Myriam Sierra Puentes
En este artículo se realiza una reseña sobre los trastornos de la alimentación, anorexia y bulimia, la relación que hacen los individuos con este comportamiento y la prevalencia, características y tratamientos más efectivos empleados en la bulimia nerviosa. Además, algunas aproximaciones para establecer subtipos de bulimia diferentes a los del DSM-IV e investigaciones sobre este trastorno del comportamiento alimentario, como la bulimia nerviosa.
López-Ibor Aliño, J J; Cervera Enguix, S
Anorexia nervosa and bulimia nervosa are at the present moment, two well defined clinical entities among the group of the eating disorders. The psychopathological differentiation of both syndromes has a great importance for diagnosis and therapy. The authors make a phenomenological description, based on case histories of patients with diagnostics of anorexia and bulimia nervosa, and try to establish an approach to the essential symptomatology of those disorders. The presence of affective symptomatology--depressive, but not exclusively--in the eating behaviour disorders in general and particularly in bulimia nervosa, is nowadays interpreted as an unspecific emotional lability as a response to stressing situations. That is to say, it is a secondary depressive symptomatology, more than a primary mood disorder preceding or underlying bulimia. There is strong evidence in favour of a dysregulation of serotonin metabolism in patients with bulimia nervosa, in the sense of a reduced activity, which manifest itself clinically by binges with food with a high content in carbohydrates. High levels of 5-HT seem to induce increasing feelings of safety, fullness and lead to an interruption of eating. Fluoxetine and this active metabolite are selective inhibitors of the reuptake of 5-HT and their antibulimic effect could be mediated by this mechanism.
Echeverría Serrano, Elizabeth
La presente investigación tuvo como objetivo estudiar la relación entre bulimia nerviosa, estilos de afrontamiento y situaciones estresantes. Se realizó una investigación no experimental, participaron 345 mujeres universitarias y la selección fue por disponibilidad. Los instrumentos utilizados fueron el Inventario de Trastornos de la Conducta Alimentaria (EDI-2), Test de Escalas de Afrontamiento para adolescentes (ACS) y la Escala de Apreciación General del Estrés (EAE). El ...
Gargallo Masjuan, Maite
En la bulimia nerviosa, como en el caso de otros trastornos mentales, suele describirse con frecuencia una alta comorbilidad con otras patologías y/o trastornos psiquiátricos, y especialmente con trastornos de la personalidad. A pesar de que numerosos estudios analizan la relación existente entre trastornos de personalidad y trastornos de la alimentación, la importancia de ésta será contemplada de forma diversa y contradictoria en la literatura, donde la co-ocurrencia entre bulimia nerviosa y...
SECCIÓN ABIERTA - 2. INFLUENCIA DE LA ESPIRITUALIDAD EN LOS ESTILOS DE AFRONTAMIENTO DE PACIENTES CON BULIMIA Y ANOREXIA NERVIOSA // INFLUENCE OF SPIRITUALITY IN COPING STYLES OF PATIENTS WITH BULIMIA AND ANOREXIA NERVOSA
Marisa Edith Oviedo Romero
Full Text Available Basándose en el supuesto de que la espiritualidad es un factor que podría influir sobre los estilos de afrontamiento de las personas ante situaciones problemáticas, se analizó la influencia de la espiritualidad en el estilo de afrontamiento de pacientes diagnosticadas de anorexia y/o bulimia nerviosa.39 mujeres de Buenos Aires, Entre Ríos, San Luis y Mendoza (Argentina, fueron evaluadas mediante el Cuestionario de Modos de Afrontamiento (WCCL y el Inventario de Sistema de Creencias (SBI–15R.Los resultados mostraron una influencia moderada de la dimensión soporte social religioso (F(1;24= 2,094; p=0,054 en el uso y/o desarrollo del estilo de afrontamiento centrado en la evaluación, no así en los demás estilos, por parte de pacientes diagnosticadas de bulimia y/o anorexia nerviosa.
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Carrillo Durán, María Victoria
En la actualidad, existe una orientación muy fuerte hacia los factores sociales como causas de los Trastornos de la Conducta Alimentaria, anorexia y bulimia nerviosas, aunque esta comprobado que estas enfermedades son multicausales, parece existir una corriente de opinion contraria a la moda y sobre todo hacia la publicidad como causantes directos de estos trastornos, de la que se han hecho eco los medios de comunicación, y la opinion publica, por el efecto que producen las imágenes y la vent...
Rosalinda Guadarrama Guadarrama; Sheila Adriana Mendoza Mojica
Este estudio identifica los factores de riesgo de anorexia y bulimia nerviosa en estudiantes de preparatoria de acuerdo a su sexo. Se trabajó con 316 alumnos de ambos sexos de una escuela privada del nivel medio superior. Los instrumentos aplicados fueron el Test de Bulit y el Test de Actitudes Alimentarias, los cuales cuentan con propiedades psicométricas adecuadas a la población mexicana. Los resultados muestran que 17% de la muestra estudiada mostró síntomas de trastorno alimentario, pred...
Maite Gargallo Masjuán; Fernando Fernández Aranda; Rosa M. Raich
En la bulimia nerviosa, como en el caso de otros trastornos mentales, suele describirse con frecuencia una alta comorbilidad con otras patologías y/o trastornos psiquiátricos, y especialmente con trastornos de la personalidad. A pesar de que numerosos estudios analizan la relación existente entre trastornos de personalidad y trastornos de la alimentación, la importancia de ésta será contemplada de forma diversa y contradictoria en la literatura, donde la co-ocurrencia entre bul...
Maite Gargallo Masjuán
Full Text Available En la bulimia nerviosa, como en el caso de otros trastornos mentales, suele describirse con frecuencia una alta comorbilidad con otras patologías y/o trastornos psiquiátricos, y especialmente con trastornos de la personalidad. A pesar de que numerosos estudios analizan la relación existente entre trastornos de personalidad y trastornos de la alimentación, la importancia de ésta será contemplada de forma diversa y contradictoria en la literatura, donde la co-ocurrencia entre bulimia nerviosa y trastornos de personalidad oscila entre el 27-84% de los casos, siendo los trastornos de personalidad del cluster B, y especialmente el límite, los más frecuentemente descritos. A grandes rasgos, cabe señalar que en la literatura sobre los trastornos de la alimentación, trastornos de la personalidad comórbidos han sido generalmente asociados a diversos factores, tales como diagnóstico, mayor impulsividad y auto-agresiones, mayor abuso de sustancias tóxicas, intentos de suicidio, mayor frecuencia de conductas de purga, trastornos afectivos, abuso sexual, mayor comorbilidad y severidad del trastorno. Asimismo, los trastornos de la personalidad han sido identificados como predictores de peor pronóstico y asociados a una mayor frecuencia de abandonos del tratamiento. En el presente estudio teórico, se analizan de forma crítica los estudios aparecidos en la literatura, durante las últimas dos décadas, sobre este tema.
Full Text Available Se presenta un caso de Bulimia nerviosa a través de la experiencia del enfermero referente del caso. La paciente escribe un diario con lo que come, las conductas purgativas y los pensamientos que tiene en esos momentos. En las sesiones se comentarán estos escritos. A continuación se presentan las reflexiones y comentarios del profesional de enfermería sobre el proceso, la paciente y los cambios que ésta sufre a través de los diálogos y reflexiones. En la conclusión se expone el rol de la enfermera referente en salud mental en el proceso de recuperación de esta enfermedad. Su herramienta es la palabra y el motor de la intervención el equipo multidisciplinar.In this paper, a case report of bulimia nervosa across view of nurse professional is presented. The patient keeps a diary of how often she eats and how often she purges. The patient might also write down his thoughts about food in the diary. In the sessions the patient begins talking about what she eats, her feelings and what she had written in the diary. Nurse’s reflexion about the process is comments and the patient’s changes across narrative. In the conclusion is expounded the importance of professional team and the narrative as work tool.
Carmen del Río Sánchez
Full Text Available La comorbilidad entre trastornos de la personalidad y trastornos de la conducta alimentaria ha sido destacada en numerosas investigaciones, encontrándose frecuencias desde un 22% hasta un 95%, según los estudios. El objetivo de este trabajo ha sido analizar este tópico en la bulimia nerviosa. Un total de 33 mujeres que cumplían los criterios diagnósticos DSM-IV para la bulimia nerviosa subtipo purgativo cumplimentaron la versión española del MCMI-II. Los resultados mostraron altas puntuaciones en la escala Esquizoide (TB=76,97, seguida por la Autodestructiva (TB=68,64, Pasivo-Agresiva (TB=68,15 y Evitativa (TB=67,12. Un 81% de las pacientes presentaba niveles clínicamente significativos de comorbilidad en alguna de las escalas (TB>75: un 45% presentaba elevaciones en una, dos o tres escalas (15% respectivamente y el 36% restante, las presentaba en cuatro o más escalas. Nuestros resultados son relativamente consistentes con el único estudio que utiliza el MCMI-II con grupos diferenciados de trastornos de conductas alimentarias, entre ellos de bulimia nerviosa subtipo purgativo; no obstante, no es posible establecer un patrón típico de rasgos de personalidad para estas pacientes
ELENA GISMERO GONZALEZ
Full Text Available De acuerdo con la observación clínica, y en algunos casos con la literatura experimental, los trastornos alimenticios van asociados a insatisfacción con la imagen corporal, así como a baja autoestima o un mal autoconcepto, y aislamiento social, alexitimia, etc. que conllevarían dificultades en las relaciones sociales. Pero ¿son estos aspectos característicos de las personas que padecen anorexia y bulimia nerviosa los que permiten diferenciarlos claramente de otros grupos?. El objetivo del presente estudio es pues, comparar pacientes con Anorexia y Bulimia Nerviosa con tres grupos: control, mujeres que hacen dieta y mujeres en psicoterapia, en medidas de autoconcepto-autoestima, satisfacción con el propio cuerpo y habilidades sociales. Los resultados apoyan la idea de que un mal autoconcepto y ciertos déficits en habilidades sociales son característicos de pacientes con anorexia y bulimia nerviosa, y que los diferencian no sólo de grupos controles normales, sino también de personas que hacen dieta para adelgazar. La insatisfacción con el propio cuerpo caracteriza al grupo de anorexia, diferenciandole tanto del grupo control, como del de psicoterapia y del de dieta.
Negro López, Cristina
La anorexia nerviosa es el trastorno de la conducta alimentaria con las mayores tasas de mortalidad entre los trastornos psicológicos, además debido a la complejidad de su curso clínico los profesionales se encuentran con dificultades a la hora de realizar una intervención. En la primera parte, se realizó una revisión conceptual de la anorexia y bulimia nerviosa y, de otros trastornos que coexisten con ellos. En la segunda parte se analiza un caso real de anorexia nerviosa, mediante el anális...
Echeburúa, Enrique; Marañón Guillan, Izaskun; Grijalvo López, Jorge
En este artículo se comparó el perfil de trastornos de personalidad en 25 pacientes con un trastorno de la conducta alimentaria (5 con anorexia restrictiva, 7 con anorexia purgativa, 5 con bulimia purgativa y 8 con un trastorno de la conducta alimentari
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Los trastornos más conocidos de la alimentación como la anorexia nerviosa y la bulimia son entidades de orden psíquico que no poseen un factor etiológico único; se destaca la constante carga publicitaria que ha transformado el concepto de imagen corporal y los patrones alimentarios.
Se ha observado que representan un problema de salud; los
grupos más vulnerables son las mujeres de 13-18 años (0.5-1% en anorexia, y 1-5% en bulimia. Ambas entidades generalmente son de curso crónico y traen consecuencias tanto físicas como sicológicas, que incluso pueden acarrear la muerte de quienes la padecen. Conociendo su potencial peligrosidad y el incremento de las imágenes visuales y las presiones socioculturales que inducen diariamente a estar delgado, a cambiar los hábitos alimentarios y a realizar ejercicio, consideramos que es de suma importancia realizar un estudio de uno de los principales síndromes psiquiátricos modernos, siguiendo de cerca los factores predisponentes y la prevalencia en el grupo de personas que están en mayor riesgo de presentarlos como son las mujeres adolescentes y en la adultez temprana.
AINA D. LÓPEZ YÁÑEZ
Full Text Available Partiendo de la teoría de Merton sobre la desviación, por la cual ciertos tipos de anomalías en la conducta derivan de la disociación entre las aspiraciones prescritas culturalmente y el acceso a los medios correctos para lograrlas, se llega a la conclusión de que la anorexia nerviosa y la bulimia son una típica respuesta a una situación de anomia. La belleza del cuerpo como objetivo cultural presenta una fuerte naturaleza anómica porque es esencialmente un atributo físico innato que no le ofrece al sujeto ningún modo de lograrlo si no se tiene. La belleza adquirida, que expresa la posibilildad que el individuo tiene de mejorar ciertos aspectos, juega un papel muy reducido. Acceder a los medios de adquirirla es algo restringido, como lo es todo lo contenido en un objeto de consumo y en el sistema de servicios, tanto económica como culturalmente.
Bulimia nervosa; Binge-purge behavior; Eating disorder - bulimia ... Many more women than men have bulimia. The disorder is most common in teenage girls and young women. The person usually knows that her eating pattern is abnormal. She ...
Impulsividad y búsqueda de sensaciones: factores asociados a síntomas de anorexia y bulimia nerviosas en estudiantes de secundaria (Impulsiveness and sensation seeking: Factors associated with symptoms of anorexia and bulimia nervosa in high school students
Full Text Available This study investigated the potential association of impulsiveness and sensation seeking and the attitudes and behaviour characteristic of anorexia and bulimia nervosa in male and female students (between 12 and 20 years. The study had an observational case-control design, in which the case group comprised symptomatic subjects who had scores above the cutoff point designated by the authors for several assessment instruments, and the control group, which comprised asymptomatic participants who had scores below the cutoff point. The study included 300 participants (136 men [45.33%] and 164 women [(54.66%] from Malaga (Spain. All participants received parental authorization to take part in the study. The participants anonymously completed the following self-administered tests: Eating Disorder Inventory (EDI-II, Eating Attitudes Test (EAT-26, Bulimia Test Revised (BULIT-R, Barratt Impulsiveness Scale (BIS-11, and (SSS-V. The results suggest an association between impulsiveness and symptomatology associated with eating disorders, anorexia, and bulimia nervosa. In contrast, sensation seeking was only associated with bulimic symptoms. In summary, the variables impulsivity and sensation seeking appear to be closely associated with eating disorders. Thus, these aspects should be addressed in healthy lifestyle programs, because their inclusion may help to reduce or prevent the increase in eating disorders in the teenage population.
Mariela Borda Pérez; Adriana Celemín Nieto; Andrea Celemín Nieto; Leonardo Palacio; Fajid Majul
Objetivo: establecer la prevalencia de riesgo de bulimia y de factores de riesgo asociados en adolecentes escolarizados de 14 a 18 años de Barranquilla. Materiales y métodos: Estudio transversal partir de una muestra representativa de escolares de cuatro establecimientos educativos de Barranquilla. Participaron 149 sujetos de 14 a 18 años. Se aplicó instrumento para determinar imagen corporal y bulimia (Body Shape Questionarie), el Bulimia Test of Edinburgh, Test de Rosemberg y DASS21, se est...
Marín Pérez, Marta
[ES]Objetivo: Conocer la prevalencia en el consumo de drogas en los diferentes tipos de Trastornos de la Conducta Alimentaria (TCA), así como la etiología de la comorbilidad entre ambos problemas. Contexto teórico: Tanto los TCA como el abuso de sustancias psicoactivas están incrementando en nuestra sociedad, lo que ha favorecido el aumento de investigaciones sobre el tema. Éstas observan una alta frecuencia de comorbilidad entre ambos problemas. Metodología: Se ha llevado a cabo una revisión...
VÍAS NERVIOSAS Y GANGLIOS ESPECIALES DEL BULBO RAQUÍDEO. [Vías nerviosas del bulbo y núcleos dependientes. ─ Vías exógenas. ─] Vía piramidal. ─ [Cordón posterior :] Cordón de Goll y de Burdach. ─ Terminaciones de sus fibras. ─ Colaterales sensitivo-motoras. ─ Núcleos de estos cordones. ─ [Cinta de Reil]i. ─ Vía cerebelosa [ascendente ó fascículo de Flechsig] y núcleo dependiente. [Ver: Freire, Miguel. Metodología usada en la presente edición. Metodología e historia de la edición en la cor...
Full Text Available Este estudio ex post facto analiza la presencia de distimia en 155 mujeres. Noventa y tres pacientes cumplían los criterios diagnósticos para un trastorno de la conducta alimentaria (TCA: 31 con anorexia nerviosa restrictiva (ANr, 31 con anorexia nerviosa purgativa/bulímica (ANp y 31 con bulimia nerviosa purgativa (BNp; y 62 mujeres constituían los dos grupos comparativos: 31 con alto riesgo de padecer un TCA (grupo comparativo sintomático: GC-S y 31 sin patología conocida (grupo comparativo no sintomático: GC-NS. Todas ellas cumplimentaron la versión española del MCMI-II. En los resultados encontramos diferencias significativas en las medias obtenidas por los grupos con TCA respecto a los dos grupos comparativos, y que presentaban el posible síndrome distímico [puntuaciones Tasa Base (TB > 74] el 50% de las pacientes con ANr, el 60% con ANp y el 63,30% de las pacientes con BNp. Sólo el 16,70% de las mujeres de alto riesgo y el 5,70% de las mujeres sin patología lo presentaban. Estos hallazgos indican que el síndrome distímico es frecuente en las mujeres con TCA, y en aquellas que presentan conductas purgativas aumenta levemente la severidad del mismo.
Research on the efficacy of hypnosis in the treatment of bulimia nervosa has produced mixed findings. This is due in part to the interplay between the characteristics of people with bulimia and the wide variety of hypnosis interventions that have been employed. Several authors have noted that methodological limitations in hypnosis research often make evaluation of treatment efficacy difficult. Many of the studies extant provide insufficient information regarding the specifics of participants' hypnotizability, the hypnotic induction, or the hypnotic suggestion(s) employed. Such limitations preclude replication and clinical implementation. This article reviews the literature with replicable methodologies and discusses the implications for evaluating treatment efficacy.
Zeeck, A; Hartmann, A; Sandholz, A; Joos, A
Bulimia nervosa is characterized by episodes of binge eating and compensatory behaviours (self-induced vomiting, laxative misuse, dietary restriction). It has a complex aetiology and is mostly found in young women. Bulimia leads to substantial physical and psychosocial morbidity. Bulimia nervosa needs specialized psychotherapeutic treatment. In most cases outpatient treatment is sufficient, but comorbidity with other psychiatric disturbances has to be taken into account. Additional psychopharmacological interventions might be helpful. After 5 to 10 years about 50% of the patients show complete remissions, 30% partial remissions and about 20% a chronic course of the illness. General practitioners, dentists and gynaecologists should be informed about typical signs of the disorder that is often hidden by the patients.
Hay, Phillipa J; Claudino, Angélica Medeiros
Up to 1% of young women may have bulimia nervosa, characterised by an intense preoccupation with body weight, uncontrolled binge-eating episodes, and use of extreme measures to counteract the feared effects of overeating. People with bulimia nervosa may be of normal weight, making it difficult to diagnose. After 10 years, about half of people with bulimia nervosa will have recovered fully, one third will have made a partial recovery, and 10% to 20% will still have symptoms. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for bulimia nervosa in adults? What are the effects of discontinuing treatment in people with bulimia nervosa in remission? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 27 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review we present information relating to the effectiveness and safety of the following interventions: cognitive behavioural therapy (CBT; alone or plus exposure/response prevention enhancement), cognitive orientation therapy, dialectical behavioural therapy, discontinuing fluoxetine in people with remission, guided self-help cognitive behavioural therapy, hypnobehavioural therapy, interpersonal psychotherapy, mirtazapine, monoamine oxidase inhibitors (MAOIs), motivational enhancement therapy, pharmacotherapy plus psychotherapy, pure or unguided self-help cognitive behavioural therapy, reboxetine, selective serotonin reuptake inhibitors (SSRIs), topiramate, tricyclic
Dolonguevich, Evelyn Ruth; Boero López, Edgardo
En el caso clínico se trató periodontalmente a la paciente C. J., con diagnóstico de bulimia y anorexia nerviosa purgativa. Se destacó el importante trabajo de motivación, que dio como resultado una respuesta excelente en su salud bucal. Se contó con la posibilidad de colocar implantes dentales con buen resultado postoperatorio, lo cual es promisorio en cuanto a lograr rehabilitarla con una solución fija, que no sufrirán de patología...
Hay, Phillipa J
Bulimia nervosa (BN) and related eating disorders such as binge eating disorder are common. General practitioners can play a key role in the identification and management of BN and related eating disorders. This article describes the presenting and associated features of BN and overviews evidence based treatment approaches. Key features are recurrent episodes of binge eating, extreme weight control behaviours and over concern about weight and shape issues. By definition people are not underweight. Risk factors include being from a western culture, obesity, exposure to a restrictive dieting environment and low self esteem. People are more likely to present asking for help in weight control or a physical problem secondary to the eating disorder. Evidenced based therapies with good outcomes in current use are cognitive behaviour therapy (in full or guided self help forms), high dose fluoxetine, and interpersonal psychotherapy. It is important to convey optimism about treatment efficacy and outcomes.
Full Text Available En condiciones normales sólo ocurre mielinización de fibras del nervio óptico por detrás de la lámina cribosa, pero se observa mielinización de parte de la capa de fibras nerviosas de la retina en el 0.32% a 0.98% de los pacientes. la mielinización intraocular generalmente es yuxtapapilar, y las fibras toman un aspecto característico: manchas blancas, nacaradas, parecidas a una pluma, que siguen la dirección de las fibras de la retina y a veces ocultan la papila. Aparte de estas características fundoscópicas, la mayoría de los pacientes son normales. Se ha encontrado que puede haber una asociación entre la mielinización de las fibras de la retina y una miopía ipsilateral, y también se ha observado ambliopía y estrabismo. Se describe un caso de mielinización de fibras nerviosas, en madre e hija, hecho que sugiere un factor genético en su génesis.
Bermúdez López, Raquel
En las últimas décadas, los Trastornos de la Conducta Alimentaria (TCA), han llegado a convertirse en uno de los problemas más importantes de nuestra sociedad. Se trata de trastornos graves cuyas consecuencias físicas y psicológicas afectan a distintas áreas de la persona, asociándose con baja calidad de vida, altas tasas de comorbilidad, deterioro psicosocial y mortalidad prematura (Herpertz-Dahlmann, 2009). Esta complejidad de los TCA hace difícil establecer un diagnóstico...
Pablo Tabernero, Ana de
Introducción: La bulimia nerviosa es, junto a la anorexia, los principales Trastornos de la Conducta Alimentaria, y se caracteriza por episodios de ingesta voraz de comida o atracón, seguido de conductas compensatorias como el vómito autoinducido, el abuso de laxantes o un exceso de actividad física. Su etiología es multifactorial, lo que dificulta su diagnóstico y tratamiento. Actualmente, se han disparado las cifras de prevalencia e incidencia, sobre todo en población adolesc...
Ayala Sánchez, Carla Haydeé
Los trastornos de la conducta alimentaria se han convertido en un importante tema relacionado a la salud debido a sus altos índices de prevalencia y mortandad así como las enfermedades que éstos conllevan. El objetivo principal de esta investigación fue analizar si las personas que presentan sintomatología del trastorno de Anorexia Nerviosa utilizan las dietas restrictivas y la perdida de peso corporal como una manera de reducir la tensión y por lo tanto, como un modo de af...
Muuss, Rolf E.
Defines bulimia and lists associated features of bulimia, physical side effects, and cognitive disturbances related to binging and purging. Asserts that bulimics resist treatment; but that such methods as cognitive, group, family, behavior, and drug therapy, and hospitalization appear promising. (Author/ABB)
Daniel Jácome Roca
Full Text Available
Los bulímicos son adictos a los alimentos por dos mecanismos posibles: uno, que perciben en forma desmedida las señales subliminales multisensoriales enviadas por los alimentos (el color rojo de la fruta se percibe con más intensidad, por ejemplo. El segundo puede radicar en que los bulímicos sufren de untrastorno en la liberación y/o señalización cerebral de las hormonas de la saciedad alimenticia provenientes del tracto gastrointestinal y del tejido adiposo como la GH-RELINA y la LEPTINA. Este artículo también resume las alteraciones endocrinas en la bulimia, además de las características de los pacientes con trastornos alimenticios como la bulimia nerviosa, la anorexia nerviosa y la enfermedad de las “comilonas compulsivas”.
Palabras Clave: Trastornos de la alimentación, saciedad, neuropéptidos/apetito, señalizaciones visuales y aromáticas
Bulimic patients are food-addicts, through two posible mechanisms. One, these persons magnify multisensensorial subliminal signals, sent by foods (i.e., red color of a fruit is perceived with greater intensity. Two, bulimics have a disordered release and/or signaling of brain-gut hormones and adipose-tissue hormones participating in saciety, such as Gh-relin and leptin. This paper includes brief remarks on endocrine dysregulation seen in” bulimia nervosa”. Also, it presents features of eating-disorder patients, such as those suffering from bulimia nervosa, anorexia nervosa y “binge-eating” disorder.
Key Words: Eating disorders, satiety, neuropeptides/ appetite, visual food cues/odor cues
de Tournemire, R
Binge eating, bulimia nervosa, binge eating disorder, anorexia-bulimia are terms often used without really knowing what precisely one is referring to. Otherwise, there are many articles concerning anorexia nervosa in medical literature, a disease, which can be seen and fascinates. These eating disorders are frequent in today's society; medical, psychological and social consequences are important. Copyright © 2013 Elsevier Masson SAS. All rights reserved.
Weinstein, Harvey M.; Richman, Ann
Bulimia has become an increasing problem in the college population. This article describes a group psychotherapeutic treatment approach to the problem. A theoretical formulation of the psychodynamics that may underlie the development of bulimia is offered. (Author/DF)
Santomango, Gloria Jean
There are three known diseases of eating disorders: compulsive overeating, anorexia nervosa, and bulimia. All three affect various body systems, are pathological in nature, and are addictive behaviors that mainly affect females. All can be fatal if not treated or under-treated. Compulsive overeating is the most known of the three disorders. The…
The article reviews the literature on anorexia nervosa, with or without bulimia, and presents a comprehensive picture of this eating disorder, focusing on terminology, historical references, prevalence, prognosis, classification, diagnostic criteria, physical and psychological characteristics, evolution of the disability, etiology, treatment, and…
Sonia Patricia Murguía-Mier, México; Claudia Unikel-Santoncini, México; Bertha Blum-Grynberg, México; Bertha Elvia Taracena-Ruiz, México
(analítico) En este trabajo analítico y cualitativo presentamos los resultados de una investigación aplicada a cinco chicas con diagnóstico de anorexia nerviosa o trastorno alimentario no especificado. Utilizamos metodología de la sociología clínica en seis sesiones grupales y dos entrevistas individuales, para conocer las instancias psíquicas que se ponen en juego cuando la joven con anorexia nerviosa es capaz de lastimar su cuerpo tan gravemente, y continuar con esa dinámica a veces hasta l...
Jorge Chaurand-Lara; Laura Pacheco-Ruiz; Diego Méndez-Rosito
Los tumores malignos de la vaina nerviosa periférica (TMVNP), también llamados neurofribrosarcomas o schwannomas malignos, representan el 10% de todos los sarcomas de tejidos blandos. El tumor usualmente se encuentra en las extremidades inferiores, y solo del 10 al 20% de las lesiones ocurren en la región de cabeza y cuello, convirtiéndolas en una entidad rara. Los neurofibromas son tumores de la vaina nerviosa que aparecen comúnmente en la neurofibromatosis 1 o enfermedad de Von Recklinghaus...
The Life with Anorexia and Bulimia Nervosa The Bachelor's thesis deals with problems of eating disordes. This work is focused on the manifestations of the illness and feelings of the women who are suffering from this disorder. The research part of the thesis is focused on the means the women use for fighting with this illness, how they deal with it and what helps them to manage the manifestations of the illness.
Milisavljević, Nemanja; Cvetković, Mirjana; Nikolić, Goran; Filipović, Branka; Milinić, Nikola
The association between celiac disease and eating disorders has been very rarely reported. This is the first report on celiac disease associated with bulimia in this part of Europe. An adult female patient with history of bulimia and one uncomplicated pregnancy was admitted to the Gastroenterology Department, due to long lasting dyspeptic symptoms, constipation, major weight loss and fatigue. After positive serological screening, the diagnosis of celiac disease was confirmed with histopathology examination of duodenal biopsy specimen. Complicated interactions between celiac disease and bulimia can make them difficult to diagnose and treat. It is important to consider the presence of celiac disease in patients with bulimia and gastrointestinal symptoms.
Sonia Patricia Murguía-Mier
Full Text Available En este trabajo analítico y cualitativo presentamos los resultados de unainvestigación aplicada a cinco chicas con diagnóstico de anorexia nerviosa o trastorno alimentariono especificado. Utilizamos metodología de la sociología clínica en seis sesiones grupales y dosentrevistas individuales, para conocer las instancias psíquicas que se ponen en juego cuando lajoven con anorexia nerviosa es capaz de lastimar su cuerpo tan gravemente, y continuar con esadinámica a veces hasta la muerte. Encontramos que no las mueve un ideal de delgadez estético yque la enfermedad es regulada por el superyó, sostenida por lo que llamamos mandatos socialessuperyóicos,que son frases coaguladas -carentes de sentido-, que las instala en un fuera de control,como un regulador implacable, propiciando el dominio de la pulsión de muerte.
Full Text Available Este estudio explora las estructuras cognitivas, entendidas como sistemas de constructos, de pacientes afectadas de bulimia nerviosa (BN. Investigaciones previas sobre los sistemas de constructos personales con sintomatología alimentaria sugieren que éstas muestran una mayor distancia entre la construcción de su sí mismo y su yo ideal, y mayor rigidez. Además, este estudio explora la presencia de dilemas implicativos (DI. Se comparó un grupo de treinta y dos mujeres con diagnóstico de BN, con un grupo no clínico de 32 mujeres aparejadas por edad. Todas las participantes fueron evaluadas utilizando la técnica de rejilla (RGT. La presencia de DIs fue más frecuente en el grupo clínico (71,9% que en el grupo control (18,8%, y se encontró, además, mayor polarización y mayor discrepancia yo-ideal (especialmente cuanto más larga era la historia de BN. Las medidas obtenidas con la RGT pueden ser útiles para la evaluación de la construcción del sí mismo y los conflictos cognitivos en pacientes con BN, y para apreciar su papel en este trastorno. Además, esta técnica puede ser útil en la clínica para explorar el sistema de constructos de los pacientes, especialmente para identificar los DIs que puedan estar manteniendo los síntomas u obstaculizando el cambio.
Thelen, Mark H.; And Others
Assessed changes in bulimia in female college students (N=44) and in relation between bulimia and interpersonal relationships over time. Found (1) stable symptomology for normals and bulimics; (2) strong negative correlations between bulimia measures and interpersonal relationships with men; and (3) improvement in symptomology and relationships…
Getzfeld, Andrew R.
This paper reviews the literature on the physiological causes of bulimia and investigates the rationale behind the usage of antidepressant medication in the treatment of bulimia nervosa. No definite conclusions can be stated regarding the physiology of bulimia, but a number of hypotheses are suggested. It appears that the hypothalamus is involved…
Carter, Frances A; McIntosh, Virginia V W; Joyce, Peter R; Frampton, Christopher M; Bulik, Cynthia M
To examine whether having a baby following treatment for bulimia nervosa places women at increased risk for continuing or relapsing eating disorders or major depression. Subjects were women who had participated in a large randomized controlled trial evaluating cognitive behavior therapy for bulimia nervosa, who were prospectively followed-up over 5 years. At follow-up assessments (at least yearly), life charts were completed with patients and childbirth was recorded. The presence of eating disorders and major depressive disorder was assessed using the Structured Interview for DSM-III-R. Childbirth was not specifically associated with increased symptomatology. This was found for both eating disorders and major depression in the same year as childbirth and for the year following childbirth. Childbirth is not specifically associated with symptomatology following treatment for bulimia nervosa.
Caballero Castell, María
Se trata de analizar los datos existentes sobre la eficacia de los tratamientos de la anorexia nerviosa en niños y adolescentes, para ello se realizó una búsqueda bibliográfica utilizando como descriptores: Tratamiento de la Anorexia nerviosa y adolescentes. Los artículos encontrados nos han proporcionado una muestra de 2784 niños y jóvenes de entre 9 y 27 años. El periodo abarcado es de 1989-2010
Full Text Available Presentamos el caso de una mujer con diagnóstico de anorexia nerviosa que desarrolló cardiomiopatía de takotsubo precipitada por estrés emocional y alteraciones del medio interno. Evolucionó favorablemente con manejo conservador. Los casos de cardiomiopatía inducida por estrés, descriptos en pacientes con trastornos de la conducta alimentaria, suelen alcanzar mayor gravedad y se asocian con la prolongación del intervalo QT por desequilibrios electrolíticos, arritmias ventriculares e hipoglucemia. Se realiza una revisión del compromiso cardiovascular en pacientes con anorexia nerviosa.
Martha Bravo Rodríguez; Argelia Pérez Hernández; Roberto Plana Bouly
Se realiza una revisión clínica del síndrome anorexia nerviosa, con énfasis en su concepto, desarrollo y cuadro clínico. Se tiene en cuenta que es un trastorno que se presenta habitualmente en adolescentes sin obesidad acusada, sólo con un discreto sobrepeso. Estudios realizados muestran significativa relación entre los síntomas y el funcionamiento interpersonal de los adolescentes anoréxicos, pues estos tienden al aislamiento o buscan la compañía de muchachos más jóvenes. También son caracte...
López Domínguez, Esther María
Trabajo Fin de Grado Curso 2015-2016 [ES]Se realizó una revisión bibliográfica sobre la anorexia nerviosa y la terapia ocupacional, intentando analizar la evolución de este trastorno que actualmente está tan en apogeo, entre otros factores como los autores, las palabras de las cuales hacen más uso en sus títulos, el idioma y las revistas que más auge han tenido en dicho tema. Además, justificando la importancia que tiene la intervención desde la terapia ocupacional en los tr...
Full Text Available Los tumores malignos de la vaina nerviosa periférica (TMVNP, también llamados neurofribrosarcomas o schwannomas malignos, representan el 10% de todos los sarcomas de tejidos blandos. El tumor usualmente se encuentra en las extremidades inferiores, y solo del 10 al 20% de las lesiones ocurren en la región de cabeza y cuello, convirtiéndolas en una entidad rara. Los neurofibromas son tumores de la vaina nerviosa que aparecen comúnmente en la neurofibromatosis 1 o enfermedad de Von Recklinghausen. Se ha reportado que los individuos con antecedentes familiares de neurofibromatosis 1 tienen un riesgo incrementado de desarrollar TMVNP en el transcurso de sus vidas, sin embargo, esta asociación no se ha confirmado en TMVNP a nivel de los nervios craneales. En este artículo los autores analizaron la literatura actual con respecto a los TMVNP del nervio trigémino, así como la inclusión de un caso inusual que involucra las 3 ramas de dicho nervio.
Sonia Patricia Murguía-Mier, México
Full Text Available (analítico En este trabajo analítico y cualitativo presentamos los resultados de una investigación aplicada a cinco chicas con diagnóstico de anorexia nerviosa o trastorno alimentario no especificado. Utilizamos metodología de la sociología clínica en seis sesiones grupales y dos entrevistas individuales, para conocer las instancias psíquicas que se ponen en juego cuando la joven con anorexia nerviosa es capaz de lastimar su cuerpo tan gravemente, y continuar con esa dinámica a veces hasta la muerte. Encontramos que no las mueve un ideal de delgadez estético y que la enfermedad es regulada por el superyó, sostenida por lo que llamamos mandatos socialessuperyóicos, que son frases coaguladas -carentes de sentido-, que las instala en un fuera de control, como un regulador implacable, propiciando el dominio de la pulsión de muerte.
Dukarm, Carolyn Piver
Bulimia nervosa and attention deficit hyperactivity disorder (ADHD) share several key features, including impulsivity and low self-esteem. Stimulant medications have been highly effective in the treatment of ADHD. However, medication management of bulimia with antidepressants has demonstrated only partial resolution of bulimic symptoms. To date, there are no published reports of controlled trials evaluating the efficacy of stimulants for bulimia. The purpose of this paper is to report 6 patients with comorbid bulimia and ADHD who were treated with the stimulant medication, dextroamphetamine. All 6 patients described reported complete abstinence from binge eating and purging after treatment with psychostimulants, and none of the patients discontinued taking the medication because of side effects. The side effect of decreased appetite proved beneficial in decreasing the desire to binge eat. However, all 6 patients remained within a healthy weight range. Data from these case reports suggest a possible benefit of screening for ADHD as part of the overall evaluation of bulimia. In addition, these cases suggest the potential role of psychostimulants in the management of bulimia because of the high rate of abstinence from bulimic symptoms and the low rate of adverse side effects. Clinical trials are needed to fully evaluate the efficacy and tolerability of psychostimulants in the treatment of bulimia nervosa.
Thelen, Mark H.; And Others
The Bulimia Test--Revised (BULIT-R) was given to 23 female subjects who met the criteria for bulimia in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-IV) and 124 female controls. The BULIT-R appears to be a valid instruction for identifying individuals who meet DSM-IV criteria for bulimia. (SLD)
Westmoreland, Patricia; Krantz, Mori J; Mehler, Philip S
Anorexia nervosa and bulimia nervosa are serious psychiatric illnesses related to disordered eating and distorted body images. They both have significant medical complications associated with the weight loss and malnutrition of anorexia nervosa, as well as from the purging behaviors that characterize bulimia nervosa. No body system is spared from the adverse sequelae of these illnesses, especially as anorexia nervosa and bulimia nervosa become more severe and chronic. We review the medical complications that are associated with anorexia nervosa and bulimia nervosa, as well as the treatment for the complications. We also discuss the epidemiology and psychiatric comorbidities of these eating disorders. Copyright © 2016 Elsevier Inc. All rights reserved.
Churruca, Kate; Perz, Janette; Ussher, Jane M
In medical and psychological literature bulimia is commonly described as a mental illness. However, from a social constructionist perspective the meaning of bulimia will always be socially and historically situated and multiple. Thus, there is always the possibility for other understandings or constructions of bulimia to circulate in our culture, with each having distinct real-world implications for those engaging in bulimic behaviors; for instance, they might potentially influence likelihood of help-seeking and the success of treatment. This study used Q methodology to explore culturally-available constructions of bulimia nervosa. Seventy-seven adults with varying experience of eating disorders took part in this Q methodological study. Online, they were asked to rank-order 42 statements about bulimia, and then answer a series of questions about the task and their knowledge of bulimia. A by-person factor analysis was then conducted, with factors extracted using the centroid technique and a varimax rotation. Six factors satisfied selection criteria and were subsequently interpreted. Factor A, "bulimia as uncontrolled behavior", positions bulimia as a behavioral rather than psychological issue. Factor B, entitled "bulimia is a distressing mental illness", reflects an understanding of bulimic behaviors as a dysfunctional coping mechanism, which is often found in psychological literature. Other perspectives position bulimia as about "self-medicating with food" (Factor C), "the pathological pursuit of thinness" (Factor D), "being the best at being thin" (Factor E), or as "extreme behavior vs. mentally ill" (Factor F). These constructions have distinct implications for the subjective experience and behavior of those engaged in bulimic behaviors, with some constructions possibly being more useful in terms of help-seeking (Factor B), while others position these individuals in ways that may be distressing, for instance as shallow (Factor D) or to blame (Factor E). This
María Yolanda Vellisca González
Full Text Available La anorexia nerviosa, como trastorno de la conducta alimentaria, está asociada a una elevada preocupación por el peso, a ideas sobrevaloradas respecto a la delgadez, a una alteración de la imagen corporal y a un miedo excesivo a engordar. En este trabajo estudiamos las diferencias en la distorsión de la percepción corporal en pacientes con anorexia nerviosa de inicio temprano vs. tardío mediante el Cuestionario de la forma corporal (Body Shape Questionnaire de Cooper, Taylor, Cooper y Fairburn (1987. La muestra clínica estaba compuesta por un total 176 pacientes diagnosticadas de anorexia nerviosa (47.1% y anorexia nerviosa atípica (52.9%. En el 21.4% de la muestra los síntomas aparecieron antes de los 14 años. El grupo de anorexia nerviosa de inicio temprano presenta una mayor distorsión de su imagen corporal que el grupo de anorexia nerviosa de inicio tardío.
Full Text Available Introduction. The association between celiac disease and eating disorders has been very rarely reported. This is the first report on celiac disease associated with bulimia in this part of Europe. Case report. An adult female patient with history of bulimia and one uncomplicated pregnancy was admitted to the Gastroenterology Department, due to long lasting dyspeptic symptoms, constipation, major weight loss and fatigue. After positive serological screening, the diagnosis of celiac disease was confirmed with histopathology examination of duodenal biopsy specimen. Conclusion. Complicated interactions between celiac disease and bulimia can make them difficult to diagnose and treat. It is important to consider the presence of celiac disease in patients with bulimia and gastrointestinal symptoms.
Thompson, G. Sue
Anorexia nervosa and bulimia are currently being studied with great intensity by the medical profession. Anorexia nervosa was first described in the medical literature in 1868, but was considered a rarity until the late 1930's. Bulimia was not identified in the medical literature until 1979. Recent studies suggest that approximately five percent…
Morand, Lucio; Muñoz Ortega, Alejandra P.
Hay una importante presión social que induce a los jóvenes a estar delgados y lo asocia a felicidad, éxito laboral, belleza, juventud y mejor calidad de vida; esto sumado a algunos rasgos individuales como problemas para ser autónomos, miedo a madurar, poca autoestima, perfeccionismo, etc. crean condiciones propicias para los llamados trastornos de la alimentación. La bulimia es uno de ellos, obedece a múltiples causas, es difícil de tratar y se caracteriza por la ingestión compulsiva y episó...
Larson, R; Johnson, C
This research suggests that daily solitude has a central role in bulimia. A sample of 15 bulimic patients and 24 normal controls carried electronic pagers for one week and filled out self-reports on their experience in response to randomly timed signals. The bulimics reported the lowest mood states when alone at home, the context in which their symptomatic behavior usually takes place. Further, those who reported the worst experiences in this context were the one's showing the most severe behavioral and affective manifestations of the disorder.
Martha Bravo Rodríguez
Full Text Available Se realiza una revisión clínica del síndrome anorexia nerviosa, con énfasis en su concepto, desarrollo y cuadro clínico. Se tiene en cuenta que es un trastorno que se presenta habitualmente en adolescentes sin obesidad acusada, sólo con un discreto sobrepeso. Estudios realizados muestran significativa relación entre los síntomas y el funcionamiento interpersonal de los adolescentes anoréxicos, pues estos tienden al aislamiento o buscan la compañía de muchachos más jóvenes. También son características de este cuadro los trastornos obsesivos-compulsivos que se relacionan o no con la comida. La restricción dietética conlleva a cambios biológicos y físicos importantes, y se destaca la alteración del sistema hipotalámico y endocrino, que da lugar a la aparición de signos y síntomas como la amenorrea, intolerancia al frío e hipotensión, entre otros. Los cambios neuroquímicos presentes en la anorexia nerviosa también se han atribuido a la desnutrición, y es probable que puedan perpetuar las alteraciones conductuales.A clinical review of the syndrome of anorexia nervosa is made, giving emphasis to its concept, development and clinical picture. It is a disorder that appears commonly in adolescents without an exaggerated obesity and with just a discrete overweight. Studies have been conducted that show a significant relation between the symptoms and the interpersonal functioning of the anorexic adolescents, since they tend to be isolated or to be accompanied by younger persons. The obesive compulsive disorders associated or not with food are also characterisitcs of this picture. The restricted diet leads to important biological and physical changes, among which the alteration of the hypothalamic and endocrine system, which gives rise to the appareance of signs and symptoms such as amenorrhea, intolerance to cold and hypotension, is stressed. The neurochemical changes present in anorexia nervosa have also been attributed to
Marle dos Santos Alvarenga
Full Text Available A bulimia nervosa é um transtorno alimentar caracterizado por compulsões alimentares e métodos compen-satórios recorrentes. Os pacientes apresentam ingestão alimentar inadequada e comportamentos alimentares disfuncionais. O adequado tratamento do transtorno requer uma equipe multiprofissional e terapia nutricional especializada. Compreender as características desse transtorno, os padrões de consumo e o comportamento alimentar, bem como atentar para as atitudes alimentares dos pacientes, é fundamental para o planejamento e para a adequada condução da abordagem nutricional. A terapia nutricional para esse transtorno é diferenciada, exigindo do nutricionista maiores habilidades de aconselhamento nutricional. Educação nutricional e acon-selhamento nutricional, com ênfase na abordagem de atitudes alimentares e insatisfação corporal, são o foco da terapia nutricional. Para o atendimento eficaz desses pacientes e o sucesso no tratamento nutricional, é importante que o profissional se mantenha atualizado sobre nutrição e transtornos alimentares e procure especialização e experiência nessa área do conhecimento.Bulimia nervosa is an eating disorder characterized by binge eating and compensatory behaviors. The patients present inappropriate food intake and dysfunctional eating behaviors. Proper treatment of this disorder requires a multidisciplinary team and specialized nutrition therapy. It is fundamental to understand the characteristics of this disorder, the intake patterns and the eating behavior, and be attentive to the eating attitudes of these patients to plan and conduct a nutritional approach properly. The nutrition therapy for this disorder is specific and demands greater skillfulness in nutrition counseling from the dietician. Nutrition therapy focuses on nutrition education and nutrition counseling, mainly addressing eating attitudes and dissatisfaction with body image. The professional must keep abreast on nutrition and
Sweeten, Mary K.
The eating disorders called anorexia nervosa and bulimia are examined in terms of their symptomatology, etiology, and treatment, and in terms of how the extension home economist or teacher can help. Resources for additional information or help are listed. (CT)
Although several writers have emphasized the habit-like characteristics of bulimia nervosa, no study has investigated the extent to which bulimia responds to treatment specifically for habit disorders. Habit reversal is a general treatment plan which teaches individuals to regain lost awareness of all aspects of a habit. The habit is then interrupted at the earliest movement in the chain by a physically competing response. Habit reversal (Azrin & Nunn, 1973) has been effective in treating oth...
Dobmeyer, Anne C.
The Anorexia Bulimia Inventory, a recently developed self-report questionnaire for the assessment of eating disorders, addresses two major limitations found in existing self-report eating disorder inventories. First, it comprehensively assesses the diagnostic symptoms of both bulimia and anorexia nervosa; and second, it assesses the frequently cooccurring problem areas (e.g., depression, anergia) that may be targeted in treatment planning for eating disorders. Although initial research on the...
Resch, M; Szendei, G; Haász, P
Gynecological problems are one of the most frequent somatic complications of eating disorders. The purpose of the present study was to assess the role of improper eating habits in the aetiology of menstrual disturbances, anovulation and hormonal related changes. Bulimia nervosa is the focus of attention since amenorrhea is considered a diagnostic criterium in anorexia nervosa. Subjects of the BITE (Bulimia Investigation Test, Edinburgh) test who were infertile were studied (n = 58) In the studied population there were 6 cases of clinical and 8 cases of subclinical bulimia nervosa. Symptoms and severity subscales of the BITE test significantly correlated with body mass index (p = 0.003). All 14 patients suffering from clinical and subclinical bulimia nervosa had pathologically low FSH and LH hormone levels. In those with clinical bulimia nervosa (n = 6) we diagnosed 4 cases of multicystic ovary (MCO) and in the eating disorder not otherwise specified (EDNOS) group (n = 22) there were 2 cases of MCO and 5 cases of polycystic ovary syndrome (PCOS). The results suggest that unsatisfactory nutrition (binges and "crash diet") in bulimia nervosa results in hormonal dysfunction, menstrual disturbances and infertility. The authors question the necessity for immediately estrogen replacement: they consider the reversibility of the hormonal status by early treatment of eating disorders is more appropriate. Excessive use of hormonal contraceptives in therapy has to be questioned.
Jimerson, D C; Wolfe, B E; Franko, D L; Covino, N A; Sifneos, P E
Previous reports indicate that some patients with eating disorders have alexithymic characteristics, including affect deficit states and paucity of imagination. This study evaluated whether nonhospitalized patients with bulimia nervosa had elevated ratings of alexithymia in comparison to age-matched controls, and whether severity of bulimic symptoms was correlated with elevations in alexithymia ratings. Because alexithymia may be secondary to concurrent depression, this study was limited to patients with bulimia nervosa who were free of major depression. The authors compared alexithymia ratings for nonhospitalized normal weight women meeting DSM-III-R criteria for bulimia nervosa (N = 20) to healthy female volunteers (N = 20), utilizing the Toronto Alexithymia Scale (TAS) as the primary assessment instrument. Subjects also completed standardized rating scales for bulimic symptoms, depression, and anxiety. Alexithymia rating scale scores were significantly higher for patients with bulimia nervosa than for controls. In comparison to controls, patients had significant elevations on TAS factors reflecting affect deficit states, but normal scores for factors reflecting imagination and abstract thinking. Frequency of binge eating or purging behaviors was not correlated with alexithymia ratings. These data indicate that some patients with bulimia nervosa have alexithymic characteristics. Affect dysregulation was more prominent than limitation in fantasy or metaphorical thought. Additional studies are needed to assess whether presence of alexithymic characteristics may be predictive of response to treatment in patients with bulimia nervosa.
José Manuel Ruiz Medina; Alicia Ríos Carbonell; Gisela Trevín Fernández; Elnis Quiala Ballester; Vivian Santoya Varela
Fundamento: las condiciones actuales en que se imparte la asignatura Morfofisiología III y el conocimiento de las dificultades históricas que existen para que los estudiantes logren la comprensión de las características morfofuncionales de las vías de conducción nerviosa hacen necesario buscar una solución. Objetivo: confeccionar un conjunto de medios que proporcione un recurso práctico para el estudio de las características morfofuncionales de las vías de conducción nerviosa y evaluar el imp...
María Yolanda Vellisca González; Santos Orejudo Hernández; José Ignacio Latorre Marín
La anorexia nerviosa, como trastorno de la conducta alimentaria, está asociada a una elevada preocupación por el peso, a ideas sobrevaloradas respecto a la delgadez, a una alteración de la imagen corporal y a un miedo excesivo a engordar. En este trabajo estudiamos las diferencias en la distorsión de la percepción corporal en pacientes con anorexia nerviosa de inicio temprano vs. tardío mediante el Cuestionario de la forma corporal (Body Shape Questionnaire) de Cooper, Taylor, Cooper y Fairbu...
Molinero Sastre, Alba
Trabajo de fin de Grado. Grado en Sociología. Curso académico 2014-2015 [ES] El presente trabajo de investigación pretende indagar acerca de la situación vivida en el círculo familiar cercano de los pacientes con Anorexia Nerviosa, centrando el trabajo de campo en Zamora. Se observa mediante técnicas cualitativas el fuerte impacto emocional, económico y social que se deriva de dicha situación así como la falta de recursos asistenciales y visibilidad política en la actualidad a la vez qu...
Santos Orejudo Hernández; Miguel Ángel Santed Germán; José Ignacio Latorre Marín; María Yolanda Vellisca González; josé David Saa Sandra
La amenorrea es un criterio para el diagnostico de la anorexia nerviosa (AN) según el DSM-IV-TR. Sin embargo, al comparar grupos de pacientes que cumplen todos los criterios de este manual para la AN con grupos de mujeres que los presentan todos salvo la amenorrea, algunos estudios no han encontrado diferencias significativas en la psicopatología típicamente asociadas con la AN. El propósito de nuestro estudio ha sido comparar variables demográficas, antropométricas, psicológicas y psicopatol...
Sabrina Vadalá; Débora Pellegrini; María Fernanda Verdaguer; Marcela Schrappe; José Álvarez; Julio E. Bruetman
Presentamos el caso de una mujer con diagnóstico de anorexia nerviosa que desarrolló cardiomiopatía de takotsubo precipitada por estrés emocional y alteraciones del medio interno. Evolucionó favorablemente con manejo conservador. Los casos de cardiomiopatía inducida por estrés, descriptos en pacientes con trastornos de la conducta alimentaria, suelen alcanzar mayor gravedad y se asocian con la prolongación del intervalo QT por desequilibrios electrolíticos, arritmias ventriculares e hipogluce...
Outlines a sociocultural perspective of bulimia. Notes that since bulimia occurs in a sociocultural context, which includes a socialized developmental path with concomittant norms and values, effective treatment must address those norms and values. Recommends group therapy. (ABB)
Segal, Shirley Ann; Figley, Charles R.
Surveyed 160 college women to examine the incidence of bulimia and its relationship to shyness. Results indicated 23 percent of the participants were bulimic. A significant relationship was found between bulimia and fear of rejection (private shyness). (JAC)
Zimpfer, David G.
Reviews descriptive and experimental research relating to the eating disorder known as bulimia nervosa. Reviews outcome studies of group treatment of bulimia to examine the effectiveness of group intervention. Provides recommendations for practice and future research. (Author/PVV)
Cesari, Joan P.
Differences between fad bulimia and clinical bulimia are presented using Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria, personality assessment measures, and responses to counseling. (Author)
Pagsberg, A K; Wang, A R
In a retrospective study of anorexia nervosa and bulimia nervosa, potential cases were traced, studied, and diagnosed according to ICD-10. Forty-two cases were found in Bornholm County, comprising the island of Bornholm in Denmark, in a population of 47,000 from 1970 to 1989. Less than half...... the number of cases in the population year by year, also increased during the late part of the study period. In 1989 the incidence rate of the high-risk group of females 10 to 24 years of age was 136 per 100,000 for anorexia nervosa and 45 per 100,000 for bulimia nervosa, and the prevalence rate was 222 per...... 100,000 for anorexia nervosa and 89 per 100,000 for bulimia nervosa....
Discusses application of the Health Belief Model to the prevention of bulimia, describing each model component. The article considers the individual's beliefs about bulimia and bulimic-like behaviors as a means of predicting the likelihood of behavior change to prevent clinically diagnosable bulimia. (SM)
Tillmann, Lisa M.
In 1996, the author published "A Secret Life in a Culture of Thinness: Reflections on Body, Food, and Bulimia" (Tillmann-Healy, 1996), an account of her struggle with binging and purging from ages 15 to 25. She came to understand bulimia as a communicative act, expressing fear, anxiety, and grief. From 25 to 35, her recovery from bulimia involved…
Lindgren, Britt-Marie; Enmark, Annika; Bohman, Anna; Lundström, Mats
To describe experiences of recovery from bulimia nervosa among young adult women. Most studies into recovery from eating disorders focus on anorexia nervosa, although some include both anorexia and bulimia nervosa. Recovery has been described as beginning with renewed self-esteem. Qualitative interview study. Fourteen women were invited to participate; five women, between 23-26 years of age, who assessed themselves as healthy for at least 2 years agreed to take part in narrative interviews. Tape-recorded interviews lasting 45-60 minutes (median 49 minutes) were conducted from February-April 2010 and transcribed verbatim. Data were analysed using qualitative content analysis. The interviews revealed four themes in recovery from bulimia nervosa: feeling stuck in bulimia nervosa, getting ready to change, breaking free of bulimia nervosa and grasping a new reality, each comprising two or more subthemes. The process of recovery was not linear, but rather went back and forth between progress and relapse. The women expressed strong ambivalence about leaving the illness behind. An important part of their recovery was their ability to accept themselves. It was essential for their recovery to be supported in developing a unique explanation of the cause of their illness. Women's ability to recover from bulimia nervosa and take control over their lives is based on their self-efficacy. Effective care should therefore strive to strengthen women's beliefs in their own abilities, to instil hope for recovery and thus to bolster their self-efficacy. © 2014 John Wiley & Sons Ltd.
Riad, M; Barton, J R; Wilson, J A; Freeman, C P; Maran, A G
Parotid gland enlargement occurs in about 25% of patients with the binge eating syndrome of bulimia nervosa. The parotid salivary secretory patterns in 28 bulimics were determined in order to investigate the functional abnormality in the glands. Bulimia patients had a reduced resting flow rate. Bulimics who developed sialadenosis (4 patients) had reduced resting and stimulated flow rates. The salivary amylase activity was increased in both the resting and stimulated states in bulimics and the sialadenosis group. The resting total protein levels were greater in the bulimics. The electrolyte and immunoglobulin levels were within normal limits. The possibility of protein and enzymatic secretory disturbances due to autonomic nerve disorders as an explanation for the development of sialadenosis in bulimia nervosa is discussed.
A review of research literature that addresses personality correlates of bulimia revealed a major problem which affects that research and its interpretation: Criteria used to define this disorder have not been consistent across investigators. A related issue is that this disorder has been described by a variety of names, such as dietary chaos syndrome, binge-eating syndrome, bulimia nervosa, etc. The second major problem that contributes to the uncertainty about the personality of bulimics is methodology. Among these have been the inclusion of individuals with a history of anorexia nervosa, the use of researcher-specific self-reports and questionnaires (primarily within a narrow population), and a lack of consistency in the testing measures used to assess personality. This very basic issue needs to be resolved if the findings in bulimia research are to be cumulative and generalizable across studies. Suggestions are offered as to how this resolution should occur.
Salbach-Andrae, Harriet; Bohnekamp, Inga; Pfeiffer, Ernst; Lehmkuhl, Ulrike; Miller, Alec L.
The aim of this study was to describe a case series of adolescents (mean age = 16.5 years, SD = 1.0) with anorexia nervosa (AN) and bulimia nervosa (BN) who received dialectical behavior therapy (DBT). Twelve outpatients with AN and BN took part in 25 weeks of twice weekly therapy consisting of individual therapy and a skills training group.…
Fichter, M M; Quadflieg, N; Rief, W
Thirty-two consecutively admitted females with bulimia nervosa (purging type) according to DSM-IV and additional impulsive behaviours (multi-impulsive bulimia (MIB)) and 32 age-matched female controls with DSM-IV bulimia nervosa (purging type) (uni-impulsive bulimia (UIB)) were assessed longitudinally on admission and at discharge following in-patient therapy and at a 2-year follow-up. Multi-impulsive bulimics were defined as presenting at least three of the six of the following impulsive behaviours in their life-time in addition to their bulimic symptoms at admission: (a) suicidal attempts, (b) severe autoaggression, (c) shop lifting (other than food), (d) alcohol abuse, (e) drug abuse, or (f) sexual promiscuity. Multi-impulsive bulimics were more frequently separated or divorced, had less schooling and held less-skilled jobs. Except for interoceptive awareness (EDI), which was more disturbed in multi-impulsive bulimics, there were no differences concerning scales measuring eating disturbances and related areas. Multi-impulsive bulimics showed more general psychopathology--anxiety, depression, anger and hostility, psychoticism--differed in several personality scales from uni-impulsive bulimics (e.g. increased excitability and anger/hostility) and had overall a less favourable course of illness. Multi-impulsive bulimics also received more in- and out-patient therapy previous to the index treatment and during the follow-up period. The data support the notion that 'multi-impulsive bulimia' or 'multi-impulsive disorder' should be classified as a distinct diagnostic group on axis I or that an 'Impulsive Personality Disorder' should be introduced on axis II. The development of more effective treatment for multi-impulsive bulimia is warranted.
Bulimia Nervosa (BN) is a chronic disorder that results in a high degree of psychological impairment for many women. This article presents a description of Interpersonal Therapy for Group (IPT-G), an evidence-based approach for the treatment of BN. The author presents a rationale for the use of IPT-G, an outline of the group model, and provides…
Katzman, Melanie; Weiss, Lillie
In spite of growing attention to the negative psychological and physiological consequences of bulimia, little has been written on its treatment. A comprehensive group treatment program was developed to increase the bulimic's comfort with herself and her body. Subjects were five single females (four college students and a nurse) who participated in…
Bauer, Barbara G.
Bulimia, an eating disorder characterized by binge eating followed by purging and intense feelings of guilt and failure, is increasing among young women. The eating behavior is only a symptom of more complex underlying problems such as feelings of inadequacy, social isolation, depression, rigid thinking, self-defeating thoughts, and perfectionism.…
Antonio García Cenador
Full Text Available Reseña La última cena: anorexia y bulimia. Massimo Recalcati. Milán: Bruno Mondadori, 1997 (traducción de Teresa Rodríguez y Mariela para Ediciones del cifrado, Buenos Aires, 2004.
