID:9809221
Iorio, D; Margiotta, N; D'Orsi, P; Bellini, O; Boschi, V
The present study evaluated impaired eating behaviour in women seeking participation in a diet-based programme of weight reduction or achievement of ideal body weight. Forty-seven obese, 42 overweight and 14 normal-weight subjects, attending an Italian university outpatient clinic completed the Eating Disorder Inventory (EDI). Forty-eight mothers of primary school children (25 normal-weight and 23 overweight) were used as controls. The EDI consists of 8 subscales, 3 evaluating psychopathology related to eating disorders (drive for thinness, bulimia, body dissatisfaction) and 5 evaluating general psychopathology (intereoceptive awareness, ineffectiveness, maturity fears, perfectionism, interpersonal distrust). Significantly altered scores in the first three subscales were observed both in normal-weight and overweight outpatients compared to the controls. The overweight outpatients scored higher than the obese patients in terms of drive for thinness and bulimia and higher than the normal-weight women for terms of bulimia, body dissatisfaction and drive for thinness. The overweight controls scored significantly higher than the normal-weight controls in the first three subscales in the remaining subscales, mean values were also higher in the overweight group, though significance was only reached in the interpersonal distrust and interoceptive awareness subscales. Impaired eating behaviour is frequent in subjects seeking participation in weight reduction or ideal body weight achievement programmes. PMID:11216128
von dem Knesebeck, Olaf; Mnich, Eva; Kofahl, Christopher; Makowski, Anna Christin; Lambert, Martin; Karow, Anne; Bock, Thomas; Härter, Martin; Angermeyer, Matthias C
The study is focused on two research questions: What are the public's estimates of the prevalence of depression, schizophrenia, bulimia nervosa and anorexia nervosa? What is the relationship between the estimated prevalence of the mental disorders and the public's desire for social distance? Analyses are based on a telephone survey in two large German cities (Hamburg and Munich, N=2014, response rate 51%). Vignettes with typical signs and symptoms suggestive of a depression, schizophrenia, bulimia nervosa and anorexia nervosa were presented. Respondents were asked about the lifetime prevalence of the mental disorders and their desire for social distance. Across all four disorders under study the respondents markedly overestimate the rates of lifetime prevalence. Increasing prevalence estimation is associated with a significant decrease in the desire for social distance in case of schizophrenia. As for depression, anorexia nervosa and bulimia nervosa there are no significant associations. Many campaigns aimed at reducing stigma emphasize the high prevalence of mental disorders. The assumption of these campaigns is that reduction of the perceived distinction leads to a decrease of the desire for social distance towards those afflicted. Our results indicate that this may not generally be an effective way to reduce stigma. PMID:23623451
Nagata, T; Kawarada, Y; Kiriike, N; Iketani, T
Several studies have noted that multi-impulsive bulimia nervosa tends to be refractory to treatment. However, it is not known whether these impulsivities are an expression of more fundamental psychopathology or simply the consequence of chaotic eating behaviors. Studies of the temporal relationship between the onset of eating disorder and the occurrence of impulsive behaviors will facilitate a better understanding of these issues. Subjects consisted of 60 patients with anorexia nervosa restricting type (AN-R), 62 patients with anorexia nervosa binge-eating/purging type (AN-BP), 114 patients with bulimia nervosa purging type (BN) and 66 control subjects. Impulsive behaviors and childhood traumatic experiences were assessed by self-report questionnaire. Multi-impulsivity (defined by at least three of the following: heavy regular alcohol drinking; suicide attempt; self-mutilation; repeated shoplifting of items other than food; sexual relationships with persons not well known to the subject) was found in 2% of AN-R, 11% of AN-BP, 18% of BN and 2% of control subjects. Eighty percent of BN patients with multi-impulsivity had a history of suicide attempts or self-mutilation history prior to the onset of bulimia nervosa. In BN patients, there tended to be a relationship between childhood parental loss or borderline personality disorder and multi-impulsivity. In conclusion, primary impulsivity (chronological prior occurrence of impulsive behaviors) does exist even in a very different culture, although the number of patients of this type is very limited. PMID:10889288
McCune, Ashley M.; Mandal, Konoy; Lundgren, Jennifer D.
