WorldWideScience

Sample records for bulimia

  1. Bulimia

    Science.gov (United States)

    ... weight gain. Many people with bulimia also have anorexia nervosa . ... to go to the hospital, unless they: Have anorexia Have major ... treat bulimia. Treatment depends on how severe the bulimia is, ...

  2. Bulimias

    OpenAIRE

    GALLANO, CARMEN

    2003-01-01

    En la clínica psicoanalítica no podemos hablar de la "bulimia", como lo hace el dsm-iv cuando define las características generales de la "bulimia nerviosa", pues lo que recibimos en la practica psicoanalítica son sujetos que se presentan como pacientes, c

  3. Bulimias

    Directory of Open Access Journals (Sweden)

    CARMEN GALLANO

    2003-01-01

    Full Text Available En la clínica psicoanalítica no podemos hablar de la "bulimia", como lo hace el dsm-iv cuando define las características generales de la "bulimia nerviosa", pues lo que recibimos en la practica psicoanalítica son sujetos que se presentan como pacientes, c

  4. Bulimia nervosa

    National Research Council Canada - National Science Library

    Hay, Phillipa J; Claudino, Angélica Medeiros

    2010-01-01

    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...

  5. [Bulimia nervosa].

    Science.gov (United States)

    Zeeck, A; Hartmann, A; Sandholz, A; Joos, A

    2006-08-01

    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.

  6. Bulimia nervosa.

    Science.gov (United States)

    Hay, Phillipa J; Claudino, Angélica Medeiros

    2010-07-19

    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

  7. Bulimia nervosa: online interventions

    National Research Council Canada - National Science Library

    Hay, Phillipa J; Claudino, Angélica Medeiros

    2015-01-01

    Up to 1% of people in the community may have bulimia nervosa, characterised by an intense preoccupation with body weight, binge-eating episodes, and use of extreme measures to counteract the feared effects of overeating...

  8. Bulimia Nervosa - medical complications.

    Science.gov (United States)

    Mehler, Philip S; Rylander, Melanie

    2015-01-01

    As with anorexia nervosa, there are many medical complications associated with bulimia nervosa. In bulimia nervosa, these complications are a direct result of both the mode and the frequency of purging behaviours. For the purposes of this article, we will review in detail the many complications of the two major modes of purging, namely, self-induced vomiting and laxative abuse; these two account for more than 90% of purging behaviours in bulimia nervosa. Some of these complications are potentially extremely dangerous and need to be well understood to effectively treat patients with bulimia nervosa. Other methods of purging, such as diuretic abuse, are much less frequently utilized and will only be mentioned briefly. In a subsequent article, the treatments of these medical complications will be presented.

  9. [Bulimia during adolescence].

    Science.gov (United States)

    de Tournemire, R

    2013-11-01

    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.

  10. The Group Treatment of Bulimia.

    Science.gov (United States)

    Weinstein, Harvey M.; Richman, Ann

    1984-01-01

    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)

  11. La bulimia y la anorexia

    OpenAIRE

    Bersh, Sonia; Fundación Valle de Lili

    2001-01-01

    Trastornos de la conducta alimentaria / El auge de la anorexia y la bulimia / Complicaciones médicas de los trastornos de la alimentación / Otros problemas emocionales / Tratamiento / Complicaciones de la anorexia y la bulimia nerviosa.

  12. Cognitive hypnotherapy with bulimia.

    Science.gov (United States)

    Barabasz, Marianne

    2012-04-01

    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.

  13. Bulimia nervosa: online interventions.

    Science.gov (United States)

    Hay, Phillipa J; Claudino, Angélica Medeiros

    2015-03-04

    Up to 1% of people in the community may have bulimia nervosa, characterised by an intense preoccupation with body weight, binge-eating episodes, and use of extreme measures to counteract the feared effects of overeating. People with bulimia nervosa are of normal weight or are overweight, making the condition distinct from anorexia nervosa. 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 question: What are the effects of online interventions for people with bulimia nervosa? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2014 (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 eight 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: applications (apps) or online programmes used as an adjunct to face-to-face therapy, delivery of self-help online, and delivery of therapy online.

  14. Bulimia: The Transgenerational View.

    Science.gov (United States)

    Roberto, Laura Giat

    1986-01-01

    Within families with bulimia, certain interactional patterns enable and perpetuate the patient's binge-eating and purging symptoms. A transgenerational treatment method is proposed, which intervenes in ongoing dysfunctional patterns, and provides a frame for creating a therapeutic metaphor ("legacy") to direct the therapy. Rationale and stages of…

  15. Bulimia: A Medical Portrait.

    Science.gov (United States)

    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…

  16. Anorexia Nervosa and Bulimia.

    Science.gov (United States)

    Csapo, Marg

    1987-01-01

    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…

  17. Anorexia nervosa and bulimia.

    Science.gov (United States)

    Smith, M S

    1984-05-01

    Anorexia nervosa may occur in one of 200 white adolescent girls, and bulimia appears to be much more common, particularly in older adolescents and young women. These disorders are distinctly uncommon in the male population. Current opinion supports a psychological basis for these disorders, although there are some findings that suggest a primary hypothalamic defect. Early warning signs of anorexia nervosa include an arrest in weight gain during puberty, increasing social isolation, hyperathleticism, and increasing concern over academic performance. Bulimia may exist concomitantly with anorexia nervosa or as an entirely separate disorder characterized by a recurrent binge-purge cycle. The signs and symptoms of these eating disorders are mainly those associated with weight loss, dehydration, and electrolyte imbalance. Because of the complex psychological issues involved, an experienced psychotherapist should be involved while the primary care clinician provides anticipatory and supportive medical care.

  18. Bulimia Nervosa/Purging Disorder.

    Science.gov (United States)

    Castillo, Marigold; Weiselberg, Eric

    2017-04-01

    Bulimia nervosa was first described in 1979 by British psychiatrist Gerald Russell as a "chronic phase of anorexia nervosa" in which patients overeat and then use compensatory mechanisms, such as self-induced vomiting, laxatives, or prolonged periods of starvation. The characterization of bulimia nervosa continues to evolve with the introduction of the DSM-5 in 2013. In this article, the epidemiology and risk factors of bulimia nervosa are identified and reviewed, along with the medical complications and psychiatric comorbidities. The evaluation of a patient with suspected bulimia nervosa is addressed, with an emphasis on acquiring a complete and thorough history as well as discovering any comorbidities that are present. Management of the patient involves both medical interventions and behavioral counseling in order to address physical, psychological, and social needs. Lastly, a new diagnosis introduced in the DSM-5, purging disorder, is described and discussed. Copyright © 2017 Mosby, Inc. All rights reserved.

  19. Bulimia and Interpersonal Relationships: A Longitudinal Study.

    Science.gov (United States)

    Thelen, Mark H.; And Others

    1990-01-01

    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…

  20. Physiological Bases of Bulimia, and Antidepressant Treatment.

    Science.gov (United States)

    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…

  1. [The nosological entity bulimia nerviosa].

    Science.gov (United States)

    López-Ibor Aliño, J J; Cervera Enguix, S

    1991-01-01

    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.

  2. bulimia nervosa.pm6

    African Journals Online (AJOL)

    QuickSilver

    treatment, eating pathology and comorbidity adolescent bulimics who presented to the Eating Disorders Program at The University of Chicago Hospitals. Clinical presentation of Bulimia Nervosa. Comorbidity: BN is a major source of psychiatric morbidity and impairs several areas of functioning. In adults, clinical features in-.

  3. The Bulimia Test--Revised: Validation with "DSM-IV" Criteria for Bulimia Nervosa.

    Science.gov (United States)

    Thelen, Mark H.; And Others

    1996-01-01

    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)

  4. Medical Complications of Anorexia Nervosa and Bulimia.

    Science.gov (United States)

    Westmoreland, Patricia; Krantz, Mori J; Mehler, Philip S

    2016-01-01

    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.

  5. La bulimia nerviosa y sus subtipos

    OpenAIRE

    Myriam Sierra Puentes

    2005-01-01

    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.

  6. Imagem do corpo e bulimia

    OpenAIRE

    Esteves, Rosita; Ramires,Vera Regina Röhnelt

    2015-01-01

    RESUMO:Analisa-se o conceito de imagem do corpo e sua alteração na bulimia sustentado no aporte psicanalítico. A partir do estudo da constituição da imagem do corpo e sua perturbação na bulimia, identificou-se uma importante articulação entre ambas, que se dá em pontos fundamentais do psiquismo, destacando-se o narcisismo, as relações objetais e a identificação. Assim, os fatores que participam da construção da imagem do corpo e estão comprometidos quando há uma patologia da mesma coincidem c...

  7. Anorexia Nervosa/Bulimia: The Teenager's Dilemma.

    Science.gov (United States)

    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…

  8. Manifestaciones bucales de la bulimia

    OpenAIRE

    Morand, Lucio; Muñoz Ortega, Alejandra P.

    2015-01-01

    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...

  9. Tratamento nutricional da bulimia nervosa Nutritional therapy for bulimia nervosa

    Directory of Open Access Journals (Sweden)

    Marle dos Santos Alvarenga

    2010-10-01

    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

  10. Anorexia Nervosa and Bulimia: A Research Review.

    Science.gov (United States)

    Sweeten, Mary K.

    1985-01-01

    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)

  11. Fad Bulimia: A Serious and Separate Counseling Issue.

    Science.gov (United States)

    Cesari, Joan P.

    1986-01-01

    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)

  12. Bulimia: Estimate of Incidence and Relationship of Shyness.

    Science.gov (United States)

    Segal, Shirley Ann; Figley, Charles R.

    1985-01-01

    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)

  13. Group Work for Bulimia: A Review of Outcomes.

    Science.gov (United States)

    Zimpfer, David G.

    1990-01-01

    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)

  14. Treating Women with Bulimia from a Sociocultural Perspective.

    Science.gov (United States)

    Hotelling, Kathy

    1986-01-01

    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)

  15. Body and Bulimia Revisited: Reflections on "A Secret Life"

    Science.gov (United States)

    Tillmann, Lisa M.