Carvalho, Maria Bernadete de; Val, Alexandre Costa; Ribeiro, Maria Mônica Freitas; Santos, Lúcia Grossi Dos
The scope of this study is to identify and contextualize aspects of the therapeutic itineraries of patients treated at a university medical clinic specialized in nervous anorexia and bulimia. For this purpose, an attempt was made to reconstitute the succession of events triggered in 20 respondents and their families with the classification of anorexia and bulimia as "health problems." The narratives were analyzed in order to link the individual experiences and the social context of their occurrence (organization of health services, characteristics of treatment and medical knowledge and characteristics of contemporary subjectivity), in light of the theoretical studies of Public Health and Psychoanalysis. Data analysis revealed that these itineraries arise from connections and disconnections between two distinct approaches: one that organizes the management of patients and the other governing the conduct of health institutions and families. If the latter presuppose a quest for health, this is not what primarily concerns the individuals in question. Their refusal to moderate their own eating disorders is notable on their itineraries, and indicates the functionality of those practices. Such practices play a part in the reconstruction of their self-images.
Full Text Available La anorexia nerviosa es una enfermedad psiquiátrica, cuya incidencia está creciendo en las últimas décadas. Afecta sobre todo a las adolescentes y mujeres jóvenes. Los signos clínicos son consecuencia de las carencias nutricionales y de los mecanismos de compensación, que el organismo implementa para conservar la vida. Las manifestaciones cutáneas y bucales son consecuencia de la desnutrición: vómitos autoprovocados, consumo de drogas o medicamentos no recetados y de la enfermedad psiquiátrica en sí misma. Se presentan diez pacientes, ocho mujeres y dos varones con signos cutáneos compatibles con anorexia nerviosa. El rango de edad es de 17 a 32 años. En orden de frecuencia se hallaron: acrocianosis, alopecia, acné, xerosis, palidez, hirsutismo, cambios en las membranas bucales y lesiones autoprovocadas. Creemos que el reconocimiento de estos signos cutáneos acompañado de un exhaustivo interrogatorio, puede colaborar en el diagnóstico de este trastorno alimentario.Anorexia nervosa is a psychiatric disease with an increasing incidence in the last decade, which affects principally adolescents and young women. Clinical signs are a consequence of malnutrition and the compensating mechanisms implemented to preserve life. Skin and oral lesions are caused by malnutrition, self-provoked vomiting, illegal drug consumption or therapeutic drugs utilization, and the psychiatric disease so far. Case reports: ten patients (eight females and two males with possible skin alterations due to anorexia nervosa, aged 17 to 32 yr. The most frequent signs, in order of priority were: acrocyanosis, alopecia, acne, xerodermia, pallor, hirsutism, oral injuries and self provoked injuries. We propose that the finding of these skin lesions plus an exhaustive questionnaire could aid to diagnose this eating disorder.
Simone Mancini Castilho
Full Text Available É vasta a literatura demonstrando a eficácia dos antidepressivos inibidores seletivos da recaptação de serotonina na Bulimia Nervosa, diminuindo a freqüência do comportamento alimentar compulsivo e dos vômitos. A boa resposta terapêutica aos agentes farmacológicos noradrenérgicos, como a desipramina e a reboxetina, embora menos encontrada na literatura, também já foi documentada. O presente relato de caso descreve o tratamento de uma paciente com Bulimia Nervosa utilizando-se reboxetina na dose de 4 a 8 mg ao dia. A resposta terapêutica vem confirmar os resultados favoráveis do uso desta droga no tratamento da Bulimia Nervosa.There is a substancial body of literature demonstrating the efficacy of selective serotonin reuptake inhibitors antidepressants (SSRI in reducing binge eating and vomiting frequency in Bulimia Nervosa. Good therapeutic response to noradrenergic agents, like desipramine and reboxetine, though not frequently reported in literature, has already been demonstrated. This case report describes the treatment of Bulimia Nervosa with reboxetine (4 to 8 mg/day and its favorable therapeutic results.
Viinamäki, Anni; Marttunen, Mauri; Fröjd, Sari; Ruuska, Jaana; Kaltiala-Heino, Riittakerttu
This study investigates the comorbidity and longitudinal associations between self-reported conduct disorder and subclinical bulimia in a community-based sample of Finnish adolescents in a 2-year prospective follow-up study. There are 2070 adolescents who participated in the survey as ninth graders (mean age 15.5) and followed-up 2 years later. The Youth Self-Report Externalizing scale was used to measure conduct disorder and DSM-IV-based questionnaire to measure bulimia. Co-occurrence of female conduct disorder and subclinical bulimia was found at ages 15 and 17. Subclinical bulimia among girls at age 15 was a risk factor for conduct disorder at age 17, but conduct disorder at age 15 was not predictive of subclinical bulimia at age 17. The pathway from bulimia to conduct disorder may be suggestive of an association with future borderline personality disorder among girls. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.
Morris, Luc G; Stephenson, Kathryn E; Herring, Sharon; Marti, Jennifer L
Mild pancreatitis has been reported as a consequence of anorexia nervosa, bulimia nervosa, or what has been termed the "dietary chaos syndrome". Either chronic malnutrition, or refeeding after periods of malnutrition, may precipitate acute pancreatitis through several pathogenetic mechanisms. A 26-year-old woman with a ten-year history of anorexia and bulimia presented with a third episode of acute pancreatitis in three months. The patient had been abstinent from alcohol for many years. Imaging studies during all three admissions failed to identify any biliary disease, including gallstones or biliary sludge. A cholecystectomy was performed, with a normal intraoperative cholangiogram, and no abnormalities on pathologic examination of the gallbladder and bile. The patient was discharged on hospital day 10 with no pain, and she has begun to return to regular eating habits. Pancreatitis has not recurred after 6 months of follow up. We have identified 14 cases in the literature of acute pancreatitis associated with anorexia or bulimia. In the absence of evidence for gallstone, alcohol or metabolic etiologies, eating disorders may contribute to the pathophysiology of some idiopathic cases of pancreatitis.
Daniel López Felipe
Full Text Available Las fibras de mielina intraoculares se presentan desde el nacimiento y suelen localizarse alrededor de la papila. El síndrome de mielinización de las fibras nerviosas retinales fue descrito por Virchow por primera vez en 1856. Este aparece como parches estriados, blanco o blanco grisáceos con los bordes imprecisos y plumosos siguiendo una configuración coincidente con la distribución de las fibras nerviosas retinales. Se presenta una paciente femenina de 4 años que es traída a consulta por desviación del ojo derecho. En el examen oftalmológico se detecta una agudeza visual con corrección de 0,1 y la oftalmoscopia confirma la mielinización de las fibras nerviosas retinales. En estos pacientes se asocia frecuentemente la miopía y ambliopía. A pesar de los pobres resultados visuales y ante la ausencia de otras terapias disponibles existe tendencia a tratamiento agresivo para la ambliopía, aunque en la literatura esto es aún controversial.
Sam A. Hardy
Full Text Available Este estudio experimental muestra la utilidad de los modelos multigrupo de curva de crecimiento latente por etapas en investigación clínica, concretamente en la evaluación y comparación de los efectos de tratamiento. Sesenta y dos pacientes femeninas (media de edad = 28,1; DT = 8 con bulimia nerviosa fueron asignadas al azar a: a un auto-tratamiento guiado compuesto por un manual de autocuidados más ocho sesiones quincenales de terapia cognitivo conductual (TCC, o b a 16 sesiones semanales de terapia cognitivo conductual (TCC. Ambos grupos mostraron mejorías significativas durante el tratamiento, aunque la TCC mostró mayor mejoría. Sin embargo, el tratamiento auto-guiado evidenció una mejoría más continuada después del tratamiento. Ambos programas mostraron variabilidad en la eficacia durante el tratamiento al menos en un resultado, mientras que el auto-tratamiento mostró una mayor variabilidad que la TCC durante el seguimiento en dos resultados. Los niveles de la línea de base estaban relacionados con los niveles en el seguimiento, particularmente en el tratamiento auto-guiado. Los modelos de curva latente ofrecen un análisis rico de estos datos y resuelven importantes cuestiones sobre las diferencias en la efectividad de los dos programas de tratamiento.
Martinez, Esteve; Castro, Josefina; Bigorra, Aitana; Morer, Astrid; Calvo, Rosa; Vila, Montserrat; Toro, Josep; Rieger, Elisabeth
To assess motivation to change in adolescent patients with bulimia nervosa through the Bulimia Nervosa Stages of Change Questionnaire (BNSOCQ), an instrument adapted from the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) already validated in anorexic patients. Subjects were 30 bulimia nervosa patients (mean age = 16.3 years) who were receiving treatment at an eating disorders unit. The evaluation instruments were: the BNSOCQ, the Eating Disorders Inventory (EDI-2) and the Beck Depression Inventory (BDI). The BNSOCQ was re-administered 1 week later to evaluate test-retest reliability. The BNSOCQ demonstrated good internal consistency (Cronbach's alpha = 0.94) and one week test-retest reliability (Pearson's r = 0.93). Negative significant correlations were found between the BNSOCQ and several EDI-2 scales (Pearson's r between -0.51 and -0.84) and the BDI (r = -0.74). The study provides initial support for the reliability and validity of the BNSOCQ as a self-report instrument for assessing motivation to change in adolescents with bulimia nervosa. 2006 John Wiley & Sons, Ltd and Eating Disorders Association
Sandberg, Katie; Erford, Bradley T.
Six commonly used instruments for assessment of eating disorders were analyzed. Effect size results from Erford et al.'s (2013) meta-analysis for the treatment of bulimia nervosa were used to compare each scale's ability to measure treatment outcomes for bulimia nervosa. Effect size comparisons indicated higher overall effect sizes using the…
Sees body image dissatisfaction as contributing to development and maintenance of bulimia nervosa and bulimic's desire for thinness breeding low self-esteem, feelings of inadequacy, and resistance to recovery. Offers treatment suggestions for body image dissatisfaction as it relates to bulimia. Advises counselors to be satisfied with their own…
Bayer, Alan E.; Baker, Daniel H.
This document presents an overview of anorexia nervosa and bulimia in adolescents. A brief review of the historical background of these eating disorders is included. Causes of anorexia and bulimia are discussed and physical, behavioral, emotional, and perceptual characteristics of the disorders are listed in a section on symptoms. The need for a…
Milano, Walter; Capasso, Anna
Bulimia nervosa, is an eating disorder characterized by excessive influence of weight and body shape on the levels of self-esteem, with pervasive feelings of failure and inadequacy. The eating is characterized by the presence of episodes of uncontrolled eating (Binge), during which the person ingests mass wide variety of foods and the feeling of not being able to stop eating. This review focuses on the metabolic and hormonal alterations in the in bulimia nervosa. A literature search was conducted using the electronic database Medline and PubMed and with additional hand searches through the reference list obtained from the articles found. Journal were searched up to 2015. Inclusion criteria were: 1) full text available in English; 2) published in a peer-reviewed journal and using the following keywords: neurotrasmitters (AgRP, BDNF, αMSH, NP Y, endocannabinoids, adiponectin, CCK, ghrelin, GLP-1, insulin, leptin, PP, PYY), hormones (FSH, LH, estrogen, progesterone, testosterone) and bulimia nervosa, eating disorders. All data reported in the present review indicated that changes in the central and peripheral neuroendocrine equilibria may favor the onset and influence the course and prognosis of an DA. However, it is still questionable whether the alterations of the peptides and hormones regulating the mechanisms of eating behavior are the cause or consequence of a compromised diet. The results of the present review indicate that the altered balance of the various peptides or hormones can be relevant not only for the genesis and / or maintenance of altered dietary behaviors, but also for the development of specific psychopathological aspects in eating disorders. Copyright© Bentham Science Publishers; For any queries, please email at firstname.lastname@example.org.
Kissileff, Harry R; Zimmerli, Ellen J; Torres, Migdalia I; Devlin, Michael J; Walsh, B Timothy
Effect of eating rate on binge size in bulimia nervosa. Bulimia Nervosa (BN) is an eating disorder characterized by recurrent episodes of binge eating. During binge eating episodes, patients often describe the rapid consumption of food, and laboratory studies have shown that during binges patients with BN eat faster than normal controls (NC), but the hypothesis that a rapid rate of eating contributes to the excessive intake of binge meals has not yet been experimentally tested. The aim of this study was to assess the effect of eating rate on binge size in BN, in order to determine whether binge size is mediated, in part, by rate of eating. Thirteen BN and 14 NC subjects were asked to binge eat a yogurt shake that was served at a fast rate (140g/min) on one occasion and at a slow rate (70g/min) on another. NC subjects consumed 169 g more when eating at the fast rate than when eating at the slow rate. In contrast, consumption rates failed to influence binge size in patients with BN (fast: 1205 g; slow: 1195 g). Consequently, there was a significant group by rate interaction. As expected, patients with BN consumed more overall than NC subjects (1200 g vs. 740 g). When instructed to binge in the eating laboratory, patients with BN ate equally large amounts of food at a slow rate as at a fast rate. NC subjects ate less at a slow rate. These findings indicate that in a structured laboratory meal paradigm binge size is not affected by rate of eating. PMID:17996257
Yu, Jessica; Agras, W Stewart; Bryson, Susan
To examine how different definitions of recovery lead to varying rates of recovery, maintenance of recovery, and relapse in bulimia nervosa (BN), end-of-treatment (EOT) and follow-up data were obtained from 96 adults with BN. Combining behavioral, physical, and psychological criteria led to recovery rates between 15.5% and 34.4% at EOT, though relapse was approximately 50%. Combining these criteria and requiring abstinence from binge eating and purging when defining recovery may lead to lower recovery rates than those found in previous studies; however, a strength of this definition is that individuals who meet this criteria have no remaining disordered behaviors or symptoms.
Santos Orejudo Hernández
Full Text Available La amenorrea es un criterio para el diagnostico de la anorexia nerviosa (AN según el DSM-IV-TR. Sin embargo, al comparar grupos de pacientes que cumplen todos los criterios de este manual para la AN con grupos de mujeres que los presentan todos salvo la amenorrea, algunos estudios no han encontrado diferencias significativas en la psicopatología típicamente asociadas con la AN. El propósito de nuestro estudio ha sido comparar variables demográficas, antropométricas, psicológicas y psicopatológicas, en ambos grupos. No se observaron diferencias estadísticamente significativas entre ambos grupos en las variables evaluadas, pero el grupo con amenorrea tenía un índice de masa corporal significativamente más bajo. Nuestros datos apoyan la hipótesis de que la amenorrea podría no ser un criterio diagnóstico útil para la AN.
Full Text Available Mediante la comparación de un caso de disorexia y de otro de bulimia, se explicitan las diferencias que separan a ambos fenómenos psicopatológicos en cuanto a sus articulaciones (atemporales. Se sostiene que mientras la disorexia se despliega en un futuro anterior propio de la temporalidad simbólica del retorno de lo reprimido, la bulimia da cuenta de una temporalidad circular impulsada por la repetición. Sin embargo, dichas diferencias sólo pueden explicarse en función de la presencia de una desigualdad aún más relevante en las articulaciones psicopato-lógicas de la bulimia y del síntoma. Si la (atemporalidad de la bulimia se distingue de aquella que opera en el síntoma, ello se debe a que la bulimia no constituye una verdadera formación sintomato-lógica.Through the comparison of a case of Dysorexia and another of Bulimia the differences, in terms of (atemporal articulations, among the two psychopathological phenomena are made explicit. It is argued that while Dysorexia unfolds in the past future of the symbolic temporality of the return of the repressed, Bulimia unravels in a circular temporality driven by repetition. These differences can only be explained through the presence of an even more relevant dissimilarity in the psycopatho-logical articulations of Bulimia and the symptom. If the (atemporality of Bulimia is distinguished from the one operating in the symptom, it is due to the fact that Bulimia does not constitute a true symptomato-logical formation.
Criquillion-Doublet, S; Samuel-Lajeunesse, B
The multiplicity of actual studies about a possible correlation between eating disorders and affective disorders is found on clinical and family studies, biological, genetic and therapeutic studies. As depressive symptoms are associated to eating disorders in 30 to 88% of the cases according to the authors, family studies suggest the existence of a relationship between eating and affective disorders but no causal link between the two can be proved. Biological tests are difficult to interpret (the dexamethasone suppression test, the TRH stimulation test, a study of platelet MAO activity, of the metabolism of neurotransmitters). The imbrication of metabolic and neuroendocrine disorders being a characteristic of both affective and eating disorders. On the level of therapy, if the results of antidepressants--essentially tricyclics and IMAO--on bulimia are effective on a short-term basis, this is not enough to prove the dysthimic nature of eating disorders. Moreover, their efficiency on the long term (over 6 months) is very controversial. It is the research on genetic and biological index which will allow the precise characterization of the nature of the relationship between eating (bulimia) and affective disorders.
ESTRUCTURA DE LA CÉLULA NERVIOSA. Membrana celular y red pericelular. ─ Protoplasma (aparato tubular, espongioplasma, grumos cromáticos, espacios lagunares y jugo celular, red neurofibrilar, granulaciones de Altmann y Held, pigmento y centrosoma). ─ Estructura del axon y de las expansiones protoplásmicas. ─ Núcleo (membrana, red cromática, red de linina, bastoncillo intranuclear, jugo nuclear y nucleolo). ─ Estructura comparada de la célula nerviosa. Inducciones fisiológicas de la estructu...
Lozano Serra, Estefanía
La Anorexia Nerviosa (AN) es el trastorno de la conducta alimentaria que más se ha estudiado a nivel neuropsicológico, aunque la mayoría de estudios sobre las alteraciones cognitivas en la AN se han llevado a cabo en población adulta. Su investigación es mucho más escasa en población adolescente, edad en la que habitualmente tiene lugar el inicio del trastorno y que conlleva importantes repercusiones en el desarrollo personal, académico/laboral y social del individuo. En el presente trabajo s...
Alex Sánchez, María Dolores
The Information and Communication Technologies (ICT) have an increasing influence on the way we relate and in shaping personal identity. The phenomenon of online social networking emerges strongly and contributes to the development of new spaces breaking with the official discourse that marks the scientific evidence on health. This paper analyzes the impact of ICT in relation to the identity of the digital natives and eating disorders (ED). Particular attention to how the network society determines the response of young people in situations of social tension is dedicated. To do this, provides a perspective on the concept of interaction from the analysis of the discourse on anorexia and bulimia in the network, and how to care nurses should consider these factors to improve efficiency and quality in clinical care and patient care.
Maria Helena Fernandes
Full Text Available The psychoanalytic clinic for anorexia and bulimia puts us into immediate contact with the question of the body, as well as with aspects typical of adolescence. These aspects especially include difficulties in early relationships with the mother regarding the management of the drives, and relationships with primary identification. Consequently, we are dealing with ideals, differentiation, autonomy, time and death. Here hypotheses that were drawn up on the basis of metapsychology are discussed, with the objective of contributing to a broader understanding of the construction of the bodily image. This process includes the perception, representation and internal experience of the patients' own bodies. The impasses experienced in the analytic situation also indicate particularities in managing the transference in these cases.
Kenyon, Martha; Samarawickrema, Nelum; Dejong, Hannah; Van den Eynde, Frederique; Startup, Helen; Lavender, Anna; Goodman-Smith, Emily; Schmidt, Ulrike
This study aimed to investigate theory of mind (ToM) in individuals with bulimia nervosa (BN), an area neglected by empirical research despite social functioning difficulties in this disorder and evidence of ToM deficits in people with anorexia nervosa (AN). ToM was assessed in 48 BN and 34 Eating Disorder Not Otherwise Specified BN-type (EDNOS-BN) outpatients and 57 healthy controls (HCs) using the Reading the Mind in the Eyes and the Reading the Mind in the Films (RMF), an ecologically valid task novel to BN research. Overall performance in BN and EDNOS-BN groups was equivalent to HCs on both tasks. Individuals with BN had enhanced negative emotion recognition on the RMF. Individuals with AN and BN have distinct socio-cognitive profiles. Further research into social cognition is required to establish the link between interpersonal difficulties and psychopathology in people with BN. Copyright © 2011 Wiley Periodicals, Inc.
Skunde, Mandy; Walther, Stephan; Simon, Joe J; Wu, Mudan; Bendszus, Martin; Herzog, Wolfgang; Friederich, Hans-Christoph
Impaired inhibitory control is considered a behavioural phenotype in patients with bulimia nervosa. However, the underlying neural correlates of impaired general and food-specific behavioural inhibition are largely unknown. Therefore, we investigated brain activation during the performance of behavioural inhibition to general and food-related stimuli in adults with bulimia nervosa. Women with bulimia and healthy control women underwent event-related fMRI while performing a general and a food-specific no-go task. We included 28 women with bulimia nervosa and 29 healthy control women in our study. On a neuronal level, we observed significant group differences in response to general no-go stimuli in women with bulimia nervosa with high symptom severity; compared with healthy controls, the patients showed reduced activation in the right sensorimotor area (postcentral gyrus, precentral gyrus) and right dorsal striatum (caudate nucleus, putamen). The present results are limited to adult women with bulimia nervosa. Furthermore, it remains unclear whether impaired behavioural inhibition in patients with this disorder are a cause or consequence of chronic illness. Our findings suggest that diminished frontostriatal brain activation in patients with bulimia nervosa contribute to the severity of binge eating symptoms. Gaining further insight into the neural mechanisms of behavioural inhibition problems in individuals with this disorder may inform brain-directed treatment approaches and the development of response inhibition training approaches to improve inhibitory control in patients with bulimia nervosa. The present study does not support greater behavioural and neural impairments to food-specific behavioural inhibition in these patients.
Mehler, Philip S; Krantz, Mori J; Sachs, Katherine V
Inherent to anorexia nervosa and bulimia nervosa are a plethora of medical complications which correlate with the severity of weight loss or the frequency and mode of purging. Yet, the encouraging fact is that most of these medical complications are treatable and reversible with definitive care and cessation of the eating-disordered behaviours. Herein, these treatments are described for both the medical complications of anorexia nervosa and those which are a result of bulimia nervosa.
Mehler, Philip S; Krantz, Mori J; Sachs, Katherine V
Inherent to anorexia nervosa and bulimia nervosa are a plethora of medical complications which correlate with the severity of weight loss or the frequency and mode of purging. Yet, the encouraging fact is that most of these medical complications are treatable and reversible with definitive care and cessation of the eating-disordered behaviours. Herein, these treatments are described for both the medical complications of anorexia nervosa and those which are a result of bulimia nervosa.
Percepção de familiares sobre a anorexia e bulimia: revisão sistemática Percepción de familiares sobre la anorexia y bulimia: revisión sistemática Family perception of anorexia and bulimia: a systematic review
Cybele Ribeiro Espíndola
Full Text Available Realizou-se revisão sistemática da literatura publicada entre 1990 e 2006 com metodologia qualitativa sobre a perspectiva de familiares de pessoas com anorexia e bulimia nervosa. Após revisão crítica dos artigos e metassíntese, utilizou-se a abordagem meta-etnográfica para analisar e sintetizar os dados. O processo de interpretação empregado foi a reciprocal translation. Dentre 3.415 estudos, nove atenderam aos critérios de inclusão e exclusão. Dois conceitos emergiram: reconhecimento da doença e repercussões da doença. Na reorganização familiar, o sentimento de impotência foi predominante. Os resultados indicam a presença de distorções sobre os conceitos da doença associadas a um comprometimento familiar, que modifica a comunicação, atitudes e comportamentos dentro de um contexto de impotência.Se realizó revisión sistemática de la literatura publicada entre 1990 y 2006 con metodología cualitativa sobre la perspectiva de familiares de personas con anorexia y bulimia nerviosa. Posterior a la revisión crítica de los artículos y metasíntesis, se utilizó el abordaje meta-etnográfico para analizar y sintetizar los datos. El proceso de interpretación empleado fue el reciprocal translation. Entre 3.415 estudios, nueve atendieron a los criterios de inclusión y exclusión. Dos conceptos emergieron: reconocimiento de la enfermedad y repercusiones de la enfermedad. En la reorganización familiar, el sentimiento de impotencia fue predominante. Los resultados indican la presencia de distorsiones sobre los conceptos de la enfermedad asociados a un compromiso familiar, que modifica la comunicación, actitudes y comportamientos dentro de un contexto de impotencia.A systematic literature review published between 1990 and 2006 using a qualitative approach was conducted to explore family members' perception of anorexia and bulimia nervosa patients. Articles were critically reviewed and a meta-synthesis analysis was carried out
Peterson, Carol B; Thuras, Paul; Ackard, Diann M; Mitchell, James E; Berg, Kelly; Sandager, Nora; Wonderlich, Stephen A; Pederson, Melissa W; Crow, Scott J
The purpose of this investigation was to examine differences in personality dimensions among individuals with bulimia nervosa, binge eating disorder, non-binge eating obesity, and a normal-weight comparison group as well as to determine the extent to which these differences were independent of self-reported depressive symptoms. Personality dimensions were assessed using the Multidimensional Personality Questionnaire in 36 patients with bulimia nervosa, 54 patients with binge eating disorder, 30 obese individuals who did not binge eat, and 77 normal-weight comparison participants. Participants with bulimia nervosa reported higher scores on measures of stress reaction and negative emotionality compared to the other 3 groups and lower well-being scores compared to the normal-weight comparison and the obese samples. Patients with binge eating disorder scored lower on well-being and higher on harm avoidance than the normal-weight comparison group. In addition, the bulimia nervosa and binge eating disorder groups scored lower than the normal-weight group on positive emotionality. When personality dimensions were reanalyzed using depression as a covariate, only stress reaction remained higher in the bulimia nervosa group compared to the other 3 groups and harm avoidance remained higher in the binge eating disorder than the normal-weight comparison group. The higher levels of stress reaction in the bulimia nervosa sample and harm avoidance in the binge eating disorder sample after controlling for depression indicate that these personality dimensions are potentially important in the etiology, maintenance, and treatment of these eating disorders. Although the extent to which observed group differences in well-being, positive emotionality, and negative emotionality reflect personality traits, mood disorders, or both, is unclear, these features clearly warrant further examination in understanding and treating bulimia nervosa and binge eating disorder.
Peterson, Carol B.; Thuras, Paul; Ackard, Diann M.; Mitchell, James E.; Berg, Kelly; Sandager, Nora; Wonderlich, Stephen A.; Pederson, Melissa W.; Crow, Scott J.
Objective The purpose of this investigation was to examine differences in personality dimensions among individuals with bulimia nervosa, binge eating disorder, non-binge eating obesity and a normal weight comparison group as well as to determine the extent to which these differences were independent of self-reported depressive symptoms. Method Personality dimensions were assessed using the Multidimensional Personality Questionnaire in 36 patients with bulimia nervosa, 54 patients with binge eating disorder, 30 obese individuals who did not binge eat, and 77 normal weight comparison participants. Results Participants with bulimia nervosa reported higher scores on measures of stress reaction and negative emotionality compared to the other three groups, and lower well-being scores compared to the normal weight comparison and the obese samples. Patients with binge eating disorder scored lower on well-being and higher on harm avoidance than the normal weight comparison group. In addition, the bulimia nervosa and binge eating disorder groups scored lower than the normal weight group on positive emotionality. When personality dimensions were re-analyzed using depression as a covariate, only stress reaction remained higher in the bulimia nervosa group compared to the other three groups and harm avoidance remained higher in the binge eating disorder than the normal weight comparison group. Conclusions The higher levels of stress reaction in the bulimia nervosa sample and harm avoidance in the binge eating disorder sample after controlling for depression indicate that these personality dimensions are potentially important in the etiology, maintenance, and treatment of these eating disorders. Although the extent to which observed group differences in well-being, positive emotionality and negative emotionality reflect personality traits, mood disorders, or both is unclear, these features clearly warrant further examination in understanding and treating bulimia nervosa and
Folke, Sofie; Daniel, Sarah Ingrid Franksdatter; Poulsen, Stig Bernt
Objective: This study investigated the relation between clients’ attachment patterns and the therapeutic alliance in two psychotherapies for bulimia nervosa. Method: Data derive from a randomized clinical trial comparing cognitive-behavioral therapy and psychoanalytic psychotherapy for bulimia...
Brown, Michael H.
Written for counselors who must help clients deal with bulimia, this article reviews bulimia's most obvious physical signs and symptoms, etiology, and behavioral characteristics. Considers innovative counseling approaches including Transpersonal Psychology, relaxation training, imagination, fantasy, hypnosis, myths, and rituals. (Author)
Ben Salem, Hela; Gaigi, Imene; El Fray, Hamouda; Gaigi, Sadok; El Ati, Jalila
The disturbances related to the feeding behavior are increasing in Tunisia. To evaluate the impact of an adapted and personalized therapeutic program, including dietetic advises and practice of yoga in Tunisian teenagers suffering from bulimia or anorexia. Our study was carried out on 31 teenagers, old 16 to 19 years, 10 were anorexics (9 girls and 1 boy) and 21 were bulimics (14 girls and 7 boys). After twelve weeks of program application a clear improvement of the physical and mental state of our subjects was recorded. Indeed, an average fall of 7.3% of the body weight of the compulsive eaters and an increase of 6.6% of that of the anorexics were obtained. On the mental level, the frequency of the subjects which make daily crises passed from 29% to 19%. More half of the subjects (54.8%) paid more not to vomit but occasionally (less than one once out of two crises). These results show that an assumption of responsibility targeted of the teenagers suffering from food behavioral problems can help them to be left there.
Tolstoi, L G
The purpose of this article is to review the basic pharmacology and the role of drugs that are used to treat anorexia nervosa and bulimia. The pharmacological treatment of eating disorders is based upon theoretical principles. The theoretical models include: (a) an illness secondary to other psychiatric disorders, (b) a disorder in the hypothalamic control of food intake, (c) a disorder of hypothalamic endocrine regulation, (d) a syndrome secondary to depressive illness, and (e) a disorder in the hypothalamic regulation of food intake. Theoretical models a, b, and c govern the choice of drug therapy for anorexia nervosa, and models d and e govern the choice of drug therapy for bulimia. Drugs used to treat anorexia nervosa and bulimia include tricyclic antidepressants and lithium carbonate. Chlorpromazine, metoclopramide, cyproheptadine, and clomiphene citrate have also been prescribed for the treatment of anorexia nervosa. Monoamine oxidase inhibitors are commonly prescribed to treat bulimia. Fenfluramine has the potential to be of therapeutic value in patients with bulimia. Although drug therapy plays a limited role in the treatment of eating disorders, drugs are commonly prescribed. Therefore, the nutritionist should be familiar with the basic pharmacology and the side effects related to drug therapy.
Crow, Scott J; Peterson, Carol B; Swanson, Sonja A; Raymond, Nancy C; Specker, Sheila; Eckert, Elke D; Mitchell, James E
Anorexia nervosa has been consistently associated with increased mortality, but whether this is true for other types of eating disorders is unclear. The goal of this study was to determine whether anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified are associated with increased all-cause mortality or suicide mortality. Using computerized record linkage to the National Death Index, the authors conducted a longitudinal assessment of mortality over 8 to 25 years in 1,885 individuals with anorexia nervosa (N=177), bulimia nervosa (N=906), or eating disorder not otherwise specified (N=802) who presented for treatment at a specialized eating disorders clinic in an academic medical center. Crude mortality rates were 4.0% for anorexia nervosa, 3.9% for bulimia nervosa, and 5.2% for eating disorder not otherwise specified. All-cause standardized mortality ratios were significantly elevated for bulimia nervosa and eating disorder not otherwise specified; suicide standardized mortality ratios were elevated for bulimia nervosa and eating disorder not otherwise specified. Individuals with eating disorder not otherwise specified, which is sometimes viewed as a "less severe" eating disorder, had elevated mortality risks, similar to those found in anorexia nervosa. This study also demonstrated an increased risk of suicide across eating disorder diagnoses.
Gross, Janet; And Others
Assessed criterion and concurrent validity of the Eating Attitudes Test and the Eating Disorder Inventory in 82 women with bulimia nervosa. Both tests demonstrated criterion validity by discriminating bulimia nervosa subjects from normals. Only weak support was found for concurrent validity within bulimia subjects. Recommends combination of…
Keski-Rahkonen, A.; Hoek, H. W.; Linna, M. S.; Raevuori, A.; Sihvola, E.; Bulik, C. M.; Rissanen, A.; Kaprio, J.
Background. Little is known about the epidemiology of bulimia nervosa outside clinical settings. We report the incidence, prevalence and outcomes of bulimia nervosa using for the first time a nationwide Study design. Method. To assess the incidence and natural course and outcomes of DSM-IV bulimia
Full Text Available Eating disorders such as bulimia nervosa rarely seem to manifest in males from non-Western cultures like India, but occur infrequently in milder forms with fewer symptoms as atypical bulimia nervosa. This report describes a male case of bulimia nervosa from rural area of India presenting with atypical features. He was treated successfully with fluoxetine and cognitive behavioural therapy.
Richards, P. Scott
This paper defines the eating disorders of anorexia nervosa, bulimia, and bulimia nervosa, a bulimic subtype of anorexia nervosa. The diagnosis of these disorders is discussed and similarities and differences among the three disorders are reviewed. Etiological factors are considered and current trends in treatment of anorexia nervosa, bulimia, and…
Cimolin, Veronica; Galli, Manuela; Vismara, Luca; Vimercati, Sara Laura; Precilios, Helmer; Cattani, Laila; Fabris De Souza, Shirley; Petroni, Maria Letizia; Capodaglio, Paolo
Anorexia (AN) and Bulimia Nervosa (BN) are two common eating disorders, which appear to share some reduced motor capacities, such as a reduced balance. The presence and the extent of other motor disorders have not been investigated in a comprehensive way. The aim of this study was to quantify gait pattern in AN and BN individuals in order to ascertain possible differences from the normality range and provide novel data for developing some evidence-based rehabilitation strategies. Nineteen AN patients (age 30.16+9.73) and 20 BN patients (age 26.8+8.41) were assessed with quantitative 3D computerized Gait Analysis. Results were compared with a group of healthy controls (CG; 30.7+5.6). AN and BN patients were characterized by different gait strategies compared to CG. Spatio-temporal parameters indicated shorter step length, with AN showing the shortest values. AN walked slower than BN and CG. As for kinematics, AN and BN showed a nonphysiologic pattern at pelvis and hip level on the sagittal and frontal plane, with BN yielding the most abnormal values. Both AN and BN patients were characterized by high ankle plantar flexion capacity at toe-off when compared to CG. As for ankle kinetics, both AN and BN showed physiologic patterns. Stiffness at hip level was close to CG in both pathologic groups; at the ankle level, stiffness was significantly decreased in both groups, with AN displaying lower values. Both AN and BN were characterized by an altered gait pattern compared to CG. Biomechanical differences were evident mainly at pelvis and hip level. Loss of lean mass may lead to musculoskeletal adaptation, ultimately causing alterations in the gait pattern.
Dania Fuentes Martínez
Full Text Available La polineuropatía urémica es la complicación neurológica más frecuente de la insuficiencia renal crónica, y son insuficientemente conocidos su prevalencia, síntomas y patrones neurofisiológicos de expresión en la población pediátrica. Es por ello que se estudiaron 23 pacientes en edades comprendidas entre 7 y 21 años, con insuficiencia renal crónica en sus diferentes grados y 23 niños supuestamente sanos, buscando la presencia de neuropatía periférica clínica o subclínica. Se realizó examen físico general y neurológico, así como la medición de las velocidades de conducción motora y sensitiva. Los síntomas predominantes fueron el dolor a la marcha (55,5 % y las parestesias (44,4 %, y fueron más frecuentes en el grupo de pacientes dialíticodependientes. La función nerviosa periférica estuvo alterada en todos los grupos estudiados, y existió correlación significativa entre la velocidad de conducción sensitiva y los valores medios de urea, creatinina y filtrado glomerular. Se hallaron diferencias significativas entre las medias de la velocidad de conducción sensitiva de los niños de los grupos predialítico, dialíticodependiente y el grupo control, y entre los grupos predialítico y con transplante renal no existieron diferencias significativas.Uremic polyneuropathy is the most frequent neurological complication of the chronic renal failure but its prevalence, symptoms and neurophysiological patterns of expression in the pediatric population are not well known. This is the reason why 23 patients aged 7-21 years with chronic renal failure at different stages and 23 supposedly healthy children were studied to look for clinical or subclinical peripheral neuropathy. General physical and neurological exams were made and sensory and motor conduction velocities were measured. The prevailing symptoms were pain on walking(55,5% and paresthesias (44,4% mainly found in dialysis-dependent patients. All the studied groups
Daley, Karen A; Jimerson, David C; Heatherton, Todd F; Metzger, Eran D; Wolfe, Barbara E
Bulimia nervosa (BN) is associated with low self-esteem. This study was designed to assess whether low self-esteem persists in nondepressed individuals who have recovered from BN (BN-R). Study groups included BN (n = 22), BN-R (n = 20), and healthy controls (n = 42). Participants were medication-free, and none met criteria for current major depression. Assessment instruments included the State Self-Esteem Scale (SSES), a self-rating scale designed to measure state-related changes in self-esteem. Consistent with previous reports, SSES scores for BN were lower than for controls (p p p p low self-esteem following recovery from BN. Follow-up studies are needed to assess whether low self-esteem contributes to recurrent dieting and risk for relapse.
Eedy, D. J.; Curran, J. G.; Andrews, W. J.
A case is reported of a young woman with bulimia nervosa who presented with profound folate deficiency. This association has not been reported before despite the increased theoretical possibility. Initially she has responded well to folic acid therapy and social support. PMID:3809077
Lowe, Michael R.; Berner, Laura A.; Swanson, Sonja A.; Clark, Vicki L.; Eddy, Kamryn T.; Franko, Debra L.; Shaw, Jena A.; Ross, Stephanie; Herzog, David B.
Objective: To investigate whether, at study entry, (a) weight suppression (WS), the difference between highest past adult weight and current weight, prospectively predicts time to first full remission from bulimia nervosa (BN) over a follow-up period of 8 years, and (b) weight change over time mediates the relationship between WS and time to first…
van Hoeken, Daphne; Veling, Wim; Sinke, Sjoukje; Mitchell, James E.; Hoek, Hans W.
Objective: To review the evidence for the validity and utility of subtyping bulimia nervosa (BN) into a purging (BN-P) and a nonpurging subtype (BN-NP), and of distinguishing BN-NP from binge eating disorder (BED), by comparing course, complications, and treatment. Method: A literature search of
Phillips, Elaine L.; Greydanus, Donald E.; Pratt, Helen D.; Patel, Dilip R.
Reviews the current literature on psychological and psychopharmacologic treatments for bulimia nervosa in the adolescent population. Describes the two most researched psychological treatments--cognitive behavior therapy and interpersonal therapy--in terms of treatment protocols and outcome research. Reviews psychopharmacologic treatment, including…
Davis, Ron; And Others
Investigated parameters of eating behavior in subjects with bulimia nervosa (BN). BN and female comparison (FC) subjects monitored hourly over several days their food intake, mood, hunger, social circumstances, and experiences of unpleasant events. BN subjects reported more positive moods prior to consuming a meal, and more negative moods prior to…
Gross, Karen B. W.; And Others
Dentists and dental hygienists are in a unique position to identify an eating disorder patient from observed oral manifestations and to refer the patient for psychological therapy. The inclusion of information on general and oral complications of bulimia and anorexia nervosa in dental and dental hygiene curriculum was examined. (MLW)
Barriguete Meléndez, J Armando; Rojo, Luis; Emmelhainz, Marisa
It is presented the current perspectives in the study and treatment of the eating disorders, in specific: anorexia nervosa and bulimia nervosa, epidemiology, and the interface among the different medical specialties, nutrition and sciences of the behavior, the diagnostic approaches, instruments and current therapeutic models.
Kaplan, Allan S.; Woodside, D. Blake
Reviews biological factors relevant to the understanding of anorexia nervosa and bulimia nervosa. Considers the physical presentation of these disorders; the medical complications of starvation, binging, and purging; and the cognitive and behavioral effects of starvation. Reviews neurophysiological and neurochemical aspects of these illnesses and…
Mallick, M. Joan
School personnel can have a vital role in the early detection and treatment of anorexia nervosa and bulimia by understanding certain signs and symptoms. This article provides specific information about early detection, approaches to use when confronting the student, and methods to facilitate treatment. (Author/DF)
Cullari, Salvatore; Redmon, William K.
This paper presents a theoretical model for a primary prevention program for bulimia and anorexia nervosa to be used with adolescents and young women considered most at risk of developing these eating disorders. Characteristics of potential anorexics and bulimics are identified to aid in the selection of target groups for the program. It is…
Objective: Oesophageal achalasia is a medical condition characterised by oesophageal aperistalsis, an increased resting pressure with partial or incomplete relaxation of the lower oesophageal sphincter. Bulimia nervosa (BN) is an eating disorder manifested by binge eating attacks followed by recurrent inappropriate ...
Anorexia nervosa (AN) and bulimia nervosa (BN) are related disorders of unknown etiology that most commonly begin during adolescence in women. AN and BN have unique and puzzling symptoms, such as restricted eating or binge-purge behaviors, body image distortions, denial of emaciation, and resistance to treatment. These are often chronic and relapsing disorders, and AN has the highest death rate of any psychiatric disorder. The lack of understanding of the pathogenesis of this illness has hindered the development of effective interventions, particularly for AN. Individuals with AN and BN are consistently characterized by perfectionism, obsessive-compulsiveness, and dysphoric mood. Individuals with AN tend to have high constraint, constriction of affect and emotional expressiveness, ahendonia and asceticism, whereas individuals with BN tend to be more impulsive and sensation seeking. Such symptoms often begin in childhood, before the onset of an eating disorder, and persist after recovery, suggesting they are traits that create a vulnerability for developing an ED. There is growing acknowledgement that neurobiological vulnerabilities make a substantial contribution to the pathogenesis of AN and BN. Considerable evidence suggests that altered brain serotonin (5-HT) function contributes to dysregulation of appetite, mood, and impulse control in AN and BN. Brain imaging studies, using 5-HT specific ligands, show that disturbances of 5-HT function occur when people are ill, and persist after recovery from AN and BN. It is possible that a trait-related disturbance of 5-HT neuronal modulation predates the onset of AN and contributes to premorbid symptoms of anxiety, obsessionality, and inhibition. This dysphoric temperament may involve an inherent dysregulation of emotional and reward pathways which also mediate the hedonic aspects of feeding, thus making these individuals vulnerable to disturbed appetitive behaviors. Restricting food intake may become powerfully
Monteleone, Palmiero; Tortorella, Alfonso; Martiadis, Vassilis; Serino, Ismene; Di Filippo, Carmela; Maj, Mario
Genes involved in serotonin transmission are likely involved in the biological predisposition to bulimia nervosa. We investigated whether the A218C polymorphism of the tryptophan-hydroxylase-1 gene was associated to bulimia nervosa and/or to some phenotypic aspects of the disorder. One hundred eighty Caucasian women (91 patients with bulimia nervosa and 89 healthy controls) were enrolled into the study. They underwent a blood sample collection for A218C polymorphism of the tryptophan-hydroxylase-1 genotyping and a clinical evaluation assessing comorbidity for Axis I and II psychiatric disorders, harm avoidance personality dimension and bulimic symptoms. The distribution of both tryptophan-hydroxylase-1 A218C genotypes and alleles did not significantly differ between patients and controls. Bulimic women with the AA genotype exhibited a more severe binge eating behavior and higher harm avoidance scores than those with CC genotype. These findings support the idea that tryptophan-hydroxylase-1 A218C polymorphism does not play a part in the genetic susceptibility to bulimia nervosa, but it seems to be involved in predisposing bulimic patients to a more disturbed eating behavior and higher harm avoidance.
This study examined the clinical characteristics including stress-related factors of eating disorders in a sample of 312 diabetic patients with end-stage renal failure. The prevalence rate of bulimia nervosa was 5.1% (16 of 312 patients). The 16 patients with bulimia nervosa were 8 men and 8 women over 58 years old. Looking at the subjects by cause of end-stage renal failure, those with diabetes mellitus exhibited significantly higher prevalence rate of bulimia nervosa than two nondiabetic groups (diabetes 10%; nephritis 1.6%; others 1.9%). As for the association of bulimia nervosa and stress-related factors, end-stage renal failure patients with diabetes who exhibited bulimia nervosa showed significantly higher scores on a measure of alexithymia. These results suggest that, when liaison psychiatrists see diabetic patients with end-stage renal failure who exhibit bulimia nervosa, they should pay close attention to stress-related symptoms including alexithymia.
Jones, A.; Clausen, Loa
OBJECTIVE: The aim of the study was to evaluate the efficacy of a brief group cognitive behavior therapy (CBT) program in treating a large cohort of patients diagnosed with bulimia nervosa. METHOD: Treatment outcome defined as reductions in bulimia related behavioral symptoms and bulimia related...... distress was examined in 205 consecutive new patients enrolled in an eight-session group CBT program. RESULTS: Significant reductions in eating disorder pathology were found on all measures of bulimia related behavioral symptoms, as well as on all measures of bulimia related distress. DISCUSSION......: There is strong evidence for the efficacy of brief group CBT in treating patients with bulimia nervosa....
Stewart, Catherine; Voulgari, Stamatoula; Eisler, Ivan; Hunt, Katrina; Simic, Mima
Existing randomized controlled trials of family therapy for treatment of bulimia nervosa in adolescence highlight the need for further development of treatments. This article describes the development of multi-family treatment for bulimia nervosa in adolescents aged 13-18. It outlines the theory guiding this development, the areas of need identified by previous studies, and the treatment that has been designed to meet these needs. Particular attention is given to the need to increase communication between family members, strategies to reduce high levels of criticism or hostility, and skills to manage emotion dysregulation and low tolerance for negative emotions. To these ends the program draws on the multi-family treatment for anorexia nervosa, cognitive behavioral therapy techniques, and dialectical behavior therapy.
Ruiz-Martínez, Ana Olivia; Universidad Nacional Autónoma de México, FES, Iztacala; Vásquez-Arevalo, Rosalía; Universidad Nacional Autónoma de México, FES, Iztacala; Mancilla Díaz, Juan Manuel; Universidad Nacional Autónoma de México, FES, Iztacala; López Aguilar, Xochitl; Universidad Nacional Autónoma de México, FES, Iztacala; Álvarez-Rayón, Georgina; Universidad Nacional Autónoma de México, FES, Iztacala; Tena-Suck, Antonio; Universidad Iberoamericana, Fundación CBA
El objetivo del presente estudio fue analizar los aspectos del funcionamiento familiar que explican parte del riesgo y la protección de los Trastornos del Comportamiento Alimentario (TCA): Anorexia Nerviosa (AN), Bulimia Nerviosa (BN) y Trastornos del Comportamiento Alimentario No Especificados (TCANE). Participaron 70 mujeres con TCA (16 con AN, 24 con BN, y 30 TCANE) y 30 mujeres sin TCA, con un promedio de 18 años. Todas fueron entrevistadas para su diagnóstico y además contestaron a...
Gonçalves, Sónia; Machado, Bárbara Freire Brito César; Martins, C.; Brandão, Isabel; Torres, António Roma; Machado, Paulo P. P.
Background: Bulimia nervosa (BN) is often related to self-control difficulties and to dysregulated behaviours. This study aimed to evaluate the frequency of self-injurious behaviour, suicide attempts, and other dysregulated behaviours in BN, using two control groups (a healthy group and a general psychiatric group), and also to examine the association between these behaviours and alleged sexual abuse in BN.Method: Women (N = 233) aged between 13 and 38 years old were evaluated using a semi-st...
The study deals with eating disorders. It tries to bring the most comprehensive overview of the two majority eating disorders, anorexia nervosa and bulimia nervosa, respectively. Both diseases have a lot in common, but also some of its specifics which are pointed out in the study. The study is conceived to make the reader in the early chapters acquainted with the various eating disorders according to international diagnostic criteria. Then there is a brief history, epidemiology and etiology a...
Anorexia nervosa (AN) and bulimia nervosa (BN) are multifactorial diseases, which are among the most prevalent disorders in child and adolescent psychiatry. Aesthetic sports are often considered as a risk factor for the development of an eating disorder. The present professorial dissertation for the first time demonstrates no higher risk for competitive athletes aged 12 to 18 years to develop an eating disorder. Research shows that psychiatric comorbidity is a very unfavorable prognostic ...
Hail, Lisa; Le Grange, Daniel
Lisa Hail, Daniel Le Grange Department of Psychiatry, University of California, San Francisco, CA, USA Abstract: Bulimia nervosa (BN) is a serious psychiatric illness that typically develops during adolescence or young adulthood, rendering adolescents a target for early intervention. Despite the increasing research devoted to the treatment of youth with anorexia nervosa (AN) and adults with BN, there remains a dearth of evidence for treating younger individuals with BN. To date, ther...
Steiger, Howard; Leichner, Pierre; Ghadirian, A. Missagh
Ample evidence suggests a rising incidence of anorexia nervosa and bulimia over the past few decades. Correspondingly, medical knowledge about the etiology, symptomatology and treatment of these eating disorders has increased. Often the front line health-care workers who treat these disorders, family physicians are in a key position for early detection and prevention of these eating disorders. An adequate understanding of relevant risk factors, symptoms and signs may allow the physician to pr...
Anderson, Drew A.; Simmons, Angela M.
This paper describes the initial development of a treatment for bulimia nervosa using a functional contextual treatment approach. Seven women (6 with a diagnosis of bulimia nervosa and 1 with a diagnosis of eating disorder not otherwise specified) completed 12 sessions of functional contextual treatment. Participants were assessed with the Eating…
McCanne, Lynn P. Fisher
Examined the relationship of anxiety, assertiveness, and locus of control to bulimia in college students. Those in therapy for bulimia (N=23) scored lower in assertivenss than did other clients in therapy (N=15) or those in the nonclient control group (N=18). All clients showed greater anxiety than did controls. (Author/BH)
Dynesen, Anja Weirsøe; Jensen, Allan Bardow; Astrup, Arne
Background: Binge eating episodes in persons with bulimia nervosa may to some extent be a result of disturbed sensations of hunger and satiety. It has been hypothesized that abnormal appetite sensations may be due to bulimia nervosa-related alterations in the release of hormones that are known...
Halasz, Hisako, Comp.
This bibliography is intended to help readers locate material on anorexia nervosa and bulimia in the collections of the Library of Congress. A scope note briefly defines the terms "anorexia nervosa" and "bulimia" and discusses similarities and differences between the two eating disorders. Four references are included as introductions to the topic…
Killian, Kyle D.
Reviews literature examining family variables associated with anorexia nervosa and bulimia nervosa and family systems treatments for these eating disorders. Presents definitions of and diagnostic criteria for anorexia and bulimia, and discusses prevalence of these disorders. Reviews role played by psychopathological, sociological, and…
Garcia Garcia, Blas; Dean Ferrer, Alicia; Diaz Jimenez, Nelida; Alamillos Granados, Francisco Jesus
Bulimia is a common cause of sialadenosis. This paper presents a case of bilateral parotid sialadenosis associated with long-standing bulimia, and reviews the relevant literature and current treatment options. A 32-year-old woman had severe bilateral parotid sialomegaly for the last 6 years, which had occurred secondary to bulimia nervosa, which she had since 14 years. Treatment with pilocarpine was unsuccessful, so she underwent bilateral conservative parotidectomy. This procedure not only improved the aesthetic appearance of the patient but also improved her social and work life and overall quality of life. Sialomegaly secondary to bulimia results in a major alteration of the aesthetics of a patient's face. Conservative measures are not enough in many cases, and parotidectomy may be the only viable option, as it can also significantly improve adherence to psychiatric treatment for bulimia, in addition to correcting the facial aesthetics.
Berner, Laura A; Stefan, Mihaela; Lee, Seonjoo; Wang, Zhishun; Terranova, Kate; Attia, Evelyn; Marsh, Rachel
Frontostriatal and frontoparietal abnormalities likely contribute to deficits in control and attentional processes in individuals with bulimia nervosa and to the persistence of dysregulated eating across development. This study assessed these processes and cortical thickness in a large sample of adolescent girls and women with bulimia nervosa compared with healthy controls. We collected anatomical MRI data from adolescent girls and women (ages 12-38 yr) with full or subthreshold bulimia nervosa and age-matched healthy controls who also completed the Conners Continuous Performance Test-II (CPT-II). Groups were compared on task performance and cortical thickness. Mediation analyses explored associations among cortical thickness, CPT-II variables, bulimia nervosa symptoms and age. We included 60 girls and women with bulimia nervosa and 54 controls in the analyses. Compared with healthy participants, those with bulimia nervosa showed increased impulsivity and inattention on the CPT-II, along with reduced thickness of the right pars triangularis, right superior parietal and left dorsal posterior cingulate cortices. In the bulimia nervosa group, exploratory analyses revealed that binge eating frequency correlated inversely with cortical thickness of frontoparietal and insular regions and that reduced frontoparietal thickness mediated the association between age and increased symptom severity and inattention. Binge eating frequency also mediated the association between age and lower prefrontal cortical thickness. These findings are applicable to only girls and women with bulimia nervosa, and our cross-sectional design precludes understanding of whether cortical thickness alterations precede or result from bulimia nervosa symptoms. Structural abnormalities in the frontoparietal and posterior cingulate regions comprising circuits that support control and attentional processes should be investigated as potential contributors to the maintenance of bulimia nervosa and useful
Berner, Laura A; Stefan, Mihaela; Lee, Seonjoo; Wang, Zhishun; Terranova, Kate; Attia, Evelyn; Marsh, Rachel
Frontostriatal and frontoparietal abnormalities likely contribute to deficits in control and attentional processes in individuals with bulimia nervosa and to the persistence of dysregulated eating across development. This study assessed these processes and cortical thickness in a large sample of adolescent girls and women with bulimia nervosa compared with healthy controls. We collected anatomical MRI data from adolescent girls and women (ages 12-38 yr) with full or subthreshold bulimia nervosa and age-matched healthy controls who also completed the Conners Continuous Performance Test-II (CPT-II). Groups were compared on task performance and cortical thickness. Mediation analyses explored associations among cortical thickness, CPT-II variables, bulimia nervosa symptoms and age. We included 60 girls and women with bulimia nervosa and 54 controls in the analyses. Compared with healthy participants, those with bulimia nervosa showed increased impulsivity and inattention on the CPT-II, along with reduced thickness of the right pars triangularis, right superior parietal and left dorsal posterior cingulate cortices. In the bulimia nervosa group, exploratory analyses revealed that binge eating frequency correlated inversely with cortical thickness of frontoparietal and insular regions and that reduced frontoparietal thickness mediated the association between age and increased symptom severity and inattention. Binge eating frequency also mediated the association between age and lower prefrontal cortical thickness. These findings are applicable to only girls and women with bulimia nervosa, and our cross-sectional design precludes understanding of whether cortical thickness alterations precede or result from bulimia nervosa symptoms. Structural abnormalities in the frontoparietal and posterior cingulate regions comprising circuits that support control and attentional processes should be investigated as potential contributors to the maintenance of bulimia nervosa and useful
Bulik, Cynthia M.; Marcus, Marsha D.; Zerwas, Stephanie; Levine, Michele D.; Via, Maria La
Case Ms. Z, a 35-year-old African-American single woman with a body mass index (BMI) of 37.8 kg/m2 (height 5 feet, 5.5 inches, weight 238 lb.), presents for an evaluation for bulimia nervosa. She was referred to the eating disorders program by her primary care physician who knew about her eating disorder, but was primarily concerned about her weight and blood pressure. Ms. Z has an advanced degree and is employed full time. She has struggled with her eating, weight, and body image since childhood and began binge eating regularly (1–2× week) at age 15. Fasting and self-induced vomiting began in her early twenties, when she achieved her lowest adult BMI of 21.6 kg (weight 130 lb. at age 23). She gained 100 pounds in the past 7 years and currently binges and purges 1–2 times a day. A typical binge consists of a box of cookies, a pint of ice cream, 7 oz. of cheese, two bowls of cereal with 2 cups of milk, and 4 pickles. Ms. Z has seen five therapists to address her eating behaviors and weight concerns and participated in numerous commercial weight loss programs. She states binge eating has always served a self-soothing purpose for her. Ms. Z has a demanding university-related job that absorbs most of her time. She has few friends and has not been in a romantic relationship for the past five years believing that no one would be interested in a woman of her size. She also claimed that food is more reliable than any man because “it’s always there when you need it and you don’t have to take care of it or stoke its ego.” She spends evenings at home working until she is completely exhausted, heads to the kitchen for an all-out binge, vomits everything up, and then cries herself to sleep. She has never smoked and does not drink alcohol. Current medications prescribed by her primary care physician include Fluoxetine (20 mg), Norvasc (5 mg), and Clonazepam (prn). What are Ms. Z’s treatment goals? What are her primary care physician’s? Is her medication for
Matellanes Palacios, Clara; Matellanes Palacios, María
La anorexia nerviosa es la enfermedad psiquiátrica más frecuente entre las mujeres jóvenes, y se caracteriza por la realización de dietas con pérdida significativa de peso y un miedo desproporcionado a su ganancia. Aunque se ha descrito principalmente en el contexto psiquiátrico, esta enfermedad desde el punto de vista nutricional puede llevar a condiciones que ponen en peligro la vida del paciente, por lo que constituye una entidad difícil de manejar. El organismo humano dispone de mecani...
Vanessa Pellegrino Toledo
Full Text Available Relato de experiência da aplicação do Processo de Enfermagem a uma paciente portadora de Anorexia Nervosa, utilizando histórico, diagnósticos, intervenções e resultados de enfermagem. As intervenções foram fundamentadas nos diagnósticos de enfermagem: distúrbio da imagem corporal, nutrição desequilibrada menos que as necessidades corporais, ansiedade, baixa autoestima crônica, intolerância a atividade, controle ineficaz do regime terapêutico, risco de infecção, volume de líquidos deficiente e isolamento social. A partir da aplicação do Processo de Enfermagem, os resultados planejados foram alcançados, proporcionando melhor qualidade de vida, no período em que permaneceu internada. Os fatores psíquicos, neurológicos, endócrinos e imunológicos, peculiares na anorexia nervosa, propiciaram a elaboração de um Processo de Enfermagem, que contribuiu de maneira positiva para a complementação da reabilitação da saúde da mesmaRelato de experiencia de la aplicación del proceso de enfermería (PE a una paciente portadora de Anorexia Nerviosa, utilizando histórico, diagnósticos, intervenciones y resultados de enfermería. Las intervenciones fueron basadas en los diagnósticos de enfermería: trastorno de la imagen corporal, nutrición alterada ingesta inferior a las necesidades corporales, ansiedad, autoestima baja crónica, intolerancia a la actividad, manejo ineficaz del régimen terapéutico, riesgo de infección, déficits de volumen de líquidos y aislamiento social. A partir de la aplicación del Proceso de Enfermería, los resultados planeados fueron alcanzados, proporcionando mejor calidad de vida en el período en que permaneció hospitalizada. Los factores psíquicos, neurológicos, endócrinos y inmunológicos, peculiares en la anorexia nerviosa, propiciaron la elaboración de un Proceso de Enfermería, que contribuyó de manera positiva para la complementación de la rehabilitación de su salud
Alicia Weisz Cobelo
Full Text Available O final do século XX enfatiza a inclusão da família no tratamento de pacientes portadores de anorexia e bulimia nervosa. Pesquisas (Castro et al.,2000; Webster et al.,2000 colocam como relevante considerar a estrutura familiar, as práticas conversacionais e os legados transgeracionais como elementos que podem estar contribuindo, de modo significativo, no desenvolvimento ou na manutenção dos transtornos alimentares. No Ambulatório de Bulimia e Transtornos Alimentares e no Projeto de Atendimento a Crianças e Adolescentes do IPQ, o grande desafio dos terapeutas de família tem sido compartilhar com famílias e pacientes suas histórias repletas de inseguranças e angústias e construir uma ponte de união entre a família e a equipe multidisciplinar, para que a compreensão dos significados, refletida por todos, possa ser agilizada e transformada em novas contribuições de vida para as pacientes e seus familiares.The end of the 20th century emphasizes the inclusion of the family in the treatment of the patients with anorexia and bulimia nervosa. Researches (Castro et al.,2000; Webster et al.,2000 determine as relevant to consider the family structure, the interaction pattern, and the "transgeneration bequest" - the legacy that goes from one generation to the next - as elements that might contribute in a significant way to the development or maintenance of the eating disorders. At the Bulimia and Eating Disorders Ambulatory and in the IPQ's Project for Attendance of Children and Adolescents, the great challenge for the family therapists has been to share with the families and patients their histories full of insecurity and anguish. The therapists must also overcome the difficulties of building a bridge that brings together the family and the multidisciplinary team so that the comprehension of the meanings, reflected by all, might be quickly transformed into new life contributions to these patients and their families.