Objective: To examine the quality of a broad range of life domains using both quantitative and qualitative methodologies. Method: Forty-eight individuals seeking inpatient treatment for an eating disorder (mean age = 29.8 years, female = 100%, white = 96.4%) from 2007 to 2009 completed the Quality of Life Inventory (QOLI) and the Eating Disorder Examination Questionnaire; a medical chart review confirmed diagnosis and treatment history. Patients diagnosed with anorexia nervosa (n = 24) and bulimia nervosa (n = 24) were compared. Body mass index (kg/m2), treatment history, number of comorbid psychiatric conditions, and eating disorder severity were used to predict quality of life. Finally, an inductive content analysis was performed on qualitative QOLI responses to contextualize the quantitative findings. Results: Participants with anorexia nervosa, compared to those with bulimia nervosa, reported significantly less satisfaction with the domain of relatives (F1,46 = 5.35; P = .025); no other significant group differences were found. The only significant predictor of QOLI global score was number of previous treatments (F1,41 = 8.67; P = .005; R2 = 0.175). Content analysis of qualitative data yielded complementary findings to the quantitative data; interesting group differences emerged for satisfaction with health with implications for measuring quality of life domains. Conclusions: Across several life domains, individuals seeking treatment for anorexia nervosa and bulimia nervosa appear to have similar levels of satisfaction, as evidenced by numeric and descriptive responses. Satisfaction with relatives, however, appears to differ between groups and suggests a specific target for intervention among patients in treatment for anorexia nervosa (eg, a family-based intervention such as the Maudsley approach). The use of quantitative and qualitative assessments, such as the QOLI, provides more clinically meaningful, contextualized information about quality of life than
Frank, Guido K.W.
Over the past decade brain imaging has helped better define eating disorder related brain circuitry. Brain research on gray and white matter volumes had been inconsistent, possibly due to the effects of acute starvation, exercise, medication and comorbidity, but newer studies controlled for such effects. Those studies suggest larger left medial orbitofrontal gyrus rectus volume in ill adult and adolescent anorexia nervosa after recovery from anorexia nervosa, and in adult bulimia nervosa. The orbitofrontal cortex is important in terminating food intake and altered function could contribute to self-starvation. The right insula, which processes taste but also interoception, was enlarged in ill adult and adolescent anorexia nervosa, as well as adults recovered from the illness. The fixed perception of being fat in anorexia nervosa could be related to altered insula function. A few studies investigated WM integrity, with the most consistent finding of reduced fornix integrity in anorexia and bulimia nervosa, a limbic pathway important in emotion but also food intake regulation. Functional brain imaging using basic sweet taste stimuli in eating disorders during the ill state or after recovery implicated repeatedly reward pathways, including insula and striatum. Brain imaging that targeted dopamine related brain activity using taste-reward conditioning tasks suggested that this circuitry is hypersensitive in anorexia nervosa, but hypo-responsive in bulimia nervosa and obesity. Those results are in line with basic research and suggest adaptive reward system changes in the human brain in response to extremes of food intake, changes that could interfere with normalization of eating behavior. PMID:25902917
Cozzi, F; Ostuzzi, R
Eating Disorders are very widespread within the adolescent population. A possible interpretation and the comprehension of such forms of psychopathology may revolve around the failure to develop a well-defined personal identity, an incapacity to achieve a sense of differentiation with respect to others, an incapacity to measure oneself against others, dependence on others, the fear of rejection and a sense of inadequacy. This study explores the relational styles and behaviour of individuals suffering from eating disorders and their influence on the development of the personality, with reference being made in particular to self-valuation, dependence on others and levels of differentiation. A sample population of 90 women with eating disorders was studied. The subjects were subdivided into 3 groups (30 with restricting anorexia nervosa, 30 with binge-eating/purging anorexia nervosa and 30 with bulimia nervosa), overlapping in terms of age, duration of disorders and interrelation style, using the Relational Competence Test. The most significant results of this study concern the question of the definition of an autonomous personal identity. This process seems to be in progress in young women suffering from bulimia nervosa who appear to be driven towards a "definition of the self in opposition" with the consequent tendency towards relational experiences outside their own family. In women with binge-eating/purging AN moreover an awareness of the difference between the self and others and of their state of dependence would appear to be present, however behaviour aimed at the determination of an autonomous self is not evident. In women with restricting anorexia nervosa a definition of the identity is totally absent; these women develop an omnipotent self in their 'oneness' with others. These relational aspects lead to the identification of a continuum between restricting anorexia nervosa, binge-eating/purging anorexia nervosa and bulimia nervosa in an evolutionary