    2009-01-01

    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…

  16. Using the Health Belief Model for Bulimia Prevention.

    Science.gov (United States)

    Grodner, Michele

    1991-01-01

    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)

  17. Binging & Purging: Youth Who Suffer Bulimia.

    Science.gov (United States)

    Strodel, Donna

    1990-01-01

    Describes bulimia, its symptoms, characteristics and bulimic's family profile. Disorder may be more difficult to hide at camp. Camp staff could be first to recognize symptoms. Describes behavior indicators of bulimics. Suggests appropriate responses and counseling techniques for helping bulimic campers. (TES)

  18. Bulimia: clinical characteristics, development, and etiology.

    Science.gov (United States)

    Kirkley, B G

    1986-04-01

    Bulimia is characterized by recurrent episodes of binge eating and severe self-deprecation, often accompanied by self-induced vomiting and/or laxative abuse. It is most often found among young women in their late teens to mid-30s. Estimates of the disorder's prevalence vary widely, depending on the diagnostic criteria used, but usually range from 5% to 20% of college age women. Binge eating typically begins in late adolescence, frequently after a period of dieting to lose weight. Self-induced vomiting usually follows the onset of binge eating by about a year. To date, theories of the disorder's etiology have included several biological models, a psychosocial model, and a biopsychosocial model. The biological models proposed have viewed bulimia as a form of biological depression, neurological disturbance, or metabolic disturbance. The psychosocial model suggests that society's pressure on young women for extreme thinness leads to excessive dietary restraint, deprivation, and, paradoxically, binge eating. The presence of anxiety or depression exacerbates the process. The biopsychosocial model appears to be the most promising. It proposes that young women with biological predispositions toward overweight, depression, or metabolic disturbance are particularly vulnerable to social pressure for thinness, the binge eating that may result from excessive dieting, and, hence, bulimia. The complex nature of bulimia suggests that a multidisciplinary team approach treatment is appropriate.

  19. Interpersonal Group Therapy for Women Experiencing Bulimia

    Science.gov (United States)

    Choate, Laura

    2010-01-01

    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…

  20. How patients describe bulimia or binge eating.

    Science.gov (United States)

    Abraham, S F; Beumont, P J

    1982-08-01

    Thirty-two patients who complained of episodes of ravenous overeating which they felt unable to control (bulimia) were asked to describe their behaviour and symptoms. There was considerable variation both between and within individuals, but a number of factors were defined which appeared to be common to all with the complaint. It is difficult to set up strict criteria for the recognition of bulimia, and those that have recently been proposed are criticized in the light of our present findings. Bulimia is usually associated with an excessive concern about body weight. It occurs in patients with anorexia nervosa, in whom it is often a relatively early feature of the illness, but it is also found in subjects of normal weight or obese subjects who have never been emaciated. Episodes of bulimia are usually preceded by dysphoric mood states. The gorging may alleviate the dysphoria temporarily, but many patients later experience negative feelings such as depression and self-depreciation. The ability to induce vomiting after a bulimic episode is a major influence determining the clinical presentation.

  1. Bulimia: A Model for Group Therapy.

    Science.gov (United States)

    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.…

  2. A Multifaceted Group Treatment of Bulimia.

    Science.gov (United States)

    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…

  3. La última cena: anorexia y bulimia

    Directory of Open Access Journals (Sweden)

    Antonio García Cenador

    2007-12-01

    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.

  4. Subclinical bulimia predicts conduct disorder in middle adolescent girls.

    Science.gov (United States)

    Viinamäki, Anni; Marttunen, Mauri; Fröjd, Sari; Ruuska, Jaana; Kaltiala-Heino, Riittakerttu

    2013-01-01

    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.

  5. Reboxetina no tratamento da bulimia nervosa Reboxetine in the treatment of bulimia nervosa

    Directory of Open Access Journals (Sweden)

    Simone Mancini Castilho

    2003-06-01

    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.

  6. Dimensions of emotion dysregulation in bulimia nervosa

    OpenAIRE

    Lavender, Jason M.; Wonderlich, Stephen A.; Peterson, Carol B.; Crosby, Ross D.; Engel, Scott G.; Mitchell, James E.; Crow, Scott J.; Smith, Tracey L.; Klein, Marjorie H.; Goldschmidt, Andrea B; Berg, Kelly C.

    2014-01-01

    The goal of this study was to examine associations between dimensions of emotion dysregulation and eating disorder (ED) symptoms in bulimia nervosa (BN). This investigation used baseline data from a BN treatment study that included 80 adults (90% women) with full or subthreshold BN. Participants completed the Difficulties in Emotion Regulation Scale (DERS) and the Eating Disorders Examination (EDE) interview. The EDE global score was significantly correlated with the DERS total score, as well...

  7. Recurrent acute pancreatitis in anorexia and bulimia.

    Science.gov (United States)

    Morris, Luc G; Stephenson, Kathryn E; Herring, Sharon; Marti, Jennifer L

    2004-07-01

    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.

  8. Bulimia Nervosa: Changes in Its Prevalence on Campus.

    Science.gov (United States)

    Hill, Laura

    1989-01-01

    Administered Survey on Eating Habits to 382 male and female university students to elicit information relevant to bulimia nervosa. Prevalence of bulimia nervosa among subjects was 10 percent using old criteria and 1 percent using modified new criteria for the disorder. Whichever criteria were used, typical bulimic student was found to be White…

  9. Treatment of Body Image Dissatisfaction among Women with Bulimia Nervosa.

    Science.gov (United States)

    Brouwers, Mariette

    1990-01-01

    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…

  10. Choosing Assessment Instruments for Bulimia Practice and Outcome Research

    Science.gov (United States)

    Sandberg, Katie; Erford, Bradley T.

    2013-01-01

    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…

  11. Adolescent Eating Disorders: Anorexia and Bulimia. Publication 352-004.

    Science.gov (United States)

    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…

  12. Assessing motivation to change in bulimia nervosa: the Bulimia Nervosa Stages of Change Questionnaire.

    Science.gov (United States)

    Martinez, Esteve; Castro, Josefina; Bigorra, Aitana; Morer, Astrid; Calvo, Rosa; Vila, Montserrat; Toro, Josep; Rieger, Elisabeth

    2007-01-01

    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

  13. Defining recovery in adult bulimia nervosa.

    Science.gov (United States)

    Yu, Jessica; Agras, W Stewart; Bryson, Susan

    2013-01-01

    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.

  14. Articulaciones (ATemporales en el Síntoma y en la Bulimia (ATemporal Articulations in the Symptom and Bulimia

    Directory of Open Access Journals (Sweden)

    Esteban Radiszcz

    2006-11-01

    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.

  15. Medical complications of bulimia nervosa and their treatments.

    Science.gov (United States)

    Sachs, Katherine; Mehler, Philip S

    2016-03-01

    The purpose of this article is to thoroughly review the medical complications associated with bulimia nervosa and their evidenced-based or typical treatments. A thorough review of medical literature to cull pertinent and best articles which guide the diagnosis and treatment of the medical complications of bulimia nervosa was performed. There are many different medical complications of bulimia nervosa which are caused by the mode and frequency of purging. Some are fluid and electrolyte alterations from the utilized mode of purging and some are due to the local damaging effects of purging behaviors on those body sites. Bulimia nervosa is a serious mental health disorder which has many medical complications associated with it. Most are reversible with treatment.

  16. Increased Mortality in Bulimia Nervosa and Other Eating Disorders

    National Research Council Canada - National Science Library

    Specker, Sheila; Peterson, Carol B; Eckert, Elke D; Swanson, Sonja A; Crow, Scott J; Mitchell, James E; Raymond, Nancy C

    2009-01-01

    .... 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. Method...

  17. Comorbidity of Anxiety Disorders With Anorexia and Bulimia Nervosa

    National Research Council Canada - National Science Library

    Kaye, Walter H; Bulik, Cynthia M; Thornton, Laura; Barbarich, Nicole; Masters, Kim

    2004-01-01

    OBJECTIVE: A large and well-characterized sample of individuals with anorexia nervosa and bulimia nervosa from the Price Foundation collaborative genetics study was used to determine the frequency of anxiety...

  18. Neural signature of behavioural inhibition in women with bulimia nervosa.

    Science.gov (United States)

    Skunde, Mandy; Walther, Stephan; Simon, Joe J; Wu, Mudan; Bendszus, Martin; Herzog, Wolfgang; Friederich, Hans-Christoph

    2016-08-01

    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.

  19. Treatments of medical complications of anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Mehler, Philip S; Krantz, Mori J; Sachs, Katherine V

    2015-01-01

    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.

  20. Implicit self-esteem in bulimia nervosa.

    Science.gov (United States)

    Cockerham, Elaine; Stopa, Lusia; Bell, Lorraine; Gregg, Aiden

    2009-06-01

    Implicit and explicit self-esteem were compared in a group of female participants with bulimia nervosa or binge eating disorder (n=20) and a healthy control group (n=20). Lower explicit and a less positive implicit self-esteem bias in the clinical group was predicted. Participants completed a self-esteem implicit association test and two explicit self-esteem measures. The eating disordered group had lower explicit self-esteem, but a more positive implicit self-esteem bias than controls. The results are discussed in relation to the idea that discrepancies between implicit and explicit self-esteem reflect fragile self-esteem and are related to high levels of perfectionism, which is associated with eating disorders.

  1. Social appearance anxiety and bulimia nervosa.

    Science.gov (United States)

    Koskina, A; Van den Eynde, F; Meisel, S; Campbell, I C; Schmidt, U

    2011-06-01

    Social appearance anxiety is an unexplored concept in eating disorders (ED). It refers to social anxiety surrounding overall appearance, including body shape, and fear of negative evaluation by others. It is potentially relevant to those with bulimia nervosa (BN) as both social anxiety and body image disturbance are commonly experienced by patients. Thirty women with BN and forty healthy controls (HC) completed the Social Appearance Anxiety Scale (SAAS), a 16-item self-report questionnaire. ED cognitions and behaviours were assessed with the Eating Disorders Examination-Questionnaire. Women with BN have significantly higher SAAS scores than HC (z=-6.79, p<0.001). In BN, SAAS scores show significant positive correlation with global ED subscales and dietary restraint. In HC, SAAS scores are correlated with shape, weight, eating concern, and global eating disturbance subscales. Preliminary findings suggest the SAAS is potentially useful in future research concerning overall risk factors for eating disturbance and treatment outcome in BN.

  2. The body in anorexia and bulimia

    Directory of Open Access Journals (Sweden)

    Maria Helena Fernandes

    2012-09-01

    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.