Zenker, J; Hagenah, U; Rossaint, R
Eating disorders are typical diseases of adolescence and early adulthood. About 1-3% of female juveniles suffer from anorexia nervosa (AN) or bulimia nervosa (BN). Today AN is still the psychiatric disease with the highest mortality rate. The peri-operative mortality rate of patients suffering from AN is in the range up to 15%. The beginning of AN is a lingering process and the majority of patients show increasingly restrictive eating habits ending in cachexia. Patients are obsessed by the predominant idea of being obese in spite of having a significant underweight. Patients suffering from bulimia break the strict regimen by eating enormous amounts of high calorie food. Such eating attacks are followed by weight reducing measures, mostly vomiting. Most of the physical changes caused by AN are due to starvation and loss of weight. The most significant medical complications are alterations of the cardiovascular system accompanied by decreasing contractility of the heart, bradycardia, electrocardiographic changes as well as disequilibrium of electrolytic and water balance. Most of these symptoms can be reversed by putting on weight.
Resch, Mária; Szendei, György; Haász, Péter
Gynecological problems are one of the most frequent somatic complications of eating disorders. The purpose of the present study was to assess the role of improper eating habits causing menstrual disturbances, anovulation and related hormonal changes. Latent bulimia nervosa is in the focus of attention since amenorrhea is considered as a diagnostic criterion of anorexia nervosa. Subjects of the BITE (Bulimia Investigation Test, Edinburgh) test were infertile patients (n = 34) of the gynecological outpatient departments after medical examination, blood-test (LH, FSH, androstenedione, DHEAS, progesterone, testosterone, SHBG, prolactin) and ultrasonic examination (uterus and ovaries). Symptoms and severity subscales of the BITE test and body mass index (BMI) were close correlation (p = 0.003, p = 0.033). In comparison with previous results, EDNOS (Eating Disorders Not Otherwise Specified) prevalence was 48%. Of hormonal changes, low LH and FSH levels (6/6) and hyperandrogenism (5/6) were significant in patients with subclinical eating disorders (n = 6) by infertile women as compared with the "normal" infertile group (n = 18; 7/18, 8/18). The recent results suggests that unsatisfactory nutrition (bulimic binges, "crash diet") is as relevant in hormonal dysfunction, menstrual disturbances and infertility as pathologically low weight in anorexia nervosa. Excessive application of contraceptives in therapy has to be taken into consideration.
McLean, Siân A; Paxton, Susan J; Massey, Robin; Hay, Phillipa J; Mond, Jonathan M; Rodgers, Bryan
Addressing stigma through social marketing campaigns has the potential to enhance currently low rates of treatment seeking and improve the well-being of individuals with the eating disorder bulimia nervosa. This study aimed to evaluate the persuasiveness of health messages designed to reduce stigma and improve mental health literacy about this disorder. A community sample of 1,936 adults (48.2% male, 51.8% female) from Victoria, Australia, provided (a) self-report information on knowledge and stigma about bulimia nervosa and (b) ratings of the persuasiveness of 9 brief health messages on dimensions of convincingness and likelihood of changing attitudes. Messages were rated moderately to very convincing and a little to moderately likely to change attitudes toward bulimia nervosa. The most persuasive messages were those that emphasized that bulimia nervosa is a serious mental illness and is not attributable to personal failings. Higher ratings of convincingness were associated with being female, with having more knowledge about bulimia nervosa, and with lower levels of stigma about bulimia nervosa. Higher ratings for likelihood of changing attitudes were associated with being female and with ratings of the convincingness of the corresponding message. This study provides direction for persuasive content to be included in social marketing campaigns to reduce stigma toward bulimia nervosa.
Wang, Li; Kong, Qing-Mei; Li, Ke; Li, Xue-Ni; Zeng, Ya-Wei; Chen, Chao; Qian, Ying; Feng, Shi-Jie; Li, Ji-Tao; Su, Yun'Ai; Correll, Christoph U; Mitchell, Philip B; Yan, Chao-Gan; Zhang, Da-Rong; Si, Tian-Mei
Bulimia nervosa is a severe psychiatric syndrome with uncertain pathogenesis. Neural systems involved in sensorimotor and visual processing, reward and impulsive control may contribute to the binge eating and purging behaviours characterizing bulimia nervosa. However, little is known about the alterations of functional organization of whole brain networks in individuals with this disorder. We used resting-state functional MRI and graph theory to characterize functional brain networks of unmedicated women with bulimia nervosa and healthy women. We included 44 unmedicated women with bulimia nervosa and 44 healthy women in our analyses. Women with bulimia nervosa showed increased clustering coefficient and path length compared with control women. The nodal strength in patients with the disorder was higher in the sensorimotor and visual regions as well as the precuneus, but lower in several subcortical regions, such as the hippocampus, parahippocampal gyrus and orbitofrontal cortex. Patients also showed hyperconnectivity primarily involving sensorimotor and unimodal visual association regions, but hypoconnectivity involving subcortical (striatum, thalamus), limbic (amygdala, hippocampus) and paralimbic (orbitofrontal cortex, parahippocampal gyrus) regions. The topological aberrations correlated significantly with scores of bulimia and drive for thinness and with body mass index. We reruited patients with only acute bulimia nervosa, so it is unclear whether the topological abnormalities comprise vulnerability markers for the disorder developing or the changes associated with illness state. Our findings show altered intrinsic functional brain architecture, specifically abnormal global and local efficiency, as well as nodal- and network-level connectivity across sensorimotor, visual, subcortical and limbic systems in women with bulimia nervosa, suggesting that it is a disorder of dysfunctional integration among large-scale distributed brain regions. These abnormalities
Tuschen-Caffier, Brunna; Bender, Caroline; Caffier, Detlef; Klenner, Katharina; Braks, Karsten; Svaldi, Jennifer
Cognitive theories suggest that body dissatisfaction results from the activation of maladaptive appearance schemata, which guide mental processes such as selective attention to shape and weight-related information. In line with this, the present study hypothesized that patients with anorexia nervosa (AN) and bulimia nervosa (BN) are characterized by increased visual attention for the most dissatisfying/ugly body part compared to their most satisfying/beautiful body part, while a more balanced viewing pattern was expected for controls without eating disorders (CG). Eye movements were recorded in a group of patients with AN (n = 16), BN (n = 16) and a CG (n = 16) in an ecologically valid setting, i.e., during a 3-min mirror exposure. Evidence was found that patients with AN and BN display longer and more frequent gazes towards the most dissatisfying relative to the most satisfying and towards their most ugly compared to their most beautiful body parts, whereas the CG showed a more balanced gaze pattern. The results converge with theoretical models that emphasize the role of information processing in the maintenance of body dissatisfaction. Given the etiological importance of body dissatisfaction in the development of eating disorders, future studies should focus on the modification of the reported patterns.
Full Text Available Cognitive theories suggest that body dissatisfaction results from the activation of maladaptive appearance schemata, which guide mental processes such as selective attention to shape and weight-related information. In line with this, the present study hypothesized that patients with anorexia nervosa (AN and bulimia nervosa (BN are characterized by increased visual attention for the most dissatisfying/ugly body part compared to their most satisfying/beautiful body part, while a more balanced viewing pattern was expected for controls without eating disorders (CG.Eye movements were recorded in a group of patients with AN (n = 16, BN (n = 16 and a CG (n = 16 in an ecologically valid setting, i.e., during a 3-min mirror exposure.Evidence was found that patients with AN and BN display longer and more frequent gazes towards the most dissatisfying relative to the most satisfying and towards their most ugly compared to their most beautiful body parts, whereas the CG showed a more balanced gaze pattern.The results converge with theoretical models that emphasize the role of information processing in the maintenance of body dissatisfaction. Given the etiological importance of body dissatisfaction in the development of eating disorders, future studies should focus on the modification of the reported patterns.
Tuschen-Caffier, Brunna; Bender, Caroline; Caffier, Detlef; Klenner, Katharina; Braks, Karsten; Svaldi, Jennifer
Objective Cognitive theories suggest that body dissatisfaction results from the activation of maladaptive appearance schemata, which guide mental processes such as selective attention to shape and weight-related information. In line with this, the present study hypothesized that patients with anorexia nervosa (AN) and bulimia nervosa (BN) are characterized by increased visual attention for the most dissatisfying/ugly body part compared to their most satisfying/beautiful body part, while a more balanced viewing pattern was expected for controls without eating disorders (CG). Method Eye movements were recorded in a group of patients with AN (n = 16), BN (n = 16) and a CG (n = 16) in an ecologically valid setting, i.e., during a 3-min mirror exposure. Results Evidence was found that patients with AN and BN display longer and more frequent gazes towards the most dissatisfying relative to the most satisfying and towards their most ugly compared to their most beautiful body parts, whereas the CG showed a more balanced gaze pattern. Discussion The results converge with theoretical models that emphasize the role of information processing in the maintenance of body dissatisfaction. Given the etiological importance of body dissatisfaction in the development of eating disorders, future studies should focus on the modification of the reported patterns. PMID:26714279
Martins, Claudia Regina Carvalho; Caccavo, Paulo Vaccari
The research aimed to identify the interaction of nurses and clients suffering from bulimia and anorexia. We use the case study as a resource in which we collect clinical data and did interviews with eight of fourteen nurses, who have been our subject-object. According to the nurses, clients are isolated from the world living in a world without hunger and mirrors reflecting a body always above the "ideal weight", they were lonely people, personnel who have lost their shine, sending signals that could extinguish their lives at any time. In the study, was possible to identify the manner in which nurses interacted and perceived customers and, as a result, we elucidate a peculiar practice in nursing.
Frank, Guido K W; Roblek, Tami; Shott, Megan E; Jappe, Leah M; Rollin, Michael D H; Hagman, Jennifer O; Pryor, Tamara
To test whether intolerance of uncertainty (IU) is related to eating disorder (ED) pathology. Thirty individuals with anorexia nervosa (AN), 19 with bulimia nervosa (BN), and 28 healthy control women (CW) completed the Intolerance of Uncertainty Scale (IUS). AN and BN groups showed higher IU compared with CW. In AN and BN, Harm Avoidance and Depression scores were positively correlated with IU. In AN but not BN, IU was related positively to Drive for Thinness and Body Dissatisfaction. Elevated IU is associated with AN and BN. Anxious traits may be inherent in EDs and IU could be a developmental factor contributing to anxiety, mood, and ED behavior in AN and BN. Copyright © 2011 Wiley Periodicals, Inc.
The aim is to understand the meaning and significance of the symptoms by means of psychoanalytical theoretical models and to give an insight into the functioning of analytical therapy, using the example of an adolescent bulimia patient. In this therapy, the cause of the bulimic illness is seen as being a failure to build an intrapsychic space, and it is shown how triangulation can be achieved via the three-dimensional analytical relationship. Particular attention is given to the theories of M. Klein and W. R. Bion. The theory of S. Freud is based upon the portrayal of bulimic symptoms as the expression of an intrapsychic conflict. The two models complement each other, leading to a more profound understanding of eating disorders.
Starr, Taylor B; Kreipe, Richard E
Recent research has modified both the conceptualization and treatment of eating disorders. New diagnostic criteria reducing the "not otherwise specified" category should facilitate the early recognition and treatment of anorexia nervosa (AN) and bulimia nervosa (BN). Technology-based studies identify AN and BN as "brain circuit" disorders; epidemiologic studies reveal that the narrow racial, ethnic and income profile of individuals no longer holds true for AN. The major organs affected long term-the brain and skeletal system-both respond to improved nutrition, with maintenance of body weight the best predictor of recovery. Twin studies have revealed gene x environment interactions, including both the external (social) and internal (pubertal) environments of boys and of girls. Family-based treatment has the best evidence base for effectiveness for younger patients. Medication plays a limited role in AN, but a major role in BN. Across diagnoses, the most important medicine is food.
Espíndola, Cybele Ribeiro; Blay, Sérgio Luís
A systematic literature review published between 1990 and 2006 using a qualitative approach was conducted to explore family members' perception of anorexia and bulimia nervosa patients. Articles were critically reviewed and a meta-synthesis analysis was carried out based on a meta-ethnographic method to analyze and summarize data. Of a total of 3,415 studies, nine met the study inclusion and exclusion criteria. Reciprocal translation was used for data interpretation allowing to identifying two concepts: disease awareness and disease impacts. Feelings of impotence were often described in family reorganization. The study results point to distortions in the concept of disease associated with family involvement, resulting in changes in communication, attitudes, and behaviors in a context of impotence.
Frank, Guido K.W.; Roblek, Tami; Shott, Megan E.; Jappe, Leah M.; Rollin, Michael D.H.; Hagman, Jennifer O.; Pryor, Tamara
Objective To test whether intolerance of uncertainty (IU) is related to eating disorder (ED) pathology. Method Thirty individuals with anorexia nervosa (AN), 19 with bulimia nervosa (BN) and 28 healthy control women (CW) completed the Intolerance of Uncertainty Scale (IUS). Results AN and BN groups showed higher IU compared to CW. In AN and BN, Harm Avoidance and Depression scores were positively correlated with IU. In AN but not BN, IU was related positively to Drive for Thinness and Body Dissatisfaction. Conclusion Elevated IU is associated with AN and BN. Anxious traits may be inherent in EDs and IU could be a developmental factor contributing to anxiety, mood and ED behavior in AN and BN. PMID:21495057
Claudia Regina Carvalho Martins
Full Text Available Investigação que objetivou identificar a interação de enfermeiros e clientes portadores de bulimia e anorexia. Utilizamos o estudo de caso como recurso, para o qual coletamos dados de prontuários e fizemos entrevistas com oito de quatorze enfermeiros, que foram nossos sujeitos-objeto. De acordo com os enfermeiros, os clientes se isolavam do mundo, vivendo num mundo sem fome e de espelhos que refletiam um corpo sempre acima do "peso ideal"; eram pessoas solitárias, que perderam o brilho pessoal, emitindo sinais de que podiam extinguir a vida deles a qualquer momento. Com o estudo, foi possível identificar a maneira pela qual os enfermeiros interagiam e percebiam os clientes e, em decorrência disso, explicitamos uma prática de cuidar peculiar na enfermagem.
Wang, Li Yan; Nichols, Lauren P; Austin, S Bryn
To assess the economic effect of the school-based obesity prevention program Planet Health on preventing disordered weight control behaviors and to determine the cost-effectiveness of the intervention in terms of its combined effect on prevention of obesity and disordered weight control behaviors. On the basis of the intervention's short-term effect on disordered weight control behaviors prevention, we projected the number of girls who were prevented from developing bulimia nervosa by age 17 years. We further estimated medical costs saved and quality-adjusted life years gained by the intervention over 10 years. As a final step, we compared the intervention costs with the combined intervention benefits from both obesity prevention (reported previously) and prevention of disordered weight control behaviors to determine the overall cost-effectiveness of the intervention. Middle schools. A sample of 254 intervention girls aged 10 to 14 years. The Planet Health program was implemented during the school years from 1995 to 1997 and was designed to promote healthful nutrition and physical activity among youth. Intervention costs, medical costs saved, quality-adjusted life years gained, and cost-effectiveness ratio. An estimated 1 case of bulimia nervosa would have been prevented. As a result, an estimated $33 999 in medical costs and 0.7 quality-adjusted life years would be saved. At an intervention cost of $46 803, the combined prevention of obesity and disordered weight control behaviors would yield a net savings of $14 238 and a gain of 4.8 quality-adjusted life years. Primary prevention programs, such as Planet Health, warrant careful consideration by policy makers and program planners. The findings of this study provide additional argument for integrated prevention of obesity and eating disorders.
Kaye, Walter H; Devlin, Bernie; Barbarich, Nicole; Bulik, Cynthia M; Thornton, Laura; Bacanu, Silviu-Alin; Fichter, Manfred M; Halmi, Katherine A; Kaplan, Allan S; Strober, Michael; Woodside, D Blake; Bergen, Andrew W; Crow, Scott; Mitchell, James; Rotondo, Alessandro; Mauri, Mauro; Cassano, Giovanni; Keel, Pamela; Plotnicov, Katherine; Pollice, Christine; Klump, Kelly L; Lilenfeld, Lisa R; Ganjei, J Kelly; Quadflieg, Norbert; Berrettini, Wade H
Twin and family studies suggest that genetic variants contribute to the pathogenesis of bulimia nervosa (BN) and anorexia nervosa (AN). The Price Foundation has supported an international, multisite study of families with these disorders to identify these genetic variations. The current study presents the clinical characteristics of this sample as well as a description of the study methodology. All probands met modified criteria for BN or bulimia nervosa with a history of AN (BAN) as defined in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994). All affected relatives met DSM-IV criteria for BN, AN, BAN, or eating disorders not otherwise specified (EDNOS). Probands and affected relatives were assessed diagnostically using both trained-rater and self-report assessments. DNA samples were collected from probands, affected relatives, and available biologic parents. Assessments were obtained from 163 BN probands and 165 BAN probands. Overall, there were 365 relative pairs available for linkage analysis. Of the affected relatives of BN probands, 62 were diagnosed as BN (34.8%), 49 as BAN (27.5%), 35 as AN (19.7%), and 32 as EDNOS (18.0%). For the relatives of BAN probands, 42 were diagnosed as BN (22.5%), 67 as BAN (35.8%), 48 as AN (25.7%), and 30 as EDNOS (16.0%). This study represents the largest genetic study of eating disorders to date. Clinical data indicate that although there are a large number of individuals with BN disorders, a range of eating pathology is represented in the sample, allowing for the examination of several different phenotypes in molecular genetic analyses. Copyright 2004 by Wiley Periodicals, Inc. Int J Eat Disord 35: 556-570, 2004.
Miján de la Torre, A; Velasco Vallejo, J L
Behavioral eating disorders (BED's) have shown an intense growth in the last years. They are considered to be caused by multiple factors, showing a bio-psycho-socio-cultural etiology. Although there are clinical signs that could alert the physician and allow an early diagnosis, their final diagnosis must meet certain criteria set in the DSM-IV (1994). Despite the fact that anorexia nervosa and bulimia nervosa in their typical forms, are the most known, there are atypical or incomplete forms of both that should be kept in mind when making the diagnosis. Anorexia nervosa is accompanied by somatic-nutritional problems that may condition the patient's life, requiring specific nutritional care. Bulimia nervosa is often accompanied by medical complications that require an exhaustive assessment. As for the nutritional support in anorexia nervosa, this must be proportional to the nutritional status of the patient and there should be no hesitation to resort to artificial nutrition using enteral nutrition through a tube in the case of severe malnutrition. In these cases there must be careful monitoring for the appearance of the re-nutrition syndrome, and this can be avoided by the slow and progressive administration of energetic nutrients, with special precautions in the supply of carbohydrates, and administering an adequate supplement of vitamins and electrolytes. Patients with a BED require a multi-disciplinary care with the simultaneous and coordinated action of a team of professionals. This type of care coupled with the experience of the team with regard to BED's and their treatment, and together with other actions and situations, may favor the final prognosis of a patient with a BED.
Keshen, Aaron; Helson, Thomas
Psychostimulants have been assessed in bulimia nervosa patients with comorbid attention deficit/hyperactivity disorder (ADHD), but few studies have examined the impact of psychostimulants on bulimia nervosa patients without comorbid ADHD. The aim of this study was to examine psychostimulants as a potential treatment for bulimia nervosa and to assess the concern of weight loss, given the medication's appetite-suppressing effects. This retrospective study describes 6 case reports of outpatients who were prescribed a psychostimulant specifically for their bulimia nervosa. The number of binge/purge days per months and body mass index were assessed. All patients demonstrated reductions in the number of binge/purge days per month, and 1 patient experienced total remission of bulimic symptoms. Minor fluctuations in weight were observed, but no clinically significant reductions in weight were noted. These findings support the need for clinical trials to examine the efficacy and safety of this potential treatment. © 2017, The American College of Clinical Pharmacology.
Clinical studies describe binge eating as a reaction to hunger, negative affect, or the need to dissociate. However, little is known about the meanings that women with bulimia nervosa and anorexia nervosa associate with binge eating. To examine how women with anorexia nervosa and bulimia nervosa interpret their experiences of binge eating. Sixteen women who engaged in binge eating and had been diagnosed with anorexia nervosa, bulimia nervosa, or their subclinical variants were interviewed about their experiences of eating disorder. Interview data were analyzed using phenomenologically-informed thematic analysis. Participants described binge eating as a practice through which the self experiences a sense of release, and existential emptiness is replaced by overwhelming fullness. Meaningful experiences of release and fullness are central to binge eating in bulimia nervosa and anorexia nervosa, and may contribute to the long-term maintenance of this practice.
Bassiouny, Mohamed A
Eating disorders have captured the attention of medical and dental professionals as well as the public for decades and continue to raise concern today. The literature devoted to anorexia and bulimia highlights myriad psychological, systemic, and dental health complications. Dental practitioners are in a unique position to discover early manifestations of these disorders. The present article reviews anorexia and bulimia, summarizing telltale behavioral traits, systemic manifestations, and dental features to facilitate recognition and enable accurate diagnosis.
Eddy, Kamryn T.; Dorer, David J.; Franko, Debra L.; Tahilani, Kavita; Thompson-Brenner, Heather; Herzog, David B.
Objective The Diagnostic and Statistical Manual of Mental Disorders (DSM) is designed primarily as a clinical tool. Yet high rates of diagnostic “crossover” among the anorexia nervosa subtypes and bulimia nervosa may reflect problems with the validity of the current diagnostic schema, thereby limiting its clinical utility. This study was designed to examine diagnostic crossover longitudinally in anorexia nervosa and bulimia nervosa to inform the validity of the DSM-IV-TR eating disorders classification system. Method A total of 216 women with a diagnosis of anorexia nervosa or bulimia nervosa were followed for 7 years; weekly eating disorder symptom data collected using the Eating Disorder Longitudinal Interval Follow-Up Examination allowed for diagnoses to be made throughout the follow-up period. Results Over 7 years, the majority of women with anorexia nervosa experienced diagnostic crossover: more than half crossed between the restricting and binge eating/purging anorexia nervosa subtypes over time; one-third crossed over to bulimia nervosa but were likely to relapse into anorexia nervosa. Women with bulimia nervosa were unlikely to cross over to anorexia nervosa. Conclusions These findings support the longitudinal distinction of anorexia nervosa and bulimia nervosa but do not support the anorexia nervosa subtyping schema. PMID:18198267
Koch, K L; Bingaman, S; Tan, L; Stern, R M
Bulimia nervosa remains a common eating disorder in young women. Little is known about upper gastrointestinal symptoms or gastric motility in patients with bulimia nervosa. The aim of this study was to measure gastric myoelectrical activity and hunger/satiety and stomach emptiness/fullness before and after a non-nutrient water load and solid-phase gastric emptying in hospitalized patients with bulimia nervosa (n = 12) and in healthy women (n = 13). Gastric myoelectrical activity was measured by means of cutaneous electrodes; visual analogue scales were used to measure perceptions of hunger/satiety and stomach emptiness/fullness. Before and after a standard water load the bulimia patients reported significantly greater stomach fullness and satiety compared with control subjects (P scrambled eggs showed the lag phase was shortened in the bulimic patients (16 +/- 4 min vs 31 +/- 4 min in controls, P < 0.01), but the percentage of meal emptied at 2 h was similar to control values. bulimia patients had exaggerated perceptions of stomach fullness and satiety in response to water; and abnormal gastric myoelectrical activity and accelerated lag phase of gastric emptying were objective stomach abnormalities detected in hospitalized patients with bulimia nervosa.
Guerdjikova, Anna I.; McElroy, Susan L.
Bulimia nervosa is associated with bipolar disorder, substance dependence, attention-deficit hyperactivity disorder, and anxiety disorders. Few reports, however, have addressed the treatment of patients with all of these conditions. We describe a young woman with bulimia nervosa, bipolar I disorder, cocaine and alcohol dependence, attention-deficit hyperactivity disorder, and panic disorder who achieved a sustained (>1 year) remission of her bulimia nervosa symptoms and significant improvemen...
Kollei, Ines; Horndasch, Stefanie; Erim, Yesim; Martin, Alexandra
Cognitive behavioral models postulate that selective attention plays an important role in the maintenance of body dysmorphic disorder (BDD). It is suggested that individuals with BDD overfocus on perceived defects in their appearance, which may contribute to the excessive preoccupation with their appearance. The present study used eye tracking to examine visual selective attention in individuals with BDD (n=19), as compared to individuals with bulimia nervosa (BN) (n=21) and healthy controls (HCs) (n=21). Participants completed interviews, questionnaires, rating scales and an eye tracking task: Eye movements were recorded while participants viewed photographs of their own face and attractive as well as unattractive other faces. Eye tracking data showed that BDD and BN participants focused less on their self-rated most attractive facial part than HCs. Scanning patterns in own and other faces showed that BDD and BN participants paid as much attention to attractive as to unattractive features in their own face, whereas they focused more on attractive features in attractive other faces. HCs paid more attention to attractive features in their own face and did the same in attractive other faces. Results indicate an attentional bias in BDD and BN participants manifesting itself in a neglect of positive features compared to HCs. Perceptual retraining may be an important aspect to focus on in therapy in order to overcome the neglect of positive facial aspects. Future research should aim to disentangle attentional processes in BDD by examining the time course of attentional processing. Copyright © 2016 Elsevier Inc. All rights reserved.
Bulik, Cynthia M; Thornton, Laura; Root, Tammy L.; Pisetsky, Emily M.; Lichtenstein, Paul; Pedersen, Nancy L.
Background We present a bivariate twin analysis of anorexia nervosa (AN) and bulimia nervosa (BN) to determine the extent to which shared genetic and environmental factors contribute to liability to these disorders. Method Focusing on females from the Swedish Twin study of Adults: Genes and Environment (STAGE) (N=7000), we calculated heritability estimates for narrow and broad AN and BN and estimated their genetic correlation. Results In the full model, the heritability estimate for narrow AN was (a2 = .57; 95% CI: .00, .81) and for narrow BN (a2 = .62; 95% CI: .08, .70) with the remaining variance accounted for by unique environmental factors. Shared environmental factors estimates were (c2 = .00; 95% CI: .00, .67) for AN and (c2 = .00; 95% CI: .00, .40) for BN. Moderate additive genetic (.46) and unique environmental (.42) correlations between AN and BN were observed. Heritability estimates for broad AN were lower (a2 = .29; 95% CI: .04, .43) than for narrow AN, but estimates for broad BN were similar to narrow BN. The genetic correlation for broad AN and BN was .79 and the unique environmental correlation was .44. Conclusions We highlight the contribution of additive genetic factors to both narrow and broad AN and BN and demonstrate a moderate overlap of both genetic and unique environmental factors that influence the two conditions. Common concurrent and sequential comorbidity of AN and BN can in part be accounted for by shared genetic and environmental influences on liability although independent factors also operative. PMID:19828139
Ruiz Ortiz, Gabriel
Pavlov mantuvo una fuerte polémica científica con Köhler durante los últimos años de su vida. En el presente trabajo se estudia un aspecto de dicha polémica: los experimentos sobre transposición de la discriminación efectuados por Köhler en Tenerife. A pesar de las críticas de Pavlov a la psicología de la Gestalt, estos estudios de Köhler tuvieron una enorme influencia en la teoría de la actividad nerviosa superior desarrollada por Pavlov. En un primer momento, y después de replicar el efecto...
It has been reported that Internet addiction is associated with substance dependence. Eating disorders have high rates of co-morbidity with substance use disorders. The relationship between Internet addiction and eating disorders was reported in a previous study. To examine the hypothesis that Internet addiction is closely associated with bulimia. The hypothesis that depression mediates the relationship between Internet addiction and bulimia symptoms was also tested. 2,036 Chinese college students were assessed on Internet addiction, eating behaviors and depression. Binge eating, compensatory behaviors, weight concern, menarche and weight change were also reported. Multiple regression analysis was used to test the mediating effect of depression. Internet addicts showed significantly higher scores on most subscales on EDI-1 than the controls. They reported significantly more binge eating, weight concern and weight change than the controls. Among all of the participants, depression was found to be a partial mediator in the relationship between Internet addiction and bulimia. This survey provides evidence of the co-morbidity of Internet addiction and bulimia.
De Prada, Juan Manuel
Juan Manuel de Prada: Escritor, crítico literario y articulista, alma máter Universidad de Salamanca, España. Un profesor universitario amigo me confiesa desolado que una amplia mayoría de sus alumnos son por completo incapaces de leer un libro; y que, entre los pocos que afrontan su lectura, sólo un puñado puede comprenderlo.
Gómez Martínez, Ma Angeles; Bernabé, José Ramon Yela; Ruiz, Alfonso Salgado; Rodríguez, María Cortés
The aim of the study was to assess the influence on reactivity to food images of the following variables: craving-trait, positive or negative mood state, and food restriction. Emotional modulation of the defense startle reflex (RMS) was assessed in 26 women at risk of suffering from bulimia nervosa; they were assigned one of to two groups: high craving-trait and low craving-trait. Before the test, positive or negative mood and restriction vs. non-restriction states were induced in each of the groups. Skin conductance response (SCR) and electromyogram activity from the orbiculari oculi region were recorded after the auditory stimuli; questionnaires such as Food Craving Trait Questionnaire (FCQ-T) and the Self-assessment Manikin (SAM) were used. Results showed that negative affect produced a negative valence of food images, more arousal, and more loss of control, as well as higher SCRs. Subjects with low FCQ-T levels reduced their RMS to food images as a consequence of experiencing positive emotions; when emotions were negative, their RMS increased.
Grilo, Carlos M; Ivezaj, Valentina; White, Marney A
This study examined the DSM-5 severity criterion for bulimia nervosa (BN) based on the frequency of inappropriate weight compensatory behaviors. 199 community volunteers classified with BN were categorized using DSM-5 severity levels and compared on demographic and clinical variables. 77 (39%) participants were categorized as mild, 68 (34%) as moderate, 32 (16%) as severe, and 22 (11%) as extreme. The severity groups did not differ significantly in demographic variables or body mass index. Shape and Weight concerns did not differ significantly across severity groups. Binge eating differed with the extreme group having significantly higher frequency than the severe, moderate, and mild groups, which did not differ from each other. Restraint differed with the extreme group having significantly higher levels than the mild group. Eating concerns differed with the extreme group having significantly higher levels than moderate and mild groups. Depression differed with the extreme group having significantly higher levels than severe, moderate, and mild groups, which did not differ from each other. Findings from this non-clinical group provide new, albeit modest, support for DSM-5 severity rating for BN based on frequency of inappropriate weight compensatory behaviors. Statistical findings indicate that differences in collateral clinical variables associated with the DSM-5 severity ratings reflect small effect sizes. Further research is needed with treatment-seeking patient groups with BN to establish the validity of the DSM-5 severity specifier and should include broader clinical and functional validators. Copyright © 2015 Elsevier Ltd. All rights reserved.
Masheb, Robin; White, Marney A
The aim of the present study was to examine overweight bulimia nervosa (BN) in a community sample of women. Volunteers (n = 1964) completed self-report questionnaires of weight, binge eating, purging, and cognitive features. Participants were classified as overweight (body mass index ≥25) or normal weight (body mass index <25). Rates of BN within the overweight and normal-weight classes did not differ (6.4% vs 7.9%). Of the 131 participants identified as BN, 64% (n = 84) were classified as overweight BN and 36% (n = 47) as normal-weight BN. The overweight BN group had a greater proportion of ethnic minorities and reported significantly less restraint than the normal-weight BN group. Otherwise, the 2 groups reported similarly, even in terms of purging and depression. In summary, rates of BN did not differ between overweight and normal-weight women. Among BN participants, the majority (two thirds) were overweight. Differences in ethnicity and restraint, but little else, were found between overweight and normal-weight BN. Findings from the present study should serve to increase awareness of the weight range and ethnic diversity of BN, and highlight the need to address weight and cultural sensitivity in the identification and treatment of eating disorders. Copyright © 2012 Elsevier Inc. All rights reserved.
Ricca, Valdo; Castellini, Giovanni; Fioravanti, Giulia; Lo Sauro, Carolina; Rotella, Francesco; Ravaldi, Claudia; Lazzeretti, Lisa; Faravelli, Carlo
The relationship between emotional states and eating behaviors is complex, and emotional eating has been identified as a possible factor triggering binge eating in bulimia nervosa (BN) and binge eating disorder. Few studies considered emotional eating in patients with anorexia nervosa. The present study evaluated the clinical correlates of emotional eating in 251 eating-disordered (EDs) subjects (70 AN restricting type, 71 AN binge eating/purging type, 110 BN purging type) and in a group of 89 healthy control subjects. Subjects were assessed by means of a clinical interview (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and several self-reported questionnaires, including the Emotional Eating Scale (EES). No significant differences were found between the 3 EDs groups in terms of EES total score, and all patients with ED showed higher EES scores compared with control subjects. Emotional eating was associated with subjective binge eating in AN binge eating/purging type and with objective binge eating in patients with BN. Among patients with AN restricting type, emotional eating was associated with restraint, but this association was lost when controlling for fear of loss of control over eating, which was the principal determinant of restraint. Emotional eating and fear of loss of control over eating are significantly associated with specific eating attitudes and behaviors, according to the different diagnoses. Emotional eating is a relevant psychopathologic dimension that deserves a careful investigation in both anorectic and bulimic patients. Copyright © 2012 Elsevier Inc. All rights reserved.
Full Text Available Background: Alexithymia is associated to Eating Disorders (ED and relevant for their prognosis but it is uncertain if it is ubiquitous, primary and necessary for ED outburst. Methods: 124 ED outpatients and 80 healthy controls were compared with the Toronto Alexithymia Scale, personality and psychopathology measures. Alexithymia and the other features are compared between anorexia nervosa (AN, bulimia nervosa (BN and control groups. Alexithymia-based clusters were explored and compared with controls. Alexithymia traits are correlated with the other features. Results: Difficulty in identifying feelings was ubiquitous in ED subjects. A Non-Alexithymic Cluster (NAC and an Alexithymic Cluster (ALC were found with no difference in AN/BN distribution. ALC displays disordered personality and high psychopathology. Self-directiveness and interoceptive awareness were independently related to alexithymia and to depressive feelings. These two features along with depressive features completely accounted for alexithymia variance. Conclusion: even though the difficulty in identifying feelings is ubiquitous in ED subjects, Alexithymia may not represent a primary trait but a complex dysfunction consequent to co-occurring character immaturity, altered interoceptive awareness, and depressive traits.
le Grange, Daniel; Binford, Roslyn B; Peterson, Carol B; Crow, Scott J; Crosby, Ross D; Klein, Marjorie H; Bardone-Cone, Anna M; Joiner, Thomas E; Mitchell, James E; Wonderlich, Stephen A
The purpose of the present work is to determine whether bulimia nervosa (BN) and eating disorder not otherwise specified, BN type (EDNOS-BN) were qualitatively distinct in terms of eating and general psychopathology. This study presents a comparison of 138 women with BN and 57 with EDNOS-BN from a multisite study on eating-related and general psychopathology measures. Although women with BN reported higher lifetime history rates of anorexia nervosa, greater binge eating and vomiting frequency, and more eating concerns, no significant differences were observed between groups on measures of perfectionism, impulsivity, obsessive-compulsiveness, anxiety, depressive symptomatology, or alcohol/substance problems. Based on the partial eta2 values, the distinction between BN and EDNOS-BN accounted for EDNOS-BN with objective bulimic episodes (OBEs; n=34) versus no OBEs (n=23) found greater EDEQ-4 Restraint subscale scores for EDNOS-BN without OBEs. However, there was no significant difference on the EDEQ-4 Eating Concern subscale between the two EDNOS-BN subgroups. The findings highlight the clinical significance of BN partial syndrome and prompt reevaluation of existing BN diagnostic boundaries. Post hoc analyses also underscore the need for greater differentiation within EDNOS. Copyright (c) 2006 by Wiley Periodicals, Inc.
Panico, Rene; Piemonte, Eduardo; Lazos, Jerónimo; Gilligan, Gerardo; Zampini, Anibal; Lanfranchi, Héctor
The aim of this study is to describe oral lesions in patients with eating disorders (ED), including Anorexia Nervosa (AN), Bulimia Nervosa (BN) and eating disorders not otherwise specified (EDNOS). A prospective case-control study was carried out from April 2003 to May 2004. Inclusion criteria for the study group were individuals with a diagnosis of ED; age and sex-matched individuals without ED were included as controls. Clinical data regarding ED, medical complications and oral examination were performed by previously calibrated professionals. Study group (n = 65) presented 46 cases of BN (71%), 13 of EDNOS (20%) and 6 of AN (9%); also, 94% (n = 61) showed oral lesions. The most common were: labial erythema, exfoliative cheilitis, orange-yellow palate, hemorrhagic lesions, lip-cheek biting and non-specific oral atrophies. Only two patients of the study group had dental erosions, and no case of major salivary gland swelling was found. ED display a wide array of oral mucosal lesions that can be regarded as their early manifestations. The dentist could be the first professional to detect symptoms of eating disorders, potentially improving early detection and treatment of ED. Copyright © 2017 Elsevier Ltd. All rights reserved.
Meryem O. Kutuk
Full Text Available Objective: Oesophageal achalasia is a medical condition characterised by oesophageal aperistalsis, an increased resting pressure with partial or incomplete relaxation of the lower oesophageal sphincter. Bulimia nervosa (BN is an eating disorder manifested by binge eating attacks followed by recurrent inappropriate compensatory behaviours, such as self-induced vomiting and excessive exercise. Dysphagia, regurgitation, vomiting, retrosternal pain, heartburn, weight loss, avoidance of eating, consumption of large amount of liquids and aberrant eating behaviours are symptoms of both achalasia and BN. Owing to these common signs and symptoms, oesophageal achalasia can be misdiagnosed as an eating disorder. In addition, oesophageal achalasia can occur as a complication of BN. It is often difficult to distinguish organic and psychological vomiting or comorbidity because of overlapping of the symptoms. Case report: We report the case of a patient who developed oesophageal achalasia following severe, repetitive vomiting as a complication of BN. Conclusion: We want to raise awareness regarding the development of a medical illness in the presence of a psychiatric disorder. Importantly, physicians should have a fundamental knowledge of these two diseases regarding their clinical patterns to differentially diagnose one or both disorders as quickly as possible.
Darcy, Alison M; Fitzpatrick, Kathleen Kara; Manasse, Stephanie M; Datta, Nandini; Klabunde, Megan; Colborn, Danielle; Aspen, Vandana; Stiles-Shields, Colleen; Labuschagne, Zandre; Le Grange, Daniel; Lock, James
Weak central coherence-a tendency to process details at the expense of the gestalt-has been observed among adults with bulimia nervosa (BN) and is a potential candidate endophenotype for eating disorders (EDs). However, as BN behaviors typically onset during adolescence it is important to assess central coherence in this younger age group to determine whether the findings in adults are likely a result of BN or present earlier in the evolution of the disorder. This study examines whether the detail-oriented and fragmented cognitive inefficiency observed among adults with BN is observable among adolescents with shorter illness duration, relative to healthy controls. The Rey-Osterrieth Complex Figure Test (RCFT) was administered to a total of 47 adolescents with DSM5 BN, 42 with purging disorder (PD), and 25 healthy controls (HC). Performance on this measure was compared across the three groups. Those with BN and PD demonstrated significantly worse accuracy scores compared to controls in the copy and delayed recall condition with a moderate effect size. These findings were exacerbated when symptoms of BN increased. Poorer accuracy scores reflect a fragmented and piecemeal strategy that interferes with visual-spatial integration in BN spectrum disorders. This cognitive inefficiency likely contributes to broad difficulties in executive functioning in this population especially in the context of worsening bulimic symptoms. The findings of this study support the hypothesis that poor global integration may constitute a cognitive endophenotype for BN. © 2014 Wiley Periodicals, Inc.
de Groot, J M; Rodin, G; Olmsted, M P
Disturbances in emotional awareness, sometimes referred to as alexithymia, have been hypothesized to contribute to the development of binge/purge symptoms among women with bulimia nervosa (BN) and/or are considered secondary to the state of depression and/or disordered eating. The present study was designed to assess alexithymia among women with BN, to evaluate the interrelationship between alexithymia, depression, and somatic symptoms, and to determine whether an intensive group psychotherapy program contributes to a reduction in the degree of alexithymia. Thirty-one of 50 BN women (62%) who completed The Toronto Hospital Day Hospital Program for Eating Disorders (DHP) were administered pretreatment and posttreatment questionnaires. Findings from this clinical sample were compared with those from 20 non-eating-disordered women who completed the same battery. Using the Toronto Alexithymia Scale (TAS), significantly more BN women were alexithymic at pretreatment (61.3%) and post-treatment (32.3%) than in the comparison group (5.0%), even when depression was controlled for. At discharge, abstinence from binge/purge episodes was associated with a significant reduction in alexithymia, although there was a significant correlation between TAS scores, depression, and vomit frequency. Alexithymia among BN women is not simply a concomitant of disordered eating. Its partial reversibility following an intensive psychotherapy program may be a direct effect of the treatment and/or may be secondary to a reduction in depressive and/or binge/purge symptoms.
Milano, W; Siano, C; Putrella, C; Capasso, A
Bulimia nervosa (BN) is one of the most common eating disorders in industrialized societies. It has been suggested that reduced serotonin activity triggers some of the cognitive and mood disturbances associated with BN. For this reason, the pharmacologic treatment of BN consists mainly of selective serotonin reuptake inhibitors (SSRIs), which have been proven effective. At present, the physiologic bases of this disorder are not yet completely understood. We conducted a randomized controlled trial to verify the efficacy of the SSRI fluvoxamine in patients with a diagnosis of BN. Twelve female outpatients aged 21 to 34 years with a diagnosis of BN-binge purging (as defined by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM IV]) were randomly assigned to 2 treatment groups: the fluvoxamine 200 mg/day group and the placebo group. The patients underwent weekly clinical assessments for 12 weeks. At the end of the observation period, there was a statistically significant reduction in the number of binge-eating crises and purging episodes in the fluvoxamine group compared with placebo. In no case was treatment interrupted because of emergent side effects. These findings support the hypothesis that fluvoxamine is well tolerated and effective in reducing binge-eating crises and purging episodes in patients with BN.
Weider, Siri; Indredavik, Marit Saebø; Lydersen, Stian; Hestad, Knut
This study explored the neuropsychological performance of patients diagnosed with anorexia nervosa (AN) or bulimia nervosa (BN) compared with healthy controls (HCs). An additional aim was to investigate the effect of several possible mediators on the association between eating disorders (EDs) and cognitive function. Forty patients with AN, 39 patients with BN, and 40 HCs who were comparable in age and education were consecutively recruited to complete a standardized neuropsychological test battery covering the following cognitive domains: verbal learning and memory, visual learning and memory, speed of information processing, visuospatial ability, working memory, executive function, verbal fluency, attention/vigilance, and motor function. The AN group scored significantly below the HCs on eight of the nine measured cognitive domains. The BN group also showed inferior performance on six cognitive domains. After adjusting for possible mediators, the nadir body mass index (lowest lifetime BMI) and depressive symptoms explained all findings in the BN group. Although this adjustment reduced the difference between the AN and HC groups, the AN group still performed worse than the HCs regarding verbal learning and memory, visual learning and memory, visuospatial ability, working memory, and executive functioning. Patients with EDs scored below the HCs on several cognitive function measures, this difference being most pronounced for the AN group. The nadir BMI and depressive symptoms had strong mediating effects. Longitudinal studies are needed to identify the importance of weight restoration and treatment of depressive symptoms in the prevention of a possible cognitive decline. © 2014 Wiley Periodicals, Inc.
Full Text Available RESUMOEste estudo teve por objetivo investigar a rede social de apoio de mulheres com anorexia e bulimia, com ênfase em suas relações afetivo-familiares. A amostra foi composta por 12 participantes atendidas em hospital universitário. Os instrumentos utilizados foram: roteiro de entrevista semiestruturada, Mapa de Rede e Genograma. Os resultados indicaram que as redes sociais das participantes têm configuração restrita, com proeminência de membros da família em sua composição. Os relacionamentos familiares oscilam, contudo, entre turbulência e distanciamento afetivo. As relações de afeto mantidas com pais, cônjuges e namorados são marcadas por divergências e insatisfações. A baixa densidade da rede de amizades e o empobrecimento da vida social resultam em isolamento e dificuldades de dar início e/ou manter relacionamentos afetivos duradouros.
Full Text Available Lisa Hail, Daniel Le Grange Department of Psychiatry, University of California, San Francisco, CA, USA Abstract: Bulimia nervosa (BN is a serious psychiatric illness that typically develops during adolescence or young adulthood, rendering adolescents a target for early intervention. Despite the increasing research devoted to the treatment of youth with anorexia nervosa (AN and adults with BN, there remains a dearth of evidence for treating younger individuals with BN. To date, there have been four published randomized controlled trials comparing psychosocial treatments, leaving significant room to improve treatment outcomes. Family-based treatment is the leading treatment for youth with AN, while cognitive-behavioral therapy is the leading intervention for adults with BN. Involving caregivers in treatment shows promising results, however, additional research is needed to investigate ways in which this treatment can be adapted further to achieve higher rates of recovery. Keywords: eating disorders, youth, family-based treatment, cognitive behavioral therapy, psychodynamic therapy, psychopharmacological treatment, evidence based treatment
Bottin, Julia; Salbach-Andrae, Harriet; Schneider, Nora; Pfeiffer, Ernst; Lenz, Klaus; Lehmkuhl, Ulrike
The present study aimed to ascertain the occurrence of personality disorders (PD) in adolescent patients with anorexia (AN) and bulimia nervosa (BN) by means of the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). 99 female adolescent patients (57 AN - restrictive type, 17 AN - binge-purging type, 25 BN; M(age) = 16.3 +/- 1.6) were consecutively assessed by means of SCID-II. Furthermore, the influence of age, axis-I-comorbidities, and type of treatment according to PD were examined. 30.3% of the patients met the criteria for PD according to SCID-II. AN patients of the binge-purging type showed higher prevalences of PD and higher dimensional scores than the other eating disorder groups. Moreover, our findings indicate that age and axis-I-comorbidities are associated with the development of PD. Significant differences in the occurrence of PD in the three eating disorder groups were found. Patients of the AN binge-purging type are more often affected than restricting AN or BN patients are. This, and also the influence of age and axis-I-comorbidities, should be taken into account in the treatment of patients with eating disorders.
Pearson, Carolyn M; Pisetsky, Emily M; Goldschmidt, Andrea B; Lavender, Jason M; Wonderlich, Stephen A; Crosby, Ross D; Engel, Scott G; Mitchell, James E; Crow, Scott J; Peterson, Carol B
Individuals with bulimia nervosa (BN) frequently endorse risky behaviors such as self-harm and substance use. However, no studies of BN to date have examined factors associated with engaging in individual or co-occurring risky behaviors. Given that individuals with BN often have personality psychopathology, which has been linked to symptoms and course of illness, this study sought to examine how personality may differentiate engagement in risky behaviors among BN individuals. A sample of 133 women with BN completed self-report measures of personality psychopathology at baseline, and then reported on bulimic and risky behaviors (e.g., substance misuse, self-harm) over 2 weeks using ecological momentary assessment. A series of hierarchical multiple regression analyses were conducted to examine the unique associations between state-level predictor variables (each risky behavior, e.g., substance misuse, and combination of risky behaviors, e.g., substance misuse plus self-harm) and trait-level personality constructs. Substance misuse behavior, above and beyond all other risky behaviors, was significantly associated with higher scores on trait dissocial behavior (P = 0.004). Substance misuse in BN has a unique association with dissocial behavior, a personality trait characterized by hostility, impulsivity, and entitlement. These results suggest that targeting personality variables may help facilitate more effective treatment of risky behaviors, including substance use in BN. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:681-688). © 2016 Wiley Periodicals, Inc.
Faris, Patricia L.; Hofbauer, Randall D.; Daughters, Randall; VandenLangenberg, Erin; Iversen, Laureen; Goodale, Robert L.; Maxwell, Robert; Eckert, Elke D.; Hartman, Boyd K.
Bulimia nervosa is characterized by consuming large amounts of food over a defined period with a loss of control over the eating. This is followed by a compensatory behavior directed at eliminating the consumed calories, usually vomiting. Current treatments include antidepressants and/or behavioral therapies. Consensus exists that these treatments are not very effective and are associated with high relapse rates. We review evidence from literature and present original data to evaluate the hypothesis that bulimia involves alterations in vago-vagal function. Evidence in support of this include (1) Laboratory studies consistently illustrate deficits in meal size, meal termination, and satiety in bulimia; (2) Basic science studies indicate that meal size and satiation are under vagal influences; (3) Anatomical, behavioral and physiological data suggest that achieving satiety and the initiation of emesis involve common neural substrates; (4) Abnormal vagal and vago-vagal reflexive functions extend to non-eating activational stimuli; and (5) Studies from our laboratory modulating vagal activation have shown significant effects on binge/vomit frequencies and suggest a return of normal satiation. We propose a model for the pathophysiology of bulimia based upon de-stabilization of a bi-stable positive vago-vagal feedback loop. This model is not meant to be complete, but rather to stimulate anatomical, psychobiological, and translational neuroscience experiments aimed at elucidating the pathophysiology of bulimia and developing novel treatment strategies. PMID:18191425
Kendzor, Darla E; Adams, Claire E; Stewart, Diana W; Baillie, Lauren E; Copeland, Amy L
Elevated rates of cigarette smoking have been reported among individuals with Bulimia Nervosa. However, little is known about eating disorder symptoms within non-clinical samples of smokers. The purpose of the present study was to compare the eating disorder symptoms of young adult female smokers (n=184) and non-smokers (n=56), to determine whether smokers were more likely to endorse bulimic symptoms and report greater body shape concern than non-smokers. Analyses indicated that smokers scored significantly higher than non-smokers on the Body Shape Questionnaire, p=.03, and the Bulimia Test-Revised, p=.006. In addition, a higher proportion of smokers than non-smokers scored > or = 85 on the Bulimia Test-Revised, p=.05, suggesting the possibility that Bulimia Nervosa diagnoses were more prevalent among smokers. No differences were found between smokers and non-smokers on other measures of eating behavior. Overall, findings suggest that smoking is specifically associated with symptoms of Bulimia Nervosa and body shape concern among young adult females.
Oberndorfer, Tyson A; Frank, Guido K W; Simmons, Alan N; Wagner, Angela; McCurdy, Danyale; Fudge, Julie L; Yang, Tony T; Paulus, Martin P; Kaye, Walter H
Recent studies suggest that altered function of higher-order appetitive neural circuitry may contribute to restricted eating in anorexia nervosa and overeating in bulimia nervosa. This study used sweet tastes to interrogate gustatory neurocircuitry involving the anterior insula and related regions that modulate sensory-interoceptive-reward signals in response to palatable foods. Participants who had recovered from anorexia nervosa and bulimia nervosa were studied to avoid confounding effects of altered nutritional state. Functional MRI measured brain response to repeated tastes of sucrose and sucralose to disentangle neural processing of caloric and noncaloric sweet tastes. Whole-brain functional analysis was constrained to anatomical regions of interest. Relative to matched comparison women (N=14), women recovered from anorexia nervosa (N=14) had significantly diminished and women recovered from bulimia nervosa (N=14) had significantly elevated hemodynamic response to tastes of sucrose in the right anterior insula. Anterior insula response to sucrose compared with sucralose was exaggerated in the recovered group (lower in women recovered from anorexia nervosa and higher in women recovered from bulimia nervosa). The anterior insula integrates sensory reward aspects of taste in the service of nutritional homeostasis. One possibility is that restricted eating and weight loss occur in anorexia nervosa because of a failure to accurately recognize hunger signals, whereas overeating in bulimia nervosa could represent an exaggerated perception of hunger signals. This response may reflect the altered calibration of signals related to sweet taste and the caloric content of food and may offer a pathway to novel and more effective treatments.
Welch, Sarah L.; Fairburn, Christopher G.
Young women (n=102) with bulimia nervosa were compared with 204 control subjects without an eating disorder and with 102 subjects with other psychiatric disorders. Results suggest that sexual and physical abuse are both risk factors for psychiatric disorders in general, including bulimia nervosa, but are not specific risk factors for bulimia. (DB)
This document provides teachers with information on the identifying features of anorexia nervosa and bulimia and suggests steps which teachers can take to encourage individual children in more positive behavior. The paper makes clear distinctions between anorexia nervosa, bulimia, and bulimarexia, describing the symptoms of each disorder. It is…
Wu, J.C.; Hagman, J.; Buchsbaum, M.S.; Blinder, B.; Derrfler, M.; Tai, W.Y.; Hazlett, E.; Sicotte, N. (Univ. of California, Irvine (USA))
Eight women with bulimia and eight age- and sex-matched normal control subjects were studied with positron emission tomography using (18F)-fluorodeoxyglucose (FDG) as a tracer of brain metabolic rate. Subjects performed a visual vigilance task during FDG uptake. In control subjects, the metabolic rate was higher in the right hemisphere than in the left, but patients with bulimia did not have this normal asymmetry. Lower metabolic rates in the basal ganglia, found in studies of depressed subjects, and higher rates in the basal ganglia, reported in a study of anorexia nervosa, were not found. This is consistent with the suggestion that bulimia is a diagnostic grouping distinct from these disorders.
Historical changes in psychological symptoms are analysed not only from a social causation approach but also from a labelling perspective. Modern eating disorders lend themselves to such an analysis because of their historical variability. Effects of the introduction and dispersion of the psychiatric concept of 'bulimia nervosa' at normal body weight and its propagation through the mass media are examined (relying on Devereux's model of 'ethnic disorders'). Data of an exploratory interview study with 39 bulimic patients evaluated along these lines (a) indicate that the recognition of bulimia has facilitated seeking of professional and non-professional help, (b) invite categorization of bulimic behaviour implying less self-blame, (c) render imitation of bulimia more probable, and (d) covary with less secretive illness behaviour indicating a broadening of underlying motivations.
Full Text Available The scientific literature has suggested that stress undergirds the development of eating disorders (ED. Therefore, this study explored whether laboratory induced stress increases self-reported drive for thinness and bulimic symptoms measured via self-report. The relationship between control, perfectionism, stress, and cognition related to ED was examined using correlational methodology. 86 participants completed an experimental task using a personal computer. All individuals completed a battery of tests before and after the stressful task. Analyses showed a significant statistical increase in average scores on the drive for thinness and bulimia measured before and after a stressful task, and path analysis revealed two different cognitive models for the mechanism leading to drive for thinness and bulimia. These findings suggest that stress is an important factor in the development of the drive for thinness and bulimia.
Laser, Eleanor; Sassack, Michael
This case report describes an effort to control bulimia nervosa by combining low-level laser therapy (LLLT)-the application of red and near-infrared light to specific body points-and hypnosis. A 29-year old female with a 14-year history of bulimia received one session of LLLT combined with hypnosis. Two weeks later, following a measurable decrease in bulimic episodes (purging), a session of psychotherapy and hypnosis was administered. Six months post-treatment, the patient has experienced a complete cessation of purging activities without recurrence. LLLT, when used in conjunction with hypnosis and psychotherapy, was effective in managing bulimia and may prove useful in treating other eating disorders.
Gonidakis, Fragiskos; Kravvariti, Vasilliki; Varsou, Eleftheria
The cross-sectional study aimed at examining the sexual function of young adult women suffering from eating disorders. The authors interviewed 53 women (26 with anorexia nervosa and 27 with bulimia nervosa) and 58 female students. Each participant was administered the Female Sexual Function Index, the Eating Attitudes Test, the Body Shape Questionnaire, and the Beck Depression Inventory. Comparisons among the 3 groups showed that patients with anorexia nervosa scored lower in each Female Sexual Function Index subscale than did healthy controls. There was no significant difference between bulimia nervosa and healthy controls. Sexual functionality of patients with anorexia nervosa was correlated only with body mass index (r = 0.5, p =.01). Sexual functionality of patients with bulimia nervosa was correlated only with the Beck Depression Inventory (r = -0.4, p =.03) Patients with anorexia nervosa had more disturbed sexual function than did controls. Sexual function can be related to the level of starvation and symptoms of depression.
Carrie J Mcadams
Full Text Available Self-evaluation closely dependent upon body shape and weight is one of the defining criteria for bulimia nervosa. We studied 53 adult women, 17 with bulimia nervosa, 18 with a recent history of anorexia nervosa, and 18 healthy comparison women, using three different fMRI tasks that required thinking about self-knowledge and social interactions: the Social Identity task, the Physical Identity task, and the Social Attribution task. Previously, we identified regions of interest (ROI in the same tasks using whole brain voxel-wise comparisons of the healthy comparison women and women with a recent history of anorexia nervosa. Here, we report on the neural activations in those ROIs in subjects with bulimia nervosa. In the Social Attribution task, we examined activity in the right temporoparietal junction, an area frequently associated with mentalization. In the Social Identity task, we examined activity in the precuneus and dorsal anterior cingulate. In the Physical Identity task, we examined activity in a ventral region of the dorsal anterior cingulate. Interestingly, in all tested regions, the average activation in subjects with bulimia was more than the average activation levels seen in the subjects with a history of anorexia but less than that seen in healthy subjects. In three regions, the right temporoparietal junction, the precuneus, and the dorsal anterior cingulate, group responses in the subjects with bulimia were significantly different from healthy subjects but not subjects with anorexia. The neural activations of people with bulimia nervosa performing fMRI tasks engaging social processing are more similar to people with anorexia nervosa than healthy people. This suggests biological measures of social processes may be helpful in characterizing individuals with eating disorders.
Canna, Antonietta; Prinster, Anna; Monteleone, Alessio Maria; Cantone, Elena; Monteleone, Palmiero; Volpe, Umberto; Maj, Mario; Di Salle, Francesco; Esposito, Fabrizio
The functional interplay between hemispheres is fundamental for behavioral, cognitive, and emotional control. Anorexia nervosa (AN) and bulimia nervosa (BN) have been largely studied with brain magnetic resonance imaging (MRI) in relation to the functional mechanisms of high-level processing, but not in terms of possible inter-hemispheric functional connectivity anomalies. Using resting-state functional MRI (fMRI), voxel-mirrored homotopic connectivity (VMHC) and regional inter-hemispheric spectral coherence (IHSC) were studied in 15 AN and 13 BN patients and 16 healthy controls (HC). Using T1-weighted and diffusion tensor imaging MRI scans, regional VMHC values were correlated with the left-right asymmetry of corresponding homotopic gray matter volumes and with the white matter callosal fractional anisotropy (FA). Compared to HC, AN patients exhibited reduced VMHC in cerebellum, insula, and precuneus, while BN patients showed reduced VMHC in dorso-lateral prefrontal and orbito-frontal cortices. The regional IHSC analysis highlighted that the inter-hemispheric functional connectivity was higher in the 'Slow-5' band in all regions except the insula. No group differences in left-right structural asymmetries and in VMHC vs. callosal FA correlations were significant in the comparisons between cohorts. These anomalies, not explained by structural changes, indicate that AN and BN, at least in their acute phase, are associated with a loss of inter-hemispheric connectivity in regions implicated in self-referential, cognitive control and reward processing. These findings may thus gather novel functional markers to explore aberrant features of these eating disorders. © 2016 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.
Accurso, Erin C; Fitzsimmons-Craft, Ellen E; Ciao, Anna; Cao, Li; Crosby, Ross D; Smith, Tracey L; Klein, Marjorie H; Mitchell, James E; Crow, Scott J; Wonderlich, Stephen A; Peterson, Carol B
This study examined the temporal relation between therapeutic alliance and outcome in two treatments for bulimia nervosa (BN). Eighty adults with BN symptoms were randomized to 21 sessions of integrative cognitive-affective therapy (ICAT) or enhanced cognitive-behavioral therapy (CBT-E). Bulimic symptoms (i.e., frequency of binge eating and purging) were assessed at each session and posttreatment. Therapeutic alliance (Working Alliance Inventory) was assessed at Sessions 2, 8, 14, and posttreatment. Repeated-measures analyses using linear mixed models with random intercepts were conducted to determine differences in alliance growth by treatment and patient characteristics. Mixed-effects models examined the relation between alliance and symptom improvement. Overall, patients in both treatments reported strong therapeutic alliances. Regardless of treatment, greater therapeutic alliance between (but not within) subjects predicted greater reductions in bulimic behavior; reductions in bulimic behavior also predicted improved alliance. Patients with higher depression, anxiety, or emotion dysregulation had a stronger therapeutic alliance in CBT-E than ICAT, while those with more intimacy problems had greater improvement in therapeutic alliance in ICAT compared to CBT-E. Therapeutic alliance has a unique impact on outcome, independent of the impact of symptom improvement on alliance. Within- and between-subjects effects revealed that changes in alliance over time did not predict symptom improvement, but rather that individuals who had a stronger alliance overall had better bulimic symptom outcomes. These findings indicate that therapeutic alliance is an important predictor of outcome in the treatment of BN. (c) 2015 APA, all rights reserved).
