8 Key excerpts on "Bulimia Nervosa"

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  eBook - ePub

  Working With Eating Disorders

  A Psychoanalytic Approach

  • Geraldine Shipton(Author)
  • 2017(Publication Date)
  • Bloomsbury Academic

    (Publisher)

  4

  BULIMIA NERVOSA

  Bulimia Nervosa was not fully distinguished from anorexia as a clinical condition, until Gerald Russell published a paper on it in the UK in 1979, though it has been associated with anorexia since the early writings of Gull (1873). Bulimia Nervosa has been described as ‘a syndrome characterised by repeated bouts of overeating and an excessive preoccupation with the control of body weight, leading to a pattern of overeating followed by vomiting or use of purgatives … often but not always with a history of an earlier episode of anorexia nervosa’ (ICD-10, p. 352). For a diagnosis to be made, the following should all be present:

    Persistent preoccupation with eating and an irresistible craving for food with bouts of overeating in which large amounts of food are consumed in a short period of time.

    Behaviour designed to counteract the effects of the above by using one or more of the following: self-induced vomiting, purging, alternating periods of starvation, use of appetite suppressants, thyroid preparations or diuretics.

    A morbid fear of fatness with a low target weight set.

  Another variant, atypical Bulimia Nervosa, has been distinguished as similar but ‘without a significant weight change or the typical over concern about body shape and weight may be absent’ (ICD-10, p. 353). The Royal College of Psychiatrists (2000) commissioned a survey of services for people with eating disorders and found ‘many cases represent intermediate forms’ (2000: 11) and would not fit neatly into their categories of anorexia nervosa, Bulimia Nervosa and binge eating disorder. This latter is ‘bingeing without compensatory behaviour’, and is associated with obesity and increased mortality rate.

  People who binge and vomit or who purge may also have enlarged salivary glands, electrolyte imbalance which can predispose them to fits and cramps, and they may have damaged the enamel on their teeth by vomiting. They may also develop long-term constipation, though short-term they are likely to have stomach cramps and diarrhoea. If they restrict their food intake too, they may have the additional symptoms outlined in Chapter 3

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  eBook - ePub

  The SAGE Encyclopedia of Abnormal and Clinical Psychology

  • Amy E. Wenzel(Author)
  • 2017(Publication Date)
  • SAGE Publications, Inc

    (Publisher)

  Joanna M. Marino Joanna M. Marino Marino, Joanna M.

  Diana L. Gaydusek Diana L. Gaydusek Gaydusek, Diana L.

  Bulimia Nervosa Bulimia Nervosa

  575 578

  Bulimia Nervosa

  Bulimia Nervosa is an eating disorder marked by recurrent episodes of binge eating (i.e., episodes of eating during which there is a perceived loss of control and an objectively large amount of food eaten in a short period of time) coupled with inappropriate compensatory behavior (e.g., self-induced vomiting or laxative misuse). An objectively large amount of food is generally viewed as a portion that is at least 3 times the typical portion size for that food. Bulimia Nervosa tends to be a secretive eating disorder, marked by feelings of shame associated with binge eating, and the utilization of compensatory strategies to counter the effects of a binge, namely fear of weight gain and a feeling of fullness. Individuals with Bulimia Nervosa, similar to individuals diagnosed with anorexia nervosa, have a marked preoccupation with body shape and size and/or desire to control body weight. Generally, individuals with Bulimia Nervosa have body weights that are within a normal weight or overweight range (body mass index between 18.5 and 30 in adults).

  The lifetime prevalence of Bulimia Nervosa ranges from 1% to 3% of the population, and the majority (75%) of those diagnosed with bulimia are women. The mean lifetime prevalence estimate is 1.0% for young females in western Europe and the United States, and rates of subthreshold bulimia (i.e., meeting all but one of the Diagnostic and Statistical Manual of Mental Disorders [DSM

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  eBook - ePub

  The Wiley Encyclopedia of Personality and Individual Differences, Set

  • (Author)
  • 2020(Publication Date)
  • Wiley

    (Publisher)

  AN is characterized within the DSM‐V as: (1) persistent restriction of energy intake resulting in significantly low body weight; (2) intense fear of gaining weight or becoming heavy, or persistent behaviors that interfere with necessary weight gain; and (3) disturbance in the way one’s body weight or shape is experienced. Two subtypes may also be specified within the diagnosis of AN when appropriate: (1) Restricting, describing presentations of symptoms in which only caloric restriction and/or excessive exercise are present or (2) binge/purge (AN‐BP), describing presentations where binge eating and purging behaviors (e.g. self‐induced vomiting, laxative misuse) are also present, concurrent with the first three diagnostic AN criteria. Any patient presenting with binge/purge symptoms who is also underweight will be given a diagnosis of AN instead of Bulimia Nervosa, described below.

