Lecture 14 Bulimia Flashcards
DSM-5 criteria for Bulimia Nervosa
- Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- 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.
- 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). - 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.
- The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
- self-evaluation unduly influenced by body shape and weight
- disturbance does not occur exclusively during episodes of anorexia nervosa
BN specifier
in partial remission: after full criteria for BN were previously met, but not all, of the criteria have been met for a sustained period of time
in full remission: after full criteria for BN previously met, none of the criteria have been met for a sustained period of time
epidemiology of BN
came to attention of professionals in the 1970s
occurs predominantly in women
co-varies with dieting
comorbid condition
substance abuse depression suicidality personality disorders anxiety disorders
assessment of BN
Eating Attitudes Test -26
Eating Disorders Inventory -3
Eating Disorders Examination
Treatment
CBT-E: CBT for BN
- lasts 20 weeks
- semi-structured
- problem-oriented
- concerned with present and future (rather than the past)
- 3 stages of treatment
3 stages of CBT-E
stage 1:
- establish sound therapeutic relationship
- educate the patient about the cognitive view on the maintenance of BN and to explain the need for both behaviour and cognitive change
- establish regular weekly weighing
stage 2:
- educate about body weight regulation, adverse effects of dieting, physical consequences of binge eating, self-induced vomiting and laxative use
- reduce frequency of overeating by introducing a pattern of regular eating and use of alternative behaviour
- reduce secrecy and enlist the cooperation of friends and relatives
- tackling dieting
- enhance problem-solving skills
- addressing concerns about shape and weight
- addressing other cognitive distortions
stage 3:
- 3 interviews at 2 week intervals
- ensure progress maintained
- relapse prevention
- maintenance of change
- problematic goal of abstinence
- awareness of vulnerability factors
- maintenance of skills for dealing with high risk situations
- plan for dealing with setbacks
cognitive view of the maintenance of bulimia nervosa
low self-esteem, extreme concerns about shape and weight, strict dieting -> binge-eating, self-induced vomiting
therapist skills
-technical competence
-establishing an effective
therapeutic relationship
-nurturing a commitment to change
-maintaining a specific therapeutic focus
-expertise and experience
therapeutic relationship
-be credible
-be caring and non-
judgemental
-develop a collaborative relationship
-balance empathy with firmness
-be positive
-gender issues
elimination of dieting
- stress the importance of ceasing to diet and provide education about weight gain
- assess food avoidance and systematically introduce avoided foods into planned meals or snacks (therapist-assisted exposure)
- relax other controls over eating
importance of prescribed regular eating pattern
- it begins to break down dieting
- it restores a sense of control
- it disrupts learned association between urges/triggers (emotional and situational) to eat or binge
problem with CBT approach
only focus on present and future, doesn’t account for past trauma
no treatments have been developed specifically
for clients with comorbid PTSD and eating disorders.
because PTSD and eating disorders share many common biological and psychological features, it is possible that treatment for one disorder could result in improvement of symptoms for the other.
Cognitive behavioral therapies (CBTs), including CBT- Enhanced for Eating Disorders (CBT-E )19 and Cognitive Processing Therapy for PTSD (CPT 20)20 are recommended for both disorders.
CPT has two forms, one that involves a written trauma narrative plus cognitive therapy to challenge and address problematic cognitions about the trauma, one’s self, and the world, and a second form, CPT-C, that uses cognitive therapy without the written trauma account. Both are effective treatments for PTSD
FBT for BN
no evidence-based treatment for adolescent with BN, FBT as the first
family-based approach: adapted FBT for AN to BN
major difference between FBT for AN and BN: adolescent with BN is encouraged to collaborate with parent in their effort at recovery
more collaborative because of ego-dystonic nature of BN in adolescent, whereas symptoms in AN are ego-syntonic
ego-syntonic: ideas acceptable to the self, compatible with one’s values and ways of thinking
also differnt: BN is more tied with other trauma, no obvious weight loss like AN
secretive nature of BN, no obvious signs of starvation, greater independence in adolescents with BN -> parents motivation for treatment lower
can be derailed by comorbidities
phases of treatment
phase 1: primary goal is for parent to re-establish healthy eating in adolescent, supervise post-meal time to prevent occurrence of compensatory behaviours
-family meal with therapist, aims to empower the parents in their ability to re-establish healthy eating
phase 2: begins only when the adolescent’s eating is normalised, control gradually returned to adolescent
phase 3: starts when adolescent can eat normally without parental supervision, general adolescent and family issues are addressed