Hannon-Engel, Sandra L; Filin, Evgeniy E; Wolfe, Barbara E
The core defining features of bulimia nervosa (BN) are repeated binge eating episodes and inappropriate compensatory (e.g., purging) behavior. Previous studies suggest an abnormal post-prandial response in the satiety-signaling peptide cholecystokinin (CCK) in persons with BN. It is unknown whether this altered response persists following remission or if it may be a potential target for the development of clinical treatment strategies. To examine the nature of this altered response, this study assessed whether CCK normalizes following remission from BN (RBN). This study prospectively evaluated the plasma CCK response and corresponding eating behavior-related ratings (e.g., satiety, fullness, hunger, urge to binge and vomit) in individuals with BN-purging subtype (n=10), RBN-purging subtype (n=14), and healthy controls (CON, n=13) at baseline, +15, +30, and +60 min following the ingestion of a standardized liquid test meal. Subject groups did not significantly differ in CCK response to the test meal. A significant relationship between CCK response and satiety ratings was observed in the RBN group (r=.59, p<.05 two-tailed). A new and unanticipated finding in the BN group was a significant relationship between CCK response and ratings of "urge to vomit" (r=.86, p<.01, two-tailed). Unlike previous investigations, CCK response did not differ in BN and CON groups. Thus the role of symptom severity remains an area of further investigation. Additionally, findings suggest that in this sample, CCK functioning following remission from BN-purging subtype is not different from controls. It remains unknown whether or not CCK functioning may be a protective or liability factor in the stabilization and recovery process. Replication studies utilizing a larger sample size are needed to further elucidate the role of CCK in recovery from BN and its potential target of related novel treatment strategies. © 2013 Elsevier Inc. All rights reserved.
Sysko, Robyn; Ojserkis, Rachel; Schebendach, Janet; Evans, Suzette M; Hildebrandt, Tom; Walsh, B Timothy
Many patients with bulimia nervosa (BN) also meet criteria for a lifetime alcohol use disorder (AUD). In order to understand possible mechanisms contributing to the co-occurrence and perpetuation of these disorders, this study investigated the importance of impulsivity and test meal intake among patients with BN by comparing women with BN only (n = 18), BN and current/past AUDs (n = 13), and healthy controls (n = 12). All participants completed assessments of eating disorder symptoms, frequency of alcohol use, binge eating, and purging via questionnaires and semi-structured interviews over two sessions. Measures of impulsivity consisted of computerized and self-report measures, and laboratory test meals. Significant differences between individuals with BN with/without comorbid AUDs were not found for test meal intake, impulsivity measures, or self-reported psychological symptoms. As hypothesized, compared to healthy controls, individuals with BN had significantly higher scores on two subscales and the total score of the Barratt Impulsiveness Scale, a trait measure of impulsivity, and consumed significantly more calories in the binge instruction meal. Total Barratt Impulsiveness Scale scores were also significantly related to kcal consumed during the laboratory test meal when individuals were instructed to binge eat (BN groups). Data from this study add to the existing literature implicating impulsivity in the psychopathology of disorders of binge eating, including BN, and also support the use of laboratory meals as a symptom-specific measure of this trait in eating disorder populations. Copyright © 2017 Elsevier Ltd. All rights reserved.
Miniati, Mario; Benvenuti, Antonella; Bologna, Elena; Maglio, Alessandra; Cotugno, Biagio; Massimetti, Gabriele; Calugi, Simona; Mauri, Mauro; Dell'Osso, Liliana
To investigate the presence of mood spectrum signs and symptoms in patients with anorexia nervosa, restricting subtype (AN-R) or bulimia nervosa (BN). 55 consecutive female patients meeting DSM-IV criteria for eating disorders (EDs) not satisfying DSM-IV criteria for Axis I mood disorders were evaluated with the Lifetime Mood Spectrum Self-Report (MOODS-SR) and the Mini-International Neuropsychiatric Interview (MINI). The MOODS-SR explored the subthreshold comorbidity for mood spectrum symptoms in patients not reaching the threshold for a mood disorder Axis I diagnosis. MOODS-SR included 161 items. Separate factor analyses of MOODS-SR identified 6 'depressive factors' and 9 'manic-hypomanic factors'. The mean total score of MOODS-SR was significantly higher in BN than in AN-R patients (97.5 ± 25.4 vs 61.1 ± 38.5, respectively; p = 0.0001). 63.6 % of the sample (n = 35) endorsed the threshold of ≥61 items, with a statistically significant difference between AN-R and BN (39.3 % vs 88.9 %; χ 2 = 14.6; df = 1; p = 0.0001). Patients with BN scored significantly higher than AN-R patients on several MOODS-SR factors: (a) MOODS-SR depressive component: 'depressive mood' (11.2 ± 7.4 vs 16.0 ± 5.8; p self-esteem' (1.1 ± 1.4 vs 2.1 ± 1.6; p definition of clinical phenotypes.
Background: Bulimia Nervosa (BN) is a serious Eating Disorder which affects 0.8-2.9% percent of the population. The etiology of BN is largely unknown and concequently there is no curative, although psychotherapy and the antidepressant fluoxetine provide symptomatic relief. Biomarkers for BN could...... support in understanding the pathophysiology of BN, and potentially in diagnosing, and monitoring of effects of treatment. This review describes genetic and serotonergic biomarkers for BN. Method: A literature search using PUBMED (20 June 2017) was done using the following search terms: 1) “Bulimia...
Eddy, Kamryn T; Tabri, Nassim; Thomas, Jennifer J; Murray, Helen B; Keshaviah, Aparna; Hastings, Elizabeth; Edkins, Katherine; Krishna, Meera; Herzog, David B; Keel, Pamela K; Franko, Debra L
The course of eating disorders is often protracted, with fewer than half of adults achieving recovery from anorexia nervosa or bulimia nervosa. Some argue for palliative management when duration exceeds a decade, yet outcomes beyond 20 years are rarely described. This study investigates early and long-term recovery in the Massachusetts General Hospital Longitudinal Study of Anorexia and Bulimia Nervosa. Females with DSM-III-R/DSM-IV anorexia nervosa or bulimia nervosa were assessed at 9 and at 20 to 25 years of follow-up (mean [SD] = 22.10 [1.10] years; study initiated in 1987, last follow-up conducted in 2013) via structured clinical interview (Longitudinal Interval Follow-Up Evaluation of Eating Disorders [LIFE-EAT-II]). Seventy-seven percent of the original cohort was re-interviewed, and multiple imputation was used to include all surviving participants from the original cohort (N = 228). Kaplan-Meier curves estimated recovery by 9-year follow-up, and McNemar test examined concordance between recovery at 9-year and 22-year follow-up. At 22-year follow-up, 62.8% of participants with anorexia nervosa and 68.2% of participants with bulimia nervosa recovered, compared to 31.4% of participants with anorexia nervosa and 68.2% of participants with bulimia nervosa by 9-year follow-up. Approximately half of those with anorexia nervosa who had not recovered by 9 years progressed to recovery at 22 years. Early recovery was associated with increased likelihood of long-term recovery in anorexia nervosa (odds ratio [OR] = 10.5; 95% CI, 3.77-29.28; McNemar χ²₁ = 31.39; P bulimia nervosa (OR = 1.0; 95% CI, 0.49-2.05; McNemar χ²₁ = 0; P = 1.0). At 22 years, approximately two-thirds of females with anorexia nervosa and bulimia nervosa were recovered. Recovery from bulimia nervosa happened earlier, but recovery from anorexia nervosa continued over the long term, arguing against the implementation of palliative care for most individuals with eating disorders. © Copyright
Villalobos Pérez, Fabiola
En este informe final de investigación aplicada se realizó una psicoterapia grupal de 16 sesiones para mujeres adolescentes con bulimia en el hospital San Rafael de Alajuela. El marco teórico y metodológico, a partir del cual se conceptualizó este trabajo, es el Psicoanálisis, por lo que la adolescencia es considerada como un momento de reestructuración subjetiva; la bulimia, de forma contraria a la posición médico-psiquiátrica, se considera como un síntoma, es decir, como una manifestación d...
Gerlinghoff, M; Backmund, H
The most important eating disorders are anorexia and bulimia, which most frequently occur for the first time during adolescence and continue into adulthood. Medical complications and accompanying psychological disturbances cause a significant mortality rate of up to 6% in anorexia and up to 3% in bulimia. The pathogenesis of eating disorders is still unclear. Current etiological concepts are multidimensional including biological, individual, familial, and sociocultural factors. In spite of a great variety of therapeutic possibilities, the prognosis for eating disorders is quite poor. In the long term, only about 50% of the persons affected overcome their illness. Preventive measures are therefore indispensable.
Jordan, Jennifer; McIntosh, Virginia V W; Carter, Janet D; Rowe, Sarah; Taylor, Kathryn; Frampton, Christopher M A; McKenzie, Janice M; Latner, Janet; Joyce, Peter R
DSM-5 has dropped subtyping of bulimia nervosa (BN), opting to continue inclusion of the somewhat contentious diagnosis of BN-nonpurging subtype (BN-NP) within a broad BN category. Some contend however that BN-NP is more like binge eating disorder (BED) than BN-P. This study examines clinical characteristics, eating disorder symptomatology, and Axis I comorbidity in BN-NP, BN-P, and BED groups to establish whether BN-NP more closely resembles BN-P or BED. Women with BN-P (n = 29), BN-NP (n = 29), and BED (n = 54) were assessed at baseline in an outpatient psychotherapy trial for those with binge eating. Measures included the Structured Clinical Interviews for DSM-IV, Eating Disorder Examination, and Eating Disorder Inventory-2. The BN-NP subtype had BMIs between those with BN-P and BED. Both BN subtypes had higher Restraint and Drive for Thinness scores than BED. Body Dissatisfaction was highest in BN-NP and predicted BN-NP compared to BN-P. Higher Restraint and lower BMI predicted BN-NP relative to BED. BN-NP resembled BED with higher lifetime BMIs; and weight-loss clinic than eating disorder clinic attendances relative to the BN-P subtype. Psychiatric comorbidity was comparable except for higher lifetime cannabis use disorder in the BN-NP than BN-P subtype These results suggest that BN-NP sits between BN-P and BED however the high distress driving inappropriate compensatory behaviors in BN-P requires specialist eating disorder treatment. These results support retaining the BN-NP group within the BN category. Further research is needed to determine whether there are meaningful differences in outcome over follow-up. Copyright © 2013 Wiley Periodicals, Inc.
Avena, Nicole M; Bocarsly, Miriam E
Food intake is mediated, in part, through brain pathways for motivation and reinforcement. Dysregulation of these pathways may underlay some of the behaviors exhibited by patients with eating disorders. Research using animal models of eating disorders has greatly contributed to the detailed study of potential brain mechanisms that many underlie the causes or consequences of aberrant eating behaviors. This review focuses on neurochemical evidence of reward-related brain dysfunctions obtained through animal models of binge eating, bulimia nervosa, or anorexia nervosa. The findings suggest that alterations in dopamine (DA), acetylcholine (ACh) and opioid systems in reward-related brain areas occur in response to binge eating of palatable foods. Moreover, animal models of bulimia nervosa suggest that while bingeing on palatable food releases DA, purging attenuates the release of ACh that might otherwise signal satiety. Animal models of anorexia nervosa suggest that restricted access to food enhances the reinforcing effects of DA when the animal does eat. The activity-based anorexia model suggests alterations in mesolimbic DA and serotonin occur as a result of restricted eating coupled with excessive wheel running. These findings with animal models complement data obtained through neuroimaging and pharmacotherapy studies of clinical populations. Information on the neurochemical consequences of the behaviors associated with these eating disorders will be useful in understanding these complex disorders and may inform future therapeutic approaches, as discussed here. This article is part of a Special Issue entitled 'Central Control of Food Intake'. Copyright © 2011 Elsevier Ltd. All rights reserved.
Hirst, Rayna B; Beard, Charlotte L; Colby, Katrina A; Quittner, Zoe; Mills, Brent M; Lavender, Jason M
Research investigating the link between eating disorder (ED) diagnosis and executive dysfunction has had conflicting results, yet no meta-analyses have examined the overall association of ED pathology with executive functioning (EF). Effect sizes were extracted from 32 studies comparing ED groups (27 of anorexia nervosa, 9 of bulimia nervosa) with controls to determine the grand mean effect on EF. Analyses included effects for individual EF measures, as well as an age-based subgroup analysis. There was a medium effect of ED diagnosis on executive functioning, with bulimia nervosa demonstrating a larger effect (Hedges's g=-0.70) than anorexia nervosa (g=-0.41). Within anorexia nervosa studies, subgroup analyses were conducted for age and diagnostic subtype. The effect of anorexia nervosa on EF was largest in adults; however, subgroup differences for age were not significant. Anorexia and bulimia nervosa are associated with EF deficits, which are particularly notable for individuals with bulimia nervosa. The present analysis includes recommendations for future studies regarding study design and EF measurement. Copyright © 2017 Elsevier Ltd. All rights reserved.
Bohon, Cara; Stice, Eric
To test the hypothesis that women with full and subthreshold bulimia nervosa show abnormal neural activation in response to food intake and anticipated food intake relative to healthy control women. Females with and without full/subthreshold bulimia nervosa recruited from the community (N = 26) underwent functional magnetic resonance imaging (fMRI) during receipt and anticipated receipt of chocolate milkshake and a tasteless control solution. Women with bulimia nervosa showed trends for less activation than healthy controls in the right anterior insula in response to anticipated receipt of chocolate milkshake (vs. tasteless solution) and in the left middle frontal gyrus, right posterior insula, right precentral gyrus, and right mid dorsal insula in response to consumptions of milkshake (vs. tasteless solution). Bulimia nervosa may be related to potential hypofunctioning of the brain reward system, which may lead these individuals to binge eat to compensate for this reward deficit, though the hypo-responsivity might be a result of a history of binge eating highly palatable foods. Copyright © 2010 Wiley Periodicals, Inc.
Sullivan, Keri A.
Compares the clinical characteristics of binge eating disorder (BED) and the related syndrome bulimia nervosa (BN). Findings suggest individuals with BED are distinguishable from those with BN on a number of traits, including higher rates of obesity and lower levels of eating concern and dietary restraint. (Contains 29 references and 2 tables.)…
Michel, Deborah Marcontell; Willard, Susan G.
This book about anorexia and bulimia is written for patients and the people who care about them. It describes the symptoms and warning signs of eating disorders, explains their presumed causes and complexities, and suggests effective treatments. The book emphasizes the critical role of psychotherapy and family therapy in recovery, explains how…
The purpose of this literature review is to examine prevalence and incident rates of both anorexia nervosa and bulimia nervosa. In addition, this article will review the psychological and sociological factors that contribute to the development and maintenance of an eating disorder. Finally, different treatment approaches will be discussed in…
Peterson, C B; Miller, K B; Willer, M G; Ziesmer, J; Durkin, N; Arikian, A; Crow, S J
The extent to which cognitive-behavioral therapy (CBT) is helpful in treating individuals with bulimic symptoms who do not meet full criteria for bulimia nervosa is unclear. The purpose of this investigation was to examine the potential efficacy of CBT for eating disorder individuals with bulimic symptoms who do not meet full criteria for bulimia nervosa. Twelve participants with subthreshold bulimia nervosa were treated in a case series with 20 sessions of CBT. Ten of the 12 participants (83.3%) completed treatment. Intent-to-treat abstinent percentages were 75.0% for objectively large episodes of binge eating (OBEs), 33.3% for subjectively large episodes of binge eating (SBEs), and 50% for purging at end of treatment. At one year follow-up, 66.7% were abstinent for OBEs, 41.7% for SBEs, and 50.0% for purging. The majority also reported improvements in associated symptoms. This case series provides support for the use of CBT with individuals with subthreshold bulimia nervosa.
Machado, Barbara C.; Goncalves, Sonia F.; Martins, Carla; Brandao, Isabel; Roma-Torres, Antonio; Hoek, Hans W.; Machado, Paulo P.
This study is the result of two Portuguese case-control studies that examined the replication of retrospective correlates and preceding life events in anorexia nervosa (AN) and bulimia nervosa (BN) development. This study aims to identify retrospective correlates that distinguish AN and BN A
Sim, Leslie; Zeman, Janice
This study examined emotion-identification skills in 19 adolescent girls (M age = 16 years, 8 months) diagnosed with a Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994) diagnosis of bulimia nervosa or eating disorder not otherwise specified in the bulimic spectrum, 19 age-matched girls…
Le Grange, Daniel; Crosby, Ross D.; Lock, James
The predictors and moderators of treatment outcome for adolescents with bulimia nervosa (BN) are explored among those who participated in family based treatment or individual supportive psychotherapy. It is concluded that family-based treatment of BN may be most effective in those cases with low levels of eating disorder psychopathology.
Keski-Rahkonen, Anna; Raevuori, Anu; Bulik, Cynthia M.; Hoek, Hans W.; Sihvola, Elina; Kaprio, Jaakko; Rissanen, Aila
Objective To examine psychiatric comorbidity and factors that influence the outcome of bulimia nervosa (BN) in the general population. Method Women from the nationwide birth cohorts of Finnish twins were screened for lifetime BN (N=59) by using questionnaires and the Structured Clinical Interview
Spangler, Diane L.; Baldwin, Scott A.; Agras, W. Stewart
Cognitive-behavioral therapy (CBT) for bulimia nervosa (BN) has received considerable empirical support for its efficacy. However, few investigators have examined the mechanisms proposed to account for the reduction of BN symptoms during CBT. The current study examined the associations between therapist interventions, client mechanisms, and…
Homan, Philipp; Grob, Simona; Milos, Gabriella; Schnyder, Ulrich; Eckert, Anne; Lang, Undine; Hasler, Gregor
A relationship between bulimia nervosa and reward-related behavior is supported by several lines of evidence. The dopaminergic dysfunctions in the processing of reward-related stimuli have been shown to be modulated by the neurotrophin brain derived neurotrophic factor (BDNF) and the hormone leptin. Using a randomized, double-blind, placebo-controlled, crossover design, a reward learning task was applied to study the behavior of 20 female subjects with remitted bulimia nervosa and 27 female healthy controls under placebo and catecholamine depletion with alpha-methyl-para-tyrosine (AMPT). The plasma levels of BDNF and leptin were measured twice during the placebo and the AMPT condition, immediately before and 1 hour after a standardized breakfast. AMPT-induced differences in plasma BDNF levels were positively correlated with the AMPT-induced differences in reward learning in the whole sample (P=.05). Across conditions, plasma brain derived neurotrophic factor levels were higher in remitted bulimia nervosa subjects compared with controls (diagnosis effect; P=.001). Plasma BDNF and leptin levels were higher in the morning before compared with after a standardized breakfast across groups and conditions (time effect; Pbulimia nervosa and controls. A role of leptin in reward learning is not supported by this study. However, leptin levels were sensitive to a depletion of catecholamine stores in both remitted bulimia nervosa and controls. © The Author 2015. Published by Oxford University Press on behalf of CINP.
Furber, Gareth; Steele, Anna; Wade, Tracey D.
A previous case-series evaluation of a six-session guided self-help (GSH) approach with 15 people with bulimia nervosa (BN) showed significant reductions across all measures, including binge eating, self-induced vomiting, weight concern, shape concern and dietary restraint. However, the reduction of binge eating and self-induced vomiting was…
Delinsky, Sherrie S.; Wilson, G. Terence
Cognitive behavior therapy (CBT) is an effective treatment for bulimia nervosa (BN). However, among patients with BN, symptom improvement is more pronounced for behavioral eating symptoms (i.e., bingeing and purging) than for body image disturbance, and the persistence of body image disturbance is associated with relapse. The need for more…
Binford, Roslyn B.; Mussell, Melissa Pederson; Crosby, Ross D.; Peterson, Carol B.; Crow, Scott J.; Mitchell, James E.
This study's purpose was to examine the extent to which participants (N = 143) receiving cognitive-behavioral therapy for bulimia nervosa (BN) reported implementing therapeutic strategies to abstain from BN behaviors, and to assess whether use of specific strategies predicts outcome at treatment end and 1-and 6-month follow-up. Frequency of…
Guiffrida, Douglas A.; Barnes, Kristin L.; Hoskins, Christine M.; Roman, Lisa L.
Presents an overview for college counselors of the literature on bulimia treatment outcomes for purposes of screening, treatment, and referral. Outlines pretreatment characteristics that seem amenable to success in brief therapy, as well as those that do not lead to a positive outcome. (Contains 37 references and 2 tables.) (Author/GCP)
Pagsberg, A K; Wang, A R
In a retrospective study of anorexia nervosa and bulimia nervosa, potential cases were traced, studied, and diagnosed according to ICD-10. Forty-two cases were found in Bornholm County, comprising the island of Bornholm in Denmark, in a population of 47,000 from 1970 to 1989. Less than half...
they are far from overweight, their bodies are comparatively fuller and more feminine than the adolescent boylike body figures favored in the recent...and laxative and diuretic use among teenagers . Journal of the American Medical Association 255(11):1447-1449; 1986. 14. Kirkley, B. Bulimia: clinical
Striegel-Moore, RH; Dohm, FA; Kraemer, HC; Schreiber, GB; Crawford, PB; Daniels, [No Value
Objective: The current study examined health services use during the past 12 months in a sample of young women with a history of an adolescent eating disorder (bulimia nervosa [BN] or binge eating disorder [BED]). Method: A community sample of 1,582 young women (mean age = 21.5 years) was
Full Text Available The UK's National Institute for Health and Care Excellence (NICE, one of the most authoritative institutions in the field of evidence-based medicine, has issued standards for management of patients with anorexia and bulimia nervosa.
Dynesen, Anja Weirsøe; Jensen, Allan Bardow; Astrup, Arne
in controls before and after intake of a meal and whether these changes may be reflected in saliva. Design: Twenty women with bulimia nervosa and 20 age- and sex-matched healthy controls participated. After an overnight fast, the subjects ate a standardized carbohydrate-rich breakfast. Whole saliva and blood...
Strober, Michael; Humphrey, Laura Lynn
Discusses familial influences in anorexia nervosa and bulimia. Reviews descriptions of family interaction, familial correlates of course and phenomenology of symptoms, and studies of familial transmission. Concludes that certain personality factors, possibly genetically determined, predispose the individual to greater sensitivity and vulnerability…
Zimmer, Marc A.
Prevention and early intervention in cases of anorexia and bulimia require that both professionals and the general public have knowledge about these eating disorders. A study was conducted to identify the questions about these disorders most often asked by the general public and to develop a guide to answer those questions for individuals of…
Our Children, 1998
Examines facts about eating disorders, which typically affect females in their teens, discussing the causes of anorexia and bulimia, describing their effects on the body, and explaining available treatment. Though eating disorders are very serious and potentially fatal, they are treatable. Treatment includes physician evaluation, possible…
Peters, Carole; And Others
Anorexia nervosa and bulimia are major concerns for high school students, especially females. These syndromes interfere with normal functioning and social development and can be life-threatening. Definitions, characteristics, symptoms, and treatment approaches for these two eating disorders are discussed, and suggestions for involvement of the…
Harrington, Brian C; Jimerson, Michelle; Haxton, Christina; Jimerson, David C
Eating disorders are life-threatening conditions that are challenging to address; however, the primary care setting provides an important opportunity for critical medical and psychosocial intervention. The recently published Diagnostic and Statistical Manual of Mental Disorders, 5th ed., includes updated diagnostic criteria for anorexia nervosa (e.g., elimination of amenorrhea as a diagnostic criterion) and for bulimia nervosa (e.g., criterion for frequency of binge episodes decreased to an average of once per week). In addition to the role of environmental triggers and societal expectations of body size and shape, research has suggested that genes and discrete biochemical signals contribute to the development of eating disorders. Anorexia nervosa and bulimia nervosa occur most often in adolescent females and are often accompanied by depression and other comorbid psychiatric disorders. For low-weight patients with anorexia nervosa, virtually all physiologic systems are affected, ranging from hypotension and osteopenia to life-threatening arrhythmias, often requiring emergent assessment and hospitalization for metabolic stabilization. In patients with frequent purging or laxative abuse, the presence of electrolyte abnormalities requires prompt intervention. Family-based treatment is helpful for adolescents with anorexia nervosa, whereas short-term psychotherapy, such as cognitive behavior therapy, is effective for most patients with bulimia nervosa. The use of psychotropic medications is limited for anorexia nervosa, whereas treatment studies have shown a benefit of antidepressant medications for patients with bulimia nervosa. Treatment is most effective when it includes a multidisciplinary, teambased approach.
Baird, Pryor; Sights, Judith R.
Observation has indicated that low self-esteem is pervasive in clients with anorexia and bulimia. Possible origins of the self-esteem deficit, its relationship to eating problems, and psychotherapeutic strategies to counteract the deficits are explored. (Author/BL)
Levine, Michael P.
This book presents a comprehensive review of anorexia nervosa and bulimia and the roles that schools can have in preventing, identifying, and treating these disorders. Chapter 1 provides an overview of student eating disorders and presents a case study of a high school student with an eating disorder. Chapter 2 discusses the nature of anorexia…
Moreno-Domínguez, Silvia; Rodríguez-Ruiz, Sonia; Fernández-Santaella, M Carmen; Ortega-Roldán, Blanca; Cepeda-Benito, Antonio
Researchers have found that dietary restraint increases food cravings and may contribute to loss of control over eating. Negative mood states often precede food cravings and binge eating. In the present study, we tested the influence of a prolonged food deprivation period over emotional states and food cravings. Twenty-one bulimia nervosa participants and 20 healthy women participants were asked to refrain from any eating for 20 hours and reported, at baseline, after 6 hours and at the end of the fasting period, their mood and craving states. Food consumption was also measured. Fasting increased food cravings in both groups but increased negative mood in healthy women only. Bulimia nervosa participants reported improved mood following food deprivation. Whereas Bulimia nervosa and healthy women participants ate moderate and similar amounts of food following the 20-hour fasting period, food cravings were significantly associated with the number of calories ingested. These findings are congruent with self-regulation theories that predict that prolonged fasting may reduce negative emotions in women with bulimia nervosa. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.
Black, C M; Wilson, G T; Labouvie, E; Heffernan, K
To evaluate the specificity of the modified Stroop test as an objective measure of bulimia nervosa. A modified Stroop Test was administered to patients with bulimia nervosa and two non-clinical control groups of restrained and unrestrained eaters. The data failed to show any specificity in the Stroop effect. Nor did the test provide a useful measure of treatment response. Taken in conjunction with previous inconsistent findings, the results of this study call into question the utility of the modified Stroop effect as a specific measure of bulimia nervosa.
Mueller, Stefanie Verena; Mihov, Yoan; Federspiel, Andrea; Wiest, Roland; Hasler, Gregor
Bulimia nervosa has been associated with a dysregulated catecholamine system. Nevertheless, the influence of this dysregulation on bulimic symptoms, on neural activity, and on the course of the illness is not clear yet. An instructive paradigm for directly investigating the relationship between catecholaminergic functioning and bulimia nervosa has involved the behavioral and neural responses to experimental catecholamine depletion. The purpose of this study was to examine the neural substrate of catecholaminergic dysfunction in bulimia nervosa and its relationship to relapse. In a randomized, double-blind and crossover study design, catecholamine depletion was achieved by using the oral administration of alpha-methyl-paratyrosine (AMPT) over 24 h in 18 remitted bulimic (rBN) and 22 healthy (HC) female participants. Cerebral blood flow (CBF) was measured using a pseudo continuous arterial spin labeling (pCASL) sequence. In a follow-up telephone interview, bulimic relapse was assessed. Following AMPT, rBN participants revealed an increased vigor reduction and CBF decreases in the pallidum and posterior midcingulate cortex (pMCC) relative to HC participants showing no CBF changes in these regions. These results indicated that the pallidum and the pMCC are the functional neural correlates of the dysregulated catecholamine system in bulimia nervosa. Bulimic relapse was associated with increased depressive symptoms and CBF reduction in the hippocampus/parahippocampal gyrus following catecholamine depletion. AMPT-induced increased CBF in this region predicted staying in remission. These findings demonstrated the importance of depressive symptoms and the stress system in the course of bulimia nervosa. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.
Full Text Available Bulimia nervosa is a serious and complex health problem encountered by many professionals, including general practitioners and dentists. The aim of the study was to describe the problem of bulimia (its prevalence, symptoms, special situations, treatment, with particular emphasis on the aspect of the oral health. The paper presents the causes and factors contributing to the disease, diagnostic criteria, the onset and the possible course of the disease, dental and oral mucosa pathologies due to bulimia as well as other comorbidities (including diabetes. The paper is of descriptive nature. The research method was based on the analysis of the available literature on bulimia nervosa supplemented by our own experience. It was concluded based on the analysed sources that appropriate diagnosis and treatment of bulimia nervosa is possible only with the cooperation of many specialists: psychiatrists or paediatric psychiatrists, dentists and general practitioners as well as other doctors if necessary. Psychotherapy is a necessary and integral aspect of treatment. Early treatment onset is essential for good treatment outcomes. Due to the low sense of illness, some patients would never meet a psychiatrist if not for the intervention of a family doctor or a dentist.
Avena, Nicole M.; Bocarsly, Miriam E.
Food intake is mediated, in part, through brain pathways for motivation and reinforcement. Dysregulation of these pathways may underlay some of the behaviors exhibited by patients with eating disorders. Research using animal models of eating disorders has greatly contributed to the detailed study of potential brain mechanisms that many underlie the causes or consequences of aberrant eating behaviors. This review focuses on neurochemical evidence of reward-related brain dysfunctions obtained through animal models of binge eating, bulimia nervosa, or anorexia nervosa. The findings suggest that alterations in dopamine (DA), acetylcholine (ACh) and opioid systems in reward-related brain areas occur in response to binge eating of palatable foods. Moreover, animal models of bulimia nervosa suggest that while bingeing on palatable food releases DA, purging attenuates the release of ACh that might otherwise signal satiety. Animal models of anorexia nervosa suggest that restricted access to food enhances the reinforcing effects of DA when the animal does eat. The activity-based anorexia model suggests alterations in mesolimbic DA and serotonin occur as a result of starvation coupled with excessive wheel running. These findings with animal models complement data obtained through neuroimaging and pharmacotherapy studies of clinical populations. Finally, information on the neurochemical consequences of the behaviors associated with these eating disorders will be useful in understanding these complex disorders and may inform future therapeutic approaches, as discussed here. PMID:22138162
Catarina Matos Brito Santos
Full Text Available TEMA: deglutição e bulimia. OBJETIVO: apresentar e discutir os achados científicos descritos na literatura quanto às características orofaríngeas relacionadas à deglutição em portadores de bulimia nervosa do tipo purgativa. CONCLUSÃO: a bulimia nervosa acarreta uma série de alterações em estruturas e funções que compõem o trânsito orofaríngeo, como erosão dentária, hipersensibilidade, enfraquecimento e fratura dos dentes, problemas de oclusão, cáries, doenças periodontais, dessensibilização intra-oral, hipogeusia, úlceras, granulomas, queilite angular, hipertrofia das glândulas parótidas, tosse e odinofagia. Existe um predomínio na literatura científica de relatos sobre alterações morfológicas em detrimento das funcionais. Poucos relatos abordaram diretamente a relação entre a bulimia e deglutição, apenas mencionando superficialmente as possibilidades de desencadeamento da disfagia orofaríngea.BACKGROUND: deglutition and bulimia. PURPOSE: to submit and discuss the scientific research concerning oropharyngeal characteristics related to deglutition in patients with purging type bulimia nervosa. CONCLUSIONS: bulimia nervosa entails a series of changes in structures and functions that compose the oropharyngeal tract, such as dental erosion, hypersensitivity, weakness and fracture of the teeth, occlusion problems, caries, periodontal diseases, intraoral desensitization, hypogeusia, ulceration, granulomas, angular cheilitis, enlargement of the parotid glands, coughs and odynophagia. There is a prevalence in the scientific literature of reports about morphologic alterations on the detriment of the functional ones. Few reports discussed the relationship between bulimia and deglutition, superficially mentioning the possibilities for triggering oropharyngeal dysphagia.
De Jonge, PV; Van Furth, EF; Lacey, JH; Waller, G
Background. There are numerous reports of personality disorder pathology in different eating disorders. However, few studies have directly compared personality pathology in bulimia nervosa, binge eating disorder and obesity. The present study examines group differences in DSM-IV personality
Guerdjikova, Anna I; McElroy, Susan L
Bulimia nervosa is associated with bipolar disorder, substance dependence, attention-deficit hyperactivity disorder, and anxiety disorders. Few reports, however, have addressed the treatment of patients with all of these conditions. We describe a young woman with bulimia nervosa, bipolar I disorder, cocaine and alcohol dependence, attention-deficit hyperactivity disorder, and panic disorder who achieved a sustained (>1 year) remission of her bulimia nervosa symptoms and significant improvement of her attention-deficit hyperactivity disorder symptoms with adjunctive methylphenidate after her bipolar, substance use, and panic disorders were successfully treated with hospitalization, intensive psychotherapy, quetiapine, and lamotrigine. Further research into the use of stimulants in bulimia nervosa, including in patients with complex comorbidity, is required.
Full Text Available Background & objectives: Patients with bulimia nervosa may have impaired mental image of their body and fear of weight gain. The aim of current research is study the effectiveness of acceptance and commitment therapy on improving body image of female students with bulimia nervosa. Methods: The design of current study is as quasi-experiment research with pre-test and post-test with control group . Statistical population consists all 12-16 years old female students with bulimia nervosa of Ardabil city in the 2013-13 academic years. In order to select the sample, at first 400 students were selected by multi stage cluster sampling method. Then between the students with bulimia nervosa, 40 subjects were selected randomly and were put in two experimental and control groups. The experimental group participated in 8 sessions of acceptance and commitment based training. Thecontrol group received no intervention. The gathered data were analyzed using multivariate analysis of covariance (MANCOVA. Results: The results show that acceptance and commitment therapy improved body image and reduced the symptoms of bulimia nervosa subjects of experimental group in comparison with the control group in the post-test (P<0.001. Conclusions: The results indicated that acceptance and commitment therapy by therapeutic strategies, improved body image of female students with bulimia nervosa. Thus, interventions based on this approach in schools for students lead to decreasing the psychological problems
Churruca, Kate; Ussher, Jane M; Perz, Janette
Bulimia, an eating disorder that affects more women than men, involves binging and compensatory behaviors. Given the importance of food in experiences of these behaviors, in this article, we examine constructions of food in accounts of bulimic behavior: how these constructions relate to cultural discourses, and their implications for subjectivity. Fifteen women who engaged in bulimic behaviors were interviewed. Through a thematic decomposition of their accounts, we identified six discursive constructions of food: "good/healthy" or "bad/unhealthy," "contaminating body and soul," "collapsed into fat," "pleasurable reward," "comfort," and "fuel for the body." Many constructions were consolidated through participants' embodied experiences, but made available through discourses in public health, biomedicine, and femininity, and had implications for subjectivity in terms of morality, spirituality, and self-worth. Thus, despite women deploying these constructions to make sense of their bulimic behaviors, they are culturally normative; this point has implications for therapeutic and preventive strategies for bulimia.
Elsharif, M; Doulias, T; Aljundi, W; Balchandra, S
Acute gastric dilation is a rare but recognised complication in patients with bulimia and anorexia following binge episodes owing to decreased bowel motility. We present a rare case of acute gastric dilation secondary to bulimia in an otherwise healthy 18-year-old female patient that resulted in compression and complete occlusion of the abdominal aorta, leading to acute mesenteric and bilateral lower limb ischaemia. This resolved immediately following a laparotomy and gastric decompression. Management of these patients is very challenging owing to the lack of a successful precedent. To our knowledge, such a catastrophic complication has only ever been reported once in the literature and the outcome was fatal. Our case is of additional importance as it offers a successful management strategy for these patients.
Cristina Moreira Marcos
Los síntomas contemporáneos parecen sostenerse en un rechazo del inconsciente y resisten a entrar en el discurso. En lugar de resaltar el aspecto simbólico del síntoma, la anorexia-bulimia revela el síntoma como la fijación de goce, lo que indica un rechazo del inconsciente. Este aspecto se evidencia en la práctica clínica de la anorexia y bulimia, en los que se ha hallado un intercambio del significante para el goce, que apunta a una patología del acto y no de las manifestaciones clínicas de...
Rodgers, Rachel Florence; Paxton, Susan J; McLean, Siân A; Massey, Robin; Mond, Jonathan M; Hay, Phillipa J; Rodgers, Bryan
Widely held stigmatizing attitudes and beliefs toward bulimic eating disorders may lead to self-blame and reduced treatment seeking. Knowledge and familiarity with mental disorders may help decrease associated stigma. However, these relationships are not well understood in bulimia nervosa (BN). A community sample of 1828 adults aged 18 to 70 years completed a survey assessing stigmatizing attitudes and beliefs toward BN, knowledge and familiarity with the disorder, as well as levels of eating disorder symptoms. Knowledge of BN was negatively associated with three dimensions of stigmatization, personal responsibility (ρ = -0.28), unreliability (ρ = -0.19), and advantages of BN (ρ = -0.23). Familiarity revealed no association with stigmatization. Both men and women with high levels of eating disorder symptoms perceived BN as less serious than the participants with low levels of symptoms. Increasing community knowledge about bulimia may help mitigate stigmatization and perceived barriers to treatment.
Freudenberg, Cara; Jones, Rebecca A; Livingston, Genvieve; Goetsch, Virginia; Schaffner, Angela; Buchanan, Linda
The effectiveness of an individualized outpatient program was investigated in the treatment of bulimia nervosa (BN) and anorexia nervosa (AN). Participants included 151 females who received outpatient eating disorder treatment in the partial hospitalization program, the intensive outpatient program, or a combination of the two programs. Outcome measures included the Eating Disorder Inventory (EDI-2), Beck Depression Inventory (BDI-II), frequency of binge eating and purging, and mean body weight. Findings included significant increases in weight for the AN group, reductions in binge eating frequency for the BN group, and reductions in EDI-2 and BDI-II scores and purging frequency for both groups. This study provides preliminary support for the efficacy of a multimodal program for the treatment of both anorexia nervosa and bulimia nervosa.
Kruger, S; Kennedy, SH
Pharmacotherapy for anorexia nervosa is considered to be of limited efficacy. However, many studies suffer methodological limitations, and the utility of newer drugs in the treatment of anorexia has not been examined yet. Although there have been more fruitful investigations on the efficacy of medication in the management of bulimia nervosa, there are still many unresolved issues regarding the optimal management of partial remission during the acute treatment phase and the intensity and duration of pharmacotherapy to achieve optimal prophylaxis. Selective serotonin reuptake inhibitors (SSRIs) control the binge urges in binge-eating disorder, but more trials are required to investigate the utility of SSRIs and other agents in maintenance treatment. We review the current status of psychopharmacotherapy for anorexia nervosa, bulimia nervosa and binge-eating disorder and evaluate the merits of newer agents in the treatment of these disorders. PMID:11109300
Wagner, Angela; Wöckel, Lars; Bölte, Sven; Radeloff, Daniel; Lehmkuhl, Gerd; Schmidt, Martin H; Poustka, Fritz
Family studies of anorexia (AN) and bulimia (BN) nervosa in relatives of patients with eating disorders compared to control subjects are rare in German-speaking countries. A German multicenter study compared first-, second- and third-degree relatives of 65 adolescent AN subjects (n = 746), 21 adolescent BN subjects (n = 265) and relatives of 11 adolescent depressive control subjects (n = 157), as well as those of 37 adolescent healthy control subjects (n = 480). Assessments included the Diagnostic Interview for Genetic Studies (DIGS), the short form of the Family Interview of Genetic Studies (FIGS), and the Eating Disorder Family History Interview. Rates of anorexia nervosa and major depressive disorder (trend) were significantly (p anorexia and bulimia nervosa. The observed differences in comorbidity patterns among eating-disordered relatives may be due to an age effect of the index patients.
Balakireva, E E; Kozlova, I A; Iakupova, L P; Savost'ianova, O L
Eighty children (66 girls and 14 boys), aged 6-16 years, with syndrome of anorexia nervosa (AN) have been studied. Two nosologic groups: pathological age crisis of childhood and adolescence (F50.0-F50.2 in ICD-10)--30 patients and slow-progressive schizophrenia (schizotypical disorder, F21.3-F21.4)--50 patients are determined. The latter group was divided according to syndrome types: syndrome of AN (28 patients); AN syndrome with predominant bulimia (11 patients); AN syndrome with dominating bulimia and vomitomanic disturbances (11 patients). Syndrome structure was determined by the stages of the course, syntropy character with other psychopathological disorders and process of their reduction. Psychotic disorders in patients of the third type were most pronounced. In each group, statistically significant EEG features, comparing to control age-matched group, were revealed. The severer were psychopathological symptoms, the less was an amount of organized and the more--desynchronized "flat" EEG.
Rigaud, D; Jiang, T; Pennacchio, H; Brémont, M; Perrin, D
There are few published studies on the triggers of binge eating in anorexia nervosa of binge/purging subtype (BPAN), bulimia nervosa (BN) and binge eating disorder (BED). We validated in 29 patients (10 BPAN, 10 BN and 9 BED) the perspicuity, the clarity and the intra- (doubles) and inter- (test-retest) reproducibility of a 24-item Start questionnaire on the triggers of binge eating. Then the Start questionnaire was administered to 176 patients (65 BPAN, 62 BN and 59 BED patients) being 27.5+9.1 yr old, having 15+9 binge eating (BE) episodes/week, with a mean binge duration of 1 hr 36min (+ 38min)/day. BE episodes occurred mainly during the second part of the day: afternoon after work (67% of the patients), "tea" time (55%), evening after dinner (42%) and at night (22%). The principal place for BE episodes was at home (96%). The BED patients avoided binges at the parents' home (89%) more often than the BPAN (62%, Peating episodes could occur despite a high satiety level (just after lunch or dinner) in 29% of the BN and in 16% of the BED patients (Pcomfort food (60%), such as chocolate, cakes, bread and pasta. The food consumed for binge episodes (in-binge food) was more often a strong trigger than the other food (not used for binges): olfaction (19% versus 10%), sight (52% versus 25%) and placing in the mouth (71% versus 26%; Peating was painful (and "not at all a pleasure") in 69% of the patients, but could also be a relaxing behavior in 31% of the patients, more often in the BED (43%) than in the BPAN patients (20%; Peating behavior was quoted as obsessive in 63% of BPAN, 92% of BN and only 34% of BED patients (Peating episodes in BPAN, BN and BED. It has also demonstrated the role of environmental determinants. Copyright © 2013 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.
Fichter, M M; Quadflieg, N; Brandl, B
The goal of the study was to contribute empirical data to the discussion of appropriate diagnostic classification of obese and nonobese, binging, and nonbinging eating disordered patients. The study consists of two parts: (1) patients with binge eating disorder (BED) (N = 22) are compared to a matched sample of patients with bulimia nervosa (BN) and to 16 patients with obesity (body mass index [BMI] > 30). These patient groups were cross-sectionally assessed using expert ratings (interview) and self-ratings. (2) A sample of 68 patients with BED were assessed longitudinally on admission and discharge of inpatient treatment and at a 3-year follow-up using the same instruments as in the first study. The study is the first to report longitudinal data on patients with BED. The general pattern of the cross-sectional data was that patients with BN not only had higher scores concerning disturbances of eating behavior and attitude but also for general psychopathology when compared to patients with obesity without marked binges. The scores of patients with BED had an intermediate position between BN and obesity but were closer to BN than to obesity. The BED group (and the obesity group) showed a high degree of body dissatisfaction, which, however, was accounted for by their high body weight. Concerning general psychopathology BED as well as BN had significantly higher scores than the obesity group in the Hopkin's Symptom Checklist (SCL) subscale anger and hostility, in the Complaint List, the PERI Demoralization Scale, and the Beck Depression Inventory. Results of the longitudinal study with BED showed marked improvement in specific and general psychopathology over time. Except for body weight this improvement largely persisted over the 3-year follow-up period. Severity of depression did not predict the course of body weight over time. Data are presented concerning the design of diagnostic criteria for eating disturbed patients not fitting criteria for BN or anorexia nervosa
Bohon, Cara; Stice, Eric
Binge eating is often preceded by reports of negative affect, but the mechanism by which affect may lead to binge eating is unclear. This study evaluated the effect of negative affect on neural response to anticipation and receipt of palatable food in women with bulimia nervosa (BN) versus healthy controls. We also evaluated connectivity between the amygdala and reward-related brain regions. Females with and without BN (n=26) underwent functional magnetic resonance imaging (fMRI) during receipt and anticipated receipt of chocolate milkshake and a tasteless solution. We measured negative affect just prior to the scan. Women with BN showed a positive correlation between negative affect and activity in the putamen, caudate, and pallidum during anticipated receipt of milkshake (versus tasteless solution). There were no significant relations between negative affect and receipt of milkshake. Connectivity analyses revealed a greater relation of amygdala activity to activation in the left putamen and insula during anticipated receipt of milkshake in the bulimia group relative to the control group. The opposite pattern was found for the taste of milkshake; the control group showed a greater relation of amygdala activity to activation in the left putamen and insula in response to milkshake receipt than the bulimia group. Results show that as negative affect increases, so does responsivity of reward regions to anticipated intake of palatable food, implying that negative affect may increase the reward value of food for individuals with bulimia nervosa or that negative affect has become a conditioned cue due to a history of binge eating in a negative mood. Copyright © 2012 Elsevier Ltd. All rights reserved.
Mueller, Stefanie Verena; Morishima, Yosuke; Schwab, Simon; Wiest, Roland; Federspiel, Andrea; Hasler, Gregor
The integration of reward magnitudes and effort costs is required for an effective behavioral guidance. This reward-effort integration was reported to be dependent on dopaminergic neurotransmission. As bulimia nervosa has been associated with a dysregulated dopamine system and catecholamine depletion led to reward-processing deficits in remitted bulimia nervosa, the purpose of this study was to identify the role of catecholamine dysfunction and its relation to behavioral and neural reward-effort integration in bulimia nervosa. To investigate the interaction between catecholamine functioning and behavioral, and neural responses directly, 17 remitted bulimic (rBN) and 21 healthy individuals (HC) received alpha-methyl-paratyrosine (AMPT) over 24 h to achieve catecholamine depletion in a randomized, crossover study design. We used functional magnetic resonance imaging (fMRI) and the monetary incentive delay (MID) task to assess reward-effort integration in relation to catecholaminergic neurotransmission at the behavioral and neural level. AMPT reduced the ability to integrate rewards and efforts effectively in HC participants. In contrast, in rBN participants, the reduced reward-effort integration was associated with illness duration in the sham condition and unrelated to catecholamine depletion. Regarding neural activation, AMPT decreased the reward anticipation-related neural activation in the anteroventral striatum. This decrease was associated with the AMPT-induced reduction of monetary earning in HC in contrast to rBN participants. Our findings contributed to the theory of a desensitized dopaminergic system in bulimia nervosa. A disrupted processing of reward magnitudes and effort costs might increase the probability of maintenance of bulimic symptoms.
Kruger, S; Kennedy, SH
Pharmacotherapy for anorexia nervosa is considered to be of limited efficacy. However, many studies suffer methodological limitations, and the utility of newer drugs in the treatment of anorexia has not been examined yet. Although there have been more fruitful investigations on the efficacy of medication in the management of bulimia nervosa, there are still many unresolved issues regarding the optimal management of partial remission during the acute treatment phase and the intensity and durat...
Bohon, Cara; Stice, Eric
Binge eating is often preceded by reports of negative affect, but the mechanism by which affect may lead to binge eating is unclear. This study evaluated the effect of negative affect on neural response to anticipation and receipt of palatable food in women with bulimia nervosa (BN) versus healthy controls. We also evaluated connectivity between the amygdala and reward-related brain regions. Females with and without BN (N = 26) underwent functional magnetic resonance imaging (fMRI) during rec...
Bassiouny, Mohamed A; Tweddale, Elizabeth
This article outlines a comprehensive, multidisciplinary strategy for treatment of patients with anorexia and bulimia nervosa. In this approach, primary medical intervention and emergency dental care are followed by the staging of treatment phases that integrate medical care, psychotherapy, nutritional counseling, and dental management, which may encompass various treatment options for repair of damaged dentition. Emphasis is placed on prevention of further tissue damage during all phases of management and following completion of the treatment course.
Abreu, Cristiano Nabuco de; Cangelli Filho, Raphael
Of the eating disorders, anorexia nervosa and bulimia nervosa are the ones that have made adolescent patients-often females and aged younger and younger-seek for help. This help is provided through a multidisciplinary treatment involving psychiatrists, psychologists and dietists. Psychotherapy has shown to be an efficient component for these patients' improvement. The present article aims at presenting a proposal of psychotherapeutic treatment based on a cognitive-constructivist approach.
McSherry, J. A.
Widespread media publicity has resulted in increased case findings of eating disorders such as anorexia nervosa and bulimia. The etiology of these conditions is complex and multifactorial, and they may have devastating effects on physical and psychological health. Family physicians have an important role to play in recognizing, evaluating and managing eating disorders. Severe anorexics—those who have lost 25% or more of the average weight for their age and height—require specialist management...
Dada, Gloria; Izu, Sheila; Montebruno, Claudia; Grau, Antoni; Feixas, Guillem
The purpose of this study was to explore the content of personal constructs in people diagnosed with bulimia nervosa (BN). We expected to find differences in the predominant content of the construct systems between women with and without BN. We analyzed the constructs elicited using the repertory grid technique from 120 women aged between 18 to 45 years, divided into two groups: a clinical group of women diagnosed with bulimia ( n = 62) and a control group of university students ( n = 58). The constructs were categorized using the Classification System for Personal Constructs (CSPC), composed of six themes which are broken down into 45 categories. For this study, a new area called "Physical" was included, and it consists of three categories. The results indicated that women diagnosed with bulimia used significantly more constructs related to the body, while the control group used more constructs from the personal area. In addition, the congruent constructs from the clinical sample were predominantly moral, or related to values and interests, while discrepant constructs were personal and physical. The findings provide evidence for the clinical use of the CSPC as an instrument for exploring the content of personal meaning systems. Understanding the patient's personal constructions about herself and others is useful for treatment. Moreover, it is important for clinicians to explore the content of constructs related to symptomatic areas, which could be hindering change, and focus on them to facilitate improvement.
Individuals with bulimia nervosa and binge eating disorder commonly report co-occurring interpersonal problems, and treatment that focuses on relationships and relational functioning has shown benefit relative to other forms of treatment. Relational psychotherapy for eating disorders can vary on several important dimensions, such as how structured and symptom-focused versus exploratory and patient-directed it is, whether it focuses on past relationships and patterns in relationships over time versus focusing on current relationships, and whether it includes the relationship with the therapist as an explicit topic of conversation and mechanism for relational change. The cases in this special section provide the opportunity to closely compare 3 therapeutic approaches on each of these dimensions. Psychoanalytic Psychotherapy for Bulimia Nervosa, Integrative Dynamic Therapy for Bulimia Nervosa, and Interpersonal Psychotherapy for the Prevention of Weight Gain and Eating Disorders are each highly distinct approaches. The authors of each case explain the intended mechanisms of treatment response, the measures that assess changes in eating disorder symptoms as well as the mechanisms of change, and provide extensive excerpts from case material to demonstrate and illustrate the particular evidence-based treatment. Therapists and researchers may usefully consider the process and outcome variables described in these interpersonal approaches. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Frank, Guido K.; Shott, Megan E.; Hagman, Jennifer O.; Mittal, Vijay A.
Objective The pathophysiology of the eating disorder anorexia nervosa remains obscure, but structural brain alterations could be functionally important biomarkers. Here we assessed taste pleasantness and reward sensitivity in relation to brain structure, which might be related to food avoidance commonly seen in eating disorders. Method We used structural magnetic resonance brain imaging to study gray and white matter volumes in individuals with restricting type currently ill (n = 19) or recovered-anorexia nervosa (n = 24), bulimia nervosa (n= 19) and healthy control women (n=24). Results All eating disorder groups showed increased gray matter volume of the medial orbitofrontal cortex (gyrus rectus). Manually tracing confirmed larger gyrus rectus volume, and predicted taste pleasantness across all groups. The analyses also indicated other morphological differences between diagnostic categories: Ill and recovered-anorexia nervosa had increased right, while bulimia nervosa had increased left antero-ventral insula gray matter volumes compared to controls. Furthermore, dorsal striatum volumes were reduced in recovered-anorexia and bulimia nervosa, and predicted sensitivity to reward in the eating disorder groups. The eating disorder groups also showed reduced white matter in right temporal and parietal areas when compared to healthy controls. Notably, the results held when controlling for a range of covariates (e.g., age, depression, anxiety, medications). Conclusion Brain structure in medial orbitofrontal cortex, insula and striatum is altered in eating disorders and suggests altered brain circuitry that has been associated with taste pleasantness and reward value. PMID:23680873
Karwautz, A; Haidvogl, M; Wagner, G; Nobis, G; Wöber-Bingöl, C; Friedrich, M H
The family environments of patients with eating disorders have been studied extensively in recent decades. The "Subjective Family Image Test" is an instrument developed especially to measure differential perceptions by family members. Assessments of subjective family image in families of adolescents by means of this test have been carried out in only a few samples. We aimed first to investigate subjective perceptions by adolescents of their family relations in a larger clinical sample of female adolescents (n = 118) suffering from anorexia nervosa of either subtype or from bulimia nervosa and to compare these perceptions with those of healthy controls (n = 96). Second we investigated intra-familial differences in perception. The main findings were that bulimia nervosa patients perceived lower individual autonomy and lower emotional connectedness than all other groups, the adolescents with bulimia perceived significantly lower autonomy and emotional connectedness within the family than their fathers, and the restrictive anorexia nervosa patients perceived higher connectedness than their fathers. The relevance of these findings for understanding family dynamics are discussed.
Cristina Moreira Marcos
Full Text Available Los síntomas contemporáneos parecen sostenerse en un rechazo del inconsciente y resisten a entrar en el discurso. En lugar de resaltar el aspecto simbólico del síntoma, la anorexia-bulimia revela el síntoma como la fijación de goce, lo que indica un rechazo del inconsciente. Este aspecto se evidencia en la práctica clínica de la anorexia y bulimia, en los que se ha hallado un intercambio del significante para el goce, que apunta a una patología del acto y no de las manifestaciones clínicas del inconsciente. Esta cuestión se abordará a partir del testimonio de Fabiola De Clercq, publicado en Tutto il pane del mondo (Todo el pan del mundo. Su asociación con la anorexia y la bulimia revela la ausencia de la alteridad a través de la entrega a una deriva pulsional. A partir de este testimonio, se busca cuestionar el modo particular de presentación de esta clínica en la que la dimensión del acto es decisiva.
MacDonald, Danielle E; McFarlane, Traci L; Olmsted, Marion P
In the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic threshold for binging and compensation in bulimia nervosa (BN) decreased from twice to once weekly for 3 months. This study investigates the validity of this change by examining whether BN patients and those whose diagnoses "shift" to BN with DSM-5 are similar in their psychological functioning. EDNOS patients whose symptoms met DSM-5 BN criteria (n=25) were compared to DSM-IV BN patients (n=146) on clinically relevant variables. No differences were found on: BMI; weight-based self-evaluation; perfectionism; depression and anxiety symptoms; or readiness for change. Differences were found on one Eating Disorder Inventory subscale (i.e., bulimia), with the BN group reporting higher scores, consistent with group definitions. These findings support the modified criteria, suggesting that psychopathology both directly and indirectly related to eating disorders is comparable between those with once weekly versus more frequent bulimic episodes. © 2013.
Carmen Leal de Assumpção
Full Text Available Os transtornos alimentares estão associados a diversas complicações clínicas graves. Distúrbios hidroeletrolíticos e metabólicos assim como várias alterações endócrinas podem estar presentes, muitas dessas decorrentes da perda de peso e dos métodos compensatórios utilizados pelos pacientes. São importantes a identificação precoce e o manuseio adequado dessas complicações para a redução dos riscos relacionados. O objetivo desse artigo é discutir as complicações clínicas associadas com a anorexia nervosa e a bulimia nervosa.Eating disorders are associated with potentially serious medical complications. Metabolic and electrolyte abnormalities and endocrine alterations can be present and many of them result from the weight loss and the purging behaviors seen in these patients. Early diagnosis and an adequate management of these complications are important to reduce the risks associated. The aim of this article is to discuss the medical complications of anorexia nervosa and bulimia nervosa.
Steinfeld, Beate; Bauer, Anika; Waldorf, Manuel; Engel, Nicole; Braks, Karsten; Huber, Thomas J; Vocks, Silja
Body-related checking behavior, as a behavioral manifestation of a disturbed body image, fosters the development and maintenance of eating disorders. The Body Checking Questionnaire (BCQ) is the most commonly used questionnaire for measuring body-related checking behavior internationally. To date, validation studies are only available for adult populations. Therefore, the aim of this study was to statistically test the German-language version of the BCQ in adolescents. A total of N=129 female adolescents were examined, comprising n=57 with Anorexia Nervosa, n=24 with Bulimia Nervosa, and n=48 healthy female adolescents. A confirmatory factor analysis supports the subdivision of the BCQ into a general factor and the subfactors "overall appearance", "specific body parts" and "idiosyncratic checking", which was also found in the original version. The internal consistencies are good (α≥0.81), and the BCQ is able to differentiate well between adolescents with and without eating disorders. Significant correlations between the BCQ and other body image questionnaires point to a good convergent validity. The German-language BCQ thus constitutes a valid and reliable instrument for measuring body-related checking behavior among adolescents in clinical research and practice. © Georg Thieme Verlag KG Stuttgart · New York.
Salbach, Harriet; Bohnekamp, Inga; Lehmkuhl, Ulrike; Pfeiffer, Ernst; Korte, Alexander
Family therapy has proven effective in the treatment of anorexia nervosa (AN) and bulimia nervosa (BN) in adolescence. While cognitive-behavioural treatment has been shown to be effective in adult patients suffering from BN, there have been few studies on the effectiveness of psychotherapy in the treatment of adolescents. Since in the majority of AN patients their illness starts in mid-adolescence, and in late adolescence in BN patients, it is crucial to develop and evaluate treatment programmes for these disorders and age groups. In view of these arguments, a programme of group psychotherapy was set up for eating-disordered patients and their parents, combining disorder-specific psychoeducational components with a family group psychotherapy approach that is more open with regard to individual treatment goals. Patients participated together with their parents in the same group. The treatment programme was evaluated within the framework of a naturalistic single-group study design. Pre-post changes were assessed. 32 female patients (29 with AN, 3 with BN) and their parents took part in the treatment programme. All of the families completed the programme, which was interpreted as a high rate of acceptance. Pre-post analysis revealed a decrease in the degree of eating-disorder symptoms. The advantages and disadvantages of this treatment programme, as well as the limitations of the pilot study are critically discussed.
Freud: enfermedades nerviosas, angustia y estrés. O del estatuto del cuerpo implicado en las dolencias del sujeto. // Freud: nervous system diseases, anxiety and stress. Or of the status of the body involved in subject’s ailments
Full Text Available What was the destiny of the so-called nervous system diseases in times of Freud? ¿What role do they play in current nosography? New terms are coined for old conditions: stress, irritable bowel syndrome, fibromyalgia, chronic fatigue… Since Freud, the psychoanalytic clinic is made of what causes an impasse to medicine, whose idiopathic symptoms disturb the organ systems and, particularly, the bodily functions in their two orders: Vegetative life, and animal or relationship life. The body of the subject represents a problem for medical practice since this latter focuses on its dysfunctions and diseases but faces up to a body occupied by a speaking-being, a body that beyond being just a living being is a body molded by language: body of a desiring and enjoying subject. // ¿Cuál fue el destino de las llamadas enfermedades nerviosas en la época de Freud? ¿Qué lugar ocupan ellas en la nosografía actual? Se acuñan nuevos términos para viejas afecciones: estrés, síndrome de intestino irritable, fibromialgia, fatiga crónica… Desde Freud la clínica psicoanalítica del cuerpo está hecha con aquello que hace impasse a la medicina, cuyos cuadros idiopáticos perturban los sistemas orgánicos y, sobre todo, las funciones corporales en sus dos órdenes: vida vegetativa y vida animal o de relación. El cuerpo del sujeto constituye un problema para la práctica médica que apunta a sus disfunciones y enfermedades pero se confronta con un cuerpo habitado por un ser-hablante, un cuerpo que más allá de ser sólo organismo viviente, es cuerpo moldeado por el lenguaje: cuerpo de un sujeto de deseo y goce.
de Vries, Sarah-Kristin; Meule, Adrian
Previous research on 'food addiction' as measured with the Yale Food Addiction Scale (YFAS) showed a large overlap between addiction-like eating and bulimia nervosa. Most recently, a revised version of the YFAS has been developed according to the changes made in the diagnostic criteria for substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders fifth edition. The current study examined prevalence and correlates of the YFAS2.0 in individuals with bulimia (n = 115) and controls (n = 341). Ninety-six per cent of participants with bulimia and 14% of controls received a YFAS2.0 diagnosis. A higher number of YFAS2.0 symptoms was associated with lower interoceptive awareness, higher depressiveness, and higher impulsivity in both groups. However, a higher number of YFAS2.0 symptoms was associated with higher body mass and weight suppression in controls only and not in participants with bulimia. The current study is the first to show a large overlap between bulimia and 'food addiction' as measured with the YFAS2.0, replicating and extending findings from studies, which used the previous version of the YFAS. Compensatory weight control behaviours in individuals with bulimia likely alleviate the association between addiction-like eating and higher body mass. Thus, the large overlap between bulimia and 'food addiction' should be taken into consideration when examining the role of addiction-like eating in weight gain and obesity. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.