  3. [ANOREXIA AND BULIMIA: IMPACT ON NETWORK SOCIETY].

    Science.gov (United States)

    Alex Sánchez, María Dolores

    2015-01-01

    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.

  4. Dimensions of emotion dysregulation in bulimia nervosa.

    Science.gov (United States)

    Lavender, Jason M; Wonderlich, Stephen A; Peterson, Carol B; Crosby, Ross D; Engel, Scott G; Mitchell, James E; Crow, Scott J; Smith, Tracey L; Klein, Marjorie H; Goldschmidt, Andrea B; Berg, Kelly C

    2014-05-01

    The goal of this study was to examine associations between dimensions of emotion dysregulation and eating disorder (ED) symptoms in bulimia nervosa (BN). This investigation used baseline data from a BN treatment study that included 80 adults (90% women) with full or subthreshold BN. Participants completed the Difficulties in Emotion Regulation Scale (DERS) and the Eating Disorders Examination interview. The Eating Disorders Examination global score was significantly correlated with the DERS total score, as well as several DERS subscales: nonacceptance, impulse and strategies. Further, the DERS goals subscale was found to be uniquely associated with frequency of purging and driven exercise, although none of the subscales were associated with frequency of objective binge eating. Findings indicate that emotion dysregulation is associated with ED symptoms in BN, suggesting the utility of interventions that address emotion regulation skills deficits in the treatment of the disorder. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.

  5. Innovations in the Treatment of Bulimia: Transpersonal Psychology, Relaxation, Imagination, Hypnosis, Myth, and Ritual.

    Science.gov (United States)

    Brown, Michael H.

    1991-01-01

    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)

  6. Client attachment security predicts alliance in a randomized controlled trial of two psychotherapies for bulimia nervosa

    DEFF Research Database (Denmark)

    Folke, Sofie; Daniel, Sarah Ingrid Franksdatter; Poulsen, Stig Bernt

    2016-01-01

    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...

  7. Personality dimensions in bulimia nervosa, binge eating disorder, and obesity.

    Science.gov (United States)

    Peterson, Carol B; Thuras, Paul; Ackard, Diann M; Mitchell, James E; Berg, Kelly; Sandager, Nora; Wonderlich, Stephen A; Pederson, Melissa W; Crow, Scott J

    2010-01-01

    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.

  8. Bulimia nervosa: revisão da literatura Bulimia nervosa: literature review

    Directory of Open Access Journals (Sweden)

    Rita Aparecida Romaro

    2002-01-01

    Full Text Available O presente estudo objetivou revisar a produção científica referente à bulimia nervosa, classificando-a em três dimensões de análise: países relacionados à pesquisa na área; periódicos de indexação; delineamentos e objetivos da pesquisa. A amostra foi composta de 200 abstracts de periódicos indexados nas bases de dados LILACS e MEDLINE, entre 1986 e outubro/2000, utilizando-se o descritor bulimia nervosa. Os Estados Unidos (43,5% e o Brasil (12,5% são os países com maior número de publicações. Os artigos estão distribuídos em 100 periódicos diferentes. O delineamento empírico predominou (75%, com destaque para o procedimento de comparação de grupos (63,5%, com a população adulta, predominado os estudos referentes às questões diagnósticas (24%, psicodinâmicas (21,5% e aos aspectos ligados ao tratamento (17%. Os dados encontrados sugerem um interesse crescente pelo assunto nos dois últimos anos, provavelmente pela maior incidência da doença, necessitando-se de mais pesquisas que associem as influências sociais e os aspectos preventivos.The aim of this paper was to revise the scientific production related to bulimia nervosa. It was classified in three dimensions of analysis: countries related to research in the area; indexed publications and designs and aims of the research. The sample comprised 200 abstracts of publications indexed in the LILACS and MEDLINE databases, between 1986 and october/2000, using the key word bulimia nervosa. The United States (43,5% and Brazil (12,5% are the countries having the largest number of publications. The articles are distributed among 100 different journals. The empirical design predominated (75%, with a greater emphasis on the procedure of group comparisons (63,5%, with adult population. Studies on diagnosis issues (24% psychodynamic issues (21,5% and aspects linked to treatment (17%. The data found suggest an increasing interest in the subject over the past two years, probably

  9. Incidence and outcomes of bulimia nervosa : a nationwide population-based study

    NARCIS (Netherlands)

    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

  10. Validity of the Eating Attitudes Test and the Eating Disorders Inventory in Bulimia Nervosa.

    Science.gov (United States)

    Gross, Janet; And Others

    1986-01-01

    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…

  11. The Treatment of Anorexia Nervosa and Bulimia: A Multidimensional Group Approach.

    Science.gov (United States)

    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…

  12. [Bulimia and anorexia among the teenagers].

    Science.gov (United States)

    Ben Salem, Hela; Gaigi, Imene; El Fray, Hamouda; Gaigi, Sadok; El Ati, Jalila

    2011-11-01

    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.

  13. Increased temporal discounting in bulimia nervosa.

    Science.gov (United States)

    Kekic, Maria; Bartholdy, Savani; Cheng, Jiumu; McClelland, Jessica; Boysen, Elena; Musiat, Peter; O'Daly, Owen G; Campbell, Iain C; Schmidt, Ulrike

    2016-12-01

    There is evidence that people with eating disorders display altered intertemporal choice behavior (the degree of preference for immediate rewards over delayed rewards). Compared to healthy controls (HC), individuals with anorexia nervosa and binge-eating disorder show decreased and increased rates of temporal discounting (TD; the devaluation of delayed rewards), respectively. This is the first study to investigate TD in people with bulimia nervosa (BN). Thirty-nine individuals with BN (2 men) and 53 HC (9 men) completed a hypothetical monetary TD task. Over 80 binary choices, participants chose whether they would prefer to receive a smaller amount of money available immediately or a larger amount available in 3 months. Self-reported ability to delay gratification (the behavioral opposite of TD) was also measured. Individuals with BN showed greater TD (i.e., a preference for smaller-sooner rewards) and a decreased self-reported capacity to delay gratification relative to HC. Experimental groups did not differ in age, gender ratio, or BMI. Increased rates of TD may contribute to some of the core symptoms of BN that appear to involve making choices between immediate and delayed rewards (i.e., binge-eating and compensatory behaviors). Altered intertemporal choice behavior could therefore be a relevant target for intervention in this patient group. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1077-1081). © 2016 Wiley Periodicals, Inc.

  14. Dysthymia in anorexia nervosa and bulimia nervosa

    Directory of Open Access Journals (Sweden)

    Mercedes Borda-Más

    2008-01-01

    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.

  15. Anorexia nervosa and bulimia: problems of "the pleasing child".

    Science.gov (United States)

    McSherry, J A

    1984-08-01

    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, but milder forms respond to treatment which can be undertaken by an interested family physician. Most cases of uncomplicated bulimia can be treated successfully in a family practice setting.

  16. Gait analysis in anorexia and bulimia nervosa.

    Science.gov (United States)

    Cimolin, Veronica; Galli, Manuela; Vismara, Luca; Vimercati, Sara Laura; Precilios, Helmer; Cattani, Laila; Fabris De Souza, Shirley; Petroni, Maria Letizia; Capodaglio, Paolo

    2013-09-13

    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.

  17. Bulimia: diagnosis and management in the primary care setting.

    Science.gov (United States)

    Lipscomb, P A

    1987-02-01

    Bulimia is an eating disorder characterized by episodic, uncontrollable overeating and frequently by purging after binges. It appears to afflict approximately 5 percent of female college students in the United States. Most sufferers are high-achieving but passive and unassertive young women from similarly high-achieving but disorganized families. Confusion over social roles for women is common in bulimic patients. Bulimia shows a strong association with affective disorders; depression is common in both bulimic patients and their close family members. Bulimic patients seem to have a pronounced affective vulnerability to rejection, loss, and failure. Bulimia presents a special diagnostic challenge to the primary care physician because of the paucity of clues provided by a typical review of systems and a physical examination, even a very thorough one. Making the diagnosis requires persistent and thorough history-gathering and is best accomplished through special attention to the psychosocial history (particularly history of depression and substance abuse, family dynamics, and recent stressors) as well as pointed questioning regarding eating behavior. Because of the severe, potentially lethal complications that may attend bulimia (including fluid and electrolyte imbalance, cardiac conduction abnormalities, gastric rupture, pneumonia), diagnosis and appropriate referral by the primary care physician may have a critical impact on the patient's life and health.

  18. The validity and utility of subtyping bulimia nervosa

    NARCIS (Netherlands)

    van Hoeken, Daphne; Veling, Wim; Sinke, Sjoukje; Mitchell, James E.; Hoek, Hans W.

    2009-01-01

    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

  19. Achalasia as a complication of bulimia nervosa: A case report ...

    African Journals Online (AJOL)

    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 ...

  20. Treatment of Bulimia Nervosa: Psychological and Psychopharmacologic Considerations.

    Science.gov (United States)

    Phillips, Elaine L.; Greydanus, Donald E.; Pratt, Helen D.; Patel, Dilip R.

    2003-01-01

    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…

  1. Weight Suppression Predicts Time to Remission from Bulimia Nervosa

    Science.gov (United States)

    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.

    2011-01-01

    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…

  2. Exposure Plus Response-Prevention Treatment of Bulimia Nervosa.

    Science.gov (United States)

    Leitenberg, Harold; And Others

    1988-01-01

    Evaluated exposure plus response-prevention treatment of bulimia nervosa among 47 women. Subjects were assigned to either exposure plus response-prevention in one setting, exposure plus response-prevention in multiple settings, cognitive-behavioral therapy, or waiting-list control conditions. Found three treatment groups improved significantly on…

  3. A Naturalistic Investigation of Eating Behavior in Bulimia Nervosa.

    Science.gov (United States)

    Davis, Ron; And Others

    1988-01-01

    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…

  4. Cognitive-Behavioral Therapy for Bulimia: An Initial Outcome Study.

    Science.gov (United States)

    Ordman, Arnold M.; Kirschenbaum, Daniel S.

