Bulimia Nervosa

Question 1

Bulimia Criterion A:

Answer 1

Recurrent episodes of binge eating, characterised by

1. eating a large amount of food in a small frame of time
2. a sense of lack of control during the episode (one cannot control how much they eat or when to stop)

Question 2

Bulimia Criterion B:

Answer 2

Recurrent inappropriate compensatory behaviours to prevent weight gain, such a vomiting, laxatives, fasting or excessive exercise

Question 3

Bulimia Criterion C:

Answer 3

once a week for 3 months

Question 4

What are the severity criteria for mild, moderate, severe or extreme?

Answer 4

mild 1-3 times
moderate 4-7 times
severe 8-13 times
extreme >14 times

Question 5

Who does bulimia affect?

Answer 5

Predominantly women, particularly dieters

Question 6

What is bulimia co-morbid with?

Answer 6

anxiety, sexual assault, depression, substance abuse, personality disorder

Question 7

Bulimia Criterion D:

Answer 7

Self evaluation is unduly influenced by body shape and weight

Question 8

What physical symptoms are seen?

Answer 8

Eroded enamel of teeth - from stomach acid
Teeth marks on hands - rusel’s sign
stomach rupture - oesophagus rupture
dehydration
arrhythmia
depletion of electrolytes
massive pressure on muscles and blood vessels (which can rupture) as you’re going against gravity

Question 9

Name the three assessments used to diagnose BN, which is the most commonly used?

Answer 9

Eating attitudes test
Eating disorders inventory
Eating disorders examination

(EDE is most common)

Question 10

What are the four subscales of the EDE?

Answer 10

Restraint - over eating, dieting rules, avoidance of eating

Eating concern - preoccupation with food, fear of losing control, eating in secret, guilt when eating

Shape concern - importance of shape, satisfaction with shape, comfort with body shape, fear of gaining weight, etc

Weight concern - importance of weight, desire to lose weight, preoccupation with weight

Question 11

What kinds of things are important to consider during treatment?

Answer 11

acceptability
attrition rates
clinical effectiveness
speed of action
breath of effects
durability
cost effectiveness

Question 12

Briefly describe bulimia treatment

Answer 12

20 weeks, semi-structured, 3 stages

Question 13

What is the aim of stage 1?

Answer 13

1. establish therapeutic relationship - always check understanding, include them in assigning hw, and agenda-setting, caring, non-judgemental, collaborative relationship, balance empathy with firmness
2. Educate the patient on the cognitive view of BN and explain the need for both bx and cognitive change
3. Educate on body weight regulation, adverse effects of dieting, physical consequences of vomiting/laxatives, etc
4. Introduce regular eating and reduce secrecy - enlist cooperation of friends/family
5. Establish weekly weigh-in

Question 14

What is the aim of stage 2?

Answer 14

1. Tackle dieting - cease dieting, and ensure they understand that weight is often not changeable
2. Enhance problem-solving skills
3. Address cognitive distortions about shape and weight - use thought diary - cognitive restructuring - challenge thoughts - beliefs are hypotheses to be tested. What are the costs of holding onto beliefs?
4. Prescribe regular meals - use daily food record (refer to dietitian and ensures meal monitoring. Starvation study showed that reducing food intake led to bingeing.
5. Assess food avoidance - we have to “inoculated” or exposed to some foods so we can be more controlled with them and relaxed around them. This also disrupts learned bx with triggers to eat and bingeing (emotional/situational). 1 calorie lettuce = 1 calorie chocolate

Question 15

Patients think that the urge to binge _______ and _______, but in reality, it will _______ if they wait it out. Try and use distractions/alternative activities

Answer 15

increases, increases, decrease

Question 16

What are the aims of stage 3?

Answer 16

aim is that progress is maintained - relapse prevention - training what to do during setbacks - awareness of vulnerability factors

Question 17

What is the cognitive view on the maintenance of bulimia?

Answer 17

Low self esteem –> extreme concerns about shape and weight –> strict dieting –> binge eating –> vomiting/laxatives –> low self-esteem/feelings of disgust

Question 18

When you have BN it is important to have a _____ _____and make sure you have a range of things to do

Answer 18

balanced lifestyle

Question 19

What is the Levi’s Principle?

Answer 19

patients have a firm belief that their weight is governed by their Jeans NOT their Genes. Place value of themselves on their jean size

Question 20

______ ______ is important in younger patients, as family members could be partly responsible for maintenance of the disorder

Answer 20

family therapy

Question 21

What is the difference between lapse and relapse?

Answer 21

Relapse is back to the beginning - square 1. This rarely happens. Patients are trained for the prevention of lapses.

Question 22

Acceptance and change…what do BN patients learn about this?

Answer 22

accept the things they cannot change - can’t control their weight. And accept who they are - social pressures, perfectionism not helping them. Changing maladaptive behaviours