Myriam Sierra Puentes
Full Text Available En este artículo se realiza una reseña sobre los trastornos de la alimentación, anorexia y bulimia, la relación que hacen los individuos con este comportamiento y la prevalencia, características y tratamientos más efectivos empleados en la bulimia nerviosa. Además, algunas aproximaciones para establecer subtipos de bulimia diferentes a los del DSM-IV e investigaciones sobre este trastorno del comportamiento alimentario, como la bulimia nerviosa.
Naessén, Sabine; Carlström, Kjell; Holst, Jens Juul
The eating disorder bulimia nervosa (BN) is characterized by frequent episodes of binge eating, followed regularly by inappropriate compensatory behavior, such as self-induced vomiting.......The eating disorder bulimia nervosa (BN) is characterized by frequent episodes of binge eating, followed regularly by inappropriate compensatory behavior, such as self-induced vomiting....
Finsterer, Josef; Stöllberger, Claudia
Recurrent vomiting due to bulimia associated with abuse of furosemide and laxatives causing severe hypokalemia may result in recurrent aborted sudden cardiac death (SCD) and seizures. We report a 25-year-old female with a history of bulimia associated with abuse of furosemide and laxatives since the age of 15 years, migraine since puberty, renal abscesses at age 20 y, and rhabdomyolysis of unknown cause at age 24 y. She experienced aborted SCD due to severe hypokalemia with symptomatic seizures at 21 and 25 years of age. Bulimia patients additionally taking laxatives or furosemide are at particular risk of SCD and rhabdomyolysis and require periodic determination of electrolytes, potassium substitution, and adequate psychiatric therapy and surveillance.
Franko, Debra L; Keshaviah, Aparna; Eddy, Kamryn T; Krishna, Meera; Davis, Martha C; Keel, Pamela K; Herzog, David B
OBJECTIVE Although anorexia nervosa has a high mortality rate, our understanding of the timing and predictors of mortality in eating disorders is limited. The authors investigated mortality in a long-term study of patients with eating disorders. METHOD Beginning in 1987, 246 treatment-seeking female patients with anorexia nervosa or bulimia nervosa were interviewed every 6 months for a median of 9.5 years to obtain weekly ratings of eating disorder symptoms, comorbidity, treatment participation, and psychosocial functioning. From January 2007 to December 2010 (median follow-up of 20 years), vital status was ascertained with a National Death Index search. RESULTS Sixteen deaths (6.5%) were recorded (lifetime anorexia nervosa, N=14; bulimia nervosa with no history of anorexia nervosa, N=2). The standardized mortality ratio was 4.37 (95% CI=2.4-7.3) for lifetime anorexia nervosa and 2.33 (95% CI=0.3-8.4) for bulimia nervosa with no history of anorexia nervosa. Risk of premature death among patients with lifetime anorexia nervosa peaked within the first 10 years of follow-up, resulting in a standardized mortality ratio of 7.7 (95% CI=3.7-14.2). The standardized mortality ratio varied by duration of illness and was 3.2 (95% CI=0.9-8.3) for patients with lifetime anorexia nervosa for 0 to 15 years (4/119 died), and 6.6 (95% CI=3.2-12.1) for those with lifetime anorexia nervosa for >15 to 30 years (10/67 died). Multivariate predictors of mortality included alcohol abuse, low body mass index, and poor social adjustment. CONCLUSIONS These findings highlight the need for early identification and intervention and suggest that a long duration of illness, substance abuse, low weight, and poor psychosocial functioning raise the risk for mortality in anorexia nervosa.
Sernec, Karin; Tomori, Martina; Zalar, Bojan
The aim of the study was to provide further and up to date information on the evaluation of the management of Anorexia and Bulimia nervosa at the Eating Disorders Unit (EDU) of the Ljubljana Psychiatric Clinic, based upon detailed assessment of the eating disorders specific and non specific symptoms of impulsive behaviors, highly correlated with these entities. 34 female patients with anorexia (restrictive or purgative type) and 38 female patients with Bulimia nervosa (purgative or non-purgative type) undergoing hospital treatment at the EDU were evaluated upon admission, as well as upon discharge and three and six months after discharge, using the Eating Disorder Questionnaire. Upon discharge a marked decrease in the overall symptoms was noted. The differences in symptoms incidences between the two groups were significantly specific for the individual form of eating disorder, especially upon admission, and were more pronounced in anorexia group. In later measurements, performed during the period of three and six months after discharge, a mild trend of increase in the disorder specific symptoms was detected in both groups, but was not statistically significant. In addition to binging on food, striking, quarreling and spending sprees are characteristics of patients with eating disorders, which in particular apply to the Bulimia nervosa group. Apart from the disorder specific symptoms, impulsive behavior was also reduced during study period, while the difference in its occurrence between the two groups gradually became non-significant. The management of patients with eating disorders at the EDU was successful in both groups, confirmed by an intense reduction of the disorder specific symptoms, impulsive behavior and increased stability recorded three and six months after discharge. The study strongly suggests that the effect of treatment regime for eating disorders can be predicted by careful assessment of the relevant symptoms and impulsive behavioral patterns.
Marly Johana Bahamón Muñetón
Full Text Available El artículo presenta resultados de la investigación dirigida a identificar y relacionar la presencia de síntomas bulímicos con el uso de estrategias de afrontamiento y variables socio-demográficas en mujeres entre los 10 y 17 años de edad. Se utilizó un diseño correlacional y se aplicó el BITEpara la medición de síntomas bulímicos y el ACS para la identificación de las estrategias de afrontamiento. Se identificó que el 59% de las 278 participantes no presenta comportamientos alterados frente a la comida y 41% presenta síntomas de bulimia. Se identificaron correlaciones entre la gravedad y el estrato socio-económico. Se hallaron correlaciones positivas entre síntomas de bulimia y las estrategias de autoinculparse y búsqueda de apoyo espiritual. También se encontró correlación positiva entre gravedad y las estrategias de búsqueda de apoyo espiritual y distracción física. Los resultados coinciden parcialmente con estudios previos sobre el tema puesto que las estrategias que se relacionan con los síntomas y gravedad de la bulimia son evitativas y centradas en la emoción. Finalmente, se expone la necesidad de realizar más estudios comparando muestras clínicas y no clínicas.
Rybakowski, Janusz K; Kaminska, Katarzyna; Charytonik, Jolanta; Akiskal, Kareen K; Akiskal, Hagop S
We investigated the effect of co-morbid bipolar disorder and bulimia on temperamental dimensions measured by TEMPS-A, relative to "pure" bulimia and "pure" bipolar disorder, in female patients. The study was performed on 47 patients with bipolar disorder (BD) with a mean age of 36±10 years, 96 patients with bulimia or bulimic type of anorexia, mean age 26±9 years and 50 control healthy females (HC), mean age 29±6 years. Among bulimic patients, a group of 68 subjects with co-morbid bulimia with bipolarity (BD+B) was identified, based on positive score of the Mood Disorder Questionnaire (MDQ). The TEMPS-A questionnaire, 110 questions version, has been used, evaluating five temperament domains: depressive, cyclothymic, hyperthymic, irritable and anxious. Parametric analysis was performed for 4 groups (BD, "pure" bulimia (PB), BD+B and HC), with 28 subjects randomly chosen from each group, using analysis of variance and cluster analysis. All clinical groups significantly differed from control group by having higher scores of depressive, cyclothymic, irritable and anxious temperaments and lower of hyperthymic one. Among patients, significantly higher scores of cyclothymic and irritable temperaments were found in BD+B compared to both PB and BD. These differences were also reflected in cluster analysis, where two clusters were identified. Bipolarity in bulimic patients assessed only by the MDQ. These results show that co-morbid bulimia and bipolar disorder is characterized by extreme dimensions of both cyclothymic and irritable temperaments, significantly higher than each single diagnosis. Possible clinical implications of such fact are discussed. Copyright © 2014 Elsevier B.V. All rights reserved.
Marsh, Rachel; Horga, Guillermo; Wang, Zhishun; Wang, Pengwei; Klahr, Kristin W.; Berner, Laura A.; Walsh, B. Timothy; Peterson, Bradley S.
Objective The authors examined functional activity in the frontostriatal systems that mediate self-regulatory capacities and conflict resolution in adolescents with bulimia nervosa. Method Functional magnetic resonance imaging was used to compare blood-oxygen-level-dependent response in 18 female adolescents with bulimia nervosa and 18 healthy female age-matched subjects during performance on a Simon spatial incompatibility task. Bayesian analyses were used to compare the two groups on patterns of brain activation during correct responses to conflict stimuli and to explore the effects of antecedent stimulus context on group differences in self-regulation and conflict resolution. Results Adolescents with and without bulimia nervosa performed similarly on the task. During correct responses in conflict trials, frontostriatal circuits—including the right inferolateral and dorsolateral prefrontal cortices and putamen—failed to activate to the same degree in adolescents with bulimia nervosa as in healthy comparison subjects. Instead, deactivation was seen in the left inferior frontal gyrus as well as a neural system encompassing the posterior cingulate cortex and superior frontal gyrus. Group differences in cortical and striatal regions were driven by the differential responses to stimuli preceded by conflict and nonconflict stimuli, respectively. Conclusions When engaging the self-regulatory control processes necessary to resolve conflict, adolescents with bulimia nervosa displayed abnormal patterns of activation in frontostriatal and default-mode systems. Their abnormal processing of the antecedent stimulus context conditioned their brain response to conflict differently from that of healthy comparison subjects, specifically in frontal regions. It is suspected that functional disturbances in frontal portions of frontostriatal systems may release feeding behaviors from regulatory control, thereby perpetuating the conflicting desires to consume fattening foods and
Fernàndez-Aranda, Fernando; Alvarez-Moya, Eva M; Martínez-Viana, Cristina; Sànchez, Isabel; Granero, Roser; Penelo, Eva; Forcano, Laura; Peñas-Lledó, Eva
We aimed to examine baseline predictors of treatment response in bulimic patients. 241 seeking-treatment females with bulimia nervosa completed an exhaustive assessment and were referred to a six-session psychoeducational group. Regression analyses of treatment response were performed. Childhood obesity, lower frequency of eating symptomatology, lower body mass index, older age, and lower family's and patient's concern about the disorder were predictors of poor abstinence. Suicidal ideation, alcohol abuse, higher maximum BMI, higher novelty seeking and lower baseline purging frequency predicted dropouts. Predictors of early symptom changes and dropouts were similar to those identified in longer CBT interventions.
Allen, Karina L; Byrne, Susan M; Crosby, Ross D
Binge eating disorder and purging disorder have gained recognition as distinct eating disorder diagnoses, but risk factors for these conditions have not yet been established. This study aimed to evaluate a prospective, mediational model of risk for the full range of binge eating and purging eating disorders, with attention to possible diagnostic differences. Specific aims were to determine, first, whether eating, weight and shape concerns at age 14 would mediate the relationship between parent-perceived childhood overweight at age 10 and a binge eating or purging eating disorder between age 15 and 20, and, second, whether this mediational model would differ across bulimia nervosa, binge eating disorder, and purging disorder. Participants (N = 1,160; 51 % female) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, which has followed children from pre-birth to age 20. Eating disorders were assessed via self-report questionnaires when participants were aged 14, 17 and 20. There were 146 participants (82 % female) with a binge eating or purging eating disorder with onset between age 15 and 20 [bulimia nervosa = 81 (86 % female), binge eating disorder = 43 (74 % female), purging disorder = 22 (77 % female)]. Simple mediation analysis with bootstrapping was used to test the hypothesized model of risk, with early adolescent eating, weight and shape concerns positioned as a mediator between parent-perceived childhood overweight and later onset of a binge eating or purging eating disorder. Subsequently, a conditional process model (a moderated mediation model) was specified to determine if model pathways differed significantly by eating disorder diagnosis. In the simple mediation model, there was a significant indirect effect of parent-perceived childhood overweight on risk for a binge eating or purging eating disorder in late adolescence, mediated by eating, weight and shape concerns in early adolescence. In the conditional process model
LaCaille, Lara Schultz
Recent research indicates that 2% to 4% of the population meet diagnostic criteria for the newly proposed binge eating disorder, and that it is much more common (30%) among the treatment-seeking obese. Although recognized as a significant problem, binge eating disorder is l1l not well understood, and there is debate about whether binge eating disorder is a distinct disorder. It has been argued that binge eating disorder is simply a variant or milder form of bulimia nervosa and not a separate ...
Brito, Graziella Nuernberg Back [UNESP
Os Transtornos alimentares (TA) como Anorexia Nervosa (AN) e Bulimia Nervosa (BN) são acompanhados de inúmeras alterações sistêmicas e bucais relacionadas ao comprometimento do estado nutricional e às práticas compensatórias inadequadas para o controle do peso. O objetivo deste estudo foi avaliar diversidade microbiológica existente na cavidade bucal de pacientes com estes transtornos, por meio de técnicas de cultivo e utilizando métodos moleculares independentes de cultivo. Foram incluídos n...
Folke, Sofie; Daniel, Sarah Ingrid Franksdatter; Gondan, Matthias
Studies of therapist adherence in relation to treatment outcome have produced mixed results. The aim of the present study was to investigate change in therapist adherence to cognitive–behavioral therapy (CBT) for bulimia nervosa over time, and to investigate the relationship between adherence......) of treatment using the Cognitive–Behavioral Therapy Treatment Protocol Adherence Scale. Change in adherence across the 3 treatment phases was examined using multilevel analysis. The relationship between early, middle, and late adherence levels and end-of-treatment binging frequency was examined using...
Weigel, Angelika; Gumz, Antje; Kästner, Denise; Romer, Georg; Wegscheider, Karl; Löwe, Bernd
The "Health care network anorexia and bulimia nervosa", a subproject of psychenet - the Hamburg network for mental health - aims to decrease the incidence of eating disorders as well as the risk for chronic illness courses. One focal project, therefore, evaluates a school-based prevention manual in a randomized controlled trial. The other one examines the impact of a systemic public health intervention on early treatment initiation in anorexia nervosa. The present article provides an overview about study design and interventions in both focal projects as well as preliminary results. © Georg Thieme Verlag KG Stuttgart · New York.
Refosco, Lísia da Luz; Macedo, Mônica Medeiros Kother
A partir de contribuições da Psicanálise apresenta-se uma leitura a respeito dos padecimentos alimentares - anorexia e bulimia - na adolescência como sendo patologias cuja dinâmica permite estabelecer ligações com características e questões dos tempos atuais. Considerando-se a adolescência como um período vital de fragilidade e de vulnerabilidade psíquica, o artigo explora alguns aspectos da sociedade contemporânea, como a cultura da performance, a imposição de ideais de perfeição e completu...
Martins, Cilene Rebolho; Pelegrini, Andreia; Matheus, Silvana Corrêa; Petroski, Edio Luiz
Objetivos: Identificar a prevalência de insatisfação com a imagem corporal e de sintomas de anorexia e bulimia em adolescentes do sexo feminino da cidade de Santa Maria (RS) e verificar a associação da insatisfação com a imagem corporal com estado nutricional, adiposidade corporal e sintomas de anorexia e bulimia. Método: Foram analisadas 258 adolescentes do sexo feminino (11 a 13 anos), estudantes de escolas públicas. Aplicou-se o Body Shape Questionnaire e o Teste de Atitudes Alimentares (E...
Yilmaz, Zeynep; Kaplan, Allan S; Tiwari, Arun K; Levitan, Robert D; Piran, Sara; Bergen, Andrew W; Kaye, Walter H; Hakonarson, Hakon; Wang, Kai; Berrettini, Wade H; Brandt, Harry A; Bulik, Cynthia M; Crawford, Steven; Crow, Scott; Fichter, Manfred M; Halmi, Katherine A; Johnson, Craig L; Keel, Pamela K; Klump, Kelly L; Magistretti, Pierre; Mitchell, James E; Strober, Michael; Thornton, Laura M; Treasure, Janet; Woodside, D Blake; Knight, Joanne; Kennedy, James L
Although low weight is a key factor contributing to the high mortality in anorexia nervosa (AN), it is unclear how AN patients sustain low weight compared with bulimia nervosa (BN) patients with similar psychopathology. Studies of genes involved in appetite and weight regulation in eating disorders have yielded variable findings, in part due to small sample size and clinical heterogeneity. This study: (1) assessed the role of leptin, melanocortin, and neurotrophin genetic variants in conferring risk for AN and BN; and (2) explored the involvement of these genes in body mass index (BMI) variations within AN and BN. Our sample consisted of 745 individuals with AN without a history of BN, 245 individuals with BN without a history of AN, and 321 controls. We genotyped 20 markers with known or putative function among genes selected from leptin, melanocortin, and neurotrophin systems. There were no significant differences in allele frequencies among individuals with AN, BN, and controls. AGRP rs13338499 polymorphism was associated with lowest illness-related BMI in those with AN (p = 0.0013), and NTRK2 rs1042571 was associated with highest BMI in those with BN (p = 0.0018). To our knowledge, this is the first study to address the issue of clinical heterogeneity in eating disorder genetic research and to explore the role of known or putatively functional markers in genes regulating appetite and weight in individuals with AN and BN. If replicated, our results may serve as an important first step toward gaining a better understanding of weight regulation in eating disorders. Copyright © 2014 Elsevier Ltd. All rights reserved.
Grilo, Carlos M; Masheb, Robin M; White, Marney A
Increasing empirical evidence supports the validity of binge-eating disorder (BED) and its inclusion as a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Contention exists regarding the criteria for BED, including whether, like bulimia nervosa (BN), it should be characterized by overvaluation of shape/weight. This study examined the significance of overvaluation for BED using two complementary comparisons groups. Participants were 324 women who completed self-report instruments as part of an Internet study. Analyses compared BMI, eating disorder (ED) features, and depressive levels in four groups: 123 overweight participants without ED, 47 BED participants who do not overvalue shape/weight, 101 BED participants who overvalue shape/weight, and 53 BN participants. Both BED groups had significantly greater ED psychopathology than the overweight group. Within BED, the group with overvaluation had significantly greater ED psychopathology and depressive levels despite no differences in binge eating. BED with overvaluation and BN groups differed little from each other but had significantly higher ED psychopathology and depressive levels than the other groups. Group differences existed despite similar age and BMI across the groups, as well as when controlling for group differences in depressive levels. These findings provide further support for the validity of BED and suggest that overvaluation of shape/weight, which provides important information about BED severity, warrants consideration as either a diagnostic specifier or as a dimensional severity rating. Although inclusion of overvaluation of shape/weight could be considered as a required criterion for BED, this would exclude a substantial proportion of BED patients with clinically significant problems.
Blechert, Jens; Feige, Bernd; Joos, Andreas; Zeeck, Almut; Tuschen-Caffier, Brunna
Objective To compare the electrocortical processing of food pictures in participants with anorexia nervosa (n = 21), bulimia nervosa (n = 22), and healthy controls (HCs) (n = 32) by measuring the early posterior negativity, an event-related potential that reflects stimulus salience and selective attention. Methods We exposed these three groups to a rapid stream of high- and low-calorie food pictures, as well as standard emotional and neutral pictures. Results Event-related potentials in the time range of 220 milliseconds to 310 milliseconds on posterior electrodes differed between groups: patients with eating disorders showed facilitated processing of both high- and low-calorie food pictures relative to neutral pictures, whereas HC participants did so only for the high-calorie pictures. Subjective palatability of the pictures was rated highest by patients with anorexia nervosa, followed by the HC and bulimia nervosa groups. Conclusions Patients with eating disorders show a generalized attentional bias for food images, regardless of caloric value. This might explain the persistent preoccupation with food in these individuals.
Hartmann, Armin; Orlinsky, David; Weber, Stefanie; Sandholz, Angelika; Zeeck, Almut
Treatment in bulimia nervosa is challenging, with rates of successful treatments for only about 50% of all patients. This study aimed to identify predictors of outcome through secondary analysis of data from a randomized clinical trial that compared inpatient and day hospital treatment for bulimia. Process measures included assessments of patients' in-session experiences, therapeutic alliance, and therapy-related intersession experiences (ISE). ISE measures were better predictors of outcome than pretreatment variables (e.g., social adjustment) or global therapeutic alliance. Outcome at 3 month follow-up was strongly related to the ISE dimension Recreating Therapeutic Dialogue with Negative Emotions, indicating a heightened risk of failure. Prediction of outcome by these variables showed a sensitivity of 0.86 and a specificity of 0.78, and 83% of patients could be correctly classified. These results show that certain aspects of ISE may serve as early and reliable indicators of long term treatment failure, prompting alternate treatment approaches and opening new directions of research. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Schäfer, Axel; Vaitl, Dieter; Schienle, Anne
This study investigated whether bulimia nervosa (BN) and binge-eating disorder (BED) are associated with structural brain abnormalities. Both disorders share the main symptom binge-eating, but are considered differential diagnoses. We attempted to identify alterations in grey matter volume (GMV) that are present in both psychopathologies as well as disorder-specific GMV characteristics. Such information can help to improve neurobiological models of eating disorders and their classification. A total of 50 participants (patients suffering from BN (purge type), BED, and normal-weight controls) underwent structural MRI scanning. GMV for specific brain regions involved in food/reinforcement processing was analyzed by means of voxel-based morphometry. Both patient groups were characterized by greater volumes of the medial orbitofrontal cortex (OFC) compared to healthy controls. In BN patients, who had increased ventral striatum volumes, body mass index and purging severity were correlated with striatal grey matter volume. Altogether, our data implicate a crucial role of the medial OFC in the studied eating disorders. The structural abnormality might be associated with dysfunctions in food reward processing and/or self-regulation. The bulimia-specific volume enlargement of the ventral striatum is discussed in the framework of negative reinforcement through purging and associated weight regulation. Copyright 2009 Elsevier Inc. All rights reserved.
Watson, Hunna J; Fursland, Anthea; Bulik, Cynthia M; Nathan, Paula
To determine whether a variant bulimic-type presentation, whereby one meets criteria for bulimia nervosa (BN) except that binge eating episodes are not objectively large (i.e., "subjective bulimia nervosa," SBN), has comparable clinical severity to established eating disorders, particularly BN. Treatment-seeking adults with BN (N = 112), SBN (N = 28), anorexia nervosa restricting type (AN-R) (N = 45), and AN-binge/purge type (AN-B/P) (N = 24) were compared. Overall, SBN could not be meaningfully distinguished from BN. SBN and BN had equivalent eating pathology, depression and anxiety symptoms, low quality of life, impulsivity, Axis I comorbidity, and lifetime psychiatric history, and comparable clinical severity to AN-R and AN-B/P. Individuals with SBN, differing from BN only by the smaller size of their binge eating episodes, had a form of eating disorder comparable in clinical severity to threshold AN and BN and warranting clinical attention. Health professionals and the community require greater awareness of this variant to optimize detection, treatment-seeking, and outcomes. Copyright © 2012 Wiley Periodicals, Inc.
Rigaud, Daniel; Brayer, Véronique; Biton-Jélic, Violaine; Païs, Vanessa; Pennacchio, Hélène; Brun, Jean-Marcel
Few effective treatments are available for severe forms of bulimia nervosa, which are accompanied by malnutrition, anxiety, and depressive mood. We previously showed in an open study that nasogastric tube feeding (TF) reduced binges and purging in patients with anorexia nervosa. This prospective randomized trial compared bulimia patients in two treatment groups: one group received TF at home, together with psychotherapy, nutritional counseling and a support group while the control group received only psychotherapy, nutritional counseling, and a support group. Patients in the first group underwent TF for 8 weeks (exclusively for 10 days and associated with meals thereafter). Assessment was based on clinical examination, laboratory results, and a variety of questionnaires (our in-house instrument for measuring binge and vomiting episodes, eating disorder inventory, Beck's depression inventory and the Hamilton rating scale for anxiety), all performed at the onset of treatment and at 8 days, 8 weeks (i.e., the end of TF), and 3 months after treatment began. Binges and vomiting disappeared faster and more frequently in TF patients than in the control group: 65% versus 29% (pbulimia nervosa, reducing the number of binge and vomiting episodes and improving nutritional status and mood.
Fassino, Secondo; Pierò, Andrea; Gramaglia, Carla; Abbate-Daga, Giovanni
To determine the levels of interoceptive awareness (IA), which measures the ability of an individual to discriminate between sensations and feelings, and between the sensations of hunger and satiety, in eating disorder patients and to identify the clinical, psychopathological and personal variables correlated with IA. Sixty-one restrictor anorectics, 61 binge-purging anorectics, 104 purging bulimics, 49 obese subjects with binge eating disorder (BED) and 47 obese subjects without BED were compared. They were assessed with the Eating Disorder Inventory-2, the Temperament and Character Inventory, and the Beck Depression Inventory, and their clinical and sociodemographic features were recorded. In all patients, the levels of IA were higher than the 'normal' ones; in bulimia nervosa, they were higher than in anorexia nervosa and obesity. Similar personal features and eating attitudes are shared by patients with bulimia nervosa and BED. In the total sample, the following variables independently correlate with IA: the Beck Depression Inventory, self- directedness and persistence. The importance of an altered IA in eating disorders is supported. Both depression and a perfectionist and poorly self-directive personality can lead to greater difficulties in discriminating hunger and satiety. Copyright 2004 S. Karger AG, Basel
Full Text Available Vitamin D3 has been described to have different extraskeletal roles by acting as parahormone in obesity, diabetes, cancer, cognitive impairment, and dementia and to have important regulatory functions in innate immunity. There are no studies showing extraskeletal changes associated with hypovitaminosis D3 in eating disorders. Methods. We have analyzed the blood of 18 patients affected by anorexia nervosa and bulimia nervosa collected over a 15-month period. We performed a panel of chemical and clinical analyses: the assay of vitamin D3, the immunoblotting of vitamin D receptor and peroxisome proliferator-activated receptor gamma, and the genotyping of 5-hydroxytryptamine transporter linked polymorphic region. Results. We choose 18 patients with a normal blood test profile such as thyroid hormones, hepatic and renal parameters, triglycerides, proteins, vitamin B12, and folic acid. Among these emerged the case of a woman with long-term anorexia nervosa and the case of a woman with long-term bulimia nervosa both complicated by anxiety and depression, severe hypovitaminosis D3, decrease of vitamin D receptor, leukopenia, and 5-hydroxytryptamine transporter linked polymorphic region short allele. Conclusion. The results induce hypothesising that the severe hypovitaminosis D3 might be responsible for the lack of the inflammatory response and the depressive symptoms in patients with long-term eating disorders.
Waller, Glenn; Gray, Emma; Hinrichsen, Hendrik; Mountford, Victoria; Lawson, Rachel; Patient, Eloise
The efficacy of cognitive-behavioral therapy (CBT) for bulimic disorders has been established in research trials. This study examined whether that efficacy can be translated into effectiveness in routine clinical practice. Seventy-eight adult women with bulimic disorders (bulimia nervosa and atypical bulimia nervosa) undertook individual CBT, with few exclusion criteria and a treatment protocol based on evidence-based approaches, utilizing individualized formulations. Patients completed measures of eating behaviors, eating attitudes, and depression pre- and post-treatment. Eight patients dropped out. The mean number of sessions attended was 19.2. No pretreatment features predicted drop-out. Treatment outcome was similar whether using treatment completer or intent to treat analyses. Approximately 50% of patients were in remission by the end of treatment. There were significant improvements in mood, eating attitudes, and eating behaviors. Reductions in bingeing and vomiting were comparable to efficacy trials. The improvements in this "real-world" trial of CBT for adults with bulimic disorders mirrored those from large, funded research trials, though the conclusions that can be reached are inevitably limited by the nature of the trial (e.g., lack of control group and therapy validation). Copyright © 2013 Wiley Periodicals, Inc.
Tasegian, Anna; Curcio, Francesco; Dalla Ragione, Laura; Rossetti, Francesca; Cataldi, Samuela; Codini, Michela; Ambesi-Impiombato, Francesco Saverio; Beccari, Tommaso; Albi, Elisabetta
Vitamin D3 has been described to have different extraskeletal roles by acting as parahormone in obesity, diabetes, cancer, cognitive impairment, and dementia and to have important regulatory functions in innate immunity. There are no studies showing extraskeletal changes associated with hypovitaminosis D3 in eating disorders. Methods. We have analyzed the blood of 18 patients affected by anorexia nervosa and bulimia nervosa collected over a 15-month period. We performed a panel of chemical and clinical analyses: the assay of vitamin D3, the immunoblotting of vitamin D receptor and peroxisome proliferator-activated receptor gamma, and the genotyping of 5-hydroxytryptamine transporter linked polymorphic region. Results. We choose 18 patients with a normal blood test profile such as thyroid hormones, hepatic and renal parameters, triglycerides, proteins, vitamin B12, and folic acid. Among these emerged the case of a woman with long-term anorexia nervosa and the case of a woman with long-term bulimia nervosa both complicated by anxiety and depression, severe hypovitaminosis D3, decrease of vitamin D receptor, leukopenia, and 5-hydroxytryptamine transporter linked polymorphic region short allele. Conclusion. The results induce hypothesising that the severe hypovitaminosis D3 might be responsible for the lack of the inflammatory response and the depressive symptoms in patients with long-term eating disorders.
Vaz, F J; Peñas, E V; Ramos, M I; López-Ibor, J J; Guisado, J A
Weight control methods used by a group of bulimic patients were studied, analyzing the relationship among compensatory strategies and other clinical variables. Sixty-nine female consecutive patients who sought help for DSM-IV bulimia nervosa were recruited for the study. The prevalence and frequency of use of binge eating and six compensatory methods (vomiting, laxatives, diuretics, diet pills, fasting, and compulsive exercise) were assessed in each patient. Factor analysis was used to group the variables, and a cluster analysis was performed on a second step. The clinical variables were finally analyzed in each of the groups isolated through cluster analysis. According to the results of the factor analysis, the compensatory strategies were identified as short-term compensatory methods (vomiting), long-term methods (diet pills, diuretics, and laxatives), and nonpurging methods (dieting and exercise). Three groups of patients were isolated through cluster analysis: short-term purgers (vomiting), long-term purgers (laxatives + diet pills + diuretics), and a mixed group (vomiting + laxatives). Long-term purgers were older and heavier, had a greater prevalence of past overweight, and used more compensatory methods. These results confirm the necessity to continue investigating alternative ways of classifying bulimia nervosa patients based on compensatory behaviors, considering the existence of clinical dimensions rather than rigid clinical subtypes.
Hueg, Anne; Resch, Franz; Haffner, Johann; Poustka, Luise; Parzer, Peter; Brunner, Romuald
Based on the personality model outlined by Robert C. Cloninger, studies in adult patient samples demonstrated that according to distinct personality profiles patients with anorexia nervosa could be differentiated from those with bulimia nervosa, as well as from healthy controls. The current study examines whether these personality-related differences also exist in adolescent patients with eating disorders and a short duration of illness. The sample studied consists of 73 consecutively admitted female patients aged 12 to 18 years, with eating disorders. The German version of the Junior Temperament and Character Inventory (JTCI) was administered to 29 patients with anorexia nervosa, restricting type (AN-R), to 16 patients with anorexia nervosa, binge-eating/purging type (AN-B), and to 28 patients with bulimia nervosa (BN). Different temperamental factors were most pronounced between AN-R and BN patients, whereas AN-B patients exhibited a personality profile between those of AN-R and BN. BN patients scored higher on Novelty Seeking but lower on Persistence than AN-R patients. In contrast to AN-R patients, both BN and AN-B patients scored lower on Self-Directedness. The current results of differential temperamental dimensions in adolescent patients with eating disorders tended to be similar to findings for adult patients, which strengthens the assumption that distinct personality factors underlie the different subtypes of eating disorders.
Józefik, Barbara; Iniewicz, Grzegorz; Ulasińska, Romualda
The aim of the study was comparison of perception of attachment patterns between adolescent girls suffering from anorexia nervosa (restrictive type), bulimia nervosa and healthy peers. Moreover, we tried to find the differences between the groups in self-esteem and identification with the culture-defined sex role. We examined 40 patients with anorexia, 32 with bulimia and 63 girls from the comparison group. Three questionnaires were used: Parental Bonding Instrument, The Culture-Free Self-Esteem Inventory and Psychological Sex Inventory. Results indicate that the parents' emotional commitment in relations with daughters from the clinical sample is weaker, and they are controlled by parents more then those from the control group. In all groups, the mothers' emotional commitment correlates positively with daughters' social self-esteem. In the anorectic group, fathers' control correlates negatively with daughters' identification with the culture-defined feminine role. In the bulimic group, fathers' emotional commitment correlates positively with self-esteem as well as daughters' identification with the culture-defined masculine role. The results concerning the bonds between the ED patients and their parents indicating dysfunctions of the bonds are generally consistent with the data from literature. Additionally they show the relationship between quality of the bonds between the patients and parents and its influence on development of self-evaluation and a sense of feminity/masculinity in anorectic and bulimic girls.
Zaider, Talia I.; Johnson, Jeffrey G.; Cockell, Sarah J.
Conducted a prospective longitudinal study to investigate whether anxiety, depressive, personality, or substance abuse disorders increase risk for onset of bulimia nervosa (BN) or binge eating disorder (BED) during adolescence. Findings for 201 adolescents suggest that adolescents with chronic depressive symptoms may be at elevated risk for the…
Stice, Eric; Bohon, Cara; Marti, C. Nathan; Fischer, Kathryn
Studies have found that individuals with bulimia nervosa can be classified into dietary and dietary-negative affect subtypes and that the latter exhibit greater eating pathology, psychiatric comorbidity, and functional impairment; a more protracted clinical course; and a worse treatment response. In this report, the authors describe 2 prospective…
Loeb, Katharine L.; Wilson, G. Terence; Labouvie, Erich; Pratt, Elizabeth M.; Hayaki, Jumi; Walsh, B. Timothy; Agras, W. Stewart; Fairburn, Christopher G.
The relationship between therapeutic alliance, therapist adherence to treatment protocol, and outcome was analyzed in a randomized trial of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy for bulimia nervosa. Independent observers rated audiotapes of full-length therapy sessions. Purging frequency was the primary outcome…
Frank, G K W; Shott, M E; Riederer, J; Pryor, T L
Anorexia and bulimia nervosa are severe eating disorders that share many behaviors. Structural and functional brain circuits could provide biological links that those disorders have in common. We recruited 77 young adult women, 26 healthy controls, 26 women with anorexia and 25 women with bulimia nervosa. Probabilistic tractography was used to map white matter connectivity strength across taste and food intake regulating brain circuits. An independent multisample greedy equivalence search algorithm tested effective connectivity between those regions during sucrose tasting. Anorexia and bulimia nervosa had greater structural connectivity in pathways between insula, orbitofrontal cortex and ventral striatum, but lower connectivity from orbitofrontal cortex and amygdala to the hypothalamus (Pbulimia nervosa effective connectivity was directed from anterior cingulate via ventral striatum to the hypothalamus. Across all groups, sweetness perception was predicted by connectivity strength in pathways connecting to the middle orbitofrontal cortex. This study provides evidence that white matter structural as well as effective connectivity within the energy-homeostasis and food reward-regulating circuitry is fundamentally different in anorexia and bulimia nervosa compared with that in controls. In eating disorders, anterior cingulate cognitive-emotional top down control could affect food reward and eating drive, override hypothalamic inputs to the ventral striatum and enable prolonged food restriction.
Vestergaard, Peter; Emborg, Charlotte; Støving, René K
OBJECTIVE: To study fracture risk in patients with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorders not otherwise specified (EDNOS). METHOD: Cohort study including all Danes diagnosed with AN (n = 2,149), BN (n = 1,294), or EDNOS (n = 942) between 1977 and 1998. Each patient...
In this study, the researches on relationships between anorexia nervosa, bulimia nervosa, self image, body image, and sex role were reviewed. The etiology of eating disorder has been said to be multidimensional. We need to consider the relationships between these factors which constitute the multidimensional model.
Zimmer, Marc A.
This report describes the research study involved in developing a document on anorexia and bulimia for the lay population. Chapter I focuses on the basic areas that provided the foundation for the study: (1) the definitions of specific eating disorders; (2) the role of the mass media in affecting anorexics and bulimics, and in educating the public…
Monteleone, P; Bifulco, M; Di Filippo, C; Gazzerro, P; Canestrelli, B; Monteleone, F; Proto, M C; Di Genio, M; Grimaldi, C; Maj, M
Endocannabinoids modulate eating behavior; hence, endocannabinoid genes may contribute to the biological vulnerability to eating disorders. The rs1049353 (1359 G/A) single nucleotide polymorphism (SNP) of the gene coding the endocannabinoid CB1 receptor (CNR1) and the rs324420 (cDNA 385C to A) SNP of the gene coding fatty acid amide hydrolase (FAAH), the major degrading enzyme of endocannabinoids, have been suggested to have functional effects on mature proteins. Therefore, we explored the possibility that those SNPs were associated to anorexia nervosa and/or bulimia nervosa. The distributions of the CNR1 1359 G/A SNP and of the FAAH cDNA 385C to A SNP were investigated in 134 patients with anorexia nervosa, 180 patients with bulimia nervosa and 148 normal weight healthy controls. Additive effects of the two SNPs in the genetic susceptibility to anorexia nervosa and bulimia nervosa were also tested. As compared to healthy controls, anorexic and bulimic patients showed significantly higher frequencies of the AG genotype and the A allele of the CNR1 1359 G/A SNP. Similarly, the AC genotype and the A allele of the FAAH cDNA 385C to A SNP were significantly more frequent in anorexic and bulimic individuals. A synergistic effect of the two SNPs was evident in anorexia nervosa but not in bulimia nervosa. Present findings show for the first time that the CNR1 1359 G/A SNP and the FAAH cDNA 385C to A SNP are significantly associated to anorexia nervosa and bulimia nervosa, and demonstrate a synergistic effect of the two SNPs in anorexia nervosa.
Wagner, Gudrun; Penelo, Eva; Nobis, Gerald; Mayrhofer, Anna; Wanner, Christian; Schau, Johanna; Spitzer, Marion; Gwinner, Paulina; Trofaier, Marie-Louise; Imgart, Hartmut; Fernandez-Aranda, Fernando; Karwautz, Andreas
Technology assisted guided self-help has been proven to be effective in the treatment of bulimia nervosa (BN). The aim of this study was to determine predictors of good long-term outcome as well as drop-out, in order to identify patients for whom these interventions are most suitable. One hundred and fifty six patients with BN were assigned to either 7 months internet-based guided self-help (INT-GSH) or to conventional guided bibliotherapy (BIB-GSH), both guided by e-mail support. Evaluations were taken at baseline, after 4, 7, and 18 months. As potential predictors, psychiatric comorbidity, personality features, and eating disorder psychopathology were considered. Higher motivation, lower frequency of binge eating, and lower body dissatisfaction at baseline predicted good outcome after the end of treatment. Lower frequency of binge eating predicted good outcome at long-term follow-up. Factors prediciting drop-out were higher depression and lower self-directedness at baseline. Technology assisted self-help can be recommended for patients with a high motivation to change, lower binge-eating frequency and lower depression scores. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.
Tatiana A. Bertulino da Silva
Full Text Available Objetivo Realizar uma revisão na literatura sobre a utilização da terapia cognitivo-comportamental (TCC no tratamento da bulimia nervosa entre 2009 e 2013. Métodos Três bases de dados eletrônicas foram pesquisadas, considerando artigos em língua inglesa, espanhola e portuguesa. Resultados Após as análises e exclusão dos artigos, seguindo o método PRISMA, foram selecionados 20 artigos. Os artigos selecionados foram produzidos ou na Europa ou nos Estados Unidos, em língua inglesa. Os diagnósticos da amostra variaram de exclusivamente bulimia nervosa (60% aos que incluíram pessoas com transtorno de compulsão alimentar (35%, além de diagnósticos mistos (5%. Os estudos foram, em sua maioria, realizados em mulheres adultas. A TCC, em sua abordagem clássica no consultório, foi utilizada em todos os artigos, ora utilizada individualmente, ora comparada com outras intervenções (internet, CD-ROM e autoajuda. Encontrou-se como resultado que a TCC diminui os sintomas de compulsão alimentar e de purgação, além de oferecer ganhos secundários aos participantes, como melhora de sintomas depressivos, de ansiedade e até mudanças na personalidade. As outras intervenções pesquisadas obtiveram bons resultados na modificação dos sintomas, demonstrando que há um novo caminho a ser galgado com essas novas formas de tratamento. Conclusão O tratamento da bulimia nervosa possui evidências suficientes para que seja realizado com a terapia cognitivo-comportamental. Além dela, intervenções psicoterápicas inovadoras baseadas na TCC clássica apresentam bons indicativos de eficácia. Futuras pesquisas sobre essas diferentes intervenções são necessárias.
Dingemans, A E; van Furth, E F
The category 'eating disorder 'not otherwise specified'' (EDNOS) in DSM-IV is restricted to eating disorders of clinical severity that do not completely fulfil the criteria for anorexia and bulimia nervosa. The EDNOS category is, by definition, often regarded as a a residual category and in principle designed to incorporate a small group of patients with atypical characteristics. Health insurance companies argue that the treatment of patients diagnosed with EDNOS should not be treated in mental health institutions and therefore should not get their treatment costs reimbursed by the insurance companies. The most important argument of the insurance companies is that patients in the EDNOS category do not display serious psychiatric symptoms. The aim of this paper is to show that EDNOS is an eating disorder category of clinical relevance. The article provides a critical overview of literature on EDNOS which studies the prevalence, severity and course of the disorder. We also discuss to what extent the fifth version of dsm solves the problems relating to this residual category. We reviewed the literature. The classification given in DSM-IV is not an accurate reflection of clinical reality. Half of the patients presenting with an eating disorder and seeking treatment do meet the criteria for EDNOS. The duration and the severity of eating disorder psychopathology, the presence of comorbidity, the mortality, and the use of the mental health care services by individuals with an eating disorder appear to be very similar in EDNOS patients and in patients with anorexia and bulimia nervosa. Eating disorder classifications can be regarded as snapshots taken throughout the course of an illness. Over of the years patients can be afflicted with various subtypes of an eating disorder. DSM-5 places fewer patients in the EDNOS category that did DSM-IV. In the latest version of dsm, namely DSM-5, the number of patients with an eating disorder classified as EDNOS has declined. There
The origin and course of eating disorders constitute a multifactorial etiopathology. This is why it is important to consider the psychological, developmental, biological and socio - cultural evaluation of each patient. The Diagnostic and Statistical Manual DSM IV - TR (APA, 1994) distinguishes two main eating disorders: Anorexia Nervosa and Bulimia Nervosa. Together with them are described a broad and heterogeneous category (EDNOS) of "atypical eating disorders," that is a clinically significant eating disorder, but that does not meet all the diagnostic criteria for Anorexia Nervosa or Bulimia Nervosa. The aim of this pilot study was to analyze the differences detectable in anorexic and bulimic patients in relation to several factors of mental functioning, particularly with respect to the presence of distinctive characteristics and symptoms and the associated substrate personality. 20 patients with eating disorders who have a residential rehabilitation program, all women, 10 diagnosed with AN aged between 18 years and 31 years, including (5 Restrictive and 5 with Purging) and 10 diagnosed with BN aged between 19 years and 31 years (including 5 with Purging). The pictures of AN and BN can be placed within a continuum of symptoms that distinguishes them exclusively for the presence or absence of bulimic episodes; also the symptom of bulaemia can be considered a most important aspect in the distinction between anorexia and bulimia as all other aspects of mental functioning appear to be similar in almost direct measurement, and finally some food pathological events are associated with personality characteristics, Axis I symptoms and quality of life, linked to specific types of global functioning. Some symptoms may have different functions depending on the patient's personality style: a patient may develop a symptom of anorexia because it is competitive and a perfectionist, another as a form of self-punishment or as a strategy to regulate the feeling of being out of
Estudio de la capa de fibras nerviosas de la retina mediante tomografía de coherencia óptica y polarimetría láser en pacientes con esclerosis múltiple: correlación con la función visual y los hallazgos de la resonancia magnética
Abalo Lojo, José Manuel
Introducción: La tomografía de coherencia óptica (OCT) y la polarimetría láser (GDx) son técnicas exploratorias de la capa de fibras nerviosas de la retina (CFNR). Hipótesis: En los pacientes con EM, el posible daño estructural de la CFNR y su correspondiente alteración de la función visual sería un reflejo del daño del SNC y por lo tanto se correlacionaría con las alteraciones de la resonancia magnética (RM) y la discapacidad Material y métodos: El estudio se ha realizado con 96 paci...
Faris, Patricia L; Eckert, Elke D; Kim, Suck-Won; Meller, William H; Pardo, Jose V; Goodale, Robert L; Hartman, Boyd K
The bilateral vagus nerves (Cranial X) provide both afferent and efferent connections between the viscera and the caudal medulla. The afferent branches increasingly are being recognized as providing significant input to the central nervous system for modulation of complex behaviors. In this paper, we review evidence from our laboratory that increases in vagal afferent activity are involved in perpetuating binge-eating and vomiting in bulimia nervosa. Preliminary findings are also presented which suggest that a subgroup of depressions may have a similar pathophysiology. Two main approaches were used to study the role of vagal afferents. Ondansetron (ONDAN), a 5-HT3 antagonist, was used as a pharmacological tool for inhibiting or reducing vagal afferent neurotransmission. Second, somatic pain detection thresholds were assessed for monitoring a physiological process known to be modulated by vagal afferents, including the gastric branches involved in meal termination and satiety. High levels of vagal activity result in an increase in pain detection thresholds. Depressive symptoms were assessed using the Beck Depression Inventory (BDI). Positron Emission Tomography (PET) was used to identify higher cortical brain areas activated by vagal stimulation produced by proximal gastric distention in normal eating subjects. Double-blind treatment of severe bulimia nervosa subjects with ONDAN resulted in a rapid and significant decrease in binge-eating and vomiting compared to placebo controls. The decrease in abnormal eating episodes was accompanied by a return of normal satiety. Pain detection thresholds measured weekly over the course of the treatment protocol were found to dynamically fluctuate in association with bulimic episodes. Thresholds were the most elevated during periods of short-term abstinence from the behaviors, suggesting that not engaging in a binge/vomit episode is accompanied by an increase in vagal activity. ONDAN also resulted in abolition of the
Lowe, Michael R; Witt, Ashley A; Grossman, Stephanie L
The cognitive behavioral model of bulimia nervosa (BN) suggests that dieting is central to the maintenance of binge eating. However, correlational and experimental studies suggest that additional clarification is needed about the nature of this relationship. Dieting, weight, eating disorder psychopathology, and depression were assessed at admission among 166 patients with BN presenting for residential treatment. As in past research, a significant fraction (43%) of patients with BN reported not currently dieting. A comparison of weight loss dieters and non-dieters found greater food restriction and eating disorder psychopathology among weight loss dieters. However, dieters reported less frequent binge eating. There were no significant group differences in depression. Results suggest that 1) while many individuals with BN are attempting to restrict their food intake, the goal of losing weight fundamentally alters the effect of such restriction on binge eating, and 2) treatment may benefit from helping patients to establish a healthier approach to achieving long-term weight stability. © 2013.
Moreno, Silvia; Warren, Cortney S; Rodríguez, Sonia; Fernández, M Carmen; Cepeda-Benito, Antonio
Food cravings are subjective, motivational states thought to induce binge eating among eating disorder patients. This study compared food cravings across eating disorders. Women (N=135) diagnosed with anorexia nervosa, restrictive (ANR) or binge-purging (ANBP) types, or bulimia nervosa, non-purging (BNNP) or purging (BNP) types completed measures of food cravings. Discriminant analysis yielded two statistically significant functions. The first function differentiated between all the four group pairs except ANBP and BNNP, with levels of various food-craving dimensions successively increasing for ANR, ANBP, BNNP, and BNP participants. The second function differentiated between ANBP and BNNP participants. Overall, the functions improved classification accuracy above chance level (44% fewer errors). The findings suggest that cravings are more strongly associated with loss of control over eating than with dietary restraint tendencies.
Giddings, T D; Miltenberger, R G
Binge-eating disorders (BED) are a common problem affecting up to 5 percent of the American population in any given 6-month period. Currently, the most widely accepted treatment is some variation of Cognitive Behavior Therapy, although the abstinence rates following this type of treatment are only around 50%. A recent study by Bosch et al. explored the effects of extinction with four women who engaged in binge-eating behavior associated with BED and bulimia nervosa (BN). The treatment was successful, with three of the four participants obtaining abstinence. To date, this has been the only study examining this procedure. The purpose of the current study was to further evaluate extinction of binge eating with four young women who met diagnostic criteria for BN. The results showed that the treatment decreased binge eating to zero for all four women, although one dropped out of the study shortly after beginning the intervention.
Gruber, N P; Dilsaver, S C
Symptoms of an eating disorder (hyperphagia, carbohydrate craving, and weight gain) are characteristic of wintertime depression. Recent findings suggest that the severity of bulimia nervosa peaks during fall and winter months, and that persons with this disorder respond to treatment with bright artificial light. However, the rates of eating disorders among patients presenting for the treatment of winter depression are unknown. This study was undertaken to determine these rates among 47 patients meeting the DSM-III-R criteria for major depression with a seasonal pattern. All were evaluated using standard clinical interviews and the Structured Clinical Interview for DSM-III-R. Twelve (25.5%) patients met the DSM-III-R criteria for an eating disorder. Eleven patients had onset of mood disorder during childhood or adolescence. The eating disorder followed the onset of the mood disorder. Clinicians should inquire about current and past symptoms of eating disorders when evaluating patients with winter depression. PMID:8580121
Laessle, R G; Beumont, P J; Butow, P; Lennerts, W; O'Connor, M; Pirke, K M; Touyz, S W; Waadt, S
In a comparison of nutritional management (NM) and stress management (SM) for treatment of bulimia nervosa, 55 female patients were randomly assigned to either treatment. Therapy consisted of 15 sessions in a group over three months, by the end of which, patients under both treatment conditions showed a significant reduction in the frequency of binge eating and vomiting and a significant improvement in various psychopathological features such as body dissatisfaction and depression. All improvements were maintained over 12-month follow-up NM produced a more rapid improvement in general eating behaviour, a faster reduction in binge frequency and a higher abstinence rate from binge eating. SM led to greater positive changes in certain psychopathological features such as feelings of ineffectiveness, interpersonal distrust and anxiety. NM should be regarded as a necessary first intervention in all bulimic patients. Further psychological therapy, such as SM, is indicated as well for some patients, depending on their specific psychological difficulties.
Joyce, J.M.; Humphries, L.; Shih, W.J.; Donohoe, K.J.; Ryo, U.Y.
Anorexia nervosa and bulimia are common eating disorders that are frequently associated with symptoms of bloating, belching, nausea, and vomiting. The authors currently studying this population with Tc-99m TETA to determine the gastric emptying time (ET) and response to metoclopramide. The authors' findings to date show that the majority (80%) of anorexics have a normal ET; the remainder are delayed. The bulimics demonstrate a normal ET in 34%, delayed in 45%, and rapid in 21%. The response to metoclopramide was good in the delayed anorexic patients and in 71% of bulimic patients treated. The extent of rapidity or delay in ET is being compared with the clinical data including age, weight/height, length and degree of disorder, diet, degree of symptoms, and response to drug and diet therapy. This correlation will help determine the incidence and severity of ET abnormality, the relation of disease and symptom severity to ET, and the effect of different treatments based on the ET
Di Paola, Fiammetta; Faravelli, Carlo; Ricca, Valdo
The aim of this study was to verify the level of expressed emotion (EE) as perceived from patients with an eating disorder (ED). The Italian translation of the Level of Expressed Emotion Scale was administered to 63 female patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of anorexia nervosa, bulimia nervosa, and binge-eating disorder and 63 control subjects, according to a case-control procedure. Patients with ED showed higher level of perceived EE than controls, whereas no significant differences were observed when comparing the 3 patient subgroups. The level of perceived EE was found to be independent of age, person who has been most influential in the patient's life, amount of contacts, and duration of treatment. Different associations between eating disorder psychopathology and EE were found, suggesting a close relationship between the emotional response and tolerance of influential person and the dysfunctional attitudes regarding eating, weight, and body shape. Copyright 2010 Elsevier Inc. All rights reserved.
Wnuk, Susan M; Greenberg, Les; Dolhanty, Joanne
This study provides outcome pilot data for an outpatient emotion-focused therapy group for 12 women with DSM-IV diagnoses of binge-eating disorder, bulimia nervosa, or eating disorder not otherwise specified. The emotion-focused therapy group involved 16 weekly sessions that targeted problematic emotions connected to eating disorder symptoms. Semi-structured clinical interviews were conducted pre- and post-treatment and self-report questionnaires were administered. From pre- to post-treatment, changes in binge eating and scores on self-report measures were statistically significant. Participants reported a decrease in the frequency of binge episodes, improvements in mood, and improvements in emotion regulation and self-efficacy.
Bello, Nicholas T; Yeomans, Bryn L
Eating disorders represent a set of psychiatric illnesses with lifelong complications and high relapse rates. Individuals with eating disorders are often stigmatized and clinicians have a limited set of treatments options. Pharmacotherapy has the potential to improve long term compliance and patient commitment to treatment for eating disorders. Areas covered: This review will examine the efficacy and safety profile of the FDA-approved medications for the treatment of bulimia nervosa (BN) and binge eating disorder (BED). This will include the evaluation of fluoxetine for BN, and lisdexamfetamine for BED. Safety information will be review from randomized control trials (RCT), open label trials, and case reports. Expert opinion: Fluoxetine for BN and lisdexamfetamine for BED are relatively safe and well-tolerated. Despite these properties, these two medications represent a limited arsenal for the pharmacological treatment of eating disorders. Thus, more research-based strategies are needed to develop safe, effective, and more targeted therapies for eating disorders.
Wilson, G. Terence; Sysko, Robyn
Objective In DSM-IV, to be diagnosed with Bulimia Nervosa (BN) or the provisional diagnosis of Binge Eating Disorder (BED), an individual must experience episodes of binge eating is “at least twice a week” on average, for three or six months respectively. The purpose of this review was to examine the validity and utility of the frequency criterion for BN and BED. Method Published studies evaluating the frequency criterion were reviewed. Results Our review found little evidence to support the validity or utility of the DSM-IV frequency criterion of twice a week binge eating; however, the number of studies available for our review was limited. Conclusion A number of options are available for the frequency criterion in DSM-V, and the optimal diagnostic threshold for binge eating remains to be determined. PMID:19610014
Monteleone, Alessio Maria; Scognamiglio, Pasquale; Volpe, Umberto; Di Maso, Virginia; Monteleone, Palmiero
Published studies suggested an implication of oxytocin in some temperament characteristics of personality. Therefore, we measured oxytocin secretion in 23 women with anorexia nervosa (AN), 27 with bulimia nervosa (BN) and 19 healthy controls and explored the relationships between circulating oxytocin and patients' personality traits. Plasma oxytocin levels were significantly reduced in AN women but not in BN ones. In healthy women, the attachment subscale scores of the reward dependence temperament and the harm avoidance (HA) scores explained 82% of the variability in circulating oxytocin. In BN patients, plasma oxytocin resulted to be negatively correlated with HA, whereas no significant correlations emerged in AN patients. These findings confirm a dysregulation of oxytocin production in AN but not in BN and show, for the first time, a disruption of the associations between hormone levels and patients' temperament traits, which may have a role in certain deranged behaviours of eating disorder patients. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
Brogan, Amy; Hevey, David; Pignatti, Riccardo
The pathological eating behaviors in Anorexia Nervosa (AN), Bulimia Nervosa (BN), and obesity are characterized by a preference for high immediate reward, despite higher future losses in terms of both physical and psychological outcomes. The present study compared the decision making profile of females with a diagnosis of AN (n = 22), BN (n = 17), obesity (n = 18), and a healthy weight comparison group (n = 20) using a standardized neuropsychological test, the Iowa Gambling Task (IGT). The three clinical groups (AN, BN, obesity) were significantly impaired on the IGT compared with the comparison group on both overall task performance and task learning; however, the three clinical groups were not significantly different from each other. Sixty-one percent to 77% of the clinical groups reached the threshold for impairment on the IGT, compared with 15% of the comparison group. The potential basis for this shared decision making profile is discussed.
Caslini, Manuela; Crocamo, Cristina; Dakanalis, Antonios; Tremolada, Martina; Clerici, Massimo; Carrà, Giuseppe
Stigmatizing attitudes toward eating disorders (EDs) may lead to reduced treatment seeking. We aimed to estimate the prevalence of stigmatizing trends and beliefs related to anorexia nervosa (AN) and bulimia nervosa (BN), and the associations with the experiential knowledge of the problem, in a large sample of Italian undergraduates. A total of 2109 participants completed an online survey including questionnaires related to stigmatizing beliefs toward AN and BN, and personal contacts with people with EDs. Undergraduates reported almost overlapping low levels of stigmatizing trends for AN and BN, apart from personal responsibility and social distance. Those aged 18 to 25 and living with family held higher stigmatizing attitudes. Stigma was lower in underweight participants and in those (12%) reporting a previous ED diagnosis. Although not improving stigmatizing attitudes, 83% of the sample was familiar with people with an ED. Antistigma actions to increase awareness on EDs and to improve treatment-seeking behaviors are needed.
Tseng, Mei-Chih Meg; Hu, Fu-Chang
The implications of impulsivity in its relationship with binge-eating or purging behaviors remain unclear. This study examined the patterns of eating behaviors and co-morbid impulsive behaviors in individuals with bulimia nervosa n optimally homogeneous classes using latent class analysis (LCA). All participants (n=180) were asked to complete a series of self-reported inventories of impulsive behaviors and other psychological measures. Information regarding the lifetime presence of symptoms of eating disorder was assessed by clinical interviews. LCA was conducted using eating disorder symptoms, impulsive behaviors, and the number of purging methods. Three latent classes of bulimic women were identified. These were women who exhibited relatively higher rates of purging, symptoms of impulsive behavior, and multiple purging methods (17.8%), women who used no more than one purging method with a low occurrence of impulsive behavior (41.7%), and women who showed higher rates of purging behaviors and the use of multiple purging methods with a low rate of impulsive behavior (41.7%). The impulsive sub-group had comparable severity of eating-related measures, frequency of binge-eating, and higher levels of general psychopathology than that of the other two sub-groups. This study provides empirical support for the existence of an impulsive subgroup with distinctive features among a non-Western group of BN patients. This study also suggests that mechanisms other than impulse dysregulation may exist for the development of binge-eating and purging behaviors in bulimia nervosa patients, or the mechanisms contributing to binge-eating and impulsive behaviors may be different. Copyright © 2011 Elsevier Inc. All rights reserved.
Aschenbrenner, Katja; Scholze, Ninette; Joraschky, Peter; Hummel, Thomas
The majority of studies on taste and smell in eating disorders have revealed several alterations of olfactory or gustatory functions. Aim of this prospective study was to employ detailed olfactory and gustatory testing in female subjects of three homogenous groups - anorexia nervosa, bulimia nervosa and healthy controls - and to look at the effects of treatment on these measures. Sixteen hospitalized female patients with anorexia (restricting type, mean age [M]=24.5 years), 24 female patients with bulimia (purging type, M=24.3 years) as well as 23 healthy controls (M=24.5 years) received olfactory ("Sniffin' Sticks") and gustatory testing ("Taste Strips"). Group differences in olfactory and gustatory sensitivity, body mass index (BMI), the Beck depression inventory, the eating attitudes test (EAT), and the influence of therapy on gustatory and olfactory function were investigated. (1) Group differences were present for odor discrimination and overall olfactory function with anorexic patients having the lowest scores. (2) Regarding taste function, controls scored higher than patients with anorexia. (3) At admission small but significant correlations were found between overall olfactory function and body weight (r(63)=0.35), BMI (r(63) = 0.37), and EAT score (r(63) = -0.27). Similarly, (4) the taste test score correlated significantly with body weight (r(63)= 0.48), and BMI (r(63) = 0.45). Finally, (5) at discharge overall olfactory and gustatory function were significantly higher compared to admission in anorexic patients. As compared to healthy controls and bulimic patients our results show lowered olfactory and gustatory sensitivities in anorexic patients that improved with increasing BMI and decreasing eating pathology in the course of treatment.