    1985-01-01

    Examined the efficacy of a cognitive-behavioral therapy for bulimia. Assigned 20 bulimic women to full- or brief-intervention therapy programs. Results indicated that full-intervention clients, relative to brief-intervention clients, substantially reduced the frequency of their bingeing-vomiting; improved their psychological adjustment; and…

  5. Depressive Thought Content Among Female College Students With Bulimia.

    Science.gov (United States)

    Brouwers, Mariette

    1988-01-01

    Compared overall depression scores on Beck Depression Inventory between women with and without bulimia and examined differences in specific depression items. Results indicated that bulimics were more depressed than controls and had distorted thoughts regarding body image, self-blame, somatic preoccupation, guilt, and suicidal ideation. (Author/NB)

  6. Bulimia nervosa in adolescents: treatment, eating pathology and ...

    African Journals Online (AJOL)

    Bulimia nervosa in adolescents: treatment, eating pathology and comorbidity. ... African Journal of Psychiatry ... Measures: Eating pathology was measured with the Eating Disorders Examination (EDE), while the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) was used to establish ...

  7. [Anorexia nervosa and bulimia nervosa. Psychological considerations for its treatment].

    Science.gov (United States)

    Barriguete Meléndez, J Armando; Rojo, Luis; Emmelhainz, Marisa

    2004-11-01

    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.

  8. Anorexia Nervosa and Bulimia: Questions and Answers for School Personnel.

    Science.gov (United States)

    Mallick, M. Joan

    1984-01-01

    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)

  9. Bulimia and Anorexia Nervosa in Dental and Dental Hygiene Curricula.

    Science.gov (United States)

    Gross, Karen B. W.; And Others

    1990-01-01

    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)

  10. A Primary Prevention Program to Reduce Bulimia and Anorexia Nervosa.

    Science.gov (United States)

    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…

  11. Biological Aspects of Anorexia Nervosa and Bulimia Nervosa.

    Science.gov (United States)

    Kaplan, Allan S.; Woodside, D. Blake

    1987-01-01

    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…

  12. The efficacy of a brief group CBT program in treating patients diagnosed with bulimia nervosa: a brief report.

    Science.gov (United States)

    Jones, Allan; Clausen, Loa

    2013-09-01

    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. 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. 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. There is strong evidence for the efficacy of brief group CBT in treating patients with bulimia nervosa. © 2013 Wiley Periodicals, Inc.

  13. Neurobiology of anorexia and bulimia nervosa.

    Science.gov (United States)

    Kaye, Walter

    2008-04-22

    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

  14. An analysis of the self-report diaries of patients with bulimia nervosa

    OpenAIRE

    2012-01-01

    D.Litt. et Phil. Bulimia nervosa is an eating disorder that has stimulated considerable research efforts in recent years. The increasing prevalence of bulimia nervosa has been partially attributed to the prevailing sociocultural notion that thinness embodies the essence of beauty, success and personal achievement. This has led to greater deinands for more efficacious treatment approaches by clinicians because of the rigid and intractable nature of the disorder. Bulimia nervosa is character...

  15. Celiac disease diagnosed after uncomplicated pregnancy in a patient with history of bulimia nervosa.

    Science.gov (United States)

    Milisavljević, Nemanja; Cvetković, Mirjana; Nikolić, Goran; Filipović, Branka; Milinić, Nikola

    2013-01-01

    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.

  16. Multi-Family Therapy for Bulimia Nervosa in Adolescence.

    Science.gov (United States)

    Stewart, Catherine; Voulgari, Stamatoula; Eisler, Ivan; Hunt, Katrina; Simic, Mima

    2015-01-01

    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.

  17. Self-forgiveness in anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Watson, Michelle J; Lydecker, Janet A; Jobe, Rebecca L; Enright, Robert D; Gartner, Aubrey; Mazzeo, Suzanne E; Worthington, Everett L

    2012-01-01

    This study investigated whether low levels of self-forgiveness were associated with eating disorder symptomatology. Participating women (N = 51) had diagnoses of anorexia nervosa, bulimia nervosa, or no eating disorder diagnosis. They completed 3 measures of self-forgiveness. Women with eating disorders had lower levels of self-forgiveness compared with control participants. Results suggest that incorporating self-forgiveness interventions into current eating disorder treatments should be evaluated in future research as they might enhance clinical outcomes.

  18. [Treating bulimia nervosa: a nurse's experience using cognitive behavior therapy].

    Science.gov (United States)

    Huang, Chiu-Min; Hsieh, Chia-Jung

    2010-04-01

    This paper focused on the experience of the authors in providing nursing care to a patient with bulimia nervosa who sought psychiatric assistance upon her first episode. The nursing period spanned a period from April 21, 2008 to June 16, 2008. After primary diagnosis, relevant data was collected by observation, interview, and a review of medical records. The patient's disease was assessed from five dimensions. Care problems faced for this patient included: altered nutrition profile, abnormal eating patterns, ineffective individual coping, and body image disturbance. The authors adopted a three-stage nursing intervention based on cognitive behavior theory (CBT). First, a caring attitude was employed to establish a good nurse-patient relationship, after which the patient was instructed to maintain a diet diary, which could be used to help identify the underlying causes of her bulimia nervosa condition. Secondly, we assisted the patient to express her emotions and feelings in order to help her disentangle herself from unhealthy perceptions regarding body image and weight. Thirdly, we assisted the patient to develop critical problem-solving abilities and coping skills that would help avoid symptom recurrence. We followed up on patient progress by telephone for one month after treatment. The treatment had successfully stabilized her emotions and bulimia nervosa did not recur. Her body weight was kept within a satisfactory range. Furthermore, she applied cognitive behavior skills in daily life continuously, and she did exercise and kept company with an individual who helped reinforce appropriate behavior. It is hoped that this report can help nurses better understand bulimia nervosa and be used as a reference in clinical care.

  19. Psychopathology and psychotherapy in adolescents with anorexia and bulimia nervosa

    OpenAIRE

    Salbach-Andrae, Harriet

    2010-01-01

    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 ...

  20. Bulimia nervosa in adolescents: prevalence and treatment challenges

    OpenAIRE

    Hail, Lisa; Le Grange, Daniel

    2018-01-01

    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...

  1. Predictors of attitudes towards treatments for bulimia nervosa.

    Science.gov (United States)

    Hepworth, Natasha S; Paxton, Susan J; Williams, Benedict

    2007-03-01

    The aim of this study was to examine, using Mental Health Literacy, acceptability and correlates of acceptability of three treatment interventions for bulimia nervosa; medication, psychological therapy and self-change/lifestyle therapies. A self-report questionnaire to ascertain correlates of attitudes towards the three interventions was used. Respondents (n = 177) were females aged 18-53 years. Psychological therapy was rated the most acceptable treatment to participants as well as the most acceptable to others, and to have most advantages and fewest disadvantages, followed by self-change/lifestyle therapies, and then medication. Social Pressures to be Thin was the most strongly endorsed cause of bulimia, followed by Low Self-Esteem, Eating Behaviour, Relationship and Family Environment, and lastly, Biology. Correlates with acceptability of different treatment approaches were identified. Although no causal link can be assumed from this design, findings suggest that women appear to have a mixed understanding of the different mechanisms that each treatment intervention adopts to treat the causes and symptoms of bulimia, particularly self-change/lifestyle therapies. This may help to explain poor adherence to interventions.

  2. [Shame and social anxiety in anorexia and bulimia nervosa].

    Science.gov (United States)

    Grabhorn, Ralph; Stenner, Hanna; Kaufbold, Johannes; Overbeck, Gerd; Stangier, Ullrich

    2005-01-01

    The importance of shame for the understanding of eating disorders has been well-known for a long time, but only few empirical studies exist to date on this aspect. Particularly the sense of self-esteem and external appearance have been attributed a major influence in the emergence of shame. Since social anxiety has increasingly been considered to be a factor in recent discussions related to eating disorders, and shame is a primary symptom of social phobia and of social anxiety in general, the present study focuses on shame and social anxiety in anorexia and bulimia, as compared to other clinical disorders. Another research question is the extent to which the prevalence of shame in eating disorders is influenced by self-esteem, attitudes about appearance and social anxiety. The sample consists of 104 (female) patients, comprising 26 patients, respectively, with anorexia nervosa, bulimia nervosa, anxiety disorders and depression. The various variables were recorded with the Internalized Shame Scale (ISS), the Social Interaction Anxiety Scale (SIAS), the Social Phobia Scale (SPS), the Appearance Attitude Scale (AAS) and the Social Autonomous Self-Esteem Scale (SAS). Patients with anorexia and bulimia nervosa have higher scores in internalized global shame than patients with anxiety disorders and depressions. In contrast to anorectic patients, however, patients with bulimia also have higher scores than the other two groups in the area of social performance anxiety; they also differ significantly from the anxiety disorders in terms of interaction anxiety. In the multiple regression analysis of the patients with eating disorders, self-esteem, performance anxiety and perfectionism with regard to appearance prove to be predictors of the affect of shame. The findings indicate that not just shame, but also social anxiety, should be regarded as important influencing factors, especially in the case of bulimia nervosa. The question remains as to what extent social anxiety is a

  3. A Pilot Study of a Functional Contextual Treatment for Bulimia Nervosa

    Science.gov (United States)

    Anderson, Drew A.; Simmons, Angela M.

    2008-01-01

    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…

  4. A Comparison of Behavioral and Cognitive-Behavioral Interventions for Bulimia Nervosa.

    Science.gov (United States)

    Thackwray, Donna E.; And Others

    1993-01-01

    Examined the relative efficacy of different treatment approaches for bulimia nervosa. Follow-up of a study using cognitive-behavioral, behavioral, and placebo groups show six-month abstinence highest in the cognitive behavioral group. Results support conceptualization of bulimia nervosa as a multifaceted disorder best treated with an approach that…

  5. Aspects of Childhood Physical Punishment and Family Environment Correlates in Bulimia Nervosa.

    Science.gov (United States)

    Rorty, Marcia; And Others

    1995-01-01

    This study compared childhood parental physical punishment among 80 women with and 40 women without a lifetime history of bulimia nervosa. Although the women with bulimia reported more and harsher physical punishment than the control group, they did not differ in the extent to which they believed the punishment was deserved or whether they were…

  6. Anorexia Nervosa/Bulimia. LC Science Tracer Bullet, TB 85-8.

    Science.gov (United States)

    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…

  7. Fearing Fat: A Literature Review of Family Systems Understandings and Treatments of Anorexia and Bulimia.

    Science.gov (United States)

    Killian, Kyle D.

