Bulimia Nervosa

Question 1

There are physical complications of Bulimia Nervosa, but what other complications are involved in the disorder?

Answer 1

Social, psychological; so many important aspects/memories of life are tainted by the disorder.

Question 2

What is the first criteria for the DSM-5 definition of Bulimia Nervosa, and what does it involve?

Answer 2

Recurrent episodes of binge eating, characterised by both of the following:

• eating, in a discrete period of time (e.g., a 2-hour period), an amount of food that is larger than what most individual’s would eat in a similar period, under similar circumstances.
• a sense of lack of control during the binge eating episode.

Question 3

What is the second criteria for the DSM-5 definition of Bulimia Nervosa?

Answer 3

Recurrent & inappropriate compensatory behaviours in order to prevent weight gain.

Question 4

What is the third criteria for the DSM-5 definition of Bulimia Nervosa?

Answer 4

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

Question 5

What are some behaviours involved in the second criteria of Bulimia Nervosa’s DSM-5 definition?

Answer 5

• self-induced vomiting;
• misuse of laxatives, diuretics, or other medications;
• fasting;
• excessive exercise.

Question 6

The two final criteria dimensions (4 & 5) for the DSM-5 definition of Bulimia Nervosa explain what?

Answer 6

• Self-evaluation is unduly influenced by body shape and weight.
• The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Question 7

Bulimia is similar to Anorexia in that one of the psychological causes are body image concerns. However, the two differ on many levels, particularly…

Answer 7

Age of onset.

Anorexia tends to start early, whereas Bulimia starts in adulthood.

Question 8

What are the two specifiers for the DSM-5 definition of Bulimia Nervosa?

Answer 8

• In partial remission; after full criteria was met, some, but not all, of the criteria have been met (for a sustained period of time).
• In full remission; after full criteria were previously met, none of the criteria have been met for a sustained period of time.

Question 9

Although Bulimia Nervosa has existed for a long time, when did it come to the attention of professionals?

Answer 9

In the 1970’s.

Question 10

It has been considered a ‘neurological’ disorder, why is this wrong and what kind of disorder is it?

Answer 10

It is a ‘cultural’ disorder because there is not something malfunctioning in the biology of a woman’s brain that is making them do this.

Question 11

Which gender does Bulimia Nervosa present in more?

Answer 11

Women.

Question 12

What is a lifestyle habit that tends to present with Bulimia Nervosa?

Answer 12

Dieting.

Question 13

What are 5 co-morbid conditions with Bulimia Nervosa?

Answer 13

• substance abuse.
• depression.
• suicidality.
• personality disorders.
• anxiety disorders.

Question 14

What are three eating disorder assessment tests that can be used to help with diagnosis, but what must be considered when implementing them?

Answer 14

• Eating Attitudes Test.
• Eating Disorders Inventory.
• Eating Disorders Examination.
  The clinician must get to know the person, understand the individual, not just numericise their distress.

Question 15

In the Eating Disorders Inventory test (EDI-3) what are some dimensions tested for that are characteristic of an eating disorder? (11)

Answer 15

• drive for thinness.
• bulimia.
• ineffectiveness.
• body dissatisfaction.
• interpersonal distrust.
• perfectionism.
• interoceptive awareness.
• maturity fears.
• asceticism.
• impulse regulation.
• social insecurity.

Question 16

What are the two most effective treatments for Bulimia Nervosa and for what age groups?

Answer 16

CBT (for adults).

Family-Based Therapy (for younger people).

Question 17

CBT-e is a therapy for Bulimia Nervosa (and other eating disorders), how long does it take and what does it involve?

Answer 17

• usually lasts 20 weeks.
• semi-structured.
• problem-orientated.
• concerned with present and future (rather than past).
• involves 3 stages of treatment.

Question 18

CBT-e is about getting the patient to change their perception on the self and the world. What is one fear they must confront?

Answer 18

The fear of regular eating.

Question 19

As a side note, from what philosophies did Cognitive Behavioural Therapy emerge from and what is taking over it now?

Answer 19

It emerged from Greek Stoicism and the philosophies of Marcus Aurelius. Now, it is being overtaken by applied Buddhism and mindfulness.

Question 20

What are the aims of Stage-1 in CBT-e? (sessions 1-8).

Answer 20

• establishing a sound therapeutic relationship.
• psychoeducation about the maintenance of BN and the need for both behavioural and cognitive change.
• establishment of weekly weighing.
• establishment of regular eating to reduce the frequency of overeating.
• reduce secrecy and enlist the help of family and friends.