Bergh, Cecilia; Brodin, Ulf; Lindberg, Greger; Södersten, Per
Evidence for the effectiveness of existing treatments of patients with eating disorders is weak. Here we describe and evaluate a method of treatment in a randomized controlled trial. Sixteen patients, randomly selected out of a group composed of 19 patients with anorexia nervosa and 13 with bulimia nervosa, were trained to eat and recognize satiety by using computer support. They rested in a warm room after eating, and their physical activity was restricted. The patients in the control group (n = 16) received no treatment. Remission was defined by normal body weight (anorexia), cessation of binge eating and purging (bulimia), a normal psychiatric profile, normal laboratory test values, normal eating behavior, and resumption of social activities. Fourteen patients went into remission after a median of 14.4 months (range 4.9–26.5) of treatment, but only one patient went into remission while waiting for treatment (P = 0.0057). Relapse is considered a major problem in patients who have been treated to remission. We therefore report results on a total of 168 patients who have entered our treatment program. The estimated rate of remission was 75%, and estimated time to remission was 14.7 months (quartile range 9.6 ≥ 32). Six patients (7%) of 83 who were treated to remission relapsed, but the others (93%) have remained in remission for 12 months (quartile range 6–36). Because the risk of relapse is maximal in the first year after remission, we suggest that most patients treated with this method recover. PMID:12082182
Olesti Baiges, M; Piñol Moreso, J L; Martín Vergara, N; de la Fuente García, M; Riera Solé, A; Bofarull Bosch, J Maria; Ricomá de Castellarnau, G
Eating disorders are characterized by changes in eating patterns associated with a series of psychosocial conflicts, low self-esteem and poor empathy, and an obsession with slimming. The aims of the present study were: 1. To determinate the prevalence of anorexia nervosa, bulimia nervosa and other eating disorders in a representative sample of adolescent girls between the ages of 12 and 21 living in the city of Reus (Spain). 2. To evaluate the association between eating disorders and alterations on the Eating Attitudes Test-40 (EAT-40), Body Attitudes Test (BAT), and the Aesthetic Body Shape Questionnaire (CIMEC). We performed a cross-sectional observational study in a random sample of adolescent girls aged between 12 and 21 years old. Information was gathered from a structured questionnaire on demographic and anthropometric factors (age, place of birth, education, etc.), clinical examination, clinical interview, DMS-IV diagnostic criteria, and three self-administered tests: EAT-40, BAT and CIMEC. A total of 551 adolescents were analyzed. The mean age was 17.6+/-2.5 years. Diagnostic criteria of anorexia nervosa were found in 0.9% (95% CI: 0.4-2.4), bulimia nervosa in 2.9% (95% CI: 1.7-4.7), and other eating disorders in 5.3% (95% CI: 3.6-7.5). The test showing the greatest alterations was the CIMEC (38%), followed by the BAT (27.1%) and EAT-40 (23.1%). All the adolescents that met the diagnostic criteria of anorexia nervosa showed alterations in all three tests. The high prevalence of eating disorders indicates the need for greater direct involvement among health professionals. The EAT-40, BAT and CIMEC are effective screening instruments for these disorders.
Blank, Shulamit; Zadik, Zvi; Katz, Inbal; Mahazri, Yemima; Toker, Iris; Barak, Igal
The objective was to propose and describe a new bio-psycho-social model of emergence and maintenance of anorexia nervosa and bulimia nervosa, and demonstrate its application to treatment. An original model, based on literature review and our own clinical experience, was created. Therapeutic guidelines were derived from the theoretical model and applied in the treatment of 97 anorexia and bulimia nervosa patients presented at the eating disorders unit at Kaplan Hospital in Israel over 18 months. A team comprising a pediatrician, a child psychiatrist, a dietician, and trained nurses collaborated in a comprehensive systemic therapeutic approach involving parents, schools, and community agents. Ninety-one girls and six boys were treated in the eating disorder unit (55 had AN, 29 had BN and 13 had EDNOS). Thirty-seven patients were hospitalized and sixty were treated in the outpatient clinic. Mean hospitalization time of the first five patients was 108 days. Mean hospitalization time of the remaining 32 patients was reduced to 32 days. The mean number of outpatient clinic interventions was 12. At the one-year follow up, 74 patients were doing well in all respects. Fourteen patients still needed a lot of supervision in eating. Five are still hospitalized and four were lost to follow up. The proposed model proves to be more than just another theory in that it is successfully applied in treatment. Short systemic therapy is very effective. The longer the delay in drastic, aggressive treatment, the worse the prognosis. Extended hospitalization periods worsen the prognosis. Weakness of the parental unit is a strong indication for inpatient care. The longer the experience in treating eating disorders, the shorter the hospitalization and number of interventions.
Carla Aparecida Cielo
Full Text Available TEMA: Características da bulimia nervosa (BN e do Refluxo Laringofaríngeo (RLF e alterações vocais e laríngeas que podem decorrer da exposição da laringe ao ácido gástrico. OBJETIVO: Descrever, por meio de revisão de literatura, as características do RLF e da BN, relacionando-os com as alterações vocais e laríngeas que podem se originar da exposição da laringe ao ácido gástrico que ocorre em ambas as condições. CONCLUSÃO: A BN se caracteriza por um transtorno alimentar de causa principalmente psicológica em que ocorre ingestão compulsiva de grande quantidade de alimentos, seguida de episódios de vômitos auto-induzidos com a finalidade de evitar o ganho de peso. O RLF consiste em uma variação clínica da DRGE, na qual o fluxo retrógrado do alimento e do ácido gástrico entra em contato com a laringe e suas estruturas. Em comum, a BN e o RLF apresentam este mecanismo de regurgitação que pode atingir a laringe. Dentre os sinais e sintomas laríngeos e vocais decorrentes da regurgitação do ácido gástrico sobre a laringe estão: globus faríngeo, disfonia, rouquidão, tosse seca, disfagia, halitose, lesões inflamatórias nas pregas vocais, laringite, amigdalite, edema e eritema glótico posterior e ou de aritenóides, da região retrocricóidea e interaritenóidea, estenose subglótica, irregularidades na mucosa das pregas vocais, hipertrofia de mucosa laríngea, leucoplasia, carcinoma, laringoespasmos, granulomas, úlcera de contato, nódulos vocais, pólipos vocais, edema difuso, granuloma, fixação uni ou bilateral de aritenóides, edema de Reinke, laringomalácia, estridor, e odinofagia.BACKGROUND: Characteristics of bulimia nervosa (BN and laryngopharyngeal reflux (LPR and laryngeal and voice disorders that can arise from exposure to gastric acid of the larynx. PURPOSE: To describe, through literature review, the characteristics of LPR and the BN, linking them with laryngeal and voice disorders that can stem
Schmidt, U; Andiappan, M; Grover, M; Robinson, S; Perkins, S; Dugmore, O; Treasure, J; Landau, S; Eisler, I; Williams, C
Cognitive-behavioural self-care is advocated as a first step in the treatment of bulimia nervosa. To examine the effectiveness of a CD-ROM-based cognitive-behavioural intervention in bulimia nervosa and eating disorder not otherwise specified (NOS) (bulimic type) in a routine setting. Ninety-seven people with bulimia nervosa or eating disorder NOS were randomised to either CD-ROM without support for 3 months followed by a flexible number of therapist sessions or to a 3-month waiting list followed by 15 sessions of therapist cognitive-behavioural therapy (CBT) (ISRCTN51564819). Clinical symptoms were assessed at pre-treatment, 3 months and 7 months. Only two-thirds of participants started treatment. Although there were significant group x time interactions for bingeing and vomiting, favouring the CD-ROM group at 3 months and the waiting-list group at 7 months, post hoc group comparisons at 3 and 7 months found no significant differences for bingeing or vomiting. CD-ROM-based delivery of this intervention, without support from a clinician, may not be the best way of exploiting its benefits.
Robinson, Paul; Serfaty, Marc
One hundred and ten people in an university population responded to emailed eating disorder questionnaires. Ninty-seven fulfilling criteria for eating disorders (bulimia nervosa (BN), binge eating disorder (BED), EDNOS) were randomised to therapist administered email bulimia therapy (eBT), unsupported Self directed writing (SDW) or Waiting list control (WLC). Measures were repeated at 3 months. Diagnosis, Beck depression inventory (BDI) and Bulimia investigatory test (BITE) scores were recorded. Follow-up rate was 63% and results must be interpreted cautiously. However significantly fewer participants who had received eBT or SDW fulfilled criteria for eating disorders at follow up compared to WLC. There was no significant difference between eBT and SDW in the analysis of variance (ANOVA), although in separate analyses, eBT was significantly superior to WLC (p < 0.02) and the difference for SDW approached significance (p = 0.06). BDI and BITE scores showed no significant change. For eBT participants there was a significant positive correlation between words written and improvement in BITE severity score. BN, BED and EDNOS can be treated via email. (c) 2007 John Wiley & Sons, Ltd and Eating Disorders Association
Leombruni, Paolo; Amianto, Federico; Delsedime, Nadia; Gramaglia, Carla; Abbate-Daga, Giovanni; Fassino, Secondo
The most studied and most frequently used pharmacologic treatments in bulimia nervosa are the selective serotonin reuptake inhibitors (SSRIs), in particular, fluoxetine. Less is known about the efficacy of the other SSRIs. To compare fluoxetine with citalopram in the treatment of bulimic patients, 37 bulimic patients were randomized to receive fluoxetine (n=18) or citalopram (n=19); these patients were assessed with regard to clinical (ie, body mass index, pathologic behaviors), psychopathologic (Eating Disorder Inventory-2, Body Shape Questionnaire, Binge-Eating Scale, Beck Depression Inventory), personality (Temperament and Character Inventory), and clinical global impression measures. These measures were compared between the 2 treatment groups at baseline and at the end of treatment. Dropout rates were similar in the 2 groups. Both groups showed significant improvement in eating psychopathology, angry feelings, and clinical global impression. Patients in the fluoxetine group displayed a greater reduction in introjected anger, whereas those in the citalopram group displayed a greater reduction in depressive feelings. Both treatments showed some effect on outcome measures, but efficacy profiles did not overlap. Citalopram may be useful in depressed patients with bulimia, whereas fluoxetine is more specific for those with introjected anger and bulimia.
Monteleone, Palmiero; Matias, Isabelle; Martiadis, Vassilis; De Petrocellis, Luciano; Maj, Mario; Di Marzo, Vincenzo
The endocannabinoid system, consisting of two cannabinoid receptors (CB1 and CB2) and the endogenous ligands anandamide (arachidonoylethanolamide (AEA)) and 2-arachidonoylglycerol (2-AG), has been shown to control food intake in both animals and humans, modulating either rewarding or quantitative aspects of the eating behavior. Moreover, hypothalamic endocannabinoids seem to be part of neural circuitry involved in the modulating effects of leptin on energy homeostasis. Therefore, alterations of the endocannabinoid system could be involved in the pathophysiology of eating disorders, where a deranged leptin signalling has been also reported. In order to verify this hypothesis, we measured plasma levels of AEA, 2-AG, and leptin in 15 women with anorexia nervosa (AN), 12 women with bulimia nervosa (BN), 11 women with binge-eating disorder (BED), and 15 healthy women. Plasma levels of AEA resulted significantly enhanced in both anorexic and BED women, but not in bulimic patients. No significant change occurred in the plasma levels of 2-AG in all the patients' groups. Moreover, circulating AEA levels were significantly and inversely correlated with plasma leptin concentrations in both healthy controls and anorexic women. These findings show for the first time a derangement in the production of the endogenous cannabinoid AEA in drug-free symptomatic women with AN or with BED. Although the pathophysiological significance of this alteration awaits further studies to be clarified, it suggests a possible involvement of AEA in the mediation of the rewarding aspects of the aberrant eating behaviors occurring in AN and BED.
Effectiveness of a web-based treatment program using intensive therapeutic support for female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified: study protocol of a randomized controlled trial.
ter Huurne, Elke D; Postel, Marloes G; de Haan, Hein A; DeJong, Cor A J
Disordered eating behavior and body dissatisfaction affect a large proportion of the Dutch population and account for severe psychological, physical and social morbidity. Yet, the threshold for seeking professional care is still high. In the Netherlands, only 7.5% of patients with bulimia nervosa and 33% of patients with anorexia nervosa are treated within the mental health care system. Easily accessible and low-threshold interventions, therefore, are needed urgently. The internet has great potential to offer such interventions. The aim of this study is to determine whether a web-based treatment program for patients with eating disorders can improve eating disorder psychopathology among female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified. This randomized controlled trial will compare the outcomes of an experimental treatment group to a waiting list control group. In the web-based treatment program, participants will communicate personally and asynchronously with their therapists exclusively via the internet. The first part of the program will focus on analyzing eating attitudes and behaviors. In the second part of the program participants will learn how to change their attitudes and behaviors. Participants assigned to the waiting list control group will receive no-reply email messages once every two weeks during the waiting period of 15 weeks, after which they can start the program. The primary outcome measure is an improvement in eating disorder psychopathology as determined by the Eating Disorder Examination Questionnaire. Secondary outcomes include improvements in body image, physical and mental health, body weight, self-esteem, quality of life, and social contacts. In addition, the participants' motivation for treatment and their acceptability of the program and the therapeutic alliance will be measured. The study will follow the recommendations in the CONSORT statement relating to designing and reporting on
Gomez Penedo, Juan Martin; Constantino, Michael J; Coyne, Alice E; Bernecker, Samantha L; Smith-Hansen, Lotte
We tested an aptitude by treatment interaction; namely, whether patients' baseline interpersonal problems moderated the comparative efficacy of cognitive-behavioral therapy (CBT) vs. interpersonal psychotherapy (IPT) for bulimia nervosa (BN). Data derived from a randomized-controlled trial. Patients reported on their interpersonal problems at baseline; purge frequency at baseline, midtreatment, and posttreatment; and global eating disorder severity at baseline and posttreatment. We estimated the rate of change in purge frequency across therapy, and the likelihood of attaining clinically meaningful improvement (recovery) in global eating disorder severity by posttreatment. We then tested the interpersonal problem by treatment interactions as predictors of both outcomes. Patients with more baseline overly communal/friendly problems showed steeper reduction in likelihood of purging when treated with CBT vs. IPT. Patients with more problems of being under communal/cold had similar reductions in likelihood of purging across both treatments. Patients with more baseline problems of being overly agentic were more likely to recover when treated with IPT vs. CBT, whereas patients with more problems of being under agentic were more likely to recover when treated with CBT vs. IPT. Interpersonal problems related to communion and agency may inform treatment fit among two empirically supported therapies for BN.
Seidenfeld, M E; Rickert, V I
Dieting behaviors and nutrition can have an enormous impact on the gynecologic health of adolescents. Teenaged patients with anorexia nervosa can have hypothalamic suppression and amenorrhea. In addition, these adolescents are at high risk of osteoporosis and fractures. Unfortunately, data suggest that estrogen replacement, even in combination with nutritional supplementation, does not appear to correct the loss of bone density in these patients. Approximately one half of adolescents with bulimia nervosa also have hypothalamic dysfunction and oligomenorrhea or irregular menses. Generally, these abnormalities do not impact bone density and can be regulated with interval dosing of progesterone or regular use of oral contraceptives. In contrast, the obese adolescent with menstrual irregularity frequently has anovulation and hyperandrogenism, commonly referred to as polycystic ovary syndrome. Insulin resistance is thought to play a role in the pathophysiology of this condition. While current management usually involves oral contraceptives, future treatment may include insulin-lowering medications, such as metformin, to improve symptoms. Because all of these patients are potentially sexually active, discussion about contraception is important.
Schebendach, Janet; Broft, Allegra; Foltin, Richard W; Walsh, B Timothy
Binge eating is a core clinical feature of bulimia nervosa (BN). Enhanced reinforcing value of food may play a role in this behavioral disturbance, but a systematic behavioral assessment of objective measures of the rewarding value of binge eating is lacking. The purpose of this study was to quantify the reinforcing value of food in BN patients as compared with normal controls. A progressive ratio (PR) computerized work task was completed under binge and non-binge instruction. The task consisted of 12 trials. The first trial required 50 keyboard taps to earn one portion of yogurt shake, and subsequent trials required progressive work increments of 200 taps for each additional portion. Completion of all 12 trials required 13,800 taps to earn 2100ml of shake. The breakpoint, defined as the largest ratio completed before a participant stopped working, was the measure of reinforcing efficacy. Ten patients and 10 controls completed the experiment. Under binge instruction, patients completed more trials and taps, and had a higher breakpoint than controls. The non-binge instruction yielded opposite findings; compared to controls, patients completed fewer trials and taps, and had a lower breakpoint. These results support the feasibility and potential utility of a PR task to quantify the reinforcing value of food in patients with BN. Copyright © 2012 Elsevier Ltd. All rights reserved.
Monteleone, Palmiero; Serritella, Cristina; Scognamiglio, Pasquale; Maj, Mario
In humans, the cephalic phase response to food ingestion consists mostly of vagal efferent activation, which promotes the secretion of entero-pancreatic hormones, including ghrelin. Since symptomatic patients with bulimia nervosa (BN) are characterized by increased vagal tone, we hypothesized an enhanced ghrelin secretion in the cephalic phase of vagal stimulation. Therefore, we investigated ghrelin response to modified sham feeding (MSF) in both BN and healthy women. Six drug-free BN women and 7 age-matched healthy females underwent MSF with initially seeing and smelling a meal, and then chewing the food without swallowing it. Blood samples were drawn immediately before and after MSF for hormone assay. Circulating ghrelin increased after MSF in both groups with BN individuals exhibiting a greater ghrelin increase, which positively correlated with the patients' weekly frequency of binge-purging. These results show for the first time an increased ghrelin secretion in the cephalic phase of vagal stimulation in symptomatic BN patients, likely resulting in a potentiation of the peripheral hunger signal, which might contribute to their aberrant binge-purging behavior. 2009 Elsevier Ltd. All rights reserved.
Peschel, Stephanie K V; Feeling, Nicole R; Vögele, Claus; Kaess, Michael; Thayer, Julian F; Koenig, Julian
Autonomic nervous system function is altered in eating disorders. We aimed to quantify differences in resting state vagal activity, indexed by high-frequency heart rate variability comparing patients with bulimia nervosa (BN) and healthy controls. A systematic search of the literature to identify studies eligible for inclusion and meta-analytical methods were applied. Meta-regression was used to identify potential covariates. Eight studies reporting measures of resting high-frequency heart rate variability in individuals with BN (n = 137) and controls (n = 190) were included. Random-effects meta-analysis revealed a sizeable main effect (Z = 2.22, p = .03; Hedge's g = 0.52, 95% CI [0.06;0.98]) indicating higher resting state vagal activity in individuals with BN. Meta-regression showed that body mass index and medication intake are significant covariates. Findings suggest higher vagal activity in BN at rest, particularly in unmedicated samples with lower body mass index. Potential mechanisms underlying these findings and implications for routine clinical care are discussed. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.
Hilker, Ines; Sánchez, Isabel; Steward, Trevor; Jiménez-Murcia, Susana; Granero, Roser; Gearhardt, Ashley N; Rodríguez-Muñoz, Rita Cristina; Dieguez, Carlos; Crujeiras, Ana B; Tolosa-Sola, Iris; Casanueva, Felipe F; Menchón, José M; Fernández-Aranda, Fernando
Food addiction (FA) has been examined in different populations. Although high FA levels are associated with greater eating disorder severity, few studies have addressed how FA relates to treatment outcome. The study aims (1) to determine whether a brief intervention for bulimia nervosa (BN) reduces FA diagnosis or severity compared with baseline and (2) to determine if FA is predictive of treatment outcome. Sixty-six female BN patients participated in the study. The Yale Food Addiction Scale was administered at two time points: prior to and following a 6-week intervention. The number of weekly binging/purging episodes, dropout and abstinence from bulimic behaviour were used as primary outcome measures. This brief intervention reduced FA severity and FA diagnosis in the 55 patients who completed treatment. FA severity was a short-term predictor of abstinence from binging/purging episodes after treatment (p = .018). Food addiction appears to be prevalent in BN although FA severity can improve following a short-term intervention. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.
Shih Weijen; Castellanos, F.X.; Domstad, P.A.; DeLand, F.H.; Humphries, L.; Digenis, G.A.
To evaluate gastric emptying in patients with bulimia, 20 patients (all women, ranging in age from 12 to 49 years) with upper gastrointestinal symptoms ingested 150-200 ..mu..Ci/sup 99m/ Tc-triethelene tetraamine polysterene resin in cereal and had scintigraphy in the supine position. Data were accumulated at 5 min intervals to determine the gastric emptying time (GET). The results showed that the gastric emptying time was prolonged in 12 patients and decreased in 8. All 12 patients with prolonged emptying time were given 10 mg metoclopramide intravenously; 9 of these had a good response and 3 had no response. Although all patients had subjective symptoms of gastric dysfunction, the results indicate that about 60% had delayed and 40% had rapid gastric emptying. The findings of two extremes of gastric emptying time remain to be explained, however, this enables (Albibi and McCullum 1983) objective documentation of gastric emptying as this technique (American Psychiatric Association 1980) can separate those patients with rapid GET from those with prolonged GET, who might benefit from metoclopramide.
Brooks, Samantha J.; O′Daly, Owen G.; Uher, Rudolf; Friederich, Hans-Christoph; Giampietro, Vincent; Brammer, Michael; Williams, Steven C. R.; Schiöth, Helgi B.; Treasure, Janet; Campbell, Iain C.
Background Previous fMRI studies show that women with eating disorders (ED) have differential neural activation to viewing food images. However, despite clinical differences in their responses to food, differential neural activation to thinking about eating food, between women with anorexia nervosa (AN) and bulimia nervosa (BN) is not known. Methods We compare 50 women (8 with BN, 18 with AN and 24 age-matched healthy controls [HC]) while they view food images during functional Magnetic Resonance Imaging (fMRI). Results In response to food (vs non-food) images, women with BN showed greater neural activation in the visual cortex, right dorsolateral prefrontal cortex, right insular cortex and precentral gyrus, women with AN showed greater activation in the right dorsolateral prefrontal cortex, cerebellum and right precuneus. HC women activated the cerebellum, right insular cortex, right medial temporal lobe and left caudate. Direct comparisons revealed that compared to HC, the BN group showed relative deactivation in the bilateral superior temporal gyrus/insula, and visual cortex, and compared to AN had relative deactivation in the parietal lobe and dorsal posterior cingulate cortex, but greater activation in the caudate, superior temporal gyrus, right insula and supplementary motor area. Conclusions Women with AN and BN activate top-down cognitive control in response to food images, yet women with BN have increased activation in reward and somatosensory regions, which might impinge on cognitive control over food consumption and binge eating. PMID:21799807
Full Text Available OBJECTIVE: Compared to other eating disorders, anorexia nervosa (AN has the highest rates of completed suicide whereas suicide attempt rates are similar or lower than in bulimia nervosa (BN. Attempted suicide is a key predictor of suicide, thus this mismatch is intriguing. We sought to explore whether the clinical characteristics of suicidal acts differ between suicide attempters with AN, BN or without an eating disorders (ED. METHOD: Case-control study in a cohort of suicide attempters (n = 1563. Forty-four patients with AN and 71 with BN were compared with 235 non-ED attempters matched for sex, age and education, using interview measures of suicidal intent and severity. RESULTS: AN patients were more likely to have made a serious attempt (OR = 3.4, 95% CI 1.4-7.9, with a higher expectation of dying (OR = 3.7,95% CI 1.1-13.5, and an increased risk of severity (OR = 3.4,95% CI 1.2-9.6. BN patients did not differ from the control group. Clinical markers of the severity of ED were associated with the seriousness of the attempt. CONCLUSION: There are distinct features of suicide attempts in AN. This may explain the higher suicide rates in AN. Higher completed suicide rates in AN may be partially explained by AN patients' higher desire to die and their more severe and lethal attempts.
Mansour, Sandra; Bruce, Kenneth R; Steiger, Howard; Zuroff, David C; Horowitz, Sarah; Anestin, Annelie S; Sycz, Lindsay
Individuals with eating disorders are said to be highly ambivalent towards change and thus have difficulty maintaining a commitment to, and motivation for, treatment. Self-Determination Theory postulates that autonomous motivation for therapy exists when individuals view their participation as freely chosen. The present study was designed to ascertain whether or not autonomous motivation was associated with treatment response in individuals with bulimia-spectrum eating disorders (BSED). One hundred and fifty-five women with DSM-IV-TR BSED participated in multimodal group therapy and completed measures to assess motivation, eating and comorbid symptoms. Hierarchical multiple regression analyses demonstrated that higher levels of autonomous motivation at pretreatment predicted lower post-treatment scores on measures of eating preoccupations (shape, weight and eating concerns), binge eating, anxiety/depression, relationship to self and others and impulsivity. These results indicate that autonomous motivation may be an important predictor of outcome following treatment for BSED. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.
Shih Weijen; Castellanos, F.X.; Domstad, P.A.; DeLand, F.H.; Humphries, L.; Digenis, G.A.
To evaluate gastric emptying in patients with bulimia, 20 patients (all women, ranging in age from 12 to 49 years) with upper gastrointestinal symptoms ingested 150-200 μCi 99m Tc-triethelene tetraamine polysterene resin in cereal and had scintigraphy in the supine position. Data were accumulated at 5 min intervals to determine the gastric emptying time (GET). The results showed that the gastric emptying time was prolonged in 12 patients and decreased in 8. All 12 patients with prolonged emptying time were given 10 mg metoclopramide intravenously; 9 of these had a good response and 3 had no response. Although all patients had subjective symptoms of gastric dysfunction, the results indicate that about 60% had delayed and 40% had rapid gastric emptying. The findings of two extremes of gastric emptying time remain to be explained, however, this enables (Albibi and McCullum 1983) objective documentation of gastric emptying as this technique (American Psychiatric Association 1980) can separate those patients with rapid GET from those with prolonged GET, who might benefit from metoclopramide. (orig.)
Wagner, Gudrun; Wagner, Gudrun; Penelo, Eva; Nobis, Gerald; Mayerhofer, Anna; Schau, Johanna; Spitzer, Marion; Imgart, Hartmut; Karwautz, Andreas
This study aims to evaluate the long-term outcome of new technology assisted guided self-help in adolescents with bulimia nervosa (BN). One hundred and twenty-six patients with BN (29 adolescents and 97 adults) were randomly allocated to a cognitive behavioural therapy-based self-help program delivered by the Internet or bibliotherapy, both accompanied by e-mail guidance. Outcomes were assessed at baseline, month 4, 7 and 18 including remission rates and eating disorder associated psychopathology. In all, 44% of adolescents vs. 38.7% of adults were in remission at month 7, and 55% of adolescents vs. 62.5% of adults were in remission at follow-up. Objective binge eating and compensatory behaviour improved significantly over time in both groups, with the highest decrease during the first 4 months. A significant decrease over time and no group differences have been found in almost all EDI-2 subscales. E-mail guided self-help (delivered via the Internet or bibliotherapy) is equally effective for adolescents as for adults with BN, and can be recommended as an initial step of treatment for this younger age group.
Goldschmidt, Andrea B; Wonderlich, Stephen A; Crosby, Ross D; Engel, Scott G; Lavender, Jason M; Peterson, Carol B; Crow, Scott J; Cao, Li; Mitchell, James E
Negative affect precedes binge eating and purging in bulimia nervosa (BN), but little is known about factors that precipitate negative affect in relation to these behaviors. We aimed to assess the temporal relation among stressful events, negative affect, and bulimic events in the natural environment using ecological momentary assessment. A total of 133 women with current BN recorded their mood, eating behavior, and the occurrence of stressful events every day for 2 weeks. Multilevel structural equation mediation models evaluated the relations among Time 1 stress measures (i.e., interpersonal stressors, work/environment stressors, general daily hassles, and stress appraisal), Time 2 negative affect, and Time 2 binge eating and purging, controlling for Time 1 negative affect. Increases in negative affect from Time 1 to Time 2 significantly mediated the relations between Time 1 interpersonal stressors, work/environment stressors, general daily hassles, and stress appraisal and Time 2 binge eating and purging. When modeled simultaneously, confidence intervals for interpersonal stressors, general daily hassles, and stress appraisal did not overlap, suggesting that each had a distinct impact on negative affect in relation to binge eating and purging. Our findings indicate that stress precedes the occurrence of bulimic behaviors and that increases in negative affect following stressful events mediate this relation. Results suggest that stress and subsequent negative affect may function as maintenance factors for bulimic behaviors and should be targeted in treatment. PsycINFO Database Record (c) 2014 APA, all rights reserved.
Fassino, Secondo; Amianto, Federico; Rocca, Giuseppe; Daga, Giovanni Abbate
The relationship between eating disorders, attachment, personality traits and eating psychopathology remains unexplored. This study tested the mediating role of temperament and character between parental bonding and psychopathology in bulimic women. 154 bulimic subjects and 154 healthy controls were compared using Parental Bonding Instrument (PBI), Temperament and Character Inventory (TCI), Eating Disorder Inventory-2 (EDI-2), and Beck Depression Inventory (BDI). Multiple regression analysis tested the mediation of personality traits between parenting and eating psychopathology. Bulimic subjects displayed low maternal and paternal care and low self-directedness, and high novelty seeking and eating psychopathology. Maternal care was negatively related to social insecurity, inadequacy and impulsiveness. Paternal care predicted novelty seeking, self-directedness, interoceptive awareness, impulsiveness, and asceticism. The mediation effect of self-directedness between paternal care and psychopathology was significant, not the one of novelty seeking. Parental care is lower in bulimic than in control women even when controlled for possible confounding variables. Some eating psychopathology traits are related to maternal and paternal care, but not the bulimia subscale. Paternal care is also related to temperament and character traits which are related to eating psychopathology. Self-directedness mediates with different degrees between parenting and eating psychopathology. Clinical implications are discussed.
Amianto, Federico; Siccardi, Sara; Abbate-Daga, Giovanni; Marech, Lucrezia; Barosio, Marta; Fassino, Secondo
The goals of the study were to explore anger correlation with bulimic symptoms and to test the mediation power of anger between personality and eating psychopathology. A total of 242 bulimia nervosa (BN) outpatients and 121 healthy controls were recruited. Assessment was performed using Temperament and Character Inventory (TCI); State-Trait Anger Expression Inventory 2 (STAXI-2); Eating Disorder Inventory-2 (EDI-2); Body Shape Questionnaire (BSQ); Binge Eating Scale (BES); and Beck Depression Inventory (BDI). Mediation was tested on the whole BN group, on controls and on two BN subgroups based on a previous history of anorexia nervosa. Self-Directedness and Cooperativeness extensively relate to anger and psychopathology in bulimic group. Bulimic symptoms are related to Trait Reactive Anger. Trait Anger and Anger Expression fully mediate Cooperativeness effects on binge eating and Impulsiveness in the BN subjects. Anger Expression-In partially mediates between Harm Avoidance and Social Insecurity/Interpersonal Distrust in BN subjects. The comparison with controls and the analysis of subgroups underlines that these patterns are specific for BN. Anger mediation between Cooperativeness, and binge eating and impulsive behaviours confirm the relevance of relational dynamics in the expression of these core eating symptoms. Relational skills may represent a relevant target for the treatment of BN. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Naumann, Eva; Tuschen-Caffier, Brunna; Voderholzer, Ulrich; Caffier, Detlef; Svaldi, Jennifer
Recent models of eating disorders emphasize the importance of ruminative thinking in the occurrence of unhealthy eating behavior. Hence, the aim of the current study was to examine the influence of induced rumination and distraction on the desire to engage in eating-related symptoms in anorexia (AN) and bulimia nervosa (BN). After a sadness induction, either a ruminative or distractive emotion regulation style was encouraged in women with AN (n = 38), BN (n = 37), and non-eating disordered controls (CG; n = 36). At baseline and after the emotion regulation induction feelings of sadness, desire to abstain from eating (DTA) and desire to binge (DTB) were assessed. Main results reveal that rumination led to a significant increase of DTA in the AN group and of DTB in patients with BN. In the CG, DTA significantly decreased after distraction. Although there were significant increases in subjective sadness in the rumination condition, no changes were found in the distraction condition. The results suggest that rumination in response to sadness has a detrimental effect on eating-related symptoms in eating disorders. (c) 2015 APA, all rights reserved).
Forrest, Lauren N; Jones, Payton J; Ortiz, Shelby N; Smith, April R
The cognitive-behavioral theory of eating disorders (EDs) proposes that shape and weight overvaluation are the core ED psychopathology. Core symptoms can be statistically identified using network analysis. Existing ED network studies support that shape and weight overvaluation are the core ED psychopathology, yet no studies have estimated AN core psychopathology and concerns exist about the replicability of network analysis findings. The current study estimated ED symptom networks among people with anorexia nervosa (AN) and bulimia nervosa (BN) and among a combined group of people with AN and BN. Participants were girls and women with AN (n = 604) and BN (n = 477) seeking residential ED treatment. ED symptoms were assessed with the Eating Disorder Examination-Questionnaire (EDE-Q); 27 of the EDE-Q items were included as nodes in symptom networks. Core symptoms were determined by expected influence and strength values. In all networks, desiring weight loss, restraint, shape and weight preoccupation, and shape overvaluation emerged as the most important symptoms. In addition, in the AN and combined networks, fearing weight gain emerged as an important symptom. In the BN network, weight overvaluation emerged as another important symptom. Findings support the cognitive-behavioral premise that shape and weight overvaluation are at the core of AN psychopathology. Our BN and combined network findings provide a high degree of replication of previous findings. Clinically, findings highlight the importance of considering shape and weight overvaluation as a severity specifier and primary treatment target for people with EDs. © 2018 Wiley Periodicals, Inc.
Klein, DA; Schebendach, JE; Brown, AJ; Smith, GP; Walsh, BT
Although it is possible that binge eating in humans is due to increased responsiveness of orosensory excitatory controls of eating, there is no direct evidence for this because food ingested during a test meal stimulates both orosensory excitatory and postingestive inhibitory controls. To overcome this problem, we adapted the modified sham feeding technique (MSF) to measure the orosensory excitatory control of intake of a series of sweetened solutions. Previously published data showed the feasibility of a “sip-and-spit” procedure in nine healthy control women using solutions flavored with cherry Kool Aid® and sweetened with sucrose (0-20%)1. The current study extended this technique to measure the intake of artificially sweetened solutions in women with bulimia nervosa (BN) and in women with no history of eating disorders. Ten healthy women and 11 women with BN were randomly presented with cherry Kool Aid® solutions sweetened with five concentrations of aspartame (0, 0.01, 0.03, 0.08 and 0.28%) in a closed opaque container fitted with a straw. They were instructed to sip as much as they wanted of the solution during 1-minute trials and to spit the fluid out into another opaque container. Across all subjects, presence of sweetener increased intake (psweetness of solutions did not differ between groups. These results support the feasibility of a MSF procedure using artificially sweetened solutions, and the hypothesis that the orosensory stimulation of MSF provokes larger intake in women with BN than controls. PMID:18773914
Rowe, Sarah L; Jordan, Jennifer; McIntosh, Virginia V W; Carter, Frances A; Frampton, Chris; Bulik, Cynthia M; Joyce, Peter R
To examine the impact of avoidant personality disorder (AVPD) on bulimia nervosa (BN) treatment outcome over 3 years. Women with BN were participating in a randomized treatment trial. The sample was split into: AVPD (n = 37), other PD (n = 37), and no PD (n = 60). Eating disorder symptomatology, depressive symptoms and psychosocial functioning were examined at pretreatment and follow-up. Multiple regression was conducted to control for high axis I comorbidity. There were no significant differences across the groups at pretreatment or follow-up on eating disorder symptoms. AVPD had worse depressive symptoms and psychosocial functioning at pretreatment which continued 3 years post-treatment. Multiple regression analyses revealed that the presence of any lifetime mood disorder contributed to these significant results. These findings suggest AVPD is not a significant predictor of BN outcome. However, AVPD is associated with poorer psychiatric symptoms although much of this variance appears to be attributable to the lifetime presence of any mood disorder. 2009 by Wiley Periodicals, Inc.
Chan, Trista Wai Sze; Ahn, Woo-Young; Bates, John E; Busemeyer, Jerome R; Guillaume, Sebastien; Redgrave, Graham W; Danner, Unna N; Courtet, Philippe
This study examined the underlying processes of decision-making impairments in individuals with anorexia nervosa (AN) and bulimia nervosa (BN). We deconstructed their performance on the widely used decision task, the Iowa Gambling Task (IGT) into cognitive, motivational, and response processes using cognitive modeling analysis. We hypothesized that IGT performance would be characterized by impaired memory functions and heightened punishment sensitivity in AN, and by elevated sensitivity to reward as opposed to punishment in BN. We analyzed trial-by-trial data of IGT obtained from 224 individuals: 94 individuals with AN, 63 with BN, and 67 healthy comparison individuals (HC). The prospect valence learning model was used to assess cognitive, motivational, and response processes underlying IGT performance. Individuals with AN showed marginally impaired IGT performance compared to HC. Their performance was characterized by impairments in memory functions. Individuals with BN showed significantly impaired IGT performance compared to HC. They showed greater relative sensitivity to gains as opposed to losses than HC. Memory functions in AN were positively correlated with body mass index. This study identified differential impairments underlying IGT performance in AN and BN. Findings suggest that impaired decision making in AN might involve impaired memory functions. Impaired decision making in BN might involve altered reward and punishment sensitivity. Copyright © 2013 Wiley Periodicals, Inc.
Zerbe, K J
Eating disorders probably result from a combination of emotional, physical, and sociologic factors and are encouraged by a society that values appearance as a measure of worth. Once believed to be a problem largely among young women, the disorders are being found increasingly among children, young athletes, men, and elderly women. Often accompanied by depression, anxiety, and personality disorders, eating disorders may be difficult to diagnose. Patients with anorexia nervosa often deny that they have a problem, despite obvious physical signs. Patients with bulimia nervosa may hide their binging and purging and have no overt signs. Primary care physicians may be the first to suspect potential problems, including a patient's fixation on food, weight, dieting, physique, and exercise. Sometimes, patients who have struggled in silence for years turn to their trusted physician for support and understanding. The first step in treatment is to address the medical complications caused by the unhealthy eating habits. Once nutritional health has been restored, patients need to reverse their entrenched and distorted body-image ideas through psychotherapy.
Wesemann, Dorette; Grunwald, Martin
Online discussion forums are often used by people with eating disorders. This study analyses 2,072 threads containing a total of 14,903 postings from an unmoderated German "prorecovery" forum for persons suffering from bulimia nervosa (www.ab-server.de) during the period from October 2004 to May 2006. The threads were inductively analyzed for underlying structural types, and the various types found were then analyzed for differences in temporal and quantitative parameters. Communication in the online discussion forum occurred in three types of thread: (1) problem-oriented threads (78.8% of threads), (2) communication-oriented threads (15.3% of threads), and (3) metacommunication threads (2.6% of threads). Metacommunication threads contained significantly more postings than problem-oriented and communication-oriented threads, and they were viewed significantly more often. Moreover, there are temporal differences between the structural types. Topics relating to active management of the disorder receive great attention in prorecovery forums. (c) 2008 by Wiley Periodicals, Inc.
Barajas Iglesias, Belén; Jáuregui Lobera, Ignacio; Laporta Herrero, Isabel; Santed Germán, Miguel Ángel
Previous studies provide relevant information about the relationship between personality and eating disorders (ED). The involvement of personality factors in the etiology and maintenance of ED indicates the need of emphasizing the study of the adolescent's personality when diagnosed of ED. The aims of this study were to analyze the adolescent's personality profiles that differ significantly in anorexia nervosa (AN) and bulimia nervosa (BN), and to explore the most common profiles and their associations with those subtypes of eating disorders (ED). A total of 104 patients with AN and BN were studied by means of the Millon Adolescent Clinical Inventory (MACI). The personality profiles that differ significantly in both AN and BN were submissive, egotistic, unruly, forceful, conforming, oppositional, self-demeaning and borderline. The most frequent profiles in AN were conforming (33.33%), egotistic (22.72%) and dramatizing (18.18%) while in the case of BN those profiles were unruly (18.42%), submissive (18.42%) and borderline (15.78%). We did not find any associations between the diagnostic subgroup (AN, BN) and the fact of having personality profiles that could become dysfunctional. Bearing in mind these results, it may be concluded that there are relevant differences between personality profiles associated with AN and BN during adolescence, so tailoring therapeutic interventions for this specific population would be important.
Striegel-Moore, Ruth H; Dohm, Faith-Anne; Kraemer, Helena C; Schreiber, George B; Crawford, Patricia B; Daniels, Stephen R
The current study examined health services use during the past 12 months in a sample of young women with a history of an adolescent eating disorder (bulimia nervosa [BN] or binge eating disorder [BED]). A community sample of 1,582 young women (mean age = 21.5 years) was classified, based on a screening interview (and, for eating disorder diagnosis, confirmatory diagnostic interview), into one of three groups: BN or BED (n = 67), other psychiatric disorder (n = 443), and no adolescent psychiatric disorder (n = 1,072). A history of BN/BED in adolescence was associated with elevated health services use, but this was a general effect associated with having a psychiatric disorder, not an effect specific to the diagnosis of an eating disorder. Total service days, outpatient psychotherapy visits, and emergency department visits were elevated in the combined group of BN/BED and other psychiatric disorder participants relative to the healthy comparison group. The women with BN/BED did not differ significantly from the women with a non-eating-related psychiatric disorder in the use of these services. The similarity of health services use in young women with BN or BED and those with other psychiatric disorders underscores the clinical and economic impact of these eating disorders. 2004 by Wiley Periodicals, Inc.
Chao, Ariana M; White, Marney A; Grilo, Carlos M
To examine eating-disorder psychopathology and depressive symptoms by smoking status (never, former, or current smoker) in persons with binge eating disorder (BED) and bulimia nervosa (BN). Participants were 575 adult volunteers from the community (mean age=36.0±12years and BMI=32.9±9.5kg/m(2); 80% white; 88% female) who were classified with BED (n=410) or BN (n=165). Participants completed a battery of questionnaires, including items about current and historical cigarette smoking, the Eating Disorder Examination -Questionnaire, and the Beck Depression Inventory. Among those with BED, depressive symptoms were significantly higher in current smokers than former or never smokers (p=.001). There were no significant differences in depressive symptoms by smoking status in participants with BN and no differences in eating-disorder psychopathology by smoking status in either the BED or BN groups. In this non-clinical group of community volunteers, we found that smoking history or status was not associated with eating disorder psychopathology in participants classified with BED and BN but was significantly associated with depressive symptoms in participants with BED. Copyright © 2015. Published by Elsevier Ltd.
Full Text Available The aim of this study was to examine differences in brain neural activation in response to monosodium glutamate (MSG, the representative component of umami, between patients with bulimia nervosa (BN and healthy women (HW controls. We analyzed brain activity after ingestion of an MSG solution using functional magnetic resonance imaging (fMRI in a group of women with BN (n = 18 and a group of HW participants (n = 18. Both groups also provided a subjective assessment of the MSG solution via a numerical rating scale. The BN group subjectively rated the MSG solution lower in pleasantness and liking than the control group, although no difference in subjective intensity was noted. The fMRI results demonstrated greater activation of the right insula in the BN group versus the control group. Compared with the HW controls, the BN patients demonstrated both altered taste perception-related brain activity and more negative hedonic scores in response to MSG stimuli. Different hedonic evaluation, expressed as the relative low pleasing taste of umami tastant and associated with altered insula function, may explain disturbed eating behaviors, including the imbalance in food choices, in BN patients.
Dakanalis, Antonios; Clerici, Massimo; Riva, Giuseppe; Carrà, Giuseppe
This study tested the new DSM-5 severity criterion for bulimia nervosa (BN) based on the frequency of inappropriate weight compensatory behaviors in a treatment-seeking sample. Participants were 345 adults with DSM-5 BN presenting for treatment. They were sub-grouped based on DSM-5 severity levels and compared on a range of variables of clinical interest and demographics. Based on DSM-5 severity definitions, 27.2 % of the sample was categorized with mild, 26.1 % with moderate, 24.9 % with severe, and 21.8 % with extreme severity of BN. Analyses revealed that the four (mild, moderate, severe, and extreme) severity groups of BN significantly differed from each other in eating disordered and body-related attitudes and behaviors, factors involved in the maintenance process of the disorder, comorbid psychiatric disorders, psychological distress, and psychosocial impairment (medium-to-large effect sizes). No significant between-group differences were observed in demographics, body mass index, or at the age when BN first occurred, lending some credence to recent suggestions that age-at-onset of BN may be more a disorder- than a severity-dependent variable. Collectively, our findings provide support for the severity indicator for BN introduced in the DSM-5 as a means of addressing heterogeneity and variability in the severity of the disorder.
Ciao, Anna C; Accurso, Erin C; Fitzsimmons-Craft, Ellen E; Le Grange, Daniel
This study examined predictors of psychological change among 80 adolescents with bulimia nervosa (BN) participating in a randomized-controlled trial comparing family-based treatment (FBT) to supportive psychotherapy (SPT). Psychological outcomes (cognitive eating disorder pathology, depression, and self-esteem) were explored at baseline, post-treatment, and 6-month follow-up. Multi-level growth models examined predictors of rate of change in psychological outcomes and moderators of treatment effects. All psychological outcomes improved through 6-month follow-up (moderate to large effect sizes) across both treatments. Overall, few significant predictors were identified. Older adolescents had faster change in self-esteem relative to younger adolescents (p = 0.03). Adolescents taking psychotropic medication at baseline had faster change in eating concerns relative to adolescents not taking medication (p = 0.02). Age (p = 0.02) and baseline purging severity (p = 0.03) moderated the relationship between treatment condition and change in eating concerns, where younger adolescents and individuals with high baseline purging had greater change when treated with FBT relative to SPT. Age and purging did not significantly moderate change in other psychological outcomes. Bulimic symptom improvement did not predict change in psychological symptoms. Generally, FBT and SPT were equally efficacious with respect to psychological improvement, although FBT may be more efficacious in younger adolescents and those with more frequent purging. Copyright © 2015 Elsevier Ltd. All rights reserved.
Full Text Available As duas abordagens terapêuticas mais estudadas para o tratamento da bulimia nervosa (BN são os tratamentos psicológicos, principalmente a terapia cognitivo-comportamental (TCC e o uso de antidepressivos. Os resultados de duas revisões sistemáticas da literatura mostram que a TCC é melhor que fila de espera e que os antidepressivos são superiores ao placebo na remissão a curto prazo dos sintomas bulímicos. A comparação direta das duas abordagens mostra que, quando usados como abordagens exclusivas, a TCC é clinicamente mais eficaz e mais aceita do que os antidepressivos. A associação dos dois tipos de tratamento é clinicamente mais eficaz que cada um isoladamente, mas a aceitação das abordagens psicológicas exclusivas é maior. Como a BN é um transtorno grave e com baixa taxa de remissão espontânea, o tratamento associado, com abordagem multidimensional e multidisciplinar, pode ser indicado.
Lunn, Susanne; Poulsen, Stig; Daniel, Sarah I F
The aim of the study was to investigate whether patients with bulimia nervosa (BN) could be subdivided into clinically meaningful groups reflecting the complex patterns of eating disorder symptoms and personality characteristics that face the clinician. Seventy patients diagnosed with BN using the Eating Disorder Examination were assessed with measures of negative affect, attachment patterns, and interpersonal problems. An exploratory hierarchical cluster analysis was performed. The study found two main subtypes differing primarily in terms of symptom severity and level of negative affect, but these subtypes were further subdivided into four clinically relevant subtypes: A dietary restraint/negative affect/high symptomatic group, an emotionally overcontrolled group, a low dietary restraint/emotionally underregulated group, and a high functioning/securely attached group. The study indicates that cluster-analytic studies, including a broad range of instruments measuring eating disorder symptoms as well as negative affect, relational patterns, and other personality characteristics, may contribute to an integration of previously suggested models of subtypes in BN. Copyright © 2012 Elsevier Inc. All rights reserved.
Gutiérrez-Maldonado, José; Pla-Sanjuanelo, Joana; Ferrer-García, Marta
Cue-exposure therapy (CET) has proven its efficacy in treating patients with bulimia nervosa and binge eating disorder who are resistant to standard treatment. Furthermore, incorporating virtual reality (VR) technology is increasingly considered a valid exposure method that may help to increase the efficacy of standard treatments in a variety of eating disorders. Although immersive displays improve the beneficial effects, expensive technology is not always necessary. We aimed to assess whether exposure to food related virtual environments could decrease food craving in a non-clinical sample. In addition, we specifically compared the effects of two VR systems (one non-immersive and one immersive) during CET. We therefore applied a one-session CET to 113 undergraduate students. Decreased food craving was found during exposure to both VR environments compared with pre-treatment levels, supporting the efficacy of VR-CET in reducing food craving. We found no significant differences in craving between immersive and non-immersive systems. Low-cost non-immersive systems applied through 3D laptops can improve the accessibility of this technique. By reducing the costs and improving the usability, VR-CET on 3D laptops may become a viable option that can be readily applied in a greater range of clinical contexts.
Wu, Mudan; Giel, Katrin Elisabeth; Skunde, Mandy; Schag, Kathrin; Rudofsky, Gottfried; de Zwaan, Martina; Zipfel, Stephan; Herzog, Wolfgang; Friederich, Hans-Christoph
To investigate neuropsychological mechanisms of impulsivity in patients with bulimia nervosa (BN) and binge-eating disorder (BED). Nineteen BN patients and 31 age- and body-mass-index (BMI)-matched healthy controls (c-BN) as well as 54 overweight and obese BED patients and 43 age- and BMI-matched healthy controls (c-BED) were investigated using an inhibitory control task (stop signal task, SST) and a decision-making under risk task (game of dice task, GDT). Compared to c-BN, BN patients demonstrated significant greater stop signal reaction times in the SST, but no differences for the frequency of risky decisions in the GDT. BED patients did not differ from c-BED in the SST or the GDT. BN but not BED patients differed from their respective control groups concerning the "stopping" component of impulsivity. These differences in motor inhibition may contribute to the behavioral distinctions in binge-eating behavior between BN and BED. Copyright © 2013 Wiley Periodicals, Inc.
Griffith, Emma; Kuyken, Willem; Watkins, Ed; Jones, Alysun
The cognitive model suggests memory biases for weight/shape and food related information could be important in the maintenance of eating disorders. The current study aims to evaluate this and extend previous research by (a) including females with eating disorder not otherwise specified (EDNOS) as a discreet group; (b) considering whether levels of hunger and the pleasantness of the stimulus words are important in word recall. The study includes three groups of females, 16 with bulimia nervosa, 18 with EDNOS and 17 non-dieting general population controls. All participants completed a self-referential encoding and memory recall task. A main effect of word type (p eating disorder groups recalled significantly more weight/shape and food words compared to all other word categories (p eating disorder groups. In relation to the recall of food words, no significant differences were found between groups for levels of hunger. Both eating disorder groups rated the negative weight/shape (p < .01), negative food (p < .01) and neutral body words (p < .01) as more unpleasant than the control group. The implications for cognitive theory and future research are discussed.
Jiménez-Murcia, Susana; Granero, Roser; Moragas, Laura; Steiger, Howard; Israel, Mimi; Aymamí, Neus; Gómez-Peña, Mónica; Sauchelli, Sarah; Agüera, Zaida; Sánchez, Isabel; Riesco, Nadine; Penelo, Eva; Menchón, José M; Fernández-Aranda, Fernando
The objective of the study was to analyse shared commonalities and differences between bulimia nervosa (BN) and certain impulse-related disorders, namely compulsive buying (CB) and gambling disorder (GD), with respect to general psychopathology and personality traits. A total of 188 female patients [50 BN without comorbid CB (BN-CB), 49 BN with comorbid CB (BN+CB), 53 GD and 36 CB] and 50 comparison non-psychiatric women participated in the current study. All patients were diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth revised edition, the Temperament and Character Inventory-Revised, and other clinical indices. A positive-growing trend was observed in psychopathology and personality traits across the four clinical groups. Comorbid BN with CB was associated with highest eating psychopathology and social anxiety. On Novelty Seeking, the CB, GD and BN+CB were similar to each other, whereas BN-CB presented a distinct profile. Moreover, the BN+CB group displayed more dysfunctional personality traits and higher general psychopathology. The clinical groups demonstrated overall higher levels of psychopathology compared with the control group. The results of this study demonstrate that disorders with impulsive traits (CB, GD, BN+CB and BN-CB) follow a linear trend in general psychopathology and specific personality traits, but differ along specific personality and psychopathological dimensions. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.
Vaz-Leal, Francisco J; Rodríguez-Santos, Laura; García-Herráiz, M Angustias; Chimpén-López, Carlos A; Rojo-Moreno, Luís; Beato-Fernández, Luís; Ramos-Fuentes, María Isabel
The study aimed to analyze the role of depression and impulsivity in the psychopathology of bulimia nervosa (BN). Seventy female patients with DSM-IV BN, purging subtype, were assessed for eating-related symptoms, body dissatisfaction, affective symptoms, impulsivity, and personality traits. Factor analysis and structural equation modeling methods were used for statistical analysis. BN appeared as a condition which incorporated 5 general dimensions: a) binge eating and compensatory behaviours; b) restrictive eating; c) body dissatisfaction; d) dissocial personality traits; and e) a cluster of features which was called «emotional instability» The 5 obtained dimensions can be grouped into 2 basic factors: body dissatisfaction/eating behaviour and personality traits/psychopathology. The first one contains the clinical items used for the definition of BN as a clinical condition in the DSM-V and the International Classification of Diseases 10, and reflects the morphology and the severity of the eating-related symptoms. The second dimension includes a cluster of symptoms (depressive symptoms, impulsivity, and borderline, self-defeating and dissocial personality traits) which could be regarded as the «psychopathological core» of BN and may be able to condition the course and the prognosis of BN. Copyright © 2013 SEP y SEPB. Published by Elsevier España. All rights reserved.
Monteleone, Alessio Maria; Monteleone, Palmiero; Serino, Ismene; Scognamiglio, Pasquale; Di Genio, Monica; Maj, Mario
Exposure to trauma during childhood is a risk factor for eating disorders (EDs) in adulthood. The biological mechanisms underlying such increased risk seem to involve the endogenous stress response system (i.e., the hypothalamic-pituitary-adrenal [HPA] axis), which undergoes trauma-induced functional changes that may persist later in life. In the present study, we examined the effects of childhood trauma experiences on HPA-axis activity, comparing saliva cortisol awakening response (CAR) in adult patients with anorexia nervosa (AN) or bulimia nervosa (BN) with CAR in adult healthy controls. Twenty-three patients with symptomatic AN, 21 patients with symptomatic BN, and 29 healthy women collected saliva samples at awakening and again after 15, 30, and 60 min. Participants also completed the Childhood Trauma Questionnaire and eating-related psychopathological rating scales. According to the Childhood Trauma Questionnaire, 13 individuals with AN and 12 individuals with BN, but none of the healthy women, reported childhood maltreatment. Compared with the control group, the non-maltreated AN patient group exhibited an enhanced CAR, whereas the group of non-maltreated BN patients showed a normal CAR. Moreover, both AN and BN patient groups with childhood maltreatment exhibited statistically significant blunting of CAR compared with non-maltreated groups. The present findings add to the evidence supporting the concept that there is a dysregulation of HPA-axis activity in symptomatic patients with EDs and suggest that childhood trauma exposure may contribute to such dysregulation. © 2014 Wiley Periodicals, Inc.
Machado, Bárbara C; Gonçalves, Sónia F; Martins, Carla; Brandão, Isabel; Roma-Torres, António; Hoek, Hans W; Machado, Paulo P
This study is the result of two Portuguese case-control studies that examined the replication of retrospective correlates and preceding life events in anorexia nervosa (AN) and bulimia nervosa (BN) development. This study aims to identify retrospective correlates that distinguish AN and BN METHOD: A case-control design was used to compare a group of women who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for AN (N = 98) and BN (N = 79) with healthy controls (N = 86) and with other psychiatric disorders (N = 68). Each control group was matched with AN patients regarding age and parental social categories. Risk factors were assessed by interviewing each person with the Oxford Risk Factor Interview. Compared to AN, women with BN reported significantly higher rates of paternal high expectations, excessive family importance placed on fitness/keeping in shape, and negative consequences due to adolescent overweight and adolescent objective overweight. Overweight during adolescence emerged as the most relevant retrospective correlate in the distinction between BN and AN participants. Family expectations and the importance placed on keeping in shape were also significant retrospective correlates in the BN group.
Kaye, Walter H; Frank, Guido K; Bailer, Ursula F; Henry, Shannan E; Meltzer, Carolyn C; Price, Julie C; Mathis, Chester A; Wagner, Angela
Anorexia nervosa (AN) and bulimia nervosa (BN) are related disorders with relatively homogenous presentations such as age of onset and gender distribution. In addition, they share symptoms, such as extremes of food consumption, body image distortion, anxiety and obsessions, and ego-syntonic neglect, raises the possibility that these symptoms reflect disturbed brain function that contributes to the pathophysiology of this illness. Recent brain imaging studies have identified altered activity in frontal, cingulate, temporal, and parietal cortical regions in AN and BN. Importantly, such disturbances are present when subjects are ill and persist after recovery, suggesting that these may be traits that are independent of the state of the illness. Emerging data point to a dysregulation of serotonin pathways in cortical and limbic structures that may be related to anxiety, behavioral inhibition, and body image distortions. In specific, recent studies using PET with serotonin specific radioligands implicate alterations of 5-HT1A and 5-HT2A receptors and the 5-HT transporter. Alterations of these circuits may affect mood and impulse control as well as the motivating and hedonic aspects of feeding behavior. Such imaging studies may offer insights into new pharmacology and psychotherapy approaches.
Lourenço, Maria; Azevedo, Álvaro; Brandão, Isabel; Gomes, Pedro S
This case-control study aims to evaluate the oral health status and orofacial problems in a group of outpatients with eating disorders (ED)-either anorexia nervosa (AN) or bulimia nervosa (BN)-further focusing on the influence of vomit. Fifty-five women outpatients with AN or BN diagnosis were invited to participate, of which 33 agreed. ED outpatients and matched controls were submitted to a questionnaire and clinical oral examination. Multivariate analysis identified a significantly higher incidence of teeth-related complications (i.e., tooth decay, dental erosion, and self-reported dentin hypersensitivity), periodontal disease, salivary alterations (i.e., hyposalivation and xerostomia), and oral mucosa-related complications in ED outpatients. Dental erosion, self-reported dentin hypersensitivity, hyposalivation, xerostomia, and angular cheilitis were found to be highly correlated with the vomiting behavior. ED outpatients were found to present a higher incidence of oral-related complications and an inferior oral health status, compared to gender- and age-matched controls. Alterations verified within outpatients were acknowledged to be quite similar to those previously reported within inpatients, in both of nature and severity, thus sustaining that the cranio-maxillofacial region is significantly affected by ED, even in the early/milder forms of the condition, as expectedly verified within outpatients.
Elran-Barak, Roni; Fitzsimmons-Craft, Ellen E; Benyamini, Yael; Crow, Scott J; Peterson, Carol B; Hill, Laura L; Crosby, Ross D; Mitchell, James E; Le Grange, Daniel
We examined eating disorders in midlife and beyond by comparing frequency of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding or eating disorder (OSFED) among midlife eating disorder treatment-seeking individuals and younger controls. We also compared demographic and eating disorder-related characteristics across diagnoses and age groups. Participants included 2,118 treatment-seeking adults who self-reported their eating-related symptoms on the Eating Disorder Questionnaire. Results showed that percent of patients with BN was significantly lower whereas percent of patients with BED and OSFED was significantly higher among midlife relative to younger patients. Percent of patients with AN did not differ between midlife and younger patients. Additionally, midlife and younger patients with BED and OSFED differed on several demographic (e.g., marital status) and eating disorder-related characteristics (e.g., BMI, compulsive exercising). This study suggests that BN is less common whereas BED and OSFED are more common among midlife eating disorder treatment-seeking individuals relative to younger controls. In addition, AN and BN present fairly similarly whereas BED and OSFED present fairly differently among midlife patients relative to younger controls. Attention to these differences and similarities is necessary to understand eating disorders in midlife.