    1994-01-01

    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…

  8. The efficacy of a brief group CBT program in treating patients diagnosed with bulimia nervosa: a brief report

    DEFF Research Database (Denmark)

    Jones, A.; Clausen, Loa

    2013-01-01

    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......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...

  9. Bulimia nerviosa, estilos de afrontamiento y situaciones estresantes

    OpenAIRE

    Echeverría Serrano, Elizabeth

    2006-01-01

    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 ...

  10. Tratamiento periodontal en un paciente con bulimia y anorexia

    OpenAIRE

    Dolonguevich, Evelyn Ruth; Boero López, Edgardo

    2009-01-01

    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...

  11. A classical case of bulimia nervosa from India.

    Science.gov (United States)

    Mandal, Piyali; Arumuganathan, S; Sagar, Rajesh; Srivastava, Pakhi

    2013-07-01

    A classic case of the bulimia nervosa in a young Indian female is reported. This is in the context of the impression that due to increasing western influence, and change in cultural concepts of beauty and thinness among women, illnesses previously considered rare in Indian subcontinent might be becoming more prevalent. Many of the established pre-disposing factors such as female gender, metropolitan domicile, family history of depressive disorder have conglomerated in this case. Rapid and sustained improvement with the low-dose Fluoxetine and the Cognitive Behavioral Therapy is also worth paid attention.

  12. The Changing “Weightscape” of Bulimia Nervosa

    Science.gov (United States)

    Bulik, Cynthia M.; Marcus, Marsha D.; Zerwas, Stephanie; Levine, Michele D.; Via, Maria La

    2014-01-01

    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

  13. Painful parotid hypertrophy with bulimia: a report of medical management.

    Science.gov (United States)

    Park, Kelly K; Tung, Rebecca C; de Luzuriaga, Arlene Ruiz

    2009-06-01

    In eating disorders, such as bulimia nervosa, body image disturbance often extends beyond the realm of weight and shape into the dermatologic spectrum. While commonly associated conditions due to binging and self-induced vomiting include cutaneous entities (e.g., Russell's sign, acne, alopecia and hypertrichosis) and oral pathologies (e.g., enamel erosion, caries and mild parotid hypertrophy), a rare but troubling manifestation is disfiguring parotid enlargement (sialoadenomegaly). This article presents a case of painful sialoadenomegaly associated with hyperamylasemia in a bulimic patient successfully managed with pilocarpine.

  14. Anorexia y Bulimia: problemas de la sociedad desarrollada

    OpenAIRE

    Asensio Aller, Marta

    2014-01-01

    Según el Instituto Nacional de la Salud de Estados Unidos un trastorno de la alimentación es una enfermedad que causa graves perturbaciones en la dieta diaria, tales como comer cantidades muy pequeñas o comer en exceso. Los trastornos de la alimentación generalmente aparecen durante la adolescencia o adultez temprana, pero también se pueden dar durante la niñez o la adultez avanzada. Los trastornos de la alimentación más comunes son la anorexia nerviosa, bulimia nerviosa y e...

  15. A abordagem familiar no tratamento da anorexia e bulimia nervosa Family assessment in the treatment of anorexia and bulimia nervosa

    Directory of Open Access Journals (Sweden)

    Alicia Weisz Cobelo

    2004-01-01

    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.

  16. Identifying Persuasive Public Health Messages to Change Community Knowledge and Attitudes About Bulimia Nervosa.

    Science.gov (United States)

    McLean, Siân A; Paxton, Susan J; Massey, Robin; Hay, Phillipa J; Mond, Jonathan M; Rodgers, Bryan

    2016-01-01

    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.

  17. Altered intrinsic functional brain architecture in female patients with bulimia nervosa.

    Science.gov (United States)

    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

    2017-11-01

    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

  18. Body image, binge eating, and bulimia nervosa in male bodybuilders.

    Science.gov (United States)

    Goldfield, Gary S; Blouin, Arthur G; Woodside, D Blake

    2006-03-01

    Male bodybuilders (MBB) exhibit more severe body dissatisfaction, bulimic eating behaviour, and negative psychological characteristics, compared with male athletic and nonathletic control subjects, but few studies have directly compared MBB and men with eating disorders. This study compared men with bulimia nervosa (MBN), competitive male bodybuilders (CMBB), and recreational male bodybuilders (RMBB) on a broad range of eating attitudes and behaviours and psychological characteristics to more accurately determine similarities and differences among these groups. Anonymous questionnaires, designed to assess eating attitudes, body image, weight and shape preoccupation, prevalence of binge eating, weight loss practices, lifetime rates of eating disorders, anabolic androgenic steroid (AAS) use, and general psychological factors, were completed by 22 MBN, 27 CMBB, and 25 RMBB. High rates of weight and shape preoccupation, extreme body modification practices, binge eating, and bulimia nervosa (BN) were reported among MBB, especially among those who competed. CMBB reported higher rates of binge eating, BN, and AAS use compared with RMBB, but exhibited less eating-related and general psychopathology compared with MBN. Few psychological differences were found between CMBB and RMBB. MBB, especially competitors, and MBN appear to share many eating-related features but few general psychological ones. Longitudinal research is needed to determine whether men with a history of disordered eating or BN disproportionately gravitate to competitive bodybuildin and (or) whether competitive bodybuilding fosters disordered eating, BN, and AAS use.

  19. [Therapeutic itineraries of individuals with symptoms of anorexia and bulimia].

    Science.gov (United States)

    Carvalho, Maria Bernadete de; Val, Alexandre Costa; Ribeiro, Maria Mônica Freitas; Santos, Lúcia Grossi Dos

    2016-08-01

    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.

  20. [Anesthesia in patients with anorexia nervosa and bulimia nervosa].

    Science.gov (United States)

    Zenker, J; Hagenah, U; Rossaint, R

    2010-03-01

    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.

  1. Uncontrollable behavior or mental illness? Exploring constructions of bulimia using Q methodology.

    Science.gov (United States)

    Churruca, Kate; Perz, Janette; Ussher, Jane M

    2014-01-01

    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

  2. Management of bulimia nervosa: a case study with the Roy adaptation model.

    Science.gov (United States)

    Seah, Xin Yi; Tham, Xiang Cong

    2015-04-01

    Bulimia nervosa is a crippling and chronic disorder, with individuals experiencing repeated binge-purge episodes. It is not widely understood by society. The use of the Roy adaptation model for the management of bulimia nervosa is examined in this article. Nursing models are utilized to provide a structure for planning and implementation of patient management. The Roy adaptation model focuses on the importance of individuals as able to adapt well to their changing surrounding environments. This model can be useful in managing patients with bulimia nervosa. © The Author(s) 2015.

  3. Diagnostic Crossover in Anorexia Nervosa and Bulimia Nervosa: Implications for DSM-V

    National Research Council Canada - National Science Library

    Franko, Debra L; Herzog, David B; Eddy, Kamryn T; Tahilani, Kavita; Thompson-Brenner, Heather; Dorer, David J

    2008-01-01

    .... 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...

  4. Celiac disease diagnosed after uncomplicated pregnancy in a patient with history of bulimia nervosa

    Directory of Open Access Journals (Sweden)

    Milisavljević Nemanja

    2013-01-01

    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.

  5. Preliminary Evidence for the Off-Label Treatment of Bulimia Nervosa With Psychostimulants: Six Case Reports.

    Science.gov (United States)

    Keshen, Aaron; Helson, Thomas

    2017-07-01

    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.

  6. Binge eating as a meaningful experience in bulimia nervosa and anorexia nervosa: a qualitative analysis.

    Science.gov (United States)

    Eli, Karin

    2015-12-01

    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.

  7. Bulimia nervosa symptomatology and body image disturbance associated with distance running and weight loss.

    OpenAIRE

    Gleaves, D H; Williamson, D A; Fuller, R D

    1992-01-01

    To investigate the hypothesis that problems characteristic of eating disorders may often be associated with distance running, 20 women who had lost weight through distance running were compared with a control group who did not exercise and had not lost weight and a comparison group of bulimia nervosa patients. Dependent variables were measures of depression, bulimia nervosa symptomatology, and body image disturbance. No differences were found between the runner group and the normal controls. ...

  8. Incidence and outcomes of bulimia nervosa: a nationwide population-based study.

    Science.gov (United States)

    Keski-Rahkonen, A; Hoek, H W; Linna, M S; Raevuori, A; Sihvola, E; Bulik, C M; Rissanen, A; Kaprio, J

    2009-05-01

    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. To assess the incidence and natural course and outcomes of DSM-IV bulimia nervosa among women from the general population, women (n=2881) from the 1975-79 birth cohorts of Finnish twins were screened for lifetime eating disorders using a two-stage procedure consisting of a questionnaire screen and the Structured Clinical Interview for DSM-IV (SCID). Clinical recovery was defined as 1-year abstinence from bingeing and purging combined with a body mass index (BMI) 19 kg/m2. The lifetime prevalence of DSM-IV bulimia nervosa was 2.3%; 76% of the women suffered from its purging subtype and 24% from the non-purging subtype. The incidence rate of bulimia nervosa was 300/100000 person-years at the peak age of incidence, 16-20 years, and 150/100000 at 10-24 years. The 5-year clinical recovery rate was 55.0%. Less than a third of the cases had been detected by health-care professionals; detection did not influence outcome. After clinical recovery from bulimia nervosa, the mean levels of residual psychological symptoms gradually decreased over time but many women continued to experience significantly more body image problems and psychosomatic symptoms than never-ill women. Few women with bulimia nervosa are recognized in health-care settings. Symptoms of bulimia are relatively long-standing, and recovery is gradual. Many clinically recovered women experience residual psychological symptoms after attaining abstinence from bingeing and purging.

  9. Oral health considerations in anorexia and bulimia nervosa. 1. Symptomatology and diagnosis.

    Science.gov (United States)

    Bassiouny, Mohamed A

    2017-01-01

    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.

  10. [On the psychodynamics of an adolescent bulimia patient].

    Science.gov (United States)

    Wittenberger, Annegret

    2005-04-01

    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.