Frank, Guido K W
Over the past decade, brain imaging has helped to better define eating disorder-related brain circuitry. Brain research on gray matter (GM) and white matter (WM) volumes had been inconsistent, possibly due to the effects of acute starvation, exercise, medication, and comorbidity, but newer studies have controlled for such effects. Those studies suggest larger left medial orbitofrontal gyrus rectus volume in ill adult and adolescent anorexia nervosa after recovery from anorexia nervosa, and in adult bulimia nervosa. The orbitofrontal cortex is important in terminating food intake, and altered function could contribute to self-starvation. The right insula, which processes taste but also interoception, was enlarged in ill adult and adolescent anorexia nervosa, as well as adults recovered from the illness. The fixed perception of being fat in anorexia nervosa could be related to altered insula function. A few studies investigated WM integrity, with the most consistent finding of reduced fornix integrity in anorexia and bulimia nervosa-a limbic pathway that is important in emotion but also food intake regulation. Functional brain imaging using basic sweet taste stimuli in eating disorders during the ill state or after recovery implicated repeatedly reward pathways, including insula and striatum. Brain imaging that targeted dopamine-related brain activity using taste-reward conditioning tasks suggested that this circuitry is hypersensitive in anorexia nervosa, but hyporesponsive in bulimia nervosa and obesity. Those results are in line with basic research and suggest adaptive reward system changes in the human brain in response to extremes of food intake-changes that could interfere with normalization of eating behavior. PMID:25902917
Anorexia nervosa and bulimia nervosa are prevalent illnesses affecting between 1% and 10% of adolescent and college age women. Developmental, family dynamic, and biologic factors are all important in the cause of this disorder. Anorexia nervosa is diagnosed when a person refuses to maintain his or her body weight over a minimal normal weight for age and height, such as 15% below that expected, has an intense fear of gaining weight, has a disturbed body image, and, in women, has primary or secondary amenorrhea. A diagnosis of bulimia nervosa is made when a person has recurrent episodes of binge eating, a feeling of lack of control over behavior during binges, regular use of self-induced vomiting, laxatives, diuretics, strict dieting, or vigorous exercise to prevent weight gain, a minimum of 2 binge episodes a week for at least 3 months, and persistent overconcern with body shape and weight. Patients with eating disorders are usually secretive and often come to the attention of physicians only at the insistence of others. Practitioners also should be alert for medical complications including hypothermia, edema, hypotension, bradycardia, infertility, and osteoporosis in patients with anorexia nervosa and fluid or electrolyte imbalance, hyperamylasemia, gastritis, esophagitis, gastric dilation, edema, dental erosion, swollen parotid glands, and gingivitis in patients with bulimia nervosa. Treatment involves combining individual, behavioral, group, and family therapy with, possibly, psychopharmaceuticals. Primary care professionals are frequently the first to evaluate these patients, and their encouragement and support may help patients accept treatment. The treatment proceeds most smoothly if the primary care physician and psychiatrist work collaboratively with clear and frequent communication. PMID:1475950
de Zwaan, Martina
The use of information and communication technologies ("e-mental health") has been suggested for the prevention and treatment of eating disorders as an addition to conventional treatment approaches. Guided internet-based self-help programs can be viewed as evidence-based treatment options for bulimia nervosa (BN) and binge eating disorder (BED) based on existing controlled studies. They represent an option within a stepped-care treatment approach and as relapse prevention after inpatient treatment. Additional fields of application for e-mental health in eating disorders are prevention and early intervention as well as carers' support. PMID:25594274
Vocks, Silja; Bauer, Anika
Body image-related interventions become increasingly important in the treatment of anorexia and bulimia nervosa. Previous studies concerning body image disturbance conducted by means of diverse research methods focused on different components of body image - the perceptive, cognitive-emotional and the behavioral component. However, regarding the etiology, maintenance and treatment of body image disturbance in eating disorders, many questions remain unanswered. An integrative perspective on the different body image components within a theoretical framework as well as the development of specific body image-related interventions according to individual indications would be desirable. PMID:25594272