Brown, Tiffany A; Avery, Jade C; Jones, Michelle D; Anderson, Leslie K; Wierenga, Christina E; Kaye, Walter H
Research supports that anorexia nervosa-restricting subtype (AN-R) and bulimia nervosa (BN) are associated with emotion regulation difficulties and alexithymia. However, the impact of diagnosis on the relationship between these constructs is less well understood. The purpose of the present study was to examine whether eating disorder diagnosis moderated the association between admission alexithymia and emotion regulation through discharge. Adult patients with AN-R (n = 54) and BN (n = 60) completed assessments at treatment admission and discharge from a partial hospital program. Eating disorder diagnosis moderated the association between admission alexithymia levels and change in global emotion dysregulation, impulse control difficulties and access to emotion regulation strategies. At higher levels of admission alexithymia, there were no differences between AN-R and BN on emotion dysregulation, whereas at lower levels of alexithymia, AN-R patients demonstrated lower levels of emotion dysregulation. Results imply that difficulties with alexithymia appear to have a greater impact on emotion dysregulation for AN-R patients. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
Vall, Eva; Wade, Tracey D
Set-shifting inefficiencies have been consistently identified in adults with anorexia nervosa (AN). It is less clear to what degree similar inefficiencies are present in those with bulimia nervosa (BN). It is also unknown whether perfectionism is related to set-shifting performance. We employed a commonly used set-shifting measure, the Trail Making Test (TMT), to compare the performance of inpatients with AN and BN with a healthy control sample. We also investigated whether perfectionism predicted TMT scores. Only the BN sample showed significantly suboptimal performance, while the AN sample was indistinguishable from controls on all measures. There were no differences between the AN subtypes (restrictive or binge/purge), but group sizes were small. Higher personal standards perfectionism was associated with better TMT scores across groups. Higher concern over mistakes perfectionism predicted better accuracy in the BN sample. Further research into the set-shifting profile of individuals with BN or binge/purge behaviours is needed. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
Brooks, Samantha J; O'Daly, Owen G; Uher, Rudolf; Friederich, Hans-Christoph; Giampietro, Vincent; Brammer, Michael; Williams, Steven C R; Schiöth, Helgi B; Treasure, Janet; Campbell, Iain C
Previous fMRI studies show that women with eating disorders (ED) have differential neural activation to viewing food images. However, despite clinical differences in their responses to food, differential neural activation to thinking about eating food, between women with anorexia nervosa (AN) and bulimia nervosa (BN) is not known. We compare 50 women (8 with BN, 18 with AN and 24 age-matched healthy controls [HC]) while they view food images during functional Magnetic Resonance Imaging (fMRI). In response to food (vs non-food) images, women with BN showed greater neural activation in the visual cortex, right dorsolateral prefrontal cortex, right insular cortex and precentral gyrus, women with AN showed greater activation in the right dorsolateral prefrontal cortex, cerebellum and right precuneus. HC women activated the cerebellum, right insular cortex, right medial temporal lobe and left caudate. Direct comparisons revealed that compared to HC, the BN group showed relative deactivation in the bilateral superior temporal gyrus/insula, and visual cortex, and compared to AN had relative deactivation in the parietal lobe and dorsal posterior cingulate cortex, but greater activation in the caudate, superior temporal gyrus, right insula and supplementary motor area. Women with AN and BN activate top-down cognitive control in response to food images, yet women with BN have increased activation in reward and somatosensory regions, which might impinge on cognitive control over food consumption and binge eating.
Wagner, Angela; Simmons, Alan N; Oberndorfer, Tyson A; Frank, Guido K W; McCurdy-McKinnon, Danyale; Fudge, Julie L; Yang, Tony T; Paulus, Martin P; Kaye, Walter H
Recent studies show that higher-order appetitive neural circuitry may contribute to restricted eating in anorexia nervosa (AN) and overeating in bulimia nervosa (BN). The purpose of this study was to determine whether sensitization effects might underlie pathologic eating behavior when a taste stimulus is administered repeatedly. Recovered AN (RAN, n=14) and BN (RBN, n=15) subjects were studied in order to avoid the confounding effects of altered nutritional state. Functional magnetic resonance imaging (fMRI) measured higher-order brain response to repeated tastes of sucrose (caloric) and sucralose (non-caloric). To test sensitization, the neuronal response to the first and second administration was compared. RAN patients demonstrated a decreased sensitization to sucrose in contrast to RBN patients who displayed the opposite pattern, increased sensitization to sucrose. However, the latter was not as pronounced as in healthy control women (n=13). While both eating disorder subgroups showed increased sensitization to sucralose, the healthy controls revealed decreased sensitization. These findings could reflect on a neuronal level the high caloric intake of RBN during binges and the low energy intake for RAN. RAN seem to distinguish between high energy and low energy sweet stimuli while RBN do not. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Stiles-Shields, Colleen; DclinPsy, Bryony Bamford; Lock, James; Le Grange, Daniel
This study investigated the prevalence of driven exercise (DE) and its role in treatment outcome for adolescents with bulimia nervosa (BN) and anorexia nervosa (AN). Participants were 201 adolescents with an eating disorder (ED) (80 with BN and 121 with AN) presenting for outpatient treatment at two specialist clinics. All adolescents participated in one of two randomized controlled trials. Descriptive statistics were conducted to evaluate the presence and frequency of baseline DE. Exploratory hierarchical regressions were used to evaluate the effect of baseline DE on treatment outcomes. About 66.3% of adolescents with BN and 23.1% of adolescents with AN presented with baseline DE. The presence of baseline DE predicted significantly worse outcomes for adolescents with AN in terms of ED symptom severity (ps adolescents with BN (ps adolescents with BN and AN. However, DE may be related to different constructs for adolescents with AN than those with BN, suggesting differences in treatment needs. © 2014 Wiley Periodicals, Inc.
Nagata, Jason M; Carlson, Jennifer L; Kao, Jessica M; Golden, Neville H; Murray, Stuart B; Peebles, Rebecka
To characterize exercise behaviors among adolescents with anorexia nervosa (AN), atypical AN, or bulimia nervosa (BN), and determine associations between exercise and medical risk. Cross-sectional electronic medical records of all patients evaluated by the Eating Disorder Program at Stanford between January 1997 and February 2011 were retrospectively reviewed. 1,083 subjects (961 females, 122 males; mean age 15.6) met eligibility criteria. Most patients (89.7%) reported exercise (mean 7.0 h per week over mean 5.4 days per week) prior to presentation. Running (49.9%), calisthenics (40.7%), walking (23.4%), soccer (20.9%), and swimming (18.2%) were the most common exercises; a majority (60.6%) reported team sport participation. Males were less likely to report team exercise (p = .005). Bradycardia (heart rate Adolescents with AN, atypical AN, and BN reported high levels of exercise. Females reported more team sport participation. Greater exercise frequency and team sport participation were associated with bradycardia. Further studies assessing the relationship between exercise and bradycardia may help inform the medical management of adolescents with these eating disorders who are more physically active. © 2017 Wiley Periodicals, Inc.
Jaite, Charlotte; Hoffmann, Falk; Glaeske, Gerd; Bachmann, Christian J
This study aimed at investigating the prevalence, psychiatric comorbidity and outpatient treatment in a sample of German children and adolescents with eating disorders (EDs). Data of a large German statutory health insurance company were analysed and outpatients aged between 10 and 21 years with an ED diagnosis in 2009 were identified. Of 248,558 insured children and adolescents, 1,404 patients (79.9 % females, mean age: 16.7; SD: 3.3 years) matched the inclusion criteria. The large majority of patients with anorexia nervosa (AN) and bulimia nervosa (BN) were females (94.7 and 92.7 %), on which we focus in the following analyses. The prevalence in females was 0.28 % (AN) and 0.20 % (BN). Psychiatric comorbidity was diagnosed in 59.8 % (AN) and 64.1 % (BN) of patients, respectively. Most patients were treated with psychotherapy (AN: 75.7 %, BN: 78.5 %), 16.4 % (AN) and 20.2 % (BN) of our patients received pharmacotherapy with either antidepressants or antipsychotics. 23.5 % (AN) and 21.1 % (BN) received no treatment with psychotherapy, antidepressants or antipsychotics. This naturalistic study suggests that in young ED outpatients, EDs seem to be underdiagnosed and treatment does not necessarily comply with current guidelines. Therefore, dissemination of state-of-the-art knowledge on diagnosis and treatment in children and adolescents with EDs constitutes an important educational goal.
Vaz, F J; García-Herráiz, A; López-Vinuesa, B; Monge, M; Fernández-Gil, M A; Guisado, J A
The aim of the study was to investigate whether the use of purgative methods in patients with eating disorders (anorexia nervosa [AN] and bulimia nervosa [BN]) could be capable of producing changes in the nutritional status of the patients. The group under study was composed of 184 female eating disordered outpatients. One hundred and sixteen patients (63.0%) fulfilled the DSM-IV diagnostic criteria for BN (90 purging type, 26 nonpurging type). Sixty eight patients (37.0%) fulfilled the DSM-IV criteria for the diagnosis of AN (48 restricting type, 20 binging-purging type). The assessment process included anthropometry (body circumferences and skinfold thickness) and body impedance analysis. The two subgroups of AN patients significantly differed from each of the BN subgroups. From a nutritional point of view, some significant differences between the two DSM-IV subtypes of AN existed, but not between the purging type and the nonpurging type of BN. The paper discusses the clinical significance of these findings. An alternative subtypification of AN patients is proposed: 1) restricting type [patients who control their food intake and do not purge]; 2) purging type [patient with true episodes of binging which are followed by purgative behaviors]; and 3) pseudopurging type [patients with subjective binging episodes who use purging methods].
Dêbska, Ewa; Janas, Adam; Bañczyk, Wojciech; Janas-Kozik, Małgorzata
The target of this work is to consider if depressive symptoms intercurrent with patients suffering from Anorexia Nervosa (AN) and Bulimia Nervosa (BN) form a depression complex or whether they are physiological depression accompanying adolescence. We wished to observe the perception of these patients,of their functioning, both social and within their families and also looking for common point in the issues mentioned above trying to locate them within the course of the basic illness. We studied 19 patients suffering from eating disorders, and aged between 12 and 24 years old. 15 of them suffered from the restrictive form of AN and 4 suffered from BN. The control group consisted of 30 healthy girls in the same age interval. In the study authors used the Beck Depression Inventory (BDI) and the Quebec Quality of Life Questionnaire. Comparison of a number of points acquired in the survey using Beck Depression Scale revealed statistic significance at the level p0.05). The authors observed a statistically significant increased frequency of suicidal thoughts in the study group compared to the controls. To diagnose depression, depressive symptoms presented by the patients must give the image of depression at the clinical level. The result of the Beck's scale needs to be confronted with the clinical picture. Depression in adolescence requires differentiation from depressiveness.
Ruuska, J; Kaltiala-Heino, R; Rantanen, P; Koivisto, A M
Body image dissatisfaction is as well a risk factor for eating disorders (ED) and a central feature of ED. The exact nature of body image in adolescent ED is still debated. This study examined attitudinal body image in adolescent anorexia nervosa (AN) and bulimia nervosa (BN), and the association of age, maturational timing, duration of eating disorder, actual weight and general psychological distress with the attitudinal body image in ED. The study group consisted of an outpatient clinical sample of adolescents attending for assessment because of eating disorders. The attitudinal body image of 57 adolescents (girls) aged 14-21 years was studied at the beginning of the treatment. The attitudes to body shape, body size, appearance, tone and femininity were studied by a Likert format scale and by the body dissatisfaction (BD) and drive for thinness scales (DT) from EDI-2 inventory. Bulimics reported more body image dissatisfaction than anorectics. In multivariate analyses BN and higher general psychological distress had strong associations with body image dissatisfaction. Longer duration of ED and earlier menarche were also associated with negative body image. Attitudinal body image differs between adolescent AN and BN. The psychological distress has a great impact on body image in ED, which should be taken into account in assessment and in treatment interventions.
Dalle Grave, Riccardo; Calugi, Simona
To evaluate (1) the Eating Disorder Not Otherwise Specified (EDNOS) prevalence in an eating disorder inpatient unit; (2) the impact of altering the diagnostic criteria for anorexia nervosa and bulimia nervosa on the prevalence of EDNOS. One hundred and eighty six eating disorder patients consecutively hospitalised were included in the study. The prevalence of anorexia nervosa, bulimia nervosa and EDNOS was evaluated with the Eating Disorder Examination (EDE). The EDNOS prevalence was recalculated after the alteration of three diagnostic criteria for anorexia nervosa and one for bulimia nervosa. Seventy eight patients (41.9%) met the diagnostic criteria for anorexia nervosa, 33 (17.8%) for bulimia nervosa and 75 (40.3%) for EDNOS. The alteration of the DSM-IV diagnostic criteria reduced the prevalence of EDNOS to 28 cases (15%). EDNOS is a very frequent diagnostic category in an inpatient setting. Altering the diagnostic criteria for anorexia nervosa and bulimia nervosa reduced significantly the prevalence of EDNOS. 2007 John Wiley & Sons, Ltd and Eating Disorders Association
Cynthia Priscila Ferreira
Full Text Available OBJETIVO: Descrever os sintomas e sinais vocais e laríngeos de pacientes com diagnóstico de bulimia. MÉTODOS: Estudo transversal, descritivo, randomizado, com experimento cego. Avaliou-se 11 indivíduos com diagnóstico de bulimia, com o subtipo purgativo, do sexo feminino e idade variando de 18 a 34 anos, que foram submetidas à avaliação fonoaudiológica e otorrinolaringológica. RESULTADOS: Os sintomas laríngeos e vocais mais relatados foram: o pigarro e a sensação de globus faríngeo relatados por dez sujeitos (90,9%. Na avaliação perceptivo-auditiva, os escores de maior ocorrência foram de grau leve em todos os parâmetros analisados. Os achados laríngeos de maior ocorrência foram os acúmulos de secreção espessa na laringe em cinco paciente (45,4%, seguido de fenda triangular médio-posterior e espessamento de mucosa na região interaritenoidea, ambos, ocorrendo em quatro sujeitos (36,3%. CONCLUSÃO: Os achados laringológicos e perceptivo-auditivos foram menos expressivos que os sintomas vocais e laríngeos relatados pelas pacientes.PURPOSE: To describe vocal and laryngeal signs and symptoms in patients with bulimia. METHODS: A blind, descriptive, randomized, transversal study was carried out. Eleven female subjects with the diagnosis of purgative bulimia nervosa and ages ranging from 18 to 34 years underwent otorhinolaryngological and vocal evaluations. RESULTS: The most common vocal and laryngeal symptoms were throat clearing and globus faringeus, related by 10 subjects (90.9%. In the auditory-perceptive evaluation, the most common scores were characterized as light in all analyzed parameters. The accumulation of thick mucus over the larynx occurred in five patients (45.4%, followed by median-posterior triangular glottic chink and mucosal thickening at the interaytenoid region, in four patients (36.3%. CONCLUSION: The laryngeal and perceptual findings were less expressive than vocal and laryngeal complaints.
Rühl, Ilka; Legenbauer, Tanja; Hiller, Wolfgang
This study investigates whether eating behavior in women with diagnosed bulimia nervosa is influenced by prior exposure to images of ideally thin models. Twenty-six participants diagnosed with bulimia nervosa (BN) and 30 normal controls (NC) were exposed to body-related and neutral TV commercials; then food that typically triggers binge eating was provided, and the amount of food eaten was measured. No significant difference for food intake between NC and BN could be found, but food intake for BN was predicted by the degree of thoughts related to eating behaviors during exposure to the thin ideal. No impact of general body image or eating pathology on food intake could be found. The results emphasize the importance of action-relevance of dysfunctional cognitions for the maintenance of eating-disordered behaviors in women with bulimia nervosa, when exposed to eating-disorder-specific triggers. Copyright © 2011 Elsevier Ltd. All rights reserved.
Espina Eizaguirre, Alberto; Ortego Sáenz de Cabezón, María Asunción; Ochoa de Alda Martínez de Apellaniz, Iñigo; Alemán Méndez, Amagoia
Objetivo: Contrastar las diferencias en el TAS-20 entre familias con una hija con un trastorno alimentario (TA) y un grupo control. Método: una muestra de 64 mujeres que presentaban un TA según criterios diagnósticos del DSM-IV (APA, 1994) [26 con anorexia nerviosa restrictiva (ANR), 14 con anorexia nerviosa bulímica (ANB) y 29 con bulimia nerviosa (BN)] complementada con un grupo “control” formado por 55 mujeres, sus padres y madres, con similares característi...
Wonderlich, Stephen A.; Peterson, Carol B.; Crosby, Ross D.; Smith, Tracey L.; Klein, Marjorie H.; Mitchell, James E.; Crow, Scott J.
Background The purpose of this investigation was to compare a new psychotherapy for bulimia nervosa, Integrative Cognitive-Affective Therapy (ICAT), with an established treatment, Cognitive-Behavioral Therapy-Enhanced (CBT-E). Method Eighty adults with symptoms of bulimia nervosa were randomized to ICAT or CBT-E for 21 sessions over 19 weeks. Bulimic symptoms, measured by the Eating Disorder Examination, were assessed at baseline, end of treatment, and 4-month follow-up. Treatment outcome, as measured by binge eating frequency, purging frequency, global eating disorder severity, emotion regulation, self-oriented cognition, depression, anxiety, and self-esteem, was determined using generalized estimating equations, logistic regression, and a general linear model (intent-to-treat). Results Both treatments were associated with significant improvement in bulimic symptoms as well as all measures of outcome, and no statistically significant differences were observed between the two conditions at end of treatment or follow-up. Intent-to-treat abstinence rates for ICAT (37.5% at end of treatment, 32.5% at follow-up) and CBT-E (22.5% at both end of treatment and follow-up) were not significantly different. Conclusions ICAT was associated with significant improvements in bulimic and associated symptoms that did not differ from those obtained with CBT-E. This initial randomized controlled trial of a new individual psychotherapy for bulimia nervosa suggests that targeting emotion and self-oriented cognition in the context of nutritional rehabilitation may be efficacious and worthy of further study. PMID:23701891
Full Text Available Background & Aims of the Study: Recently, a lot of discussions have been done about the third wave of behavioral and cognitive approaches, particularly in areas with eating disorders. The aim of current research is the effectiveness of acceptance and commitment based training on the maladaptive schemas of female students with bulimia nervosa. Materials & Methods: The design of current study is as quasi-experiment research with pre-test and post-test with control group. Statistical population consist of all high school female students of Arak city in the 2013-14 academic years. Samples were selected at first by multi stage cluster sampling method and after completing young schema questionnaire short form and Diagnostic Interview, were placement using random sampling method in two experimental and control groups (N=20 per group. The experimental group participated in 8 sessions of acceptance and commitment based training and control group received no intervention. The gathered data were analyzed using Multivariate analysis of covariance (MANCOVA. Results: The results show that there exist significant differences between the pre-test and post-test scores of the experimental group. This difference is significant at the level of 0.01. Therefore it seems that acceptance and commitment based training decreased maladaptive schemas of students with bulimia nervosa. Conclusions: The results of current research explain the importance of acceptance and commitment therapy in decreasing maladaptive schema of female students with bulimia nervosa. Thus, interventions based on this approach in schools for students lead to decreasing the psychological problems
Frank, Guido K; Shott, Megan E; Hagman, Jennifer O; Mittal, Vijay A
The pathophysiology of anorexia nervosa remains obscure, but structural brain alterations could be functionally important biomarkers. The authors assessed taste pleasantness and reward sensitivity in relation to brain structure, which may be related to food avoidance commonly seen in eating disorders. The authors used structural MR imaging to study gray and white matter volumes in women with current restricting-type anorexia nervosa (N=19), women recovered from restricting-type anorexia nervosa (N=24), women with bulimia nervosa (N=19), and healthy comparison women (N=24). All eating disorder groups exhibited increased gray matter volume of the medial orbitofrontal cortex (gyrus rectus). Manual tracing confirmed larger gyrus rectus volume, and volume predicted taste pleasantness ratings across all groups. Analyses also indicated other morphological differences between diagnostic categories. Antero-ventral insula gray matter volumes were increased on the right side in the anorexia nervosa and recovered anorexia nervosa groups and on the left side in the bulimia nervosa group relative to the healthy comparison group. Dorsal striatum volumes were reduced in the recovered anorexia nervosa and bulimia nervosa groups and predicted sensitivity to reward in all three eating disorder groups. The eating disorder groups also showed reduced white matter in right temporal and parietal areas relative to the healthy comparison group. The results held when a range of covariates, such as age, depression, anxiety, and medications, were controlled for. Brain structure in the medial orbitofrontal cortex, insula, and striatum is altered in eating disorders and suggests altered brain circuitry that has been associated with taste pleasantness and reward value.
Franko, Debra L.; Keshaviah, Aparna; Eddy, Kamryn T.; Krishna, Meera; Davis, Martha C.; Keel, Pamela K.; Herzog, David B.
Objective Although anorexia nervosa has a high mortality rate, our understanding of the timing and predictors of mortality in eating disorders is limited. The authors investigated mortality in a long-term study of patients with eating disorders. Method Beginning in 1987, 246 treatment-seeking women with anorexia nervosa or bulimia nervosa were interviewed every 6 months for a median of 9.5 years to obtain weekly ratings of eating disorder symptoms, comorbidity, treatment participation, and psychosocial functioning. From January 2007 to December 2010 (median follow-up of 20 years), vital status was ascertained with a National Death Index search. Results Sixteen deaths (6.5%) were recorded (lifetime anorexia nervosa, N=14; bulimia nervosa with no history of anorexia nervosa, N=2). The standardized mortality ratio was 4.37 [95% CI=2.4-7.3] for lifetime anorexia nervosa and 2.33 [95% CI=0.3-8.4] for bulimia nervosa with no history of anorexia nervosa. Risk of premature death among women with lifetime anorexia nervosa peaked within the first 10 years of follow-up resulting in a standardized mortality ratio of 7.7 [95% CI=3.7-14.2]. The standardized mortality ratio varied by duration of illness and was 3.2 [95% CI=0.9-8.3] for women with lifetime anorexia nervosa for 0-15 years (4/119 died), and 6.6 [95% CI=3.2-12.1] for women with lifetime anorexia nervosa for >15-30 years (10/67 died). Multivariate predictors of mortality included alcohol abuse (panorexia nervosa. PMID:23771148
Le, Long Khanh-Dao; Hay, Phillipa; Wade, Tracey; Touyz, Stephen; Mihalopoulos, Cathrine
This study was to model the cost-effectiveness of specialist-delivered cognitive behavioral therapy for bulimia nervosa (CBT-BN) compared to no intervention within the Australian context. An illness-death model was developed to estimate the cost per disability-adjusted life-year (DALY) averted of CBT-BN over 2 years from the healthcare perspective. Target population was adults aged 18-65 years with BN. Results are reported as incremental cost-effectiveness ratios (ICER) in 2013 Australian dollars per DALY averted. Uncertainty and sensitivity analyses were conducted to test the robustness of results. Primary analysis indicated that CBT-BN was associated with greater DALY averted (0.10 DALY per person) and higher costs ($1,435 per person) than no intervention, resulting the mean ICER of $14,451 per DALY averted (95% uncertainty interval [UI]: $8,762 to $35,650). Uncertainty analysis indicated CBT-BN is 99% likely to be cost-effective at a threshold of $50,000 per DALY averted. Including the patients' time and travel costs resulted in the mean ICER of $18,858 per DALY averted (95% UI: $11,235 to $46,026). Sensitivity analysis indicated the intervention was not cost-effective if over 80% people discontinued treatment. Other analyses including a reduced time horizon, increased remission rates, and 4-month effect size of CBT-BN increases the ICERs but these ICERs remained well below under a threshold of $50,000 per DALY averted. This study has demonstrated that CBT-BN for adults with BN is a cost-effective treatment intervention. Further research is required to investigate the practicability of CBT-ED and the cost-effectiveness of other formats of CBT-BN delivery. © 2017 Wiley Periodicals, Inc.
Mond, Jonathan M; Hay, Phillipa J; Rodgers, Bryan; Owen, Cathy; Beumont, Pierre J V
To examine the beliefs of women concerning causes and risk factors for eating-disordered behaviour. Face-to-face interviews were conducted with a community sample of 208 women aged 18-45 years. Respondents were presented with a vignette describing a fictional person meeting diagnostic criteria for bulimia nervosa (BN) and were asked to indicate whether each of several factors was 'very likely', 'likely' or 'not likely' to be a cause of the problem described, which factor was most likely to be a cause, and whether particular subgroups of people would be 'more likely', 'less likely' or 'equally likely' to have or develop the problem described. 'Having low self-esteem' was considered very likely to be a cause of BN by 75.0% of respondents, and the most likely cause by 40.5% of respondents. Other factors perceived as significant were 'problems from childhood', 'portrayal of women in the media', 'being overweight as a child or adolescent' and 'day-to-day problems', while genetic factors and pre-existing psychological problems were perceived to be of minor significance. Most respondents believed that women aged under 25 years were at greatest risk of having or developing BN. Women's beliefs concerning causes and risk factors for BN are generally consistent with empirical evidence. However, information concerning the increased risk associated with pre-existing anxiety and affective disorders might usefully be included in prevention programs. Systematic investigation of the benefits of addressing individuals' beliefs concerning risk factors for eating disorders - as opposed to risk factors per se - would be of interest.
Steiger, H; Gauvin, L; Israël, M; Koerner, N; Ng Ying Kin, N M; Paris, J; Young, S N
Bulimia nervosa (BN) is reported to co-occur with childhood abuse and alterations in central serotonin (5-hydroxytryptamine [5-HT]) and cortisol mechanisms. However, findings also link childhood abuse to anomalous 5-HT and cortisol function, and this motivated us to explore relationships between childhood abuse and neurobiological variations in BN. Thirty-five bulimic and 25 nonbulimic women were assessed for childhood physical and sexual abuse, eating symptoms, and comorbid psychopathological tendencies. These women provided blood samples for measurement of platelet hydrogen-3-paroxetine binding and serial prolactin and cortisol responses following oral administration of the partial 5-HT agonist meta-chlorophenylpiperazine (m-CPP). Bulimic women showed markedly lower mean +/- SD density (B(max)) of paroxetine-binding sites (631.12 +/- 341.58) than did normal eaters (1213.00 +/- 628.74) (t(54) = -4.47; P =.001). Paroxetine binding did not vary with childhood abuse. In contrast, measures of peak change on prolactin levels after m-CPP administration (Delta-peak prolactin) indicated blunted response in abused bulimic women (7.26 +/- 7.06), nonabused bulimic women (5.62 +/- 3.95), and abused women who were normal eaters (5.73 +/- 5.19) compared with nonabused women who were normal eaters (13.57 +/- 9.94) (F(3,51) = 3.04, P =.04). Furthermore, individuals reporting childhood abuse showed decreased plasma cortisol levels relative to nonabused women who were normal eaters. Findings imply that BN and childhood abuse are both generally associated with reduced 5-HT tone but that childhood abuse may be somewhat more specifically linked to reduced cortisol levels (ie, hypothalamic-pituitary-adrenal axis) activity.
Amianto, Federico; Caroppo, Paola; D'Agata, Federico; Spalatro, Angela; Lavagnino, Luca; Caglio, Marcella; Righi, Dorico; Bergui, Mauro; Abbate-Daga, Giovanni; Rigardetto, Roberto; Mortara, Paolo; Fassino, Secondo
Recent studies focussing on neuroimaging features of eating disorders have observed that anorexia nervosa (AN) is characterized by significant grey matter (GM) atrophy in many brain regions, especially in the cerebellum and anterior cingulate cortex. To date, no studies have found GM atrophy in bulimia nervosa (BN) or have directly compared patients with AN and BN. We used voxel-based morphometry (VBM) to characterize brain abnormalities in AN and BN patients, comparing them with each other and with a control group, and correlating brain volume with clinical features. We recruited 17 AN, 13 BN and 14 healthy controls. All subjects underwent high-resolution magnetic resonance imaging (MRI) with a T1-weighted 3D image. VBM analysis was carried out with the FSL-VBM 4.1 tool. We found no global atrophy, but regional GM reduction in AN with respect to controls and BN in the cerebellum, fusiform area, supplementary motor area, and occipital cortex, and in the caudate in BN compared to AN and controls. Both groups of patients had a volumetric increase bilaterally in somatosensory regions with respect to controls, in areas that are typically involved in the sensory-motor integration of body stimuli and in mental representation of the body image. Our VBM study documented, for the first time in BN patients, the presence of volumetric alterations and replicated previous findings in AN patients. We evidenced morphological differences between AN and BN, demonstrating in the latter atrophy of the caudate nucleus, a region involved in reward mechanisms and processes of self-regulation, perhaps involved in the genesis of the binge-eating behaviors of this disorder. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Klein, D A; Schebendach, J E; Brown, A J; Smith, G P; Walsh, B T
Although it is possible that binge eating in humans is due to increased responsiveness of orosensory excitatory controls of eating, there is no direct evidence for this because food ingested during a test meal stimulates both orosensory excitatory and postingestive inhibitory controls. To overcome this problem, we adapted the modified sham feeding technique (MSF) to measure the orosensory excitatory control of intake of a series of sweetened solutions. Previously published data showed the feasibility of a "sip-and-spit" procedure in nine healthy control women using solutions flavored with cherry Kool Aid and sweetened with sucrose (0-20%). The current study extended this technique to measure the intake of artificially sweetened solutions in women with bulimia nervosa (BN) and in women with no history of eating disorders. Ten healthy women and 11 women with BN were randomly presented with cherry Kool Aid solutions sweetened with five concentrations of aspartame (0, 0.01, 0.03, 0.08 and 0.28%) in a closed opaque container fitted with a straw. They were instructed to sip as much as they wanted of the solution during 1-minute trials and to spit the fluid out into another opaque container. Across all subjects, presence of sweetener increased intake (psolutions than controls (p=0.03 for total intake across all solutions). Self-report ratings of liking, wanting and sweetness of solutions did not differ between groups. These results support the feasibility of a MSF procedure using artificially sweetened solutions, and the hypothesis that the orosensory stimulation of MSF provokes larger intake in women with BN than controls.
Raevuori, Anu; Suokas, Jaana; Haukka, Jari; Gissler, Mika; Linna, Milla; Grainger, Marjut; Suvisaari, Jaana
We aimed to examine the prevalence and incidence of type 2 diabetes (T2D) in a large patient cohort treated for binge eating disorder (BED), bulimia nervosa (BN), and anorexia nervosa. Patients (N = 2,342) treated at the Eating Disorder Unit of Helsinki University Central Hospital over the period up to 16 years were compared with matched general population controls (N = 9,368) in three stages: before entering to the treatment for an eating disorder, after the entrance until the end of the study period, and combined any time before, during, and after the treatment. The study population was linked with the oral TSD medication data of 17 years from The Medical Reimbursement Register. Data were analyzed using conditional and Poisson regression models. Before entering to the treatment for eating disorders, the risk of T2D was substantially increased in patients compared with controls (OR 6.6, 95% CI 4.0-10.7). At the end of the study period, the lifetime prevalence of T2D was 5.2% among patients, 1.7% among controls (OR 3.4, 95% CI 2.6-4.4), and in male patients, it was significantly higher compared with females. Of those treated for BED, every third had T2D by the end of the study period (OR 12.9, 95% CI 7.4-22.5), whereas the same was true for 4.4% of those with BN (OR 2.4, 95% CI 1.7-3.5). Our findings provide strong support for the association between T2D and clinically significant binge eating. Disturbed glucose metabolism may contribute to the onset and maintenance of BED and BN. © 2014 Wiley Periodicals, Inc.
Dakanalis, Antonios; Colmegna, Fabrizia; Zanetti, Maria Assunta; Di Giacomo, Ester; Riva, Giuseppe; Clerici, Massimo
A new severity specifier for bulimia nervosa (BN), based on the frequency of inappropriate weight compensatory behaviours (e.g., laxative misuse, self-induced vomiting, fasting, diuretic misuse, and excessive exercise), has been added to the most recent (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a means of addressing variability and heterogeneity in the severity of the disorder. While existing research provides support for the DSM-5 severity specifier for BN in adult patients, evidence for its validity and clinical utility in youth is currently lacking. To address this gap, data from 272 treatment-seeking adolescents with DSM-5 BN (94.2% female, M age = 15.3 years, SD 1.7) were analysed to examine whether these patients, sub-grouped based on the DSM-5 severity definitions, would show meaningful differences in a broad range of clinical variables and demographic and physical characteristics. Analyses revealed that participants categorized with mild, moderate, severe, and extreme severity of BN significantly differed from each other in 15 variables regarding eating disorder pathological features and putative maintenance factors (i.e., core low self-esteem, perfectionism, social appearance anxiety, body surveillance, and mood intolerance), health-related quality of life and comorbid psychiatric (i.e., affective and anxiety) disorders (large effect sizes). Between-group differences in demographics, body mass index, or age-of-BN onset were not observed. Collectively, our findings provide support for the utility of the frequency of inappropriate weight compensatory behaviours as a severity indicator for BN and suggest that age-at-onset of BN is probably more disorder- than severity-dependent. Implications for future research are outlined.
Fetissov, Sergueï O.; Hallman, Jarmila; Oreland, Lars; af Klinteberg, Britt; Grenbäck, Eva; Hulting, Anna-Lena; Hökfelt, Tomas
The hypothalamic arcuate nucleus is involved in the control of energy intake and expenditure and may participate in the pathogenesis of eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN). Two systems are of particular interest in this respect, synthesizing α-melanocyte-stimulating hormone (α-MSH) and synthesizing neuropeptide Y, respectively. We report here that 42 of 57 (74%) AN and/or BN patients studied had in their plasma Abs that bind to melanotropes and/or corticotropes in the rat pituitary. Among these sera, 8 were found to bind selectively to α-MSH-positive neurons and their hypothalamic and extrahypothalamic projections as revealed with immunostaining on rat brain sections. Adsorption of these sera with α-MSH peptide abolished this immunostaining. In the pituitary, the immunostaining was blocked by adsorption with α-MSH or adrenocorticotropic hormone. Additionally, 3 AN/BN sera bound to luteinizing hormone-releasing hormone (LHRH)-positive terminals in the rat median eminence, but only 2 of them were adsorbed with LHRH. In the control subjects, 2 of 13 sera (16%) displayed similar to AN/BN staining. These data provide evidence that a significant subpopulation of AN/BN patients have autoantibodies that bind to α-MSH or adrenocorticotropic hormone, a finding pointing also to involvement of the stress axis. It remains to be established whether these Abs interfere with normal signal transduction in the brain melanocortin circuitry/LHRH system and/or in other central and peripheral sites relevant to food intake regulation, to what extent such effects are related to and/or could be involved in the pathophysiology or clinical presentation of AN/BN, and to what extent increased stress is an important factor for production of these autoantibodies. PMID:12486250
Brand-Gothelf, Ayelet; Parush, Shula; Eitan, Yehudith; Admoni, Shai; Gur, Eitan; Stein, Daniel
Individuals with anorexia nervosa (AN) and bulimia nervosa (BN) may exhibit reduced ability to modulate sensory, physiological, and affective responses. The aim of the present study is to assess sensory modulation disorder (SMD) symptoms in patients with AN and BN. We assessed female adolescent and young adult inpatients with restrictive type anorexia nervosa (AN-R; n = 20) and BN (n = 20) evaluated in the acute stage of their illness, and 27 female controls. Another group of 20 inpatients with AN-R was assessed on admission and discharge, upon achieving their required weight. Participants completed standardized questionnaires assessing the severity of their eating disorder (ED) and the sensory responsiveness questionnaire (SRQ). Inpatients with AN-R demonstrated elevated overall sensory over-responsiveness as well as elevated scores on the taste/gustatory, vestibular/kinesthetic and somatosensory/tactile SRQ modalities compared with patients with BN and controls. Significant correlations between the severity of sensory over-responsiveness and ED-related symptomatology were found in acutely-ill patients with AN-R and to a lesser extent, following weight restoration. Elevated sensory over-responsiveness was retained in weight-restored inpatients with AN-R. Inpatients with BN demonstrated greater sensory under-responsiveness in the intensity subscale of the SRQ, but not in the frequency and combined SRQ dimensions. Female inpatients with AN-R exhibited sensory over-responsiveness both in the acute stage of their illness and following weight restoration, suggesting that sensory over-responsiveness may represent a trait related to the illness itself above and beyond the influence of malnutrition. The finding for sensory under-responsiveness in BN is less consistent. © 2015 Wiley Periodicals, Inc.
Full Text Available INTRODUCTION: Little is known about the contribution of impulsivity, inattention and comorbid attention deficit/hyperactivity disorder (ADHD in the development and maintenance of bulimia nervosa (BN. In particular, their specific contribution to disordered eating symptoms and whether they have additive effects to the general psychopathological burden remains unclear. METHODS: Fifty-seven female patients seeking treatment for BN and 40 healthy controls completed diagnostic questionnaires and interviews that investigated: a ADHD, b impulsivity, c eating disorders and d general psychopathology. Attentional processes and impulsivity were assessed by a comprehensive computer-based neuropsychological battery. RESULTS: Twenty-one percent of patients with BN met the clinical cut-off for previous childhood ADHD compared to 2.5% of healthy controls. Adult ADHD according to DSM IV was also more prevalent in patients with BN, with an odds ratio of 4.2. Patients with BN and previous childhood ADHD were more impulsive and inattentive than patients with BN alone. These patients also displayed more severely disordered eating patterns and more general psychopathological symptoms compared with those without ADHD. Severity of eating disorder symptoms was better explained by inattentiveness than by either impulsivity or hyperactivity. DISCUSSION: Our data suggest an elevated rate of former childhood and current ADHD-symptoms in treatment-seeking patients with BN. Stronger impulsivity and inattention associated with more severe neuropsychological deficits and eating disorder symptoms indicate an additive risk that is clinically relevant for these patients. Thus, clinicians should identify comorbid patients who might profit from additional ADHD-specific treatments.
Nagl, Michaela; Jacobi, Corinna; Paul, Martin; Beesdo-Baum, Katja; Höfler, Michael; Lieb, Roselind; Wittchen, Hans-Ulrich
We aimed to assess the prevalence, incidence, age-of-onset and diagnostic stability of threshold and subthreshold anorexia nervosa (AN) and bulimia nervosa (BN) in the community. Data come from a prospective-longitudinal community study of 3021 subjects aged 14-24 at baseline, who were followed up at three assessment waves over 10 years. Eating disorder (ED) symptomatology was assessed with the DSM-IV/M-CIDI at each wave. Diagnostic stability was defined as the proportion of individuals still affected with at least symptomatic eating disorders (EDs) at follow-ups. Baseline lifetime prevalence for any threshold ED were 2.9 % among females and 0.1 % among males. For any subthreshold ED lifetime prevalence were 2.2 % for females and 0.7 % for males. Symptomatic expressions of EDs (including core symptoms of the respective disorder) were most common with a lifetime prevalence of 11.5 % among females and 1.8 % among males. Symptomatic AN showed the earliest onset with a considerable proportion of cases emerging in childhood. 47 % of initial threshold AN cases and 42 % of initial threshold BN cases showed at least symptomatic expressions of any ED at any follow-up assessment. Stability for subthreshold EDs and symptomatic expressions was 14-36 %. While threshold EDs are rare, ED symptomatology is common particularly in female adolescents and young women. Especially threshold EDs are associated with a substantial risk for stability. A considerable degree of symptom fluctuation is characteristic especially for subthreshold EDs.
Mathisen, Therese Fostervold; Rosenvinge, Jan H; Friborg, Oddgeir; Pettersen, Gunn; Stensrud, Trine; Hansen, Bjørge Herman; Underhaug, Karoline E; Teinung, Elisabeth; Vrabel, KariAnne; Svendsen, Mette; Bratland-Sanda, Solfrid; Sundgot-Borgen, Jorunn
Knowledge about physical fitness in women with bulimia nervosa (BN) or binge-eating disorder (BED) is sparse. Previous studies have measured physical activity largely through self-report, and physical fitness variables are mainly restricted to body mass index (BMI) and bone mineral density. We expanded the current knowledge in these groups by including a wider range of physical fitness indicators and objective measures of physical activity, assessed the influence of a history of anorexia nervosa (AN), and evaluated predictive variables for physical fitness. Physical activity, blood pressure, cardiorespiratory fitness (CRF), muscle strength, body composition, and bone mineral density were measured in 156 women with BN or BED, with mean (SD) age 28.4 years (5.7) and BMI 25.3 (4.8) kg m -2 . Level of physical activity was higher than normative levels, still Fitness in women with BN were on an average comparable with recommendations or normative levels, while women with BED had lower CRF and higher BMI, VAT, and body fat percentage. We found 10-12% with masked obesity. A history of AN did not predict current physical fitness, still values for current body composition were lower when comparing those with history of AN to those with no such history. Overall, participants with BN or BED displayed adequate physical fitness; however, a high number had unfavorable CRF and body composition. This finding calls for inclusion of physical fitness in routine clinical examinations and guided physical activity and dietary recommendations in the treatment of BN and BED. © 2018 The Authors International Journal of Eating Disorders Published by Wiley Periodicals, Inc.
Full Text Available Background The present paper reports the results of research aimed at identifying intra-group differences among females suffering from different eating disorders (anorexia nervosa, bulimia nervosa or binge eating disorder in terms of the subjects’ psychological traits, adoption of socio-cultural norms (through media pressure, internationalization of norms, and exposure to information concerning body image standards, and the level of body dissatisfaction. The following research question was asked: is it possible to distinguish specific profiles of psychological characteristics, as well as levels of body dissatisfaction, social pressure, media exposure and internalization of common standards of body image? Participants and procedure The clinical population consisted of 121 females aged 20-26. The research was conducted in the years 2007-2012. The following research methods and procedures were applied: 1 a clinical interview, 2 the Contour Drawing Rating Scale, 3 the Eating Disorder Inventory (EDI, 4 a Polish translation of the Socio-cultural Attitudes Towards Appearance Questionnaire (SATAQ-3. Results Cluster analysis of the research data allowed four significantly different clusters to be distinguished in the group of 121 examined females suffering from eating disorders. In the next step, analysis of variance (the ANOVA test was used to compare the differences between the examined clusters in terms of the investigated variables and their indicators. Conclusions Due to significant differences between the examined females in terms of the strength levels and the configuration of psychological and socio-cultural variables investigated in the present study, the females were classified into four different psychological types referred to as neurotic, perfectionist, impulsive and adolescent-narcissistic.
Lladó, Gina; González-Soltero, Rocío; Blanco Fernández de Valderrama, María José
Introduction: Adolescence is a vulnerable period for the onset of eating disorders (ED) such as anorexia and bulimia nervosas. Body dissatisfaction, a precipitating factor for ED, leads adolescents to seek information on the Internet about diets. In this context, pro-Ana (proanorexia) and pro-Mia (probulimia) are on-line pages that promulgate highly harmful contents for health related to weight loss and ED. Objectives: The aim of this study was to analyze quantity, quality and social diffusion strategies used by pro-Ana and pro-Mia webpages. Methods: A web search was done in the Google Chrome browser, using the keywords “anorexia”, “bulimia”, “eating disorders”, “Ana and Mia”, “pro-Ana and pro-Mia”, “anorexic nation”, “obesity”, “healthy lifestyles” and “healthy nutrition”. The top 20 results for each search were selected and analyzed according to positioning rates (PageRank, PR). The quality of these resources was analyzed by a previously published questionnaire. Finally, a study of the diffusion in social networks like Facebook and Twitter was performed for pro-Ana and pro-Mia pages using SharedCount. Results: Searches for pro-Ana and pro-Mia reported more than a million entries. The pages were poorly positioned. Blog contents were the most shared between all the analyzed pages. Conclusions: pro-Ana and pro-Mia are resources with a clear intention to establish a contact with people with an eating disorder or who are at risk for developing one, in order to strengthen the communication through the blogosphere.
Haynos, Ann F; Pearson, Carolyn M; Utzinger, Linsey M; Wonderlich, Stephen A; Crosby, Ross D; Mitchell, James E; Crow, Scott J; Peterson, Carol B
Evidence suggests that eating disorder subtypes reflecting under-controlled, over-controlled, and low psychopathology personality traits constitute reliable phenotypes that differentiate treatment response. This study is the first to use statistical analyses to identify these subtypes within treatment-seeking individuals with bulimia nervosa (BN) and to use these statistically derived clusters to predict clinical outcomes. Using variables from the Dimensional Assessment of Personality Pathology-Basic Questionnaire, K-means cluster analyses identified under-controlled, over-controlled, and low psychopathology subtypes within BN patients (n = 80) enrolled in a treatment trial. Generalized linear models examined the impact of personality subtypes on Eating Disorder Examination global score, binge eating frequency, and purging frequency cross-sectionally at baseline and longitudinally at end of treatment (EOT) and follow-up. In the longitudinal models, secondary analyses were conducted to examine personality subtype as a potential moderator of response to Cognitive Behavioral Therapy-Enhanced (CBT-E) or Integrative Cognitive-Affective Therapy for BN (ICAT-BN). There were no baseline clinical differences between groups. In the longitudinal models, personality subtype predicted binge eating (p = 0.03) and purging (p = 0.01) frequency at EOT and binge eating frequency at follow-up (p = 0.045). The over-controlled group demonstrated the best outcomes on these variables. In secondary analyses, there was a treatment by subtype interaction for purging at follow-up (p = 0.04), which indicated a superiority of CBT-E over ICAT-BN for reducing purging among the over-controlled group. Empirically derived personality subtyping appears to be a valid classification system with potential to guide eating disorder treatment decisions. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:506-514). © 2016 Wiley Periodicals, Inc.
Jakovina, Trpimir; Crnković Batista, Maja; RaŽić Pavičić, Andrea; Žurić Jakovina, Iva; Begovac, Ivan
The aim of this study was to examine whether there is a difference in the dimensions of attachment and difference in emotional regulation between the group of female patients suffering from bulimia nervosa (BN) and the control group. We also wanted to examine whether emotional regulation has a mediating role in the relationship between dimensions of attachment and severity of BN symptoms. The study included a total of 100 female participants from 15 to 25 years of age (M=20.40, SD=3.26). The clinical group consisted of 50 patients suffering from BN, and the control group consisted of 50 healthy female subjects. Female patients suffering from BN achieved higher scores in the dimensions of anxiety (t 98 =-5.12, p=0.00) and avoidance (t 98 =-4.30, p=0.00). Dimension of attachment related anxiety (β=0.44, p=0.00) proved to be a statistically significant predictor of BN symptoms. Subjects of the clinical group also achieved significantly higher (t 98 =7.41, p=0.00) emotional dysregulation than participants of the control group. We also found that the mediation effect of emotional regulation on the association between anxiety and BN symptoms was statistically significant (z'=4.43, p=0.00). Patients suffering from BN showed significantly higher levels of attachment related anxiety and avoidance as well as significantly higher level of difficulties in emotional regulation than healthy controls. Attachment anxiety proved to be a significant predictor of symptoms BN, suggesting that the attachment related anxiety is stronger correlate of BN symptoms than avoidance, and may represent a risk factor for more severe BN symptoms. It was also found that the relationship between attachment related anxiety and BN symptoms were mediated by emotional regulation.
Eddy, K T; Swanson, S A; Crosby, R D; Franko, D L; Engel, S; Herzog, D B
Anorexia nervosa (AN) and bulimia nervosa (BN) are marked by longitudinal symptom fluctuations. DSM-IV-TR does not address how to classify eating disorder (ED) presentations in individuals who no longer meet full criteria for these disorders. To consider this issue, we examined subthreshold presentations in women with initial diagnoses of AN and BN. A total of 246 women with AN or BN were followed for a median of 9 years; weekly symptom data were collected at frequent intervals using the Longitudinal Interval Follow-up Evaluation of Eating Disorders (LIFE-EAT-II). Outcomes were ED presentations that were subthreshold for 3 months, including those narrowly missing full criteria for AN or BN, along with binge eating disorder (BED) and purging disorder. During follow-up, most women (77.6%) experienced a subthreshold presentation. Subthreshold presentation was related to intake diagnosis (Wald chi2=8.065, df=2, p=0.018). Individuals with AN most often developed subthreshold presentations resembling AN; those with BN were more likely to develop subthreshold BN. Purging disorder was experienced by half of those with BN and one-quarter of those with AN binge/purge type (ANBP); BED occurred in 20% with BN. Transition from AN or BN to most subthreshold types was associated with improved psychosocial functioning (p<0.001). Subthreshold presentations in women with lifetime AN and BN were common, resembled the initial diagnosis, and were associated with modest improvements in psychosocial functioning. For most with lifetime AN and BN, subthreshold presentations seem to represent part of the course of illness and to fit within the original AN or BN diagnosis.
Steinhausen, Hans-Christoph; Jensen, Christina Mohr
To study recent time trends in the incidence of diagnosed anorexia nervosa (AN) and bulimia nervosa (BN) based on nationwide psychiatric register data. The Danish Psychiatric Central Research Registry was used to identify the incidence of diagnosed cases with AN and BN at the ages of 4-65 years from 1995 to 2010. Age- and sex-adjusted incidence rates per 100,000 person-years were calculated and were adjusted for time trends in the total number of people diagnosed in psychiatry. Time trends were analyzed using JoinPoint regression analysis. A total of N = 5,902 persons had a first-time incidence of AN, and a total of N = 5,113 had first-time incidence of BN. Incidence rates increased for AN from 6.4 to 12.6 per 100,000 person-years, and for BN from 6.3 to 7.2 per 100,000 person-years. In 2010, the male-to-female ratio was 1:8 for AN, and 1:20 for BN. There was an earlier onset for AN than for BN, and age at incidence decreased during the observation period for AN but not for BN. A sizeable part of the increasing incidence rates for AN and in particular, the younger AN age groups, could be attributed to an increase in the total number of N = 249,607 persons with first-time diagnoses in psychiatry. Incidence rates had increased slightly for AN, but were stable for BN across 16 years in this nationwide study and to a large extent were reflective of a general increase in diagnosed mental disorders. © 2015 Wiley Periodicals, Inc.
Brewerton, Timothy D; Dansky, Bonnie S; O'Neil, Patrick M; Kilpatrick, Dean G
Studies of birth patterns in anorexia nervosa have shown relative increases between March and August, while studies in Bulimia Nervosa (BN) have been negative. Since there are no studies using representative, nonclinical samples, we looked for seasonal birth patterns in women with BN and in those who ever endorsed bingeing or purging. A national, representative sample of 3,006 adult women completed structured telephone interviews including screenings for bulimia nervosa (BN) and questions about month, date, and year of birth. Season of birth was calculated using traditional definitions. Differences across season of birth between subjects with (n = 85) and without BN (n = 2,898), those with (n = 749) and without bingeing (n = 2,229), and those with (n = 267) and without any purging (n = 2,715) were compared using chi-square analyses. There were significant differences across season of birth between subjects: (1) with and without BN (p = 0.033); (2) with and without bingeing (p = 0.034), and; (3) with and without purging (p = 0.001). Fall had the highest relative number of births for all categories, while spring had the lowest. In a national representative study of nontreatment seeking subjects significant differences in season of birth were found for subjects with lifetime histories of BN, binge eating and purging. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012). Copyright © 2011 Wiley Periodicals, Inc.
Bruce, Kenneth R; Steiger, Howard; Israël, Mimi; Groleau, Patricia; Ng Ying Kin, N M K; Ouellette, Anne-Sophie; Sycz, Lindsay; Badawi, Ghislaine
Evidence associates Bulimia Nervosa (BN) with altered functioning of the hypothalamic-pituitary-adrenal (HPA) axis, but the clinical implications of such alterations need to be better understood. We contrasted cortisol responses to the dexamethasone suppression test (DST) in bulimic and non-eating disordered women and examined relationships among DST cortisol responses, eating symptoms and co-morbid disturbances. Sixty women with Bulimia Spectrum (BS) Disorders (either BN or normal weight Eating Disorder NOS with regular binge eating or purging) and 54 non-eating disordered women of similar age and body mass index participated in a 0.5 mg DST, and completed interviews and questionnaires assessing eating symptoms and co-morbid psychopathology. Compared with the normal-eater group, the BS women demonstrated significantly less DST suppression. Among BS women, DST non-suppression was associated with more severe depression, anxiety and eating preoccupations. Our findings show BS women to show less DST suppression compared to normal eater women, and results link extent of non-suppression, in BS individuals, to severity of depression, anxiety and eating preoccupations. Copyright © 2012 Elsevier Inc. All rights reserved.
It is the position of the American Dietetic Association that nutrition intervention, including nutritional counseling, by a registered dietitian (RD) is an essential component of the team treatment of patients with anorexia nervosa, bulimia nervosa, and other eating disorders during assessment and treatment across the continuum of care. Diagnostic criteria for eating disorders provide important guidelines for identification and treatment. However, it is thought that a continuum of disordered eating may exist that ranges from persistent dieting to subthreshold conditions and then to defined eating disorders, which include anorexia nervosa, bulimia nervosa, and binge eating disorder. Understanding the complexities of eating disorders, such as influencing factors, comorbid illness, medical and psychological complications, and boundary issues, is critical in the effective treatment of eating disorders. The nature of eating disorders requires a collaborative approach by an interdisciplinary team of psychological, nutritional, and medical specialists. The RD is an integral member of the treatment team and is uniquely qualified to provide medical nutrition therapy for the normalization of eating patterns and nutritional status. RDs provide nutritional counseling, recognize clinical signs related to eating disorders, and assist with medical monitoring while cognizant of psychotherapy and pharmacotherapy that are cornerstones of eating disorder treatment. Specialized resources are available for RDs to advance their level of expertise in the field of eating disorders. Further efforts with evidenced-based research must continue for improved treatment outcomes related to eating disorders along with identification of effective primary and secondary interventions.
Gómez Candela, Carmen; Palma Milla, Samara; Miján-de-la-Torre, Alberto; Rodríguez Ortega, Pilar; Matía Martín, Pilar; Loria Cohen, Viviana; Campos Del Portillo, Rocío; Virgili Casas, M ª Nuria; Martínez Olmos, Miguel Á; Mories Álvarez, M ª Teresa; Castro Alija, M ª José; Martín-Palmero, Ángela
Bulimia nervosa and binge eating disorder are unique nosological entities. Both show a large variability related to its presentation and severity which involves different therapeutic approaches and the need to individualize the treatment, thus it is indispensable a multidisciplinary approach. Patients with bulimia nervosa may suffer from malnutrition and deficiency states or even excess weight, while in binge eating disorders, it is common overweight or obesity, which determine other comorbidities. Many of the symptoms and complications are associated with compensatory behaviors. There are many therapeutic tools available for the treatment of these patients. The nutritional approach contemplates the individualized dietary advice which guarantees an adequate nutritional state and nutritional education. Its objective is to facilitate the voluntary adoption of eating behaviors that promote health and allow the long-term modification of eating habits and the cessation of purgatory and bingeing behaviors. Psychological support is a first-line treatment and it must address the frequent disorder of eating behavior and psychiatric comorbidities. Psychotropic drugs are effective and widely used although these drugs are not essential. The management is carried out mainly at an outpatient level, being the day hospital useful in selected patients. Hospitalization should be reserved to correct serious somatic or psychiatric complications or as a measure to contain non-treatable conflict situations. Most of the guidelines' recommendations are based on expert consensus, with little evidence which evaluates clinical results and cost-effectiveness.
McLean, Siân A; Paxton, Susan J; Massey, Robin; Hay, Phillipa J; Mond, Jonathan M; Rodgers, Bryan
Stigmatizing attitudes towards eating disorders negatively impacts treatment seeking. To determine the effect of interventions to reduce stigma, a measure of stigma that is simple to implement is required. This study aimed to develop a measure of stigmatizing attitudes and beliefs towards bulimia nervosa (SAB-BN) and evaluate the distribution of beliefs across gender, age, education, and income groups. Participants were 1828 community adults (890 men; 938 women) aged 18-65 sampled from the Australian Electoral Roll responded to a mailed questionnaire. Participants provided demographic information and completed the SAB-BN questionnaire. Five components of stigmatizing attitudes and beliefs were identified; advantages of BN, minimization/low seriousness, unreliability, social distance, and personal responsibility. Stigma was low except on social distance and personal responsibility sub-scales, which indicated negative attitudes toward people with bulimia. Men compared with women and lower compared with higher education and income groups held significantly higher stigmatizing attitudes and beliefs. There were few differences between age groups in stigma. Differences between demographic groups provides evidence for known-groups validity. The SAB-BN questionnaire provides a potentially useful tool for evaluating stigma in relation to BN. Results provide insight into components of stigma and the demographic groups to whom interventions should be targeted. Copyright © 2013 Wiley Periodicals, Inc.
Fäldt Ciccolo, Erica B
Elements of family dynamics have been shown to be related to onset, course, as well as prognosis of anorexia nervosa and bulimia nervosa. The goal was to explore the experience of family relations in a group of patients with eating disorders using a projective family test. The Patient group (anorexia=21, bulimia=16), as well as a healthy Control group, were given a projective family test, the Eating Disorder Inventory-2, as well as Karolinska Scales of Personality. The Patient group expressed more discord within the family picture than the Control group, such as cold and loveless relationships and not feeling validated. The group of patients reporting the most family discord did not show more eating disorder pathology or general psychopathology. They did, however, have higher scores on the Eating Disorder Inventory-2 subscale Maturity Fears, as well as higher values on the Karolinska Scales of Personality subscale Socialization. These results are interpreted within the background of methodological challenges in this area of research.
Donnelly, Brooke; Touyz, Stephen; Hay, Phillipa; Burton, Amy; Russell, Janice; Caterson, Ian
In recent decades there has been growing interest in the use of neuroimaging techniques to explore the structural and functional brain changes that take place in those with eating disorders. However, to date, the majority of research has focused on patients with anorexia nervosa. This systematic review addresses a gap in the literature by providing an examination of the published literature on the neurobiology of individuals who binge eat; specifically, individuals with bulimia nervosa (BN) and binge eating disorder (BED). A systematic review was conducted in accordance with PRISMA guidelines using PubMed, PsycInfo, Medline and Web of Science, and additional hand searches through reference lists. 1,003 papers were identified in the database search. Published studies were included if they were an original research paper written in English; studied humans only; used samples of participants with a diagnosed eating disorder characterised by recurrent binge eating; included a healthy control sample; and reported group comparisons between clinical groups and healthy control groups. Thirty-two papers were included in the systematic review. Significant heterogeneity in the methods used in the included papers coupled with small sample sizes impeded the interpretation of results. Twenty-one papers utilised functional Magnetic Resonance Imaging (fMRI); seven papers utilized Magnetic Resonance Imaging (MRI) with one of these using both MRI and Positron Emission Technology (PET); three studies used Single-Photon Emission Computed Tomography (SPECT) and one study used PET only. A small number of consistent findings emerged in individuals in the acute phase of illness with BN or BED including: volume reduction and increases across a range of areas; hypoactivity in the frontostriatal circuits; and aberrant responses in the insula, amygdala, middle frontal gyrus and occipital cortex to a range of different stimuli or tasks; a link between illness severity in BN and neural changes
Full Text Available The International Classification of Diseases, 10th edition (ICD-10 defines atypical bulimia nervosa (ABN as an eating disorder that encompasses several different syndromes, including the DSM-IV binge eating disorder (BED. We investigated whether patients with BED can be differentiated clinically from patients with ABN who do not meet criteria for BED. Fifty-three obese patients were examined using the Structured Clinical Interview for DSM-IV and the ICD-10 criteria for eating disorders. All volunteers completed the Binge Eating Scale (BES, the Beck Depression Inventory, and the Symptom Checklist-90 (SCL-90. Individuals fulfilling criteria for both ABN and BED (N = 18, ABN without BED (N = 16, and obese controls (N = 19 were compared and contrasted. Patients with ABN and BED and patients with ABN without BED displayed similar levels of binge eating severity according to the BES (31.05 ± 7.7 and 30.05 ± 5.5, respectively, which were significantly higher than those found in the obese controls (18.32 ± 8.7; P < 0.001 and P < 0.001, respectively. When compared to patients with ABN and BED, patients with ABN without BED showed increased lifetime rates of agoraphobia (P = 0.02 and increased scores in the somatization (1.97 ± 0.85 vs 1.02 ± 0.68; P = 0.001, obsessive-compulsive (2.10 ± 1.03 vs 1.22 ± 0.88; P = 0.01, anxiety (1.70 ± 0.82 vs 1.02 ± 0.72; P = 0.02, anger (1.41 ± 1.03 vs 0.59 ± 0.54; P = 0.005 and psychoticism (1.49 ± 0.93 vs 0.75 ± 0.55; P = 0.01 dimensions of the SCL-90. The BED construct may represent a subgroup of ABN with less comorbities and associated symptoms.