  11. Anorexia/bulimia-related sialadenosis of palatal minor salivary glands.

    Science.gov (United States)

    Mignogna, M D; Fedele, S; Lo Russo, L

    2004-08-01

    In patients affected by alimentary disorders sialadenosis is frequently observed. This non-inflammatory condition is described to affect major salivary glands, leading to the characteristic parotid and/or submandibular swelling. Thus fine-needle aspiration cytology or parotid open biopsy are generally required to diagnose histologically the disorder. We report the case of a 28-year-old patient affected by bulimia/anorexia nervosa who presented, in addition to parotid enlargement, a bilateral symmetric painless soft swelling of the hard palate. The lesion was biopsied and histopathological examination showed the classical features of sialadenosis. To our knowledge, this is the first case of sialadenosis affecting palatal minor salivary glands. It underlines that when sialadenosis is clinically suspected, clinicians could check also patients' oral cavity for minor salivary glands involvement, in order to potentially avoid invasive extra-oral procedures and to easily confirm diagnosis with an intra-oral biopsy.

  12. [Erythema ab igne in a patient with bulimia nervosa].

    Science.gov (United States)

    Beneke, Johannes; Koerner, Michael; de Zwaan, Martina

    2014-05-01

    Erythema ab igne (EAI) is a skin lesion, which is characterized by a localized netlike erythema. For the occurrence of the dermatosis a continuous or regular heat exposure and infrared radiation to a skin area is necessary. The reticulated maculae could fade after stopping the heat exposure, persist as hyperpigmentation and in single cases a malignant transformation is possible. We present a patient with bulimia nervosa (BN), who developed an EAI after consequent use of a hot-water bottle. In the context of the eating disorder the patient reported a general feeling of cold. She avoided the contact with the abdomen to prevent a stimulation of the digestion. Therefore the EAI was located predominantly on the medial thighs. After stopping the heat application the EAI faded slightly in the periphery und turned browner. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Anatomical characteristics of the cerebral surface in bulimia nervosa.

    Science.gov (United States)

    Marsh, Rachel; Stefan, Mihaela; Bansal, Ravi; Hao, Xuejun; Walsh, B Timothy; Peterson, Bradley S

    2015-04-01

    The aim of this study was to examine morphometric features of the cerebral surface in adolescent and adult female subjects with bulimia nervosa (BN). Anatomical magnetic resonance images were acquired from 34 adolescent and adult female subjects with BN and 34 healthy age-matched control subjects. We compared the groups in the morphological characteristics of their cerebral surfaces while controlling for age and illness duration. Significant reductions of local volumes on the brain surface were detected in frontal and temporoparietal areas in the BN compared with control participants. Reductions in inferior frontal regions correlated inversely with symptom severity, age, and Stroop interference scores in the BN group. These findings suggest that local volumes of inferior frontal regions are smaller in individuals with BN compared with healthy individuals. These reductions along the cerebral surface might contribute to functional deficits in self-regulation and to the persistence of these deficits over development in BN. © 2014 Society of Biological Psychiatry.

  14. [Nurses and clientele with anorexia and bulimia: a case study].

    Science.gov (United States)

    Martins, Claudia Regina Carvalho; Caccavo, Paulo Vaccari

    2012-01-01

    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.

  15. Family perception of anorexia and bulimia: a systematic review.

    Science.gov (United States)

    Espíndola, Cybele Ribeiro; Blay, Sérgio Luís

    2009-08-01

    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.

  16. Anorexia nervosa and bulimia nervosa: brains, bones and breeding.

    Science.gov (United States)

    Starr, Taylor B; Kreipe, Richard E

    2014-05-01

    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.

  17. Treating a complex case of alcoholism and bulimia

    Directory of Open Access Journals (Sweden)

    Tamara Devesa

    2017-03-01

    Full Text Available This paper presents the case study of a man treated for alcohol addiction, bulimia, and a generalized lack of control. The results obtained show full compliance with the objectives established for the intervention. The aim of this article is to explain, in a case of such complexity, which were the underlying processes that allowed for the therapeutic change to take place in such a small number of sessions. From this analysis it is hypothesized that some of the factors that could explain this success are related to the adaptation of the intervention techniques, such as the therapist´ discourse, and to the client´s dispositional and functional variables.

  18. Bulimia nervosa and substance use disorder: similarities and differences.

    Science.gov (United States)

    Ram, A; Stein, D; Sofer, S; Kreitler, S

    2008-01-01

    The purpose of this study was to compare bulimia nervosa (BN) and substance use disorders (SUD) in cognitive-motivational terms. The cognitive orientation theory was used as a framework for testing the hypothesis that the commonality between BN and SUD consists of a similar motivational disposition for eating disorders, rather than for addiction, as was previously claimed. It was expected that BN and SUD patients would differ from controls but not from each other. The participants were 31 BN, 20 SUD, and 20 healthy controls. They were administered questionnaires for assessing anxiety, depression, addiction and the cognitive orientation for eating disorders. On most parameters BN and SUD scored higher than controls but did not differ from each other except in norm beliefs. Treatment of BN should consider the similarity of BN to SUD in the pathological tendency for eating disorders.

  19. Enfermeiros e clientela com bulimia e anorexia: estudo de caso

    Directory of Open Access Journals (Sweden)

    Claudia Regina Carvalho Martins

    2012-06-01

    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.

  20. Visceral perceptions and gastric myoelectrical activity in healthy women and in patients with bulimia nervosa.

    Science.gov (United States)

    Koch, K L; Bingaman, S; Tan, L; Stern, R M

    1998-02-01

    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.

  1. Diagnostic Crossover in Anorexia Nervosa and Bulimia Nervosa: Implications for DSM-V

    Science.gov (United States)

    Eddy, Kamryn T.; Dorer, David J.; Franko, Debra L.; Tahilani, Kavita; Thompson-Brenner, Heather; Herzog, David B.

    2011-01-01

    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

  2. Effect of eating rate on binge size in Bulimia Nervosa

    Science.gov (United States)

    Kissileff, Harry R; Zimmerli, Ellen J; Torres, Migdalia I; Devlin, Michael J; Walsh, B Timothy

    2008-01-01

    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

  3. The economic effect of Planet Health on preventing bulimia nervosa.

    Science.gov (United States)

    Wang, Li Yan; Nichols, Lauren P; Austin, S Bryn

    2011-08-01

    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.

  4. The Effectiveness of Acceptance and Commitment Therapy on Improving Body Image of Female Students with Bulimia Nervosa

    OpenAIRE

    Moslem Abbasi; Parviz Porzoor; Kazem Moazedi; Taher Aslani

    2015-01-01

    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 Ard...

  5. The relationship between Internet addiction and bulimia in a sample of Chinese college students: depression as partial mediator between Internet addiction and bulimia.

    Science.gov (United States)

    Tao, ZhuoLi

    2013-09-01

    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.

  6. Childhood Sexual and Physical Abuse as Risk Factors for the Development of Bulimia Nervosa: A Community-Based Case Control Study.

    Science.gov (United States)

    Welch, Sarah L.; Fairburn, Christopher G.

    1996-01-01

    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)

  7. Psychometric characteristics of Spanish adaptation of a Test for Bulimia (BULIT).

    Science.gov (United States)

    Vázquez Morejón, A J; García-Bóveda, R Jiménez; Vázquez-Morejón Jiménez, R

    2007-01-01

    The high prevalence of bulimia nervosa among eating disorders and limited repertoire of assessment tools available for these disorders in Spanish have resulted in special interest regarding the adaptation of a specific instrument such as the Bulimia Test (BULIT). A total of 119 outpatients, most of them women (97.5%) seen in a community mental health center, were assessed with the Spanish adaptation of the Bulimia Test (BULIT) and by Eating Attitudes Test (EAT-40). Reliability (internal consistency and temporal reliability) and validity (convergent and discriminant) were studied. Cronbach's alpha coefficient (alpha: 0.93) shows high internal consistency while the temporal reliability is supported by the high correlation observed (r=0.83) between applications conducted in an interval of 8-10 weeks. In relationship with convergent validity, moderate correlations were observed with the global score on EAT (r=0.38) and substantial correlation with the EAT Bulimia subscale (r=0.69). By using an 88 cutoff on the BULIT, the test properly classified 90% of the bulimic subjects and 100% of those without eating disorder. The results firmly supported the reliability and validity of this Spanish adaptation, stressing its utility as a screening device to detect current or incipient cases of bulimia and to assess severity of bulimic symptoms.

  8. Cigarette smoking is associated with body shape concerns and bulimia symptoms among young adult females.

    Science.gov (United States)

    Kendzor, Darla E; Adams, Claire E; Stewart, Diana W; Baillie, Lauren E; Copeland, Amy L

    2009-01-01

    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.

  9. Altered insula response to sweet taste processing after recovery from anorexia and bulimia nervosa.

    Science.gov (United States)

    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

    2013-10-01

    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.

  10. Prevalence of Disordered Eating Behaviors and Bulimia Nervosa in a Sample of Mexican American Female College Students.

    Science.gov (United States)

    Lester, Regan; Petrie, Trent A.

    1998-01-01

    Disordered eating behaviors and bulimia nervosa were examined in a sample of female Mexican Americans. Results showed that 1.45% to 4.3% could be classified with bulimia. Just over 11% indicated regular binge eating. Dieting and exercising were the primary techniques used for weight control. Implications for intervention are briefly discussed.…

  11. Dying on the Inside: What Every Teacher Needs to Know About Anorexia Nervosa, Bulimia, and the Individual Child.

    Science.gov (United States)

    Zimmer, Marc

    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…

  12. Achalasia as a complication of bulimia nervosa: A case report

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    Meryem O. Kutuk

    2017-02-01

    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.

  13. Central coherence in adolescents with bulimia nervosa spectrum eating disorders.

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    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

    2015-07-01

    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.

  14. [Assessment of emotional reactivity to food images in bulimia nervosa].

    Science.gov (United States)

    Gómez Martínez, Ma Angeles; Bernabé, José Ramon Yela; Ruiz, Alfonso Salgado; Rodríguez, María Cortés

    2011-11-01

    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.

  15. Oral mucosal lesions in Anorexia Nervosa, Bulimia Nervosa and EDNOS.

    Science.gov (United States)

    Panico, Rene; Piemonte, Eduardo; Lazos, Jerónimo; Gilligan, Gerardo; Zampini, Anibal; Lanfranchi, Héctor

    2018-01-01

    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.