Question 21

What are the aims of Stage-2 in CBT-e? (sessions 9-16).

Answer 21

• tackling the need to diet (which leads to binging/purging cycle).
• challenge the false beliefs about being overweight.
• enhance problem solving skills.
• address other cognitive distortions.

Question 22

What are the aims of Stage-2 in CBT-e? (sessions 17-19).

Answer 22

It is basically relapse prevention, with the sessions spread out at 2-week intervals. The aim is to ensure that progress is maintained.

Question 23

What is the cognitive view of the maintenance of Bulimia Nervosa? (and what does it leave out?)

Answer 23

1. Low self esteem, (leads to);
2. Extreme concerns about shape and weight, (leads to);
3. Strict dieting, (leads to);
4. Binge-eating, (leads to 1., 2., 3., and);
5. Self-induced vomiting, (leads to 1., and 4.).
   This view is missing out the influence of trauma.

Question 24

What must the therapist be skilled at?

Answer 24

Being good with people, establishing a trusting relationship, optimism that everyone can get better.

Question 25

The therapist’s role is not just about being nice, what is it really about?

Answer 25

Being firm, direct & truthful. It is important to challenge people but in balance with firmness.

Question 26

What are some medical complications associated with Bulimia Nervosa? (Even if the person appears to have a normal weight?)

Answer 26

Electrolyte imbalance from repeated purging as well as damage to the heart and other organs.

Question 27

What does a regular eating pattern normally involve?

Answer 27

Eating 3 meals per day, along with 2 snacks.

Question 28

What does evidence suggest about the efficacy of dieting?

Answer 28

That they generally NEVER WORK.

Question 29

When a patient with Bulimia Nervosa begins to remove dieting from their life and introduce structured eating, what else need to be addressed?

Answer 29

Foods that are normally feared or avoided should be reintroduced (exposure therapy). And other controlling attitudes toward food should be relaxed.

Question 30

Why is the prescription of a regular eating plan so important? (3 points).

Answer 30

Because it can stop the habit of dieting, restore a sense of control and break the association between certain (emotional/situational) triggers and the urge to binge.

Question 31

Research on food cravings suggest what?

Answer 31

The avoidance of a particular food, which you crave, is likely to result in eventually overeating that food.

Question 32

What is one problem with the CBT approach to Bulimia Nervosa?

Answer 32

It doesn’t address child sexual abuse, a common causal factor for Bulimia Nervosa. Must also address the psychological/emotional factors contributing to the maintenance of the illness IF you want to prevent relapse.

Question 33

Why might survivors of sexual abuse develop an eating disorder?

Answer 33

Because sexual abuse violates the boundaries of the self so dramatically that inner sensations of hunger, fatigue or sexuality become difficult to identify. Many abused people turn to food to relieve a range of tensions that have nothing to do with hunger. Furthermore, many survivors work to become very fat or thin in order to render themselves as unattractive, or, alternatively, create a ‘perfect’ body that makes them feel powerful and in control.

Question 34

Bulimia Nervosa is often a illness that develops after the onset of another mental disorder, which one? And is there a therapy that treats both together?

Answer 34

PTSD. No, there is no treatment for the comorbidity of Bulimia Nervosa and PTSD.

Question 35

What is a therapy for PTSD that can help with Bulimia Nervosa?

Answer 35

Cognitive Processing Therapy (CPT) that involves either a written trauma narrative and cognitive therapy OR CPT-C that uses cognitive therapy without the written trauma account.

Question 36

What is egosyntonic? What id egodystonic?

Answer 36

Egosyntonic: instincts and ideas fit with the individual’s values and self.
Egodystonic: instincts and ideas are distressing for the individual.

Question 37

Bulimia Nervosa is more likely to be egosyntonic or egodystonic? What about Anorexia Nervosa?

Answer 37

Bulimia Nervosa is more likely to be egodystonic, as their disorder is at odds with their values and they are likely to be distressed by it. Whereas Anorexia Nervosa is more likely to be egosyntonic, meaning the disorder aligns with their values - a perspective that is much harder to treat.

Question 38

Anorexia and Bulimia sometimes will develop into the other illness. Which is more likely to develop into which illness?

Answer 38

Anorexia is more likely to develop into Bulimia.

Question 39

Anorexia Nervosa can also have bingeing/purging behaviours. Why is it then classified as Anorexia and not Bulimia?

Answer 39

Because the weight is so low in the person that even if they still binge, their calorie intake is so restricted that they are at an incredibly low (risky) weight.