  Bulimia Nervosa

  Bulimia Nervosa (BN) is characterized in the DSM‐V as: (1) recurrent episodes of binge eating, (2) recurrent, inappropriate compensatory behavior in order to prevent weight gain such as: self‐induced vomiting; misuse of laxatives, diuretics, or other medications; restricting caloric intake; or excessive exercise, (3) self‐evaluation being unduly influenced by body shape and weight. Episodes of binge eating under the BN diagnosis are characterized as “Eating, in a discrete period of time (e.g. 2 hours), an amount of food that is definitely larger than most people would eat during a similar period of time under similar circumstances and having a sense of lack of control over the eating during the episode.” For a diagnosis of BN to be made, these behaviors must be occurring, on average, at least once a week for at least three months.

  Binge‐Eating Disorder

  Binge‐eating disorder (BED) was added as its own categorical ED in DSM‐V. Similar to BN, the first defining feature of BED is recurrent episodes of binge eating during which an individual consumes, in a discrete time period (e.g. 2 hours), an amount that is “definitely larger” than what most people typically consume in a similar span of time under similar circumstances. However, unlike Bulimia Nervosa, BED episodes of binge eating are not regularly followed by the use of inappropriate compensatory behaviors.

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  eBook - ePub

  Treating Bulimia Nervosa and Binge Eating

  An Integrated Metacognitive and Cognitive Therapy Manual

  • Myra Cooper, Gillian Todd, Adrian Wells(Authors)
  • 2008(Publication Date)
  • Routledge

    (Publisher)

  CHAPTER 2 Diagnosis and assessment

  This chapter describes the main features and the diagnostic criteria for Bulimia Nervosa. It provides a brief summary of the epidemiology of BN, comorbidity and differential or additional diagnosis issues. The process of undertaking an assessment with the patient is then covered in some detail, including information on the usefulness of establishing a history of anorexia nervosa (AN), how to identify BN as the primary problem, suitability for the new treatment and advice on appropriate assessment measures. A detailed Clinical Interview Proforma is provided to help clinicians undertake the pre-treatment assessment. This covers the main areas in which information is required to undertake the new treatment.

  THE KEY FEATURES OF Bulimia Nervosa

  As the brief portrait of Jessica in Chapter 1 . suggests, Bulimia Nervosa is a serious mental health problem with significant negative consequences for sufferers. Families and friends are often affected, and the burden in caring for sufferers can be high, particularly when the problem is long term.

  Bulimia Nervosa is characterised most dramatically by recurrent episodes of binge eating. A very large amount of food may be consumed. A review suggests that the number of calories consumed in a typical ‘binge’ for those with a diagnosis of Bulimia Nervosa (e.g. American Psychiatric Association 2000) ranges from 1,110 to 4,394 (Guertin 1999). The patient experiences a sense of loss of control over eating during a binge. The patient often describes feeling unable to stop eating once they have tasted a desired food and many believe their insatiable hunger or emptiness drives their bingeing.

  Binge eating is followed by inappropriate compensatory behaviour, including self-induced vomiting, misuse of laxatives, diuretics, enemas, medications (such as diet pills), fasting or excessive exercise. A minority of patients may also use illicit drugs such as cocaine or ecstasy. Some buy drugs (e.g. thyroxin) over the internet that are normally available only with a medical prescription, in order to reduce their appetite and increase their metabolism. Some buy such drugs (e.g. ipecac) to aid vomiting or to function as a compensatory behaviour following bingeing, although this is not typical of the majority of those with BN. These more extreme, destructive behaviours are often associated with severe personality dysfunction, particularly Cluster B personality disorders (American Psychiatric Association 2000). Such patients may also engage in self harm, including overdosing, parasuicidal behaviour, cutting, burning or other extreme self-punishing behaviours. In patients where extreme behaviour functions as self punishment, the behaviour is usually best conceptualised and treated as self harm. Alternatively, treatment for borderline personality disorder may be most appropriate.

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  eBook - ePub

  The Handbook of Child and Adolescent Clinical Psychology

  A Contextual Approach

  • Alan Carr(Author)
  • 2015(Publication Date)
  • Routledge

    (Publisher)

  17 Anorexia and Bulimia Nervosa DOI: 10.4324/9781315744230-17 Anorexia nervosa and Bulimia Nervosa are the main eating disorders of concern in child and adolescent clinical psychology (American Psychiatric Association, 2006 ; Agras, 2010 ; Le Grange & Lock, 2011 ; Lock, 2012 ; NICE, 2004c). These eating disorders typically have their onset in adolescence. In both conditions there is an over-valuation of body shape and weight, with self-worth being judged almost exclusively in terms of these personal attributes. With anorexia, the primary feature is the maintenance of a very low body weight, whereas with bulimia the main feature is a cycle of binge eating and self-induced vomiting or other extreme weight control measures including dieting, excessive exercise, and laxative use. An example of a typical eating disorder case is presented in Box 17.1. Eating disorders are of concern because they are dangerous (Arcelus et al., 2011 ; Gowers, 2013 ; Klump et al., 2009 ; Mitchell & Crow, 2010 ; Steinhausen, 2011). In chronic cases they lead to many medical complications including growth retardation, osteoporosis, gastrointestinal bleeding, dehydration, electrolyte abnormalities and cardiac arrest. The mortality rate among women with anorexia is 12 times that of the normal population and about double that in other psychological disorders such as schizophrenia, bipolar disorder or depression. Eating disorders are associated with a raised suicide risk. It is ironic that in our Western industrialized culture where food is plentiful, self-starvation and a pattern of bingeing and purging are major problems affecting teenage girls. In this chapter, after considering the classification, clinical features and epidemiology of eating disorders, a variety of theoretical explanations concerning their aetiology will be considered along with relevant empirical evidence

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  eBook - ePub

  Hope with Eating Disorders Second Edition

  a self-help guide for parents, friends and carers

  • Lynn Crilly(Author)
  • 2019(Publication Date)
  • Hammersmith Health Books

    (Publisher)

  I felt very powerful while I was anorexic because I thought I was in control of everything and this is the danger with this illness. At the same time, my back was hurting all the time, I couldn’t sleep on my front as I was in constant pain, I saw myself huge in the mirror whereas, in reality, I was terribly skinny and felt down. It was a daily battle in my head with this bitchy voice telling me I was fat. I thought I was becoming crazy. It was different with bulimia, I felt lonely and ashamed most of the time, really diminished as a human being because I was not able to control myself anymore.

  Bulimia shares some characteristics with self-harm, the binge-and-purge cycle providing a release for emotional tension and a way to inflict punishment on the body for feelings of guilt or inadequacy. Again, as with anorexia nervosa, it is not certain that significant trauma has occurred in the sufferer’s past. The contingent factor is the person’s sensitivity and innate inability to cope with difficult situations, rather than the severity of their life circumstances.

  There are, though, some common factors between the two conditions: just as with anorexia, there are many different ways to suffer from bulimia. Like anorexia, bulimia is a mental illness with physical symptoms. Also, like anorexia, it is sadly still woefully misunderstood, although steps are now being taken to raise awareness.

  Bulimia Nervosa is distinguished by the act of bingeing and purging. Sufferers first gorge on a huge amount of food (either objectively speaking, or what they consider to be a huge portion), and this is followed by what are known as ‘compensatory behaviours’. These ‘behaviours’ most commonly involve sufferers forcing themselves to vomit, taking laxatives, or a combination of the two. This is often coupled with periods of starvation, excessive exercising or even sleeping for large quantities of time to ‘work off’ the calories consumed.

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  eBook - ePub

  Eating and Weight Disorders

  • Carlos M. Grilo(Author)
  • 2014(Publication Date)
  • Psychology Press

    (Publisher)

  4 Understanding, assessing, and treating Bulimia Nervosa    

  Introduction

  Bulimia Nervosa (BN) has been the focus of aggressive research efforts since Russell's (1979) paper describing Bulimia Nervosa. The striking convergence of several descriptive accounts of Bulimia Nervosa that soon followed from several countries stimulated research on this problem (Abraham & Beumont, 1982; Fairburn & Cooper, 1982; Pyle et al., 1981). In the two decades that followed, considerable progress has been achieved. As noted in chapter 2 , there remains uncertainty about the exact nature of the distribution of BN and very little is known about its etiology or development. Thus, additional research is necessary to inform how to proceed with prevention or early intervention programs. In contrast, progress has been made in understanding factors that serve to maintain the disorder. This, in turn, has resulted in considerable progress in establishing the utility of certain treatments. Text Box 4.1 gives some clinical examples of Bulimia Nervosa. The chapter then continues with an overview of the major assessment issues relevant to BN followed by a summary of the major research findings about treatments.

   

  Assessment of Bulimia Nervosa

  The assessment of BN is complicated by a number of factors. First, many persons with BN are tremendously embarrassed and ashamed about their problem and are frequently unwilling to reveal it. The secrecy frequently goes beyond just shame. For instance, in many instances when friends, family, or even health care providers inquire about these problems, persons with BN will deny the problem. This denial is very different from the denial characteristic of many persons with anorexia nervosa (AN). In AN, the denial of the

  TEXT BOX 4.1

  Clinical examples of Bulimia Nervosa

  J.S. is a 19-year-old single white female. She had always been average weight but tended to feel slightly overweight. During her freshman year in college she gained 25 pounds. When she returned home for the summer, she felt a bit uncomfortable wearing light clothes. Within a week's time she either perceived or was the recipient of several unkind teasing comments from several peers and an unsupportive comment from her mother. She decided to diet and began to decrease her eating and began to exercise. She returned to college ten pounds lighter and continued to diet reasonably. Several of her peers living in her dorm suite had also begun to diet during the summer and they all began to share their experiences and to try to support each other.

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  eBook - ePub

  The Wiley Handbook of Eating Disorders

  • Linda Smolak, Michael P. Levine(Authors)
  • 2015(Publication Date)
  • Wiley-Blackwell

    (Publisher)

  18, 165–179.
• Keel, P. K., Dorer, D., Eddy, K., Franko, D., Charatan, D., & Herzog, D. (2003). Predictors of mortality in eating disorders.
  Archives of General Psychiatry
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• Kent, A., Goddard, K., van den Berk, P., Raphael, F., McCluskey, S., & Lacey, J. H. (1997). Eating disorders in women admitted to hospital following deliberate self-poisoning.
  Acta Psychiatrica Scandinavica
  , 95, 140–144.
• Lacey, J. H. (1993). Self-damaging and addictive behavior in Bulimia Nervosa: A catchment area study.
  British Journal of Psychiatry
  , 163, 190–194.
• Lacey, J. H., & Evans, C. D. H. (1986). The impulsivist: A multi-impulsive personality disorder.
  British Journal of Addiction
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• Lacey, J. H., & Mourelli, E. (1986). Bulimic alcoholics: Some features of a clinical population.
  British Journal of Addiction
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• Lasègue, C. (1873). De l'anorexie hysterique [Of hysterical anorexia].
  Archives Generales de Médecine
  1, 385–403.
• Lopez, A., Yager, J., & Feinstein, R. E. (2010). Medical futility and psychiatry: Palliative care and hospice care as a last resort in the treatment of refractory anorexia nervosa.
  International Journal of Eating Disorders
  , 43, 372–377.
• McIntosh, V. W., Jordan, J., & Bulik, C. M. (2010). Specialist supportive clinical management for anorexia nervosa. In M. Grilo & J. E. Mitchell (Eds.),
  The treatment of eating disorders: A clinical handbook
  (pp. 108–129). New York: Guilford Press.
• McIntosh, V. W., Jordan, J., Luty, S. E., Carter, F. A., McKenzie, J. M., Bulik, C. M., & Joyce, P. R. (2006). Specialist supportive clinical management for anorexia nervosa.
  International Journal of Eating Disorders
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• Morgan, J. F., & Lacey, J. H. (1999). Scratching and fasting: A study of pruritus and anorexia nervosa.
  British Journal of Dermatology
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• Morgan, J. F., Lacey, J. H., & Reid, S. (1999). Anorexia nervosa: Changes in sexuality during weight restoration.
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