  16. Bulimia nervosa in overweight and normal-weight women.

    Science.gov (United States)

    Masheb, Robin; White, Marney A

    2012-02-01

    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.

  17. The validity and utility of subtyping bulimia nervosa.

    Science.gov (United States)

    van Hoeken, Daphne; Veling, Wim; Sinke, Sjoukje; Mitchell, James E; Hoek, Hans W

    2009-11-01

    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. A literature search of psychiatry databases for studies published in peer-reviewed journals that used the DSM-definitions of BN and BED, and included both individuals with BN-NP and individuals with BN-P and/or BED. Twenty-three studies compared individuals with BN-NP (N = 671) to individuals with BN-P (N = 1795) and/or individuals with BED (N = 1921), two of which reported on course, 12 on comorbidity and none on treatment response-the indicators for validity and clinical utility. The differences found were mainly quantitative rather than qualitative, suggesting a gradual difference in severity from BN-P (most severe) through BN-NP to BED (least severe). None of the comparisons provided convincing evidence for the validity or utility of the BN-NP diagnosis. Three options for the position of BN-NP in DSM-V were suggested: (1) maintaining the BN-NP subtype, (2) dropping nonpurging compensatory behavior as a criterion for BN, so that individuals currently designated as having BN-NP would be designated as having BED, and (3) including BN-NP in a broad BN category.

  18. Evaluation of the DSM-5 severity indicator for bulimia nervosa.

    Science.gov (United States)

    Grilo, Carlos M; Ivezaj, Valentina; White, Marney A

    2015-04-01

    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.

  19. Neuropsychological correlates of decision making in patients with bulimia nervosa.

    Science.gov (United States)

    Brand, Matthias; Franke-Sievert, Christiane; Jacoby, Georg E; Markowitsch, Hans J; Tuschen-Caffier, Brunna

    2007-11-01

    In addition to the core psychopathology of bulimia nervosa (BN), patients with BN often show impulsive behavior that has been related to decision making deficits in other patient groups, such as individuals with anorexia nervosa and pathological gamblers. However, it remains unclear whether BN patients also show difficulties in decision making. In this study, 14 patients with BN and 14 healthy comparison subjects, matched for age, gender, education, body mass index, and intelligence, were examined with the Game of Dice Task (M. Brand, E. Fujiwara, et al., 2005), a gambling task that has fixed winning probabilities and explicit rules for gains and losses, as well as with a neuropsychological test battery and personality questionnaires. On the task, the patients with BN chose the disadvantageous alternatives more frequently than did the comparison subjects. Performance on the Game of Dice Task was related to executive functioning but not to other neuropsychological functions, personality, or disease-specific variables in the BN group. Thus, in patients with BN, decision making abnormalities and executive reductions can be demonstrated and might be neuropsychological correlates of the patients' dysfunctional everyday-life decision making behavior. Neurocognitive functions should be considered in the treatment of BN. PsycINFO Database Record (c) 2007 APA, all rights reserved.

  20. Frontostriatal circuits and the development of bulimia nervosa

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    Laura A. Berner

    2014-11-01

    Full Text Available Bulimia nervosa (BN is characterized by both recurrent episodes of binge eating that are, in part, defined by a sense of loss of control and compensatory behaviors to avoid weight gain. Impulsive behaviors are also common in individuals with BN, indicating more pervasive difficulties in behavioral self-regulation. Findings from functional and anatomical neuroimaging studies of individuals with BN suggest dysfunction in the dorsal frontostriatal circuits that support self-regulatory capacities and habit learning and in overlapping ventral circuits that support reward processing and reward-based learning. In this review, we describe the normal development of frontostriatal circuits and then present behavioral and neuroimaging data from adolescents and adults with BN. These data suggest that the abnormal maturation of frontostriatal circuits may contribute to the habitual binge-eating and purging behaviors of BN. Future longitudinal imaging studies will improve understanding of how these circuits contribute to the developmental trajectory of BN and will inform novel interventions that could target or prevent the impulsive and habit-like features of this disorder.

  1. Alexithymia in anorexia and bulimia: Ubiquitous and primary trait?

    Directory of Open Access Journals (Sweden)

    F. Amianto

    2016-05-01

    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.

  2. Neuropsychological function in patients with anorexia nervosa or bulimia nervosa.

    Science.gov (United States)

    Weider, Siri; Indredavik, Marit Saebø; Lydersen, Stian; Hestad, Knut

    2015-05-01

    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.

  3. [Personality disorders in adolescent patients with anorexia and bulimia nervosa].

    Science.gov (United States)

    Bottin, Julia; Salbach-Andrae, Harriet; Schneider, Nora; Pfeiffer, Ernst; Lenz, Klaus; Lehmkuhl, Ulrike

    2010-09-01

    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.

  4. Bulimia nervosa in adolescents: prevalence and treatment challenges

    Directory of Open Access Journals (Sweden)

    Hail L

    2018-01-01

    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

  5. Treating bulimia with hypnosis and low-level light therapy: a case report

    Science.gov (United States)

    Laser, Eleanor; Sassack, Michael

    2012-03-01

    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.

  6. Stressful task increases drive for thinness and bulimia: a laboratory study

    Science.gov (United States)

    Sassaroli, Sandra; Fiore, Francesca; Mezzaluna, Clarice; Ruggiero, Giovanni Maria

    2015-01-01

    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. Eighty-six participants completed an experimental task using a personal computer (PC). 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. PMID:25999901

  7. Meal-induced compositional changes in blood and saliva in persons with bulimia nervosa

    DEFF Research Database (Denmark)

    Dynesen, Anja Weirsøe; Jensen, Allan Bardow; Astrup, Arne

    2008-01-01

    of potentially xerogenic medication. Subjects with bulimia nervosa experienced reduced hunger, which could not be explained by pre- or postprandial alterations in circulating ghrelin, leptin, insulin, or glucose concentrations. Conclusions: There were no apparent differences in the composition of blood...... to be involved in the physiologic regulation of appetite and metabolism. Objective: The objective was to investigate whether circulating concentrations of the appetite-regulating peptides leptin and ghrelin and markers of metabolism (glucose and insulin) are different in persons with bulimia nervosa than...... 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...

  8. Stressful task increases drive for thinness and bulimia: a laboratory study.

    Directory of Open Access Journals (Sweden)

    Sandra eSassaroli

    2015-05-01

    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.

  9. Sexual function of women suffering from anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Gonidakis, Fragiskos; Kravvariti, Vasilliki; Varsou, Eleftheria

    2015-01-01

    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.

  10. Greater left cerebral hemispheric metabolism in bulimia assessed by positron emission tomography

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    Wu, J.C.; Hagman, J.; Buchsbaum, M.S.; Blinder, B.; Derrfler, M.; Tai, W.Y.; Hazlett, E.; Sicotte, N. (Univ. of California, Irvine (USA))

    1990-03-01

    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.

  11. Epidemiology of anorexia nervosa and bulimia nervosa in Bornholm County, Denmark, 1970-1989

    DEFF Research Database (Denmark)

    Pagsberg, A K; Wang, A R

    1994-01-01

    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....

  12. A qualitative study of young women's experiences of recovery from bulimia nervosa.

    Science.gov (United States)

    Lindgren, Britt-Marie; Enmark, Annika; Bohman, Anna; Lundström, Mats

    2015-04-01

    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.

  13. Perceptual body image of patients with anorexia or bulimia nervosa and their fathers.

    Science.gov (United States)

    Benninghoven, D; Tetsch, N; Kunzendorf, S; Jantschek, G

    2007-03-01

    Little is known about how fathers of patients with eating disorders perceive their own body. In this study we investigated body image perception of patients with anorexia and bulimia nervosa and body image perception of their fathers in a computer assisted approach. A computer program, the somatomorphic matrix, is presented that allows modeling of perceived and desired body-images of patients and their relatives. Patients and fathers rated their own body images and fathers additionally rated the body images of their daughters. The images implemented in the program correspond with defined percentages of body fat and muscularity. Selected images were compared with subjects' anthropometric data regarding body fat and muscularity. Data from 42 father-daughter-dyads (27 patients with anorexia, 15 with bulimia nervosa) were examined. Differences between both diagnostic groups were compared and associations between fathers' and daughters' body image perceptions within each group were investigated. Patients with anorexia nervosa overestimated their bodies on the body fat dimension. Patients with bulimia nervosa wished to have a body with less fat. Fathers of both groups of patients perceived their own bodies correctly but wished to have less body fat and to be more muscular. The wish for a change in body fat of anorexia nervosa patients was highly correlated with fathers' BMI (r=0.49; p=0.009). The wish for a change in body fat of bulimia nervosa patients was correlated with fathers' distorted body image perception in terms of muscularity (r=-0.66, p=0.007) and with fathers' wish for a more muscular body (r=-0.51, p=0.05). Body images of patients with eating disorders and their fathers are related in the group of patients with bulimia nervosa. Perhaps, body images of fathers should be addressed in family therapy with patients with bulimia nervosa.

  14. Neural responses during social and self-knowledge tasks in bulimia nervosa

    Directory of Open Access Journals (Sweden)

    Carrie J Mcadams

    2013-09-01

    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.

  15. Propuesta de atención grupal para adolescentes: bulimia como síntoma

    OpenAIRE

    Villalobos Pérez, Fabiola

    2013-01-01

    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...

  16. Sexual orientation as a factor in risk for binge eating and bulimia nervosa: a review.

    Science.gov (United States)

    Heffernan, K

    1994-12-01

    Research on binge eating and bulimia nervosa among lesbians and gay men is reviewed. The thesis that the different value pot on physical appearance in these groups may function as a mediator of risk for eating problems is considered. Studies indicate that gay men focus on their appearance more than heterosexual men and may be at higher risk. Lesbians, who are arguably less invested in societal norms of attractiveness, may be at lower risk than heterosexual women, but the findings are mixed. Implications for conceptual models of risk for bulimia nervosa, and for awareness of lesbian and gay experiences by therapists, are discussed.

  17. Restricción alimentaria y bulimia nerviosa : ¿un vínculo causal?

    OpenAIRE

    Mora Giral, Marisol

    1994-01-01

    Hemos revisado la evidencia disponible sobre la relación entre dieta y bulimia, particularmente los estudios que sugieren un vínculo causal entre estas dos variables: estudios longitudinales, modelos causales y evidencia experimental. Hemos examinado también modelos, hipótesis y teorías que den soporte teórico a esta relación We have reviewed available evidence about the relationship between diet and bulimia, mainly all those surveys suggesting a causal link between these variables: longit...