Fernandez-Aranda, Fernando; Jimenez-Murcia, Susana; Santamaría, Juan J; Giner-Bartolomé, Cristina; Mestre-Bach, Gemma; Granero, Roser; Sánchez, Isabel; Agüera, Zaida; Moussa, Maher H; Magnenat-Thalmann, Nadia; Konstantas, Dimitri; Lam, Tony; Lucas, Mikkel; Nielsen, Jeppe; Lems, Peter; Tarrega, Salomé; Menchón, José Manuel
Although cognitive behavioral therapy (CBT) has been demonstrated to be the most effective approach for the treatment of bulimia nervosa (BN), there is lack of studies showing whether a combination with a serious video game (SVG) might be useful to enhance patients' emotional regulation capacities and general outcome. The aims of this study were (a) to analyze whether outpatient CBT + SVG, when compared with outpatient CBT - SVG, shows better short-term outcome; (b) to examine whether the CBT + SVG group is more effective in reducing emotional expression and levels of anxiety than CBT - SVG. Thirty-eight patients diagnosed as having BN according to DSM-5 criteria were consecutively assigned to two outpatient group therapy conditions (that lasted for 16 weekly sessions): 20 CBT + SVG versus 18 CBT - SVG. Patients were assessed before and after treatment using not only a food and binging/purging diary and clinical questionnaires in the field of eating disorders but also additional indexes for measuring anger expression and anxiety. Regarding the post-treatment psychometric measures, most of the mean differences (Eating Disorder Inventory-2, Symptom Checklist-Revised, State-Trait Anxiety Index, and partially State-Trait Anger Expression Inventory) achieved moderate to high effect size (d > 0.5), in the sense that CBT + SVG obtained the best results compared with the CBT - SVG group. Regarding therapy outcome (dropout, partial remission, and total remission), CBT + SVG showed better results and a moderate effect size emerged for the comparison of the risk of dropout during the treatment, being higher for CBT - SVG compared with CBT + SVG (44.1 percent versus 20.0 percent, d = 0.54). Although the sample size in our study was low, and consequently results should be considered with caution, we have obtained promising findings suggesting that in the short-term CBT + SVG might be a good option not only for improving
Raevuori, Anu; Kaprio, Jaakko; Hoek, Hans W.; Sihvola, Elina; Rissanen, Aila; Keski-Rahkonen, Anna
Objective: The authors tested the hypothesis that either prenatal feminization or masculinization hormone influences in utero or later socialization affects the risk for anorexia and bulimia nervosa and disordered eating in members of opposite-sex twin pairs. Method: Finnish twins (N=2,426 women,
Smyth, Joshua M.; Wonderlich, Stephen A.; Heron, Kristin E.; Sliwinski, Martin J.; Crosby, Ross D.; Mitchell, James E.; Engel, Scott G.
The relation of mood and stress to binge eating and vomiting in the natural environments of patients with bulimia nervosa (BN) was examined using real-time data collection. Women (n = 131; mean age = 25.3 years) with BN carried a palmtop computer for 2 weeks and completed ratings of positive affect (PA), negative affect (NA), anger/hostility (AH),…
Mond, J. M.; Marks, P.; Hay, P. J.; Rodgers, B.; Kelly, C.; Owen, C.; Paxton, S. J.
This research examined the "mental health literacy" of adolescents concerning eating-disordered behavior. A vignette describing a fictional 16-year old female meeting diagnostic criteria for bulimia nervosa was presented to 522 female high school students, followed by a series of questions concerning treatment of and treatment-seeking…
Hague, Anne; Kovacich, Joann
The incidence of bulimia nervosa has increased significantly in the second half of the twentieth century and its occurrence is more than twice that of anorexia nervosa. Due to its complex nature, successful treatment requires an interdisciplinary approach with nutritional, psychological, medical, pharmacological and dental therapies. Despite…
Graham, Lisa; Walton, Mark
Many patients who experience bulimia nervosa (BN) and binge eating disorder (BED) find it hard to access evidence-based treatments. Rates of failure to enter outpatient services following initial assessment are high, as are dropout rates from specialist outpatient eating disorders services. To offer CD-Rom CBT, a cognitive-behavioural multi-media supported self-help treatment, in a locality-based outpatient NHS Eating Disorders Service to patients who have binge eating disorder and bulimia nervosa. Patients referred to a catchment-based NHS outpatient eating disorders service who were assessed and had an eating disorder with a binge-eating component were offered CD-Rom based CBT (Overcoming Bulimia) whilst on the waiting list for individual CBT. Forty patients completed the 8 sessions and attended the evaluation appointment (13 had BN, 27 had BED). For both groups, there were significant improvements in well-being and functioning, as well as significant reductions in problems and risk. There was also a significant reduction on the "Bulimic Subscale" of the EDI. These results were comparable with the original study findings (Schmidt, Treasure and Williams, 2001). Dropouts from the CD-Rom reflected rates common to other EDS treatments suggesting that CD-Rom did not directly impact upon service dropout rates. Computer assisted CBT for Eating Disorders offers a promising, feasible and acceptable first step for patients who have bulimia nervosa or binge eating disorder and access treatment from specialist eating disorders services.
Full Text Available Background: Several studies have highlighted the implications of impulsivity and novelty seeking for both the maintenance and the process of recovery from bulimia nervosa. Cognitive behavioral therapy (CBT is the treatment of choice for bulimia nervosa, but for some cases, this treatment alone might not be sufficient for reducing the high levels of impulsivity. The paper presents a case report of a patient with bulimia nervosa, examining the effectiveness of using a videogame (Playmancer as an additional intervention designed to address impulsivity. Design: Psychometric and neuropsychological measures were collected at baseline. After this assessment, Playmancer was applied prior to CBT, following an A-B-A-C-A single case experimental design. Impulsivity levels were assessed with the Conners’ Continuous Performance Test II (CPT-II. After the Playmancer treatment, the patient started CBT, and the levels of impulsivity were recorded again. Finally, psychometric and neuropsychological measures were collected after treatment. Weekly frequency of binges and vomiting were also recorded during the entire procedure. Results: After the videogame intervention, psychometric measures such as anxiety levels, impulsivity and novelty seeking decreased. Regarding the neuropsychological measures, impulsivity levels (measured with the CPT-II progressively decreased throughout the intervention, and an improvement in decision making capacities was observed. Furthermore, the frequency of binges also decreased during and after the videogame intervention. Discussion: This case report suggests that using the Playmancer videogame to reduce impulsivity prior to CBT may enhance the final results of the treatment for bulimia nervosa.
Rodrigo Sanches Peres
Full Text Available O presente estudo teve como objetivo verificar a utilização de técnicas projetivas na avaliação de características psicopatológicas de pacientes com transtornos alimentares. Trata-se de uma revisão sistemática de literatura, realizada a partir de buscas nas bases de dados LILACS e Banco de Teses/CAPES com o emprego dos descritores "anorexia" e "bulimia". As referências localizadas foram selecionadas, recuperadas na íntegra e submetidas a uma apreciação qualitativa, organizada em dimensões de análise específicas. As principais características psicopatológicas reportadas foram: passividade, introversão e obsessividade, conflitos, tensões e angústias em relação à figura materna, grave distorção da imagem corporal e tendência à fusão nos relacionamentos interpessoais. Evidenciou-se, ainda, o predomínio de delineamentos metodológicos incipientes. Novas pesquisas envolvendo o emprego de técnicas projetivas no contexto dos transtornos alimentares são necessárias para prover os profissionais de evidências empíricas, que possam ser aproveitadas em protocolos de avaliação multidisciplinar adequados à população brasileira.This study aimed to review the Brazilian literature on the use of projective techniques in the assessment of psychopathological features of patients with eating disorders. It is a systematic literature review from searches on LILACS and CAPES Thesis Databases, with the use of the descriptors "anorexia" and "bulimia". The obtained references were selected and, later, recovered in full version and submitted to a qualitative appreciation, organized in specific dimensions. The main psychopathological features reported were: passivity, introversion and obsessiveness, conflicts, tensions and anxieties in relation to the maternal figure, severe distortion of body image and tendency to merge in interpersonal relationships. The researches analysis revealed predominance of weak methodological designs. New
Raevuori, Anu; Kaprio, Jaakko; Hoek, Hans W; Sihvola, Elina; Rissanen, Aila; Keski-Rahkonen, Anna
The authors tested the hypothesis that either prenatal feminization or masculinization hormone influences in utero or later socialization affects the risk for anorexia and bulimia nervosa and disordered eating in members of opposite-sex twin pairs. Finnish twins (N=2,426 women, N=1,962 men with known zygosity) from birth cohorts born 1974-1979 were assessed at age 22 to 28 years with a questionnaire for eating disorder symptoms. Based on the questionnaire screen, women (N=292), men (N=53), and their cotwins were interviewed to assess diagnoses of anorexia nervosa and bulimia nervosa (per DSM-IV and broad criteria). In women from opposite-sex twin pairs, the prevalence of DSM-IV or broad anorexia nervosa was not significantly different than that of women from monozygotic pairs or same-sex dizygotic pairs. Of the five male anorexia nervosa probands, only one was from an opposite-sex twin pair. Bulimia nervosa in men was too rare to be assessed by zygosity; the prevalence of DSM-IV or broad bulimia nervosa did not differ in women from opposite- versus same-sex twin pairs. In both sexes, the overall profile of indicators on eating disorders was rather similar between individuals from opposite- and same-sex pairs. The authors found little evidence that the risk for anorexia nervosa, bulimia nervosa, or disordered eating was associated with zygosity or sex composition of twin pairs, thus making it unlikely that in utero femininization or masculinization or socialization effects of growing up with an opposite-sex twin have a major influence on the later development of eating disorders.
Le Grange, Daniel; Lock, James; Agras, W Stewart; Bryson, Susan W; Jo, Booil
There is a paucity of randomized clinical trials (RCTs) for adolescents with bulimia nervosa (BN). Prior studies suggest cognitive-behavioral therapy adapted for adolescents (CBT-A) and family-based treatment for adolescent bulimia nervosa (FBT-BN) could be effective for this patient population. The objective of this study was to compare the relative efficacy of these 2 specific therapies, FBT-BN and CBT-A. In addition, a smaller participant group was randomized to a nonspecific treatment (supportive psychotherapy [SPT]), whose data were to be used if there were no differences between FBT-BN and CBT-A at end of treatment. This 2-site (Chicago and Stanford) randomized controlled trial included 130 participants (aged 12-18 years) meeting DSM-IV criteria for BN or partial BN (binge eating and purging once or more per week for 6 months). Outcomes were assessed at baseline, end of treatment, and 6 and 12 months posttreatment. Treatments involved 18 outpatient sessions over 6 months. The primary outcome was defined as abstinence from binge eating and purging for 4 weeks before assessment, using the Eating Disorder Examination. Participants in FBT-BN achieved higher abstinence rates than in CBT-A at end of treatment (39% versus 20%; p = .040, number needed to treat [NNT] = 5) and at 6-month follow-up (44% versus 25%; p = .030, NNT = 5). Abstinence rates between these 2 groups did not differ statistically at 12-month follow-up (49% versus 32%; p = .130, NNT = 6). In this study, FBT-BN was more effective in promoting abstinence from binge eating and purging than CBT-A in adolescent BN at end of treatment and 6-month follow-up. By 12-month follow-up, there were no statistically significant differences between the 2 treatments. Study of Treatment for Adolescents With Bulimia Nervosa; http://clinicaltrials.gov/; NCT00879151. Copyright © 2015 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.
Lavagnino, Luca; Amianto, Federico; D'Agata, Federico; Huang, Zirui; Mortara, Paolo; Abbate-Daga, Giovanni; Marzola, Enrica; Spalatro, Angela; Fassino, Secondo; Northoff, Georg
Alterations in the resting-state functional connectivity (rs-FC) of several brain networks have been demonstrated in eating disorders. However, very few studies are currently available on brain network dysfunctions in bulimia nervosa (BN). The somatosensory network is central in processing body-related stimuli and it may be altered in BN. The present study therefore aimed to investigate rs-FC in the somatosensory network in bulimic women. Sixteen medication-free women with BN (age = 23 ± 5 years) and 18 matched controls (age = 23 ± 3 years) underwent a functional magnetic resonance resting-state scan and assessment of eating disorder symptoms. Within-network and seed-based functional connectivity analyses were conducted to assess rs-FC within the somatosensory network and to other areas of the brain. Bulimia nervosa patients showed a decreased rs-FC both within the somatosensory network (t = 9.0, df = 1, P = 0.005) and with posterior cingulate cortex and two visual areas (the right middle occipital gyrus and the right cuneus) (P = 0.05 corrected for multiple comparison). The rs-FC of the left paracentral lobule with the right middle occipital gyrus correlated with psychopathology measures like bulimia (r = -0.4; P = 0.02) and interoceptive awareness (r = -0.4; P = 0.01). Analyses were conducted using age, BMI (body mass index), and depressive symptoms as covariates. Our findings show a specific alteration of the rs-FC of the somatosensory cortex in BN patients, which correlates with eating disorder symptoms. The region in the right middle occipital gyrus is implicated in body processing and is known as extrastriate body area (EBA). The connectivity between the somatosensory cortex and the EBA might be related to dysfunctions in body image processing. The results should be considered preliminary due to the small sample size.
Cybele Ribeiro Espíndola
Full Text Available OBJETIVO: Esta revisão sistemática teve como objetivo organizar o conjunto das informações disponibilizadas pelos estudos qualitativos sobre a vivência dos pacientes portadores de bulimia e transtorno da compulsão alimentar periódica. METODOLOGIA: Pesquisas foram conduzidas nas seguintes bases de dados: PubMed, ISI, PsycINFO, EMBASE, LILACS e SciELO, no período de 1990 a 2005. Critérios de inclusão: 1 artigos com foco principal na bulimia ou transtorno da compulsão alimentar periódica; 2 pesquisas originais em inglês, espanhol, francês ou português; 3 uso de qualquer método qualitativo, como entrevista, grupo focal ou observação de campo. Critérios de exclusão: artigos exclusivamente teóricos ou que utilizam população infantil ou da terceira idade. Utilizou-se a abordagem meta-etnográfica para sintetizar os dados. Cada estudo foi lido, e as categorias centrais de cada um foram comparadas e interpretadas com as categorias de todos os outros estudos. RESULTADOS: Foram incluídos 15 estudos de um total de 3.415 artigos. Sete temas centrais que se sobrepõem foram identificados: representação da doença; sentimentos negativos (medo, culpa, raiva, solidão, perda de controle; sentimentos positivos (auto-controle; poder; função do sintoma; relacionamentos interpessoais; história pessoal; contexto sociocultural; recuperação. CONCLUSÕES: Embora muitos aspectos sejam negativos, a experiência, como um todo, não é referida apenas como má. Alguns aspectos dos transtornos alimentares são sentidos como benéficos, segundo os pacientes.OBJECTIVE: The aim of this systematic review is to identify the scope of qualitative investigations on the life experience of patients with bulimia and binge eating disorder. METHODOLOGY: Searches were conducted using the following databases: PubMed, ISI, PsycInfo, Embase, LILACS and Scielo, for articles published between 1990 and 2005. Inclusion criteria were: 1 articles with main focus on
Insatisfação com a imagem corporal e relação com estado nutricional, adiposidade corporal e sintomas de anorexia e bulimia em adolescentes Body image dissatisfaction and its relationship with nutritional status, body fat, and anorexia and bulimia symptoms in adolescents
Cilene Rebolho Martins
Full Text Available Objetivos: Identificar a prevalência de insatisfação com a imagem corporal e de sintomas de anorexia e bulimia em adolescentes do sexo feminino da cidade de Santa Maria (RS e verificar a associação da insatisfação com a imagem corporal com estado nutricional, adiposidade corporal e sintomas de anorexia e bulimia. Método: Foram analisadas 258 adolescentes do sexo feminino (11 a 13 anos, estudantes de escolas públicas. Aplicou-se o Body Shape Questionnaire e o Teste de Atitudes Alimentares (EAT-26. Foram calculados o índice de massa corporal e o percentual de gordura. Foram utilizados o teste qui-quadrado e a regressão logística. Resultados: A prevalência de insatisfação com a imagem corporal foi de 25,3% e a de sintomas de anorexia e bulimia foi de 27,6%. A insatisfação com a imagem corporal apresentou associação com o estado nutricional, sendo que as adolescentes com excesso de peso apresentaram maior insatisfação (razão de chances = 2,64; IC95%= 1,02-6,83. Conclusão: As prevalências de insatisfação corporal e sintomas de anorexia e bulimia foram elevadas. O estado nutricional parece ser o melhor preditor da insatisfação corporal.Objectives: To identify the prevalence of body image dissatisfaction and anorexia and bulimia symptoms in adolescent girls from the city of Santa Maria, Brazil, and to determine the association of body image dissatisfaction with nutritional status, body fat, and anorexia and bulimia symptoms. Method: We investigated 258 adolescent girls (11 to 13 years from public schools. The Body Shape Questionnaire and the Eating Attitudes Test (EAT-26 were used. Body mass index and percent body fat were calculated. The chi-square test and logistic regression were used. Results: The prevalence of body image dissatisfaction was 25.3% and the prevalence of anorexia and bulimia symptoms was 27.6%. Body image dissatisfaction was associated with nutritional status, with overweight girls presenting higher
Janner, Simone F M; Suter, Valerie G A; Altermatt, Hans Jörg; Reichart, Peter A; Bornstein, Michael M
Necrotizing sialometaplasia (NS) is a rare and benign lesion that mostly affects the posterior hard palate. Its importance resides in its clinical and microscopic characteristics, which can closely mimic malignant neoplasias, in particular oral squamous cell carcinoma and mucoepidermoid carcinoma. Accurate histopathologic evaluation of an incisional biopsy is considered as the diagnostic gold standard. NS lesions heal spontaneously within weeks, and no further treatment is necessary. We report a case of a bilateral palatal NS in a 22-yearold woman with bulimia, where an incisional biopsy confirmed the clinical diagnosis. The different clinical stages of the lesions from onset to resolution and the possible etiologic factors are described in detail, as well as a discussion of the differential diagnoses of palatal ulcers. When taking a biopsy from suspicious oral lesions, care has to be taken that an appropriate tissue sample is harvested, and the histopathologic analysis is performed by an experienced pathologist to establish a correct diagnosis.
Bachar, Eytan; Latzer, Yael; Kreitler, Shulamit; Berry, Elliot M.
The authors investigated the applicability of self psychological treatment (SPT) and cognitive orientation treatment (COT) to the treatment of anorexia and bulimia. Thirty-three patients participated in this study. The bulimic patients (n = 25) were randomly assigned either to SPT, COT, or control/nutritional counseling only (C/NC). The anorexic patients (n = 8) were randomly assigned to either SPT or COT. Patients were administered a battery of outcome measures assessing eating disorders symptomatology, attitudes toward food, self structure, and general psychiatric symptoms. After SPT, significant improvement was observed. After COT, slight but nonsignificant improvement was observed. After C/NC, almost no changes could be detected.(The Journal of Psychotherapy Practice and Research 1999; 8:115–128) PMID:10079459
Thaw, J M; Williamson, D A; Martin, C K
The diagnostic criteria used to define eating disorders have been the focus of debate for many years. The primary aim of this study was to evaluate the impact of altering DSM-IV diagnostic criteria upon the base rates of anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS). Five controversial criteria were systematically modified and the impact of these changes on base rates of full-syndrome and partial-syndrome eating disorders was assessed in 193 patients referred to two specialty eating disorder clinics. Modification of a single criterion resulted in relatively small changes in base rates of AN and BN, whereas modification of the two severity criteria led to more substantial changes. These findings have significant implications for future modifications of the DSM classification.
Berrios-Hernandez, Mayra N; Rodríguez-Ruiz, Sonia; Perez, Marisol; Gleaves, David H; Maysonet, Marielisa; Cepeda-Benito, Antonio
The purpose of this study was to examine the psychometric properties of a Spanish version of the Bulimia Test-Revised (BULIT-R). The goal was to test the factor-structure equivalence of the BULIT-R across two samples of college students from two different cultures, Spain and the US. Researchers using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) have reported different model solutions for the factor-structure of the BULIT-R: a one-factor model, a four-factor model, a five-factor model and a six-factor model. For the two samples, CFA did not support any of the models previously reported in the literature. EFA supported a six- and a four-factor models for the US and Spanish samples, respectively. 2007 John Wiley & Sons, Ltd and Eating Disorders Association
Background With the imminent publication of the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there has been a growing interest in the study of the boundaries across the three bulimic spectrum syndromes [bulimia nervosa-purging type (BN-P), bulimia nervosa-non purging type (BN-NP) and binge eating disorder (BED)]. Therefore, the aims of this study were to determine differences in treatment response and dropout rates following Cognitive Behavioural Therapy (CBT) across the three bulimic-spectrum syndromes. Method The sample comprised of 454 females (87 BED, 327 BN-P and 40 BN-NP) diagnosed according to DSM-IV-TR criteria who were treated with 22 weekly outpatient sessions of group CBT therapy. Patients were assessed before and after treatment using a food and binging/purging diary and some clinical questionnaires in the field of ED. “Full remission” was defined as total absence of binging and purging (laxatives and/or vomiting) behaviors and psychological improvement for at least 4 (consecutive). Results Full remission rate was found to be significantly higher in BED (69.5%) than in both BN-P (p < 0.005) and BN-NP (p < 0.001), which presented no significant differences between them (30.9% and 35.5%). The rate of dropout from group CBT was also higher in BED (33.7%) than in BN-P (p < 0.001) and BN-NP (p < 0.05), which were similar (15.4% and 12.8%, respectively). Conclusions Results suggest that purging and non-purging BN have similar treatment response and dropping out rates, whereas BED appears as a separate diagnosis with better outcome for those who complete treatment. The results support the proposed new DSM-5 classification PMID:24200085
Agüera, Zaida; Riesco, Nadine; Jiménez-Murcia, Susana; Islam, Mohammed Anisul; Granero, Roser; Vicente, Enrique; Peñas-Lledó, Eva; Arcelus, Jon; Sánchez, Isabel; Menchon, Jose Manuel; Fernández-Aranda, Fernando
With the imminent publication of the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there has been a growing interest in the study of the boundaries across the three bulimic spectrum syndromes [bulimia nervosa-purging type (BN-P), bulimia nervosa-non purging type (BN-NP) and binge eating disorder (BED)]. Therefore, the aims of this study were to determine differences in treatment response and dropout rates following Cognitive Behavioural Therapy (CBT) across the three bulimic-spectrum syndromes. The sample comprised of 454 females (87 BED, 327 BN-P and 40 BN-NP) diagnosed according to DSM-IV-TR criteria who were treated with 22 weekly outpatient sessions of group CBT therapy. Patients were assessed before and after treatment using a food and binging/purging diary and some clinical questionnaires in the field of ED. "Full remission" was defined as total absence of binging and purging (laxatives and/or vomiting) behaviors and psychological improvement for at least 4 (consecutive). Full remission rate was found to be significantly higher in BED (69.5%) than in both BN-P (p < 0.005) and BN-NP (p < 0.001), which presented no significant differences between them (30.9% and 35.5%). The rate of dropout from group CBT was also higher in BED (33.7%) than in BN-P (p < 0.001) and BN-NP (p < 0.05), which were similar (15.4% and 12.8%, respectively). Results suggest that purging and non-purging BN have similar treatment response and dropping out rates, whereas BED appears as a separate diagnosis with better outcome for those who complete treatment. The results support the proposed new DSM-5 classification.
Siega-Riz, Anna Maria; Haugen, Margaretha; Meltzer, Helle M; Von Holle, Ann; Hamer, Robert; Torgersen, Leila; Knopf-Berg, Cecilie; Reichborn-Kjennerud, Ted; Bulik, Cynthia M
Little is known concerning the dietary habits during pregnancy of women with eating disorders that may lie in the causal pathway of adverse birth outcomes. We examined the nutrient and food group intakes of women with bulimia nervosa and binge-eating disorder during pregnancy and compared these with intakes of women with no eating disorders. Data on 30,040 mother-child pairs from the prospective Norwegian Mother and Child Cohort Study were used in cross-sectional analyses. Dietary information was collected by using a food-frequency questionnaire during the first half of pregnancy. Statistical testing by eating disorder categories with the non-eating-disorder category as the referent group was conducted by using log means adjusted for confounding and multiple comparisons. Food group differences were analyzed by using a Wilcoxon's two-sided normal approximation test that was also adjusted for multiple comparisons. Women with binge-eating disorder before and during pregnancy had higher intakes of total energy, total fat, monounsaturated fat, and saturated fat, and lower intakes of folate, potassium, and vitamin C than the referent (P eating disorder during pregnancy had higher intakes of total energy and saturated fat than the referent (P = 0.01). Several differences emerged in food group consumption between women with and without eating disorders, including intakes of artificial sweeteners, sweets, juice, fruit, and fats. Women with bulimia nervosa before and during pregnancy and those with binge-eating disorder before pregnancy exhibit dietary patterns that differ from those in women without eating disorders, that are reflective of their symptomatology, and that may influence pregnancy outcomes.
Comparing cognitive behavioural therapy for eating disorders integrated with behavioural weight loss therapy to cognitive behavioural therapy-enhanced alone in overweight or obese people with bulimia nervosa or binge eating disorder: study protocol for a randomised controlled trial
Palavras, Marly Amorim; Hay, Phillipa; Touyz, Stephen; Sainsbury, Amanda; da Luz, Felipe; Swinbourne, Jessica; Estella, Nara Mendes; Claudino, Ang?lica
Background Around 40?% of individuals with eating disorders of recurrent binge eating, namely bulimia nervosa and binge eating disorder, are obese. In contrast to binge eating disorder, currently there is no evidence base for weight management or weight loss psychological therapies in the treatment of bulimia nervosa despite their efficacy in binge eating disorder. Thus, a manualised therapy called HAPIFED (Healthy APproach to weIght management and Food in Eating Disorders) has been developed...
Monteleone, Alessio Maria; Castellini, Giovanni; Volpe, Umberto; Ricca, Valdo; Lelli, Lorenzo; Monteleone, Palmiero; Maj, Mario
Anorexia nervosa and bulimia nervosa are severe eating disorders whose etiopathogenesis is still unknown. Clinical features suggest that eating disorders may develop as reward-dependent syndromes, since eating less food is perceived as rewarding in anorexia nervosa while consumption of large amounts of food during binge episodes in bulimia nervosa aims at reducing the patient's negative emotional states. Therefore, brain reward mechanisms have been a major focus of research in the attempt to contribute to the comprehension of the pathophysiology of these disorders. Structural brain imaging data provided the evidence that brain reward circuits may be altered in patients with anorexia or bulimia nervosa. Similarly, functional brain imaging studies exploring the activation of brain reward circuits by food stimuli as well as by stimuli recognized to be potentially rewarding for eating disordered patients, such as body image cues or stimuli related to food deprivation and physical hyperactivity, showed several dysfunctions in ED patients. Moreover, very recently, it has been demonstrated that some of the biochemical homeostatic modulators of eating behavior are also implicated in the regulation of food-related and non-food-related reward, representing a possible link between the aberrant behaviors of ED subjects and their hypothesized deranged reward processes. In particular, changes in leptin and ghrelin occur in patients with anorexia or bulimia nervosa and have been suggested to represent not only homeostatic adaptations to an altered energy balance but to contribute also to the acquisition and/or maintenance of persistent starvation, binge eating and physical hyperactivity, which are potentially rewarding for ED patients. On the basis of such findings new pathogenetic models of EDs have been proposed, and these models may provide new theoretical basis for the development of innovative treatment strategies, either psychological and pharmacological, with the aim to
Aline Cavalcante de Souza
Full Text Available Objetivo: Avaliar como se relacionam as atitudes alimentares e corporais de pacientes com anorexia ou bulimia nervosa. Métodos: Pacientes adultas de um ambulatório especializado, com diagnóstico de anorexia (n = 48 ou bulimia nervosa (n = 58, responderam à Disordered Eating Attitude Scale (DEAS para avaliação das atitudes alimentares e ao Body Attitude Questionnaire (BAQ para atitudes corporais – ambos traduzidos e validados para mulheres jovens do Brasil. A correlação entre os escores da DEAS e do BAQ foi avaliada utilizando o coeficiente de Pearson. Modelos de regressão linear testaram preditores para atitudes alimentares e corporais. Resultados: Pacientes com bulimia apresentam relação com o alimento mais disfuncional – subescala 1 da DEAS (p 0,6 para ambas apenas quando se analisou a relação com o alimento e o sentir-se gorda e entre atitudes corporais como um todo e a relação com o alimento. O escore total da DEAS foi preditor da BAQ total: cada um ponto na DEAS aumenta 0,788 na BAQ (R2 = 0,628. Conclusão: Pacientes com bulimia apresentam pior relação com o alimento e piores atitudes corporais. As atitudes corporais se correlacionaram com as atitudes alimentares, de maneira mais forte para pacientes com anorexia; atitudes alimentares mais disfuncionais predizem pior relação com o corpo para ambos os diagnósticos.
The diagnosis and treatment of eating disorders in childhood and adolescence demands specific knowledge of the particular features of symptomatology and approaches in this age group. The diagnostic criteria in the handbooks are only conditionally valid in young patients and their application must be adapted to the patient’s age. Clinically relevant atypical eating disorders have a prevalence similar to the classic forms of anorexia nervosa or bulimia nervosa. High rates of comorbidity exist, ...
Wagner, Gudrun; Penelo, Eva; Wanner, Christian; Gwinner, Paulina; Trofaier, Marie-Louise; Imgart, Hartmut; Waldherr, Karin; Wöber-Bingöl, Ciçek; Karwautz, Andreas F K
Cognitive-behavioural therapy (CBT)-based guided self-help is recommended as a first step in the treatment of bulimia nervosa. To evaluate in a randomised controlled trial (Clinicaltrials.gov registration number: NCT00461071) the long-term effectiveness of internet-based guided self-help (INT-GSH) compared with conventional guided bibliotherapy (BIB-GSH) in females with bulimia nervosa. A total of 155 participants were randomly assigned to INT-GSH or BIB-GSH for 7 months. Outcomes were assessed at baseline, month 4, month 7 and month 18. The greatest improvement was reported after 4 months with a continued reduction in eating disorder symptomatology reported at month 7 and 18. After 18 months, 14.6% (n = 7/48) of the participants in the INT-GSH group and 25% (n = 7/28) in the BIB-GSH group were abstinent from binge eating and compensatory measures, 43.8% (n = 21/48) and 39.2% (n = 11/28) respectively were in remission. No differences regarding outcome between the two groups were found. Internet-based guided self-help for bulimia nervosa was not superior compared with bibliotherapy, the gold standard of self-help. Improvements remain stable in the long term.
Oinonen, Kirsten A; Bird, Jessica L
This study examined the hypothesis that lower prenatal androgen exposure and earlier puberty are associated with more dysfunctional eating attitudes and behaviors. Relationships between both age at menarche (AAM) and 2D:4D (a marker of prenatal androgen exposure), and EDI-2-Body Dissatisfaction, EDI-2-Drive for Thinness, and EDI-2-Bulimia scores, were examined in women using correlations and regressions. Earlier menarche was associated with higher drive for thinness after controlling for BMI and negative affect, but only in women who were not exclusively heterosexual. Higher 2D:4D was associated with higher Bulimia and Body Dissatisfaction scores, but only in exclusively heterosexual women, and relationships disappeared when covariates were controlled. Later AAM and higher 2D:4D were unique predictors of higher Bulimia scores for exclusive heterosexuals when BMI was controlled. These findings suggest future research should examine sexual orientation as a mediator or moderator of prenatal and postnatal organizational hormonal effects on women's disordered eating attitudes and behaviors. Copyright Â© 2011 Elsevier Ltd. All rights reserved.
Koupil, Ilona; Tooth, Leigh; Heshmati, Amy; Mishra, Gita
To study social patterning of overeating and symptoms of disordered eating in a general population. A representative, population-based cohort study. The Australian Longitudinal Study on Women's Health (ALSWH), Survey 1 in 1996 and Survey 2 in 2000. Women (n 12 599) aged 18-23 years completed a questionnaire survey at baseline, of whom 6866 could be studied prospectively. Seventeen per cent of women reported episodes of overeating, 16 % reported binge eating and 10 % reported compensatory behaviours. Almost 4 % of women reported symptoms consistent with bulimia nervosa. Low education, not living with family, perceived financial difficulty (OR=1·8 and 1·3 for women with severe and some financial difficulty, respectively, compared with none) and European language other than English spoken at home (OR=1·5 for European compared with Australian/English) were associated with higher prevalence of binge eating. Furthermore, longitudinal analyses indicated increased risk of persistent binge eating among women with a history of being overweight in childhood, those residing in metropolitan Australia, women with higher BMI, smokers and binge drinkers. Overeating, binge eating and symptoms of bulimia nervosa are common among young Australian women and cluster with binge drinking. Perceived financial stress appears to increase the risk of binge eating and bulimia nervosa. It is unclear whether women of European origin and those with a history of childhood overweight carry higher risk of binge eating because of genetic or cultural reasons.
Full Text Available Background: Bulimia nervosa (BN is a type of feeding disorder that starts in adolescence and presents a variety of symptoms, recurrent vomiting in the oral cavity that may reach down to the larynx - similarly to gastro-esophageal reflux, causing laryngeal and voice disorder alterations. Objective: These studies aimed at surveying the literature and investigate the studies that considered BN a risk factor for voice disorders and its epidemiology, complications, diagnostic criteria, and management. Materials and Methods: A review of the literature was done based on a survey of BIOMED CENTRAL and COCHRANE @ OVID databases, which are linked to the IMU ezproxy virtual library (http://ezp.imu.edu.my/menu. The keywords "bulimia nervosa", "teenage complications" and "voice changes" were used. Citations with summaries were chosen to limit the topic, for the period between 2000 and 2010, in English. Results: Of the ninety three papers we found, twenty three were used as a basis for this review. Among them, only three discuss BN as an etiology factor associated with voice changes in adult women, and we did not find any paper associating this with bulimic teenagers. Conclusion: It is necessary to observe laryngeal and vocal signs and symptoms associated with BN, especially in teenagers whose voices are going through a period of change. The contribution of this type of investigation, which should begin with a clinical history, is essential for minimizing the complications of bulimia nervosa. Thus, adolescents and adults with voice disorders should be investigated in greater detail.
Hagan, M M; Moss, D E
To test the hypothesis that experience with food restriction produces persistent binge eating. The Minnesota semistarvation experiment and studies of prisoners-of-war show that chronic food restriction produces dramatic changes in eating behavior (including binge eating) that endure decades after restriction has ceased. Bulimia nervosa patients who restrict also binge. Restriction may be a risk factor in the etiology of binge eating and bulimia. Animals were subjected to four different patterns of 12-week restriction-refeeding cycles. The rats were either food restricted (dieting) or not restricted and refed regular or palatable food (binging). Thirty days after normalization (full feeding, no restriction cycling), rats with a history of cycles of restriction and hyperphagia continued to exhibit persistent binge eating. This effect was shown particularly with palatable food, in stated conditions, and in response to acute 24-hr deprivation. Results from this animal model implicate restriction and overeating on palatable food as biological determinants of binge-eating behaviors, including bulimia nervosa.
Full Text Available A woman with severe, refractory bulimia nervosa underwent treatment for comorbid depression using repetitive transcranial magnetic stimulation (rTMS of the dorsomedial prefrontal cortex (DMPFC using a novel technique. Unexpectedly, she showed a rapid, dramatic remission from bulimia nervosa. For 5 months pre-treatment, she had reported two 5-hour binge-purge episodes per day. After rTMS session 2 the episodes stopped entirely for 1 week; after session 10 there were no further recurrences. Depression scores improved more gradually to remission at session 10. Full remission from depression and binge-eating/purging episodes was sustained more than 2 months after treatment completion. In neuroimaging studies, the DMPFC is important in impulse control, and is underactive in bulimia nervosa. DMPFC-rTMS may have enhanced the patient’s ability to deploy previously acquired strategies to avoid binge-eating and purging via a reduction in her impulsivity. A larger sham-controlled trial of DMPFC-rTMS for binge-eating and purging behavior may be warranted.
Tortorella, Alfonso; Monteleone, Palmiero; Martiadis, Vassilis; Perris, Francesco; Maj, Mario
Feeding is subjected to circadian regulation; therefore, changes in the components of the endogenous oscillator regulating circadian rhythms may be involved in disordered rhythmicity of eating behavior as it occurs in anorexia nervosa (AN) and bulimia nervosa (BN). We investigated whether the 3111T/C polymorphism of the CLOCK gene, which is part of the endogenous oscillator system, was associated to AN and/or BN. A total of 241 women, including 90 healthy controls, 60 patients with AN and 91 patients with BN, participated into the study. The frequencies of 3111T/C genotypes and alleles did not significantly differ among the groups. In both the AN and BN group, subjects carrying one copy of the C allele had a lifetime body weight significantly lower than those carrying the T/T genotype. These findings, although preliminary, suggest that the 3111T/C polymorphism of the CLOCK gene does not play a major role in the genetic vulnerability to AN and BN, but it seems to predispose eating disorders (EDs) patients to a more severe lifetime body weight loss. 2007 Wiley-Liss, Inc.
Cláudia Raulino Tramontt
Full Text Available INTRODUÇÃO: Estudos nacionais mostram variações na prevalência de compulsão alimentar entre 14,9 a 18,1%, enquanto a bulimia nervosa (BN apresenta-se em torno de 1 a 3,6%. Indivíduos que apresentam transtornos alimentares procuram espaços onde o exercício físico é estimulado e assim mascaram características da doença, exercitando-se compulsivamente após um episódio de compulsão alimentar. OBJETIVO: Identificar a prevalência de transtorno da compulsão alimentar periódica (TCAP e bulimia nervosa em praticantes de exercício físico associando ao estado nutricional, modalidade, frequência, duração e objetivo da prática do exercício físico. MÉTODOS: Estudo transversal composto por 103 indivíduos maiores de 18 anos com idade média de 37,7 (DP±15,6 anos, de ambos os sexos, praticantes de exercício físico há pelo menos três meses ininterruptos antes do início da pesquisa. Para análise da prevalência de TCAP e BN foi utilizado o Questionário sobre Alimentação e Peso (QEWP-R e um questionário específico sobre exercício físico. O estado nutricional foi classificado conforme o IMC. RESULTADOS: A prevalência de TCAP entre os indivíduos praticantes de exercício físico foi de 0,97%. Houve associação entre valores de IMC mais alto (p=0,026, idade menor (para TCAP p=0,036, BN p=0,01 e objetivo da prática de exercício físico declarado "estética" (para TCAP p=0,011 e BN p=0,043 com maiores pontuações nos escores de TCAP e BN. CONCLUSÃO: A prevalência de TCAP e BN encontrada neste estudo está de acordo com o referido na literatura internacional. Não foram encontradas associações entre compulsão alimentar e maior frequência de exercício físico.
Hall, A. R.
The focus of this thesis is eating disorders, specifically treatment outcomes for individuals with eating disorders. This thesis consists of three parts. The first part of the thesis is a systematic literature review on the treatment outcomes and dropout rates for men with eating disorders. Men with eating disorders are often excluded from research because of the low prevalence rates of eating disorders in men. The consequence of this is that treatment guidelines are developed based on resear...
Yela Bernabé, José Ramon; Gómez Martínez, Maria Ángeles; Cortés Rodríguez, María; Salgado Ruiz, Alfonso
The aim of this study is to compare the effectiveness of two exposure procedures on habituation of emotional responses to food stimuli: (a) exposure to external cues (food images) without eating forbidden food (CE) and (b) exposure to external cues eating forbidden food (with purge prevention). The influence of craving-trait and mood state on the habituation process is also studied. Emotional modulation of the defense startle reflex was assessed in 26 women at risk of bulimia nervosa. After four exposure trials, changes in the following variables were measured: (a) food craving-state; (b) physiological measures: hearth rate (HR) and skin conductance response (SCR); (c) motivational patterns towards food (defense startle response); and (d) valence, arousal and dominance of the emotional response to food images. After treatment, subjects tended to show non-significant lower SCR and heart orientation responses (vs. defense responses); defense startle response was also significantly lower. The exposure procedure, the induced emotional state and the number of exposure trials are analyzed.
Lavender, Jason M; Utzinger, Linsey M; Cao, Li; Wonderlich, Stephen A; Engel, Scott G; Mitchell, James E; Crosby, Ross D
Although negative affect (NA) has been identified as a common trigger for bulimic behaviors, findings regarding NA following such behaviors have been mixed. This study examined reciprocal associations between NA and bulimic behaviors using real-time, naturalistic data. Participants were 133 women with bulimia nervosa (BN) according to the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders who completed a 2-week ecological momentary assessment protocol in which they recorded bulimic behaviors and provided multiple daily ratings of NA. A multilevel autoregressive cross-lagged analysis was conducted to examine concurrent, first-order autoregressive, and prospective associations between NA, binge eating, and purging across the day. Results revealed positive concurrent associations between all variables across all time points, as well as numerous autoregressive associations. For prospective associations, higher NA predicted subsequent bulimic symptoms at multiple time points; conversely, binge eating predicted lower NA at multiple time points, and purging predicted higher NA at 1 time point. Several autoregressive and prospective associations were also found between binge eating and purging. This study used a novel approach to examine NA in relation to bulimic symptoms, contributing to the existing literature by directly examining the magnitude of the associations, examining differences in the associations across the day, and controlling for other associations in testing each effect in the model. These findings may have relevance for understanding the etiology and/or maintenance of bulimic symptoms, as well as potentially informing psychological interventions for BN. (c) 2016 APA, all rights reserved).
Monteleone, Palmiero; Tortorella, Alfonso; Scognamiglio, Pasquale; Serino, Ismene; Monteleone, Alessio Maria; Maj, Mario
Stress is a precipitating factor for both binge eating and bulimia nervosa (BN); however, the biological mechanisms through which it may trigger binge eating are poorly understood. There is evidence that the adrenal hormone cortisol and the gastric peptide ghrelin might be involved in stress-induced food ingestion. We hypothesized that symptomatic patients with BN might disclose deranged responses of ghrelin and/or cortisol to stressors and that this could be related to their binge-eating behaviour. Here we investigated salivary cortisol and ghrelin responses to the Trier Social Stress Test (TSST) in 10 women with acute BN and 10 age-matched healthy females. Eating-related psychopathology and behaviours were assessed by self-report measures. No significant differences emerged between bulimic patients and healthy controls in the pre-stress salivary levels of both cortisol and ghrelin. The BN patients displayed normal cortisol but enhanced ghrelin responses to TSST. No significant correlations emerged between stress-induced salivary hormone changes and self-report measures of binge eating. To our knowledge, this is the first study showing deranged salivary ghrelin reactivity to a psychosocial stressor in symptomatic patients with BN. The extent to which this could contribute to the binge-eating behaviour of BN subjects awaits clarification. Copyright © 2012 S. Karger AG, Basel.
MacDonald, Danielle E; Trottier, Kathryn; McFarlane, Traci; Olmsted, Marion P
Rapid response (RR) to eating disorder treatment has been reliably identified as a predictor of post-treatment and sustained remission, but its definition has varied widely. Although signal detection methods have been used to empirically define RR thresholds in outpatient settings, RR to intensive treatment has not been investigated. This study investigated the optimal definition of RR to day hospital treatment for bulimia nervosa and purging disorder. Participants were 158 patients who completed ≥6 weeks of day hospital treatment. Receiver operating characteristic (ROC) analysis was used to create four definitions of RR that could differentiate between remission and nonremission at the end of treatment. Definitions were based on binge/vomit episode frequency or percent reduction from pre-treatment, during either the first four or first two weeks of treatment. All definitions were associated with higher remission rates in rapid compared to nonrapid responders. Only one definition (i.e., ≤3 episodes in the first four weeks of treatment) predicted sustained remission (versus relapse) at 6- and 12-month follow-up. These findings provide an empirically derived definition of RR to intensive eating disorder treatment, and provide further evidence that early change is an important prognostic indicator. Copyright © 2015 Elsevier Ltd. All rights reserved.
MacDonald, Danielle E; Trottier, Kathryn; Olmsted, Marion P
Rapid and substantial behavior change (RSBC) early in cognitive behavior therapy (CBT) for eating disorders is the strongest known predictor of treatment outcome. Rapid change in other clinically relevant variables may also be important. This study examined whether rapid change in emotion regulation predicted treatment outcomes, beyond the effects of RSBC. Participants were diagnosed with bulimia nervosa or purging disorder (N = 104) and completed ≥6 weeks of CBT-based intensive treatment. Hierarchical regression models were used to test whether rapid change in emotion regulation variables predicted posttreatment outcomes, defined in three ways: (a) binge/purge abstinence; (b) cognitive eating disorder psychopathology; and (c) depression symptoms. Baseline psychopathology and emotion regulation difficulties and RSBC were controlled for. After controlling for baseline variables and RSBC, rapid improvement in access to emotion regulation strategies made significant unique contributions to the prediction of posttreatment binge/purge abstinence, cognitive psychopathology of eating disorders, and depression symptoms. Individuals with eating disorders who rapidly improve their belief that they can effectively modulate negative emotions are more likely to achieve a variety of good treatment outcomes. This supports the formal inclusion of emotion regulation skills early in CBT, and encouraging patient beliefs that these strategies are helpful. © 2017 Wiley Periodicals, Inc.
Heaner, Martica K; Walsh, B Timothy
During the last 25 years, the careful examination of the eating behavior of individuals with eating disorders has provided critical insights into the nature of these disorders. Crucially, studies investigating components of different eating behaviors have documented that Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Binge Eating Disorder (BED) are characterized by objective disturbances in eating patterns that are significantly different than behaviors exhibited by individuals who do not have these eating disorders. The detailed description of the disturbances in eating behavior has helped to identify diagnostic criteria associated with each disorder, and has led to important hypotheses about the underlying pathophysiology. These advances in understanding have provided, and continue to provide, a foundation for translational research and for the development of novel treatment interventions. This review is based on a presentation given by B. Timothy Walsh, M.D. at the 40th anniversary symposium of the Columbia University Appetite talks outlining the evolution of the discovery of the characteristic eating disturbances seen with each disorder. Copyright © 2013 Elsevier Ltd. All rights reserved.
Cook, Brian J; Steffen, Kristine J; Mitchell, James E; Otto, Maxwell; Crosby, Ross D; Cao, Li; Wonderlich, Stephen A; Crow, Scott; Hill, Laura; Le Grange, Daniel; Powers, Pauline
The objective of this study was to investigate diagnostic differences in weight suppression (e.g., the difference between one's current body weight and highest non-pregnancy adult body weight) and exercise among Bulimia Nervosa (BN) and Binge Eating Disorder (BED). Because exercise may be a key contributor to weight suppression in BN, we were interested in examining the potential moderating effect of exercise on weight suppression in BN or BED. Participants with BN (n = 774) and BED (n = 285) completed self-report surveys of weight history, exercise and eating disorder symptoms. Generalised linear model analyses were used to examine the associations among diagnosis, exercise frequency and their interaction on weight suppression. Exercise frequency and BN/BED diagnosis were both associated with weight suppression. Additionally, exercise frequency moderated the relationship between diagnosis and weight suppression. Specifically, weight suppression was higher in BN than in BED among those with low exercise frequency but comparable in BN and BED among those with high exercise frequency. Our results suggest that exercise frequency may contribute to different weight suppression outcomes among BN and BED. This may inform clinical implications of exercise in these disorders. Specifically, much understanding of the differences among exercise frequency and the compensatory use of exercise in BN and BED is needed. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
Conceição, Eva M; Crosby, Ross; Mitchell, James E; Engel, Scott G; Wonderlich, Stephen A; Simonich, Heather K; Peterson, Caroline B; Crow, Scott J; Le Grange, Daniel
Picking or ribbling (P&N) is a newly studied eating behavior characterized by eating in an unplanned and repetitious manner in between meals and snacks. This behavior seems to be related to poorer weight loss outcomes after bariatric surgery for weight loss in severely obese patients, but clarification is still required regarding its value in other clinical samples. The purpose of this study was to investigate the frequency of P&N across different eating disorder samples, as well as to examine its association with psychopathological eating disorder features. Our sample included treatment-seeking adult participants, recruited for five different clinical trials: 259 binge eating disorder (BED); 264 bulimia nervosa (BN), and 137 anorexia nervosa (AN). Participants were assessed using the Eating Disorders Examination interview before entering the clinical trials. P&N was reported by 44% of the BED; 57.6% of the BN; and 34.3% of the AN participants. No association was found between P&N and BMI, the presence of compensatory behaviors, binge eating, or any of the eating disorder examination subscales. This study suggests that P&N behavior is highly prevalent across eating disorder diagnoses, but it is not associated with psychopathology symptoms or other eating disordered behaviors. Copyright © 2013 Wiley Periodicals, Inc.
Chen, Eunice Y; Matthews, Lauren; Allen, Charese; Kuo, Janice R; Linehan, Marsha Marie
This treatment development study provides summary data for standard Dialectical Behavior Therapy (DBT) with minimal adaptation for 8 women with binge-eating disorder (BED) (5) or bulimia nervosa (BN) (3) and Borderline Personality Disorder (BPD). DBT involved 6 months of weekly skills group, individual DBT, therapist consultation team meeting, and 24-hour telephone coaching. Assessments were conducted at pre-, post-treatment, and 6-months follow-up and utilized standardized clinical interviews including the Eating Disorders Examination (EDE), Personality Disorders Exam, and the Structured Clinical Interview for DSM-IV. From pre- to post-treatment, effect sizes for objective binge eating, total EDE scores and global adjustment were large and for number of non-eating disorder axis I disorders and for suicidal behavior and self-injury were medium. From pre- to 6-months follow-up, effect sizes were large for all these outcomes. This provides promising pilot data for larger studies utilizing DBT for BED or BN and BPD. (c) 2008 by Wiley Periodicals, Inc.
Monteleone, P; Scognamiglio, P; Monteleone, A M; Perillo, D; Maj, M
Sensitivity to punishment (SP) and sensitivity to reward (SR) are personality characteristics that may have relevance for the pathophysiology of eating disorders (EDs). Moreover, personality characteristics are known to modulate the activity of the hypothalamus-pituitary-adrenal (HPA) axis, which is the main component of the endogenous stress response system. As stress has been implicated in the aetiology and the maintenance of EDs, we aimed to study the HPA axis activity in relation to SP and SR, as conceptualized by Gray's reinforcement sensitivity theory (RST), in patients with anorexia nervosa (AN) or bulimia nervosa (BN). Twenty-five women with AN, 23 women with BN and 19 healthy women volunteered for the study. HPA axis activity was assessed by measurement of the salivary cortisol awakening response (CAR). The subjects' SP and SR were measured by the behavioural inhibition system (BIS)/behavioural approach system (BAS) scales. The CAR was significantly enhanced in AN patients, but not in BN patients, compared to healthy women. The CAR correlated significantly with BAS measures, negatively in healthy controls and positively in binge-purging AN patients and BN women. SP, measured by the BIS scale, was higher in patients than in controls. These findings confirm the occurrence of an enhanced activity of the HPA axis in symptomatic AN, but not in symptomatic BN, and show for the first time that the CAR is associated with SR, as conceptualized by the RST, negatively in healthy subjects but positively in binge-purging ED patients.
Vestergaard, Peter; Emborg, Charlotte; Støving, René K; Hagen, Claus; Mosekilde, Leif; Brixen, Kim
To study fracture risk in patients with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorders not otherwise specified (EDNOS). Cohort study including all Danes diagnosed with AN (n = 2,149), BN (n = 1,294), or EDNOS (n = 942) between 1977 and 1998. Each patient was compared with three randomly drawn age- and gender-matched control subjects. Fracture risk was increased in AN after diagnosis compared to controls (incidence rate ratio: 1.98, 95% CI: 1.60-2.44), but not before. The increased fracture risk persisted more than 10 years after diagnosis. A significant increase in fracture risk was found before diagnosis in BN (1.31, 95% CI: 1.04-1.64), with a trend towards an increase after diagnosis (1.44, 95% CI: 0.93-2.22). EDNOS patients had a significant increase in fracture risk before (1.39, 95% CI: 1.06-1.81) and after diagnosis (1.77, 95% CI: 1.25-2.51). The increased fracture risk many years after diagnosis indicates permanent skeletal damage. Copyright 2002 by Wiley Periodicals, Inc.
Alvarenga, M S; Koritar, P; Pisciolaro, F; Mancini, M; Cordás, T A; Scagliusi, F B
The objective was to compare eating attitudes, conceptualized as beliefs, thoughts, feelings, behaviors and relationship with food, of anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED) patients and a group of obese (OBS) without eating disorders (ED). Female patients from an Eating Disorder (ED) Unit with AN (n=42), BN (n=52) and BED (n=53) and from an obesity service (n=37) in Brazil answered the Disordered Eating Attitude Scale (DEAS) which evaluate eating attitudes with 5 subscales: relationship with food, concerns about food and weight gain, restrictive and compensatory practices, feelings toward eating, and idea of normal eating. OBS patients were recruited among those without ED symptoms according to the Binge Eating Scale and the Questionnaire on Eating and Weight Patterns. ANOVA was used to compare body mass index and age between groups. Bonferroni test was used to analyze multiple comparisons among groups. AN and BN patients presented more dysfunctional eating attitudes and OBS patients less dysfunctional (peating." BED patients were worst than OBS for "Relationship with food" and as dysfunctional as AN patients - besides their behavior could be considered the opposite. Differences and similarities support a therapeutic individualized approach for ED and obese patients, call attention for the theoretical differences between obesity and ED, and suggest more research focused on eating attitudes. Copyright © 2014 Elsevier Inc. All rights reserved.
Smith, Kathryn E; Ellison, Jo M; Crosby, Ross D; Engel, Scott G; Mitchell, James E; Crow, Scott J; Peterson, Carol B; Le Grange, Daniel; Wonderlich, Stephen A
The DSM-5 includes severity specifiers (i.e., mild, moderate, severe, extreme) for anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED), which are determined by weight status (AN) and frequencies of binge-eating episodes (BED) or inappropriate compensatory behaviors (BN). Given limited data regarding the validity of eating disorder (ED) severity specifiers, this study examined the concurrent and predictive validity of severity specifiers in AN, BN, and BED. Adults with AN (n = 109), BN (n = 76), and BED (n = 216) were identified from previous datasets. Concurrent validity was assessed by measures of ED psychopathology, depression, anxiety, quality of life, and physical health. Predictive validity was assessed by ED symptoms at the end of the treatment in BN and BED. Severity categories did not differ in baseline validators, though the mild AN group evidenced greater ED symptoms compared to the severe group. In BN, greater severity was related to greater end of treatment binge-eating and compensatory behaviors, and lower likelihood of abstinence; however, in BED, greater severity was related to lower ED symptoms at the end of the treatment. Results demonstrated limited support for the validity of DSM-5 severity specifiers. Future research is warranted to explore additional validators and possible alternative indicators of severity in EDs. © 2017 Wiley Periodicals, Inc.
Lee, Jung Eun; Namkoong, Kee; Jung, Young-Chul
Binge-eating disorder (BED)characterized by recurrent episodes of binge-eating without inappropriate compensatory behaviors is classified as an official diagnosis in DSM-5. However, the neural bases that differentiate BED from other eating disorders such as bulimia nervosa (BN), are still under debate. Thirty-nine participants (HC, n=14; BN, n=13; BED, n=12) underwent functional MRI while performing a Stroop-Match-to-Sample task. This pilot study investigated how food images interfered with the behavioral performances and blood-oxygenation-level-dependent neuronal activity. Compared to healthy controls, participants with BN showed lower accuracy indicating impaired cognitive control over interference. Compared to healthy controls, participants with BED demonstrated stronger activations in the ventral striatum in response to food images. By contrast, participants with BN exhibited stronger activations in the premotor cortex and dorsal striatum. These aberrant ventral and dorsal frontostriatal activations in response to food images are associated with increased reward sensitivity and habitual binge-eating/purging behaviors in BED and BN. Copyright © 2017 Elsevier B.V. All rights reserved.
Utzinger, Linsey M; Mitchell, James E; Cao, Li; Crosby, Ross D; Crow, Scott J; Wonderlich, Stephen A; Peterson, Carol B
This study examined whether having a history of anorexia nervosa (AN) or bulimia nervosa (BN) is associated with response to treatment in adults with binge eating disorder (BED). Data from 189 adults diagnosed with BED who were randomly assigned to one of three group cognitive-behavioral (CBT) treatments were analyzed to compare those with and without a history of AN/BN. A total of 16% of the sample had a history of AN/BN. The BED subgroup with a history of AN/BN presented with higher rates of mood disorders and greater eating-related symptom severity at baseline. Participants with a history of AN/BN also had higher global eating disorder (ED) symptoms at end of treatment (EOT), and more frequent objective binge-eating episodes at EOT and 12-month follow-up. These findings suggest that in adults with BED, a history of AN/BN is predictive of greater eating-related symptom severity following group-based CBT and poorer short- and long-term binge-eating outcomes. These findings suggest that considering ED history in the treatment of adults with BED may be clinically useful. © 2015 Wiley Periodicals, Inc.
Full Text Available Body dissatisfaction is the most relevant body image disturbance in bulimia nervosa (BN. Research has shown that viewing one's own body evokes negative thoughts and emotions in individuals with BN. However, the psychophysiological mechanisms involved in this negative reaction have not yet been clearly established. Our aim was to examine the emotional and attentional processes that are activated when patients with BN view their own bodies.We examined the effects of viewing a video of one's own body on the physiological (eye-blink startle, cardiac defense, and skin conductance and subjective (pleasure, arousal, and control ratings responses elicited by a burst of 110 dB white noise of 500 ms duration. The participants were 30 women with BN and 30 healthy control women. The experimental task consisted of two consecutive and counterbalanced presentations of the auditory stimulus preceded, alternatively, by a video of the participant's own body versus no such video.The results showed that, when viewing their own bodies, women with BN experienced (a greater inhibition of the startle reflex, (b greater cardiac acceleration in the first component of the defense reaction, (c greater skin conductance response, and (d less subjective pleasure and control combined with greater arousal, compared with the control participants.Our findings suggest that, for women with BN, peripheral-physiological responses to self-images are dominated by attentional processes, which provoke an immobility reaction caused by a dysfunctional negative response to their own body.
Dryer, Rachel; Uesaka, Yuri; Manalo, Emmanuel; Tyson, Graham
To identify similarities and differences in beliefs about the causes of Bulimia Nervosa (BN) held by Asian (Japanese) women and Western (Australian) women, and hence, to examine the applicability of belief models of eating disorders (ED) across different cultures. Four hundred three Japanese and 256 Australian female university students (aged 17-35 years) completed a questionnaire that gauged beliefs about the causes of BN. Among the Australian women, the four-component structure of perceived causes (dieting and eating practices, family dynamics, socio-cultural pressure, and psychological vulnerability) found in Dryer et al. (2012) was replicated. Among the Japanese women, however, a three-component structure (without the psychological vulnerability component) was obtained. The groups also differed in the causal component they most strongly endorsed, that being socio-cultural pressure for the Australian women, and dieting and eating practices for the Japanese women. The Japanese participants were found to endorse three out of the four Western-based causal explanations for BN, but the relative importance they placed on those explanations differed from that of the Australian participants. Further research is needed, particularly to establish whether Japanese women simply fail to see psychological vulnerability as a viable cause of BN, or there are in fact cultural differences in the extent to which such vulnerability causes BN. © 2014 Wiley Periodicals, Inc.
Collins, Brittany; Breithaupt, Lauren; McDowell, Jennifer E; Miller, L Stephen; Thompson, James; Fischer, Sarah
The impact of acute stress on the neural processing of food cues in bulimia nervosa (BN) is unknown, despite theory that acute stress decreases cognitive control over food and hence increases vulnerability to environmental triggers for binge eating. Thus, the goals of this manuscript were to explore the impact of acute stress on the neural processing of food cues in BN. In Study 1, 10 women with Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) BN and 10 healthy controls participated in an fMRI paradigm examining the neural correlates of visual food cue processing pre and post an acute stress induction. Whole brain analysis indicated that women with BN exhibited significant decreases in activation in the precuneus, associated with self-referential processing, the paracingulate gyrus, and the anterior vermis of the cerebellum. Healthy controls exhibited increased activation in these regions in response to food cues poststress. In Study 2, 17 women with DSM-5 BN or otherwise specified feeding and eating disorder with BN symptoms participated in the same paradigm. A region of interest analysis replicated findings from Study 1. Replication of imaging findings in 2 different samples suggests the potential importance of these regions in relation to BN. Decreased activation in the precuneus, specifically, is consistent with models of BN that posit that binge eating serves as a concrete distraction from aversive internal stimuli. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Degortes, Daniela; Tenconi, Elena; Santonastaso, Paolo; Favaro, Angela
The aim of the present study was to investigate executive functioning and visuospatial abilities in patients with bulimia nervosa (BN), with a particular interest in exploring the impact of a previous diagnosis of anorexia nervosa (AN). Several neuropsychological tasks were administered to 89 BN patients (52 with a previous history of AN and 37 without previous AN) and 160 healthy women. A poorer performance on set-shifting measures (Wisconsin Card Sorting Test) was found only in BN patients with a previous history of AN. Decision-making abilities (Iowa Gambling Task) were significantly impaired in the whole sample of BN patients, but difficulties were more pronounced in the subgroup with previous AN. Finally, we did not find any differences in response inhibition and visuospatial abilities between the two samples of BN patients and healthy women. Our findings support the idea that cognitive abilities in patients with BN are more impaired in the presence of a prior history of AN. The clinical and treatment implications of our findings should be explored in future studies. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.