Obese people as a group have similar mental health as normal weight people, and there are no psychiatric features characteristic of obesity in general. However, small subgroups of obese individuals may have psychiatric abnormalities which are specific for obesity, such as body image disturbance or periodic compulsive overeating (bulimia). Obesity is strongly related to sociocultural factors. In western countries obesity is commoner in lower than in higher social classes. Thus, the development of obesity is influenced by social status. However, also the converse is true: recent observations suggest that obese people lose social status. This is probably due to prejudice and discrimination against obese persons in the modern western society. PMID:3477994
Eating disorders are a complex set of illnesses most commonly affecting white adolescent girls and young women. The most common eating disorders seen in the primary care setting are anorexia nervosa, bulimia nervosa, and binge eating disorder. Treatment in the primary care environment ideally involves a physician, therapist, and nutritionist, although complex cases may require psychiatric and other specialist care. Early diagnosis and treatment are associated with improved outcomes, whereas the consequences of untreated eating disorders, particularly anorexia nervosa, can be devastating, including death. PMID:27262009
Johnson, W G; Schlundt, D G
Anorexia and bulimia are eating disorders affecting a significant number of adolescent and young adult women. The core symptoms of both disorders are similar and include a fear of obesity, body image disturbance, erratic eating patterns, and purging. These symptoms produce significant physical and psychologic complications. Both anorexia and bulimia appear to have a common origin in a fear of obesity and dieting. Anorectics, being "successful" dieters, lose a significant amount of weight; whereas bulimics alternate between binges and purges. Treatment for the eating disorders is gradually evolving as clinical research experience accumulates. For anorexia, hospitalization is indicated when weight falls below 15% of ideal, and most investigators agree that therapy for the core symptoms cannot be undertaken until weight is restored. During the impatient stay, a behavior modification program can effectively organize medical, nutritional, and psychologic support, and offers the quickest and most direct route to weight restoration. The nasogastric tube and total parenteral nutrition are used primarily for those who are severely emaciated or who actively resist standard modes of therapy. Inpatient treatment is most effectively and efficiently rendered in a specialized eating disorder unit. Once weight restoration is progressing, behavior therapy for core symptoms is commenced and continued on an outpatient basis. A variety of behavioral techniques are employed, and they are designed primarily to influence anorectic assumptions and beliefs. Although there may be a brief inpatient stay for initiation of treatment, the bulk of therapy for bulimia occurs on an outpatient basis. The available literature indicates that behavioral techniques and antidepressant medication are effective for the symptoms of bulimia. Early identification of core symptoms of both disorders can lead to an initiation of treatment before the core symptoms become ingrained. A potentially more effective
Komori, K; Arai, H; Gotoh, T; Imazu, T; Honda, M; Fujioka, H
A 27-year-old woman had been suffering from bulimia and habitual vomiting for about 7 years and was incidentally found to have right renal stones by computed tomography. She was referred to our hospital for the treatment of these caluculi. On admission, she presented with hypokalemia, hypochloremia and metabolic alkalosis and was diagnosed with anorexia nervosa. Following successful removal by percutaneous nephrolithotripsy and extracorporeal shockwave lithotripsy the stones were found to consist of pure ammonium urate. Since the urine of an anorexia nervosa patient tends to be rich in uric acid and ammonium, anorexia nervosa seems to be associated with ammonium urate urinary stones. PMID:11107533
Yanovski, S Z
Eating disorders are associated with numerous biological perturbations; however, sorting out cause from effect is difficult. Neuroendocrine and metabolic abnormalities are seen in both anorexia nervosa and bulimia nervosa, but they have not been described in binge eating disorder, in which neither starvation nor compensatory behaviors are present. Although these findings may reflect biologic differences among subgroups of binge eaters, an alternative explanation is that many of the biological correlates of binge eating are the result of metabolic derangement secondary to starvation and/or purging. The identification of binge eating disorder provides an opportunity to study the causes and concomitants of binge eating in the absence of compensatory behaviors. PMID:8820523
Marazziti, D.; Macchi, E.; Rotondo, A.; Placidi, G.F.; Cassano, G.B.
Platelet /sup 3/H-imipramine binding was investigated in 8 patients affected by bulimia according to DSM III criteria, and in 7 health volunteers. The Bmax /+ -/SD (fmol/mg protein) was 356 /+ -/ 53 in patients, and 1144 /+ -/ 134 in controls. The Kd /+ -/ SD (nM) was 1.35 /+ -/ 0.44 in patients, and 1.90 /+ -/ 0.72 in controls. There was a significant difference in Bmax values in the two groups, whereas no significant difference was observed in Kd values. This study suggests the possible involvement of the indoleamine system in bullimia.
Wolfe, Barbara E; Dunne, Julie P; Kells, Meredith R
Eating disorders are chronic psychiatric illnesses with significant medical complications, psychological distress, and psychiatric comorbidity. Although many patients are treated on an outpatient basis, inpatient care for the more severely ill hospitalized patient can be challenging given the severity of illness and concurrent issues requiring intervention. This article provides an overview of the clinical characteristics of eating disorders typically seen for inpatient care, focusing primarily on anorexia nervosa and bulimia nervosa, and the associated key areas for nursing assessment, diagnoses, and plan of care during hospitalization. PMID:27229277
de la Gándara Martín, J J; de Dios Franco, A; Cerezo Rodríguez, P; Redondo Martínez, A L
Eight women and one man affected by the denominated "Dressing Disorder" are described. We show, analyze and discuss their social and demographic features, antecedents, onset and course, acquiring behaviours and its consequences, diagnosis, gnosographic features, results of the psychodiagnostic tests, evolutive relationships with the psychiatric diagnosis and treatment undergone. By the light of these data we propose a pathogenic scheme which remarks the importance of the Depression and Bulimia as precipitations or causative factors, because they give use to a low self-esteem and a use of anomalous defense mechanisms which origin the altered acquiring behaviours. Criteria for its diagnosis are proposed and more appropriate denominations are discussed. PMID:2075846
Thompson, Alexandra E; Clark, Camilla N; Hardy, Christopher J; Fletcher, Phillip D; Greene, John; Rohrer, Jonathan D; Warren, Jason D
Accounts of altered eating behavior in semantic dementia generally emphasize gluttony and abnormal food preferences. Here we describe two female patients with no past history of eating disorders who developed early prominent aversion to food in the context of an otherwise typical semantic dementia syndrome. One patient (aged 57) presented features in line with anorexia nervosa while the second patient (aged 58) presented with a syndrome more suggestive of bulimia nervosa. These cases add to the growing spectrum of apparently dichotomous behavior patterns in the frontotemporal dementias and illustrate a potentially under-recognized cause of eating disorders presenting in later life. PMID:26963051
Bertrand, Audrey; Bélanger, Claude; O'Connor, Kieron
Several similarities exist in the phenomenology of obsessive-compulsive disorder (OCD) and eating disorders (ED : anorexia nervosa and bulimia). Both disorders include obsessive thoughts and compulsive or ritualized behaviours. Furthermore, these two disorders frequently present with similar comorbid disorders. In this article, the authors examine similarities between ED and OCD, and whether eating disorders can be conceptualized as a variant of obsessive-compulsive disorders. This raises the possibility that treatments proven effective for OCD could be successfully adapted for ED. The authors consequently further examine both treatments utilized for both disorders. PMID:21983909
Rome, Ellen S
Anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified remain a significant cause of morbidity and mortality in girls and young women. Management of eating disorders typically requires a multidisciplinary team approach, often spear-headed by the clinician initially detecting the illness. This article addresses the definitions and prevalence of eating disorders, tips on recognition and management of medical complications, and reproductive health concerns for these young women. Issues surrounding care of the patient with the female athlete triad, or amenorrhea, osteopenia, and eating disorders, are also discussed. PMID:12836725
Wonderlich, Anna L; Ackard, Diann M; Henderson, Judith B
This study evaluated the association between childhood beauty pageants and adult disordered eating, body dissatisfaction, depression, and self-esteem. Eleven women who participated in childhood beauty pageants were matched on age and BMI with 11 non-participating women. Childhood pageant participants scored higher on body dissatisfaction, interpersonal distrust, and impulse dysregulation than non-participants, and showed a trend toward greater ineffectiveness. There were no significant differences between groups on measures of bulimia, body perception, depression, and self-esteem. These findings suggest childhood beauty pageant participation may influence adult body dissatisfaction, interpersonal distrust, and impulse dysregulation, but not bulimic behaviors, body perception, depression, and self-esteem. PMID:16864534
Thompson, Alexandra E.; Clark, Camilla N.; Hardy, Christopher J.; Fletcher, Phillip D.; Greene, John; Rohrer, Jonathan D.; Warren, Jason D.