  18. Recovery From Anorexia Nervosa and Bulimia Nervosa at 22-Year Follow-Up.

    Science.gov (United States)

    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

    2017-02-01

    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.

  19. [Eating disorders in childhood and adolescence. Anorexia nervosa, bulimia nervosa, binge eating disorder].

    Science.gov (United States)

    Gerlinghoff, M; Backmund, H

    2004-03-01

    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.

  20. Therapeutic alliance in a randomized clinical trial for bulimia nervosa.

    Science.gov (United States)

    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

    2015-06-01

    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).

  1. CCK response in bulimia nervosa and following remission.

    Science.gov (United States)

    Hannon-Engel, Sandra L; Filin, Evgeniy E; Wolfe, Barbara E

    2013-10-02

    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.

  2. Interhemispheric functional connectivity in anorexia and bulimia nervosa.

    Science.gov (United States)

    Canna, Antonietta; Prinster, Anna; Monteleone, Alessio Maria; Cantone, Elena; Monteleone, Palmiero; Volpe, Umberto; Maj, Mario; Di Salle, Francesco; Esposito, Fabrizio

    2017-05-01

    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.

  3. Bulimia nervosa-nonpurging subtype: closer to the bulimia nervosa-purging subtype or to binge eating disorder?

    Science.gov (United States)

    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

    2014-04-01

    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.

  4. Cognitive Behavior Therapy with Body Image Exposure for Bulimia Nervosa: A Case Example

    Science.gov (United States)

    Delinsky, Sherrie S.; Wilson, G. Terence

    2010-01-01

    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…

  5. Depression and Drive for Thinness are Associated with Persistent Bulimia Nervosa in the Community

    NARCIS (Netherlands)

    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

  6. An Examination of the Mechanisms of Action in Cognitive Behavioral Therapy for Bulimia Nervosa

    Science.gov (United States)

    Spangler, Diane L.; Baldwin, Scott A.; Agras, W. Stewart

    2004-01-01

    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…

  7. Reward Abnormalities Among Women with Full and Subthreshold Bulimia Nervosa: A Functional Magnetic Resonance Imaging Study

    Science.gov (United States)

    Bohon, Cara; Stice, Eric

    2010-01-01

    Objective 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. Method 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. Results 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 (versus 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 (versus tasteless solution). Discussion Bulimia nervosa may be related to potential hypo-functioning 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. PMID:21997421

  8. Emotion Awareness and Identification Skills in Adolescent Girls with Bulimia Nervosa

    Science.gov (United States)

    Sim, Leslie; Zeman, Janice

    2004-01-01

    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…

  9. Cognitive-behavioral therapy for subthreshold bulimia nervosa: A case series.

    Science.gov (United States)

    Peterson, C B; Miller, K B; Willer, M G; Ziesmer, J; Durkin, N; Arikian, A; Crow, S J

    2011-09-01

    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.

  10. Predictors and Moderators of Outcome in Family-Based Treatment for Adolescent Bulimia Nervosa

    Science.gov (United States)

    Le Grange, Daniel; Crosby, Ross D.; Lock, James

    2008-01-01

    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.

  11. The Clinical Features of Binge Eating Disorder and Bulimia Nervosa: What Are the Differences?

    Science.gov (United States)

    Sullivan, Keri A.

    2001-01-01

    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.)…

  12. Client Pretreatment Characteristics as Predictors of Outcome in Brief Therapy for Bulimia.

    Science.gov (United States)

    Guiffrida, Douglas A.; Barnes, Kristin L.; Hoskins, Christine M.; Roman, Lisa L.

    2001-01-01

    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)

  13. Comparison of Six- and Eight-Session Cognitive Guided Self-Help for Bulimia Nervosa

    Science.gov (United States)

    Furber, Gareth; Steele, Anna; Wade, Tracey D.

    2004-01-01

    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…

  14. Coping Strategies in Bulimia Nervosa Treatment: Impact on Outcome in Group Cognitive-Behavioral Therapy

    Science.gov (United States)

    Binford, Roslyn B.; Mussell, Melissa Pederson; Crosby, Ross D.; Peterson, Carol B.; Crow, Scott J.; Mitchell, James E.

    2005-01-01

    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…

  15. The role of BDNF, leptin, and catecholamines in reward learning in bulimia nervosa.

    Science.gov (United States)

    Homan, Philipp; Grob, Simona; Milos, Gabriella; Schnyder, Ulrich; Eckert, Anne; Lang, Undine; Hasler, Gregor

    2014-12-07

    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.

  16. Health services use in women with a history of bulimia nervosa or binge eating disorder

    NARCIS (Netherlands)

    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

  17. Brief Group Psychoeducation for Bulimia Nervosa: Assessing the Clinical Significance of Change.

    Science.gov (United States)

    Davis, Ron; And Others

    1990-01-01

    Brief intervention designed to promote symptom management was completed by 41 women with bulimia nervosa. Findings revealed diversity of outcomes that individuals reported following participation in intervention. Found differential reporting of clinically significant change in favor of specific eating psychopathology relative to personality…

  18. The Relationship between Childhood Sexual Abuse and Subsequent Onset of Bulimia Nervosa.

    Science.gov (United States)

    Miller, Debra A. F.; And Others

    1993-01-01

    This study compared 72 young adult women identified as suffering from bulimia nervosa with 72 matched controls. Bulimic women reported higher rates of sexual abuse after the age of 12 with an adult relative as the perpetrator, reported dissociative experiences as more common, and reported more negative and unusual mealtime experiences. (Author/JDD)

  19. Mechanisms of Action in Cognitive-Behavioral and Pharmacological Interventions for Obesity and Bulimia Nervosa.

    Science.gov (United States)

    Craighead, Linda W.; Agras, W. Stewart

    1991-01-01

    Summarizes data pertaining to separate and combined effects of cognitive-behavioral and psychopharmacologic treatments for obesity and bulimia nervosa. Anorexiant medication appears to enhance restraint and facilitates weight loss with behavioral interventions in the treatment of obesity, but relapse occurs once medication is withdrawn.…

  20. Morita-Based Therapy and Its Use across Cultures in the Treatment of Bulimia Nervosa.

    Science.gov (United States)

    LeVine, Peg

    1993-01-01

    Provides an overview of classical inpatient Morita therapy (a four-stage treatment for anxiety-based neurotic disorders), contrasts it with features of rational emotive therapy (RET), and illustrates an intervention program for women suffering from bulimia nervosa. A session-to-session short-term treatment methodology is provided. (Author/SR)

  1. Cognitive-Behavioral and Response-Prevention Treatments for Bulimia Nervosa.

    Science.gov (United States)

    Agras, W. Stewart; And Others

    1989-01-01

    Assessed treatment for bulimia nervosa among 77 female patients assigned to wait-list control, self-monitoring of caloric intake and purging behaviors, cognitive-behavioral treatment, and cognitive-behavioral treatment plus response prevention of vomiting. All treatment groups showed significant improvement; control group did not.…

  2. [Temperament and character of Polish women with anorexia and bulimia nervosa].

    Science.gov (United States)

    Mikołajczyk, Elzbieta; Samochowiec, Jerzy; Smiarowska, Małgorzata; Syrek, Szymon

    2004-01-01

    One of the factors influencing eating disorders are personality traits. The authors analyse temperament and character of healthy women. The Cloninger Temperament and character Inventory was applied to 52 eating disordered patients (33 with anorexia nervosa and 19 with bulimia nervosa). The patients were divided into subgroups of restrictive type and bulimic types of anorexia, bulimia and bulimic episodes. In all the subgroups of the patients a higher result was obtained on the harm avoidance scale (HA), cooperativeness (C) and the self transcendence ST2 subscale. Lower results were seen in self-directedness (SD) in the SD2, SD3 and SD5 subscales. The subgroups differed in temperament. Bulimia patients noted a higher need for NS stimulation and a higher reward dependence (RD). Anorectic patients had higher results in the persistance scale (P), whilst the restrictive anorectic patients had lower results in the NS1 and RD3 subscales. The TCI Inventory is a useful tool, helping for a precise measurement of the difference in temperament of anorectic and bulimia patients as compared to their healthy peers.

  3. Psychological responses to body shape exposure in patients with bulimia nervosa.

    Science.gov (United States)

    Tuschen-Caffier, B; Vögele, C; Bracht, S; Hilbert, A

    2003-05-01

    One of the unresolved issues regarding research on bulimia nervosa concerns the question as to how patients diagnosed with bulimia nervosa respond to body image exposure. In addition, it remains unclear whether there are differential responses associated with different exposure techniques (e.g. in vivo exposure vs. exposure by visualization). The aim of the present study was to investigate psychological responses to body image exposure. Twenty participants diagnosed with bulimia nervosa (DSM IV) and twenty non-eating disordered individuals were exposed to their body image using a video recording (video confrontation). In addition, they were asked to imagine and describe the appearance of their body (imagery task). Results indicate that self-reported negative emotions increased in response to both, video confrontation and imagery task, in the clinical as well as in the control group. Furthermore, video confrontation led to more pronounced group differences than exposure by visualization (imagery task). Participants diagnosed with bulimia nervosa took less time to describe their waist, hips and bottom compared to non-eating disturbed controls. This last result could be interpreted in terms of avoidance behavior and other mechanisms during body image exposure.

  4. The Prevalence of Bulimia Nervosa in the US College Student Population.

    Science.gov (United States)

    Drewnowski, Adam; And Others

    1988-01-01

    A phone survey of 1,007 male and female college students revealed that 1.1 percent of the women and 0.2 percent of the men were bulimic according to the revised (DSM IIIR) diagnostic criteria. At 2.2. percent, bulimia was most prevalent among undergraduate women living in group housing on campus. (Author/BJV)

  5. Weight-Loss Expectancies, Relative Weight, and Symptoms of Bulimia in Young Women.

    Science.gov (United States)

    Thombs, Dennis L.; And Others

    1996-01-01

    A canonical correlation analysis of various weight concerns in a sample of college women revealed that strong expectations of weight loss benefits and a high relative body weight were positively correlated with the four major symptoms of bