19 Bulimia Nervosa

Question 1

What is the prevalence of Bulimia Nervosa?

Answer 1

1-3% lifetime prevalence

Question 2

What are the 2 symptoms in the A criterion for Bulimia Nervosa?

Answer 2

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

Question 3

What is the B criterion for Bulimia Nervosa?

Answer 3

B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.

Question 4

What is the C criterion for Bulimia Nervosa? (Frequency)

Answer 4

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.

Question 5

What is the D criterion for Bulimia Nervosa?

Answer 5

Self-evaluation is unduly influenced by body shape and weight. [And not just self-evaluation; you think other people judge you in the same way]

Question 6

What’s the difference between Anorexia Nervosa binge-eating/purging type and Bulimia Nervosa?

Answer 6

Disorder is classed as AN if the weight loss is beyond a certain point (i.e. BMI 18 or equivalent). So the two disorders can, in some cases, differ only in the weight of the patient. So a patient with fluctuating weight would fluctuate between diagnoses.

Question 7

What causes the damage in BN –the binge-eating or the purging?

Answer 7

The purging.

Question 8

Are people with BN usually underweight?

Answer 8

No. Usually normal or overweight. 10-15% are obese.

Question 9

What are 5 health problems associated with BN?

Answer 9

1. Heart problems (similar to AN)
2. Irritable bowel syndrome
3. Vomiting destroys teeth
4. Throat problems including cancer
5. Dry skin because of electrolyte balance

Question 10

What biological factors predict BN?

Answer 10

1. Family history of BN
2. Family predisposition for obesity
3. Family history of substance abuse

Question 11

What 2 social factors are associated with BN?

Answer 11

1. Report teasing about shape and weight

2. Interpersonal relationships usually not great

Question 12

What 3 psychological factors are associated with BN?

Answer 12

1. Low self-esteem
2. Neuroticism
3. Dysfunctional thinking, especially related to weight

Question 13

Describe Stice’s dual pathway model of BN (2001)

Answer 13

Three inter-relating factors:
Dietary restriction
Negative affect
Binge-eating

Binge-eating episodes are triggered by dietary restriction and/or negative affect. The binges then increase dietary restriction and negative affect.

Question 14

Describe Fairburn’s cognitive model for BN (1986)

Answer 14

Overevaluation of weight, shape and control leads to

Strict dieting, which leads to

Binge eating, which leads to more dieting and overevaluation, as well as

Compensatory purging, which leads to

Binge eating, which…

Question 15

Does dieting predict binge eating?

Answer 15

Apparently not, according to Evelyn’s review of 26 studies.

Question 16

What did Evelyn find were the results on binge eating of putting normal weight to obese adults on a low-calorie diet?

Answer 16

A decrease both in weight AND in binge-eating.

Question 17

What may be the reason why studies such as Ancel Keys (1950) starvation study might have led to binge-eating?

Answer 17

Starvation studies use high carb diet. This may cause binge-eating.

Question 18

Describe the Keys (1950) Starvation Study. Why is this study important?

Answer 18

Done in 1950s. 32 men were given 1500 calories of hi-carb food – turnips, rice potatoes. War diet. Had to live in the hospital. Had to do 11k walking per week. Had to lose kilo per week, and if didn’t lose weight, less food. Until lose 25% of bodyweight – until 16 BMI. Then established maintenance diet.

As soon as given food freely, they started to binge eat. This normalised around 5 months later. The results of this study are why specialists suggest that dieting causes binge eating. NONSENSE –IT ALSO MAKES SENSE A PRIORI.

Question 19

What results have been observed in dieting programs for Bulimics? Burton and Stice (2006)

Answer 19

In their six-week program, Burton and Stice (2006) found significant reduction in binge eating and compensatory behaviors and a slight reduction in weight, maintained at 3-month follow up.
Effect size for the reduction in binge eating was comparable to the effects of 20 sessions of CBT (i.e. healthy diet: r=.50 versus CBT r=.55).

Question 20

Is there any evidence that dieting comes BEFORE binge-eating?

Answer 20

No. Binge-eating often comes before dieting.

Question 21

What is the usual clinical practice regarding binge-eaters and diets, and why does this run counter to the evidence?

Answer 21

Clinical practice is to get binge-eaters off dieting and onto a regular eating plan. But there is no evidence that dieting causes binge-eating.

Question 22

What 5 therapies have proven efficacy for Bulimia Nervosa?

Answer 22

1. Motivational enhancement therapy (MET)
2. Dialectical behavioural therapy
   –DBT combines cognitive behavioural techniques with distress tolerance, mindfulness exercises and interpersonal training
3. Drugs –SSRIs, Prozac is FDA-approved for Bulimia
4. CBT
5. Interpersonal psychotherapy

Question 23

What are the 6 steps in Fairburn’s 1995 self-help manual for Bulimia Nervosa?

Answer 23

1. Getting started –daily record of eating and weight control behaviours and their triggers
2. Regular eating–3 main meals and 3 snacks
3. Alternatives to binge –e.g. socialising, walking
4. Problem-solving –dealing with stressful situations
5. Stopping dieting
6. Preventing relapse –deal with ongoing problems (e.g. relationship difficulties, anxiety, low SE

Question 24

How effective is CBT for BN?

Answer 24

Not very. Only around 27% of patients recover.