ABSTRACT Accounts of altered eating behavior in semantic dementia generally emphasize gluttony and abnormal food preferences. Here we describe two female patients with no past history of eating disorders who developed early prominent aversion to food in the context of an otherwise typical semantic dementia syndrome. One patient (aged 57) presented features in line with anorexia nervosa while the second patient (aged 58) presented with a syndrome more suggestive of bulimia nervosa. These cases add to the growing spectrum of apparently dichotomous behavior patterns in the frontotemporal dementias and illustrate a potentially under-recognized cause of eating disorders presenting in later life. PMID:26963051
Volpe, Umberto; Tortorella, Alfonso; Manchia, Mirko; Monteleone, Alessio M; Albert, Umberto; Monteleone, Palmiero
Age at onset (AAO) of eating disorders has classically been described in adolescence. We analyzed data from 806 subjects with anorexia nervosa (AN) or bulimia nervosa (BN) and performed a normal distribution admixture analysis to determine their AAO. No significant differences were found concerning the AAO functions of AN and BN subjects. Both groups had a mean AAO of about 18 years. Most of the subjects with AN (75.3%) and BN (83.3%) belonged to the early onset group. The definition of AAO for ED may be crucial for planning treatment modalities, with specific consideration of their clinical history and course. PMID:27086237
Mercer, M E; Holder, M D
Extensive research indicates a strong relationship between endogenous opioid peptides (EOPs) and food intake. In the present paper, we propose that food cravings act as an intervening variable in this opioid-ingestion link. Specifically, we argue that altered EOP activity may elicit food cravings which in turn may influence food consumption. Correlational support for this opioidergic theory of food cravings is provided by examining various clinical conditions (e.g. pregnancy, menstruation, bulimia, stress, depression) which are associated with altered EOP levels, intensified food cravings, and increased food intake. PMID:9468764
Tamburrino, M B; Campbell, N B; Franco, K N; Evans, C L
Rumination has been reported to be a relatively rare disorder of eating during infancy. Over the past decade, there appears to be a renewed interest in and recognition of adult rumination. Although some authors believe adult rumination is benign, others have begun to link it with both eating disorders and depressive symptoms. This paper presents two adult cases whose rumination was associated with anorexia and bulimia nervosa. More identification and study of adult rumination is needed to clarify its course and medical significance. PMID:7894448
Forsberg, Sarah; Lock, James
Best-practice guidelines for the treatment of child and adolescent eating disorders recommend the inclusion of parents. Family-based treatment (FBT) posits that families are not only important in supporting their children but are critical change agents in the recovery process. As originally developed for anorexia nervosa, parents take a central role in managing and disrupting eating disorder symptoms. The most evidence-based treatment model for adolescent anorexia nervosa, FBT has also recently been found to be useful in the treatment of adolescent bulimia nervosa. This article provides a summary of the theoretic model, evidence base, and application of FBT. PMID:26092743
Robb, Adelaide S; Dadson, Michele J
Eating disorders are one of the rare psychiatric disorders with a large preponderance of female patients. The other articles in this issue review eating disorders in children and adolescents and focus primarily on female patients. This article reviews the eating disorders that occur in male children and teenagers, including anorexia nervosa, bulimia nervosa, binge eating disorder, a subtype of body dysmorphic disorder named muscle dysmorphobia, and obesity. This article reviews subgroups of boys who are at higher risk for developing eating disorders. The article commences with the difference in male perceptions of body image and dieting behaviors. PMID:12109328