L16 - Bulimia Nervosa

Question 1

What is Bulimia Nervosa (BN) characterised by?

Answer 1

Recurrent episodes of binge eating in a discrete time period (2 hrs).
- more than most would eat, lack of control.
Followed by recurrent inappropriate compensatory behaviours.
- e.g. vomiting, laxatives, diuretics, fasting, exercise.
On average at least once a week for ≥ 3 months.

Severity: Mild (1-3), Moderate (4-7), Severe (8-13), Extreme (≥14).

Question 2

What are the common comorbid disorders with BN?

Answer 2

• Substance Disorder.
• Depression.
• Anxiety.
• Suicidality.
• Personality Disorders (BPD is common).

Question 3

How can BN be assessed in a clinical setting?

Answer 3

• Eating Attitudes Test (Garner & Garfinkel, 1979).
• Eating Disorders Inventory (Garner, 2004): commonly used.
• Eating Disorder Examination EDE (Cooper & Fairburn, 1987).

Question 4

What are the main features of Cooper and Fairburn’s (1987) Eating Disorder Examination (EDE)?

Answer 4

• Most commonly used measure.
• 1 hr long.
• Has a self-report version (EDE-Q).
• Sensitive to change, reliable and valid.

Assesses 4 sub-scales:

1. Restraint (over-eating, food avoidance).
2. Shape Concern (flat stomach, dissatisfaction, feel fat).
3. Eating Concern (Preoccupation with food/eat/calories, social eating, guilt).
4. Weight Concerns (desire to lose weight, importance of weight).

Question 5

What is the Cognitive Model of BN?

Answer 5

Low self-esteem -> concerns about shape/weight -> strict dieting -> binge-eating -> self-induced vomiting/laxative use.

Positive feedback loop.

Question 6

What are some of the considerations to take into account before treating for BN?

Answer 6

• Acceptability.
• Attrition rates.
• Clinical effectiveness.
• Speed of action.
• Breadth of effects (stop bingeing, lift mood).
• Durability of effects.
• Cost effectiveness.

Question 7

What is CBT-E?

Answer 7

CBT-E stands for Cognitive Behavioural Therapy-Enriched, and aims to teach patients how to change eating habits, thinking style, and low self-esteem, usually over 20 weeks.

Question 8

What is the aim of Stage 1 in CBT-E?

Answer 8

Stage 1 (Sessions 1-8):

• establish good therapeutic relationship.
• educate on the cognitive view and it’s maintenance of BN.
• Identify need for cog. & behav. change.
• Educate on health risks of binge/purging.
• Reduce secrecy and increase social support.

Question 9

What is the aim of Stage 2 in CBT-E?

Answer 9

Stage 2 (Sessions 9-16):

• tackle dieting.
• reintroduce enjoyable foods.
• enhance problem solving skills.
• address shape and weight concerns.
• address other cognitive distortions.

Question 10

What is the aim of Stage 3 in CBT-E?

Answer 10

Stage 3 (Sessions 17-19):

• 3 interviews at 2 week intervals.
• ensure progress is maintained.
• relapse prevention.
• teach skills to deal with high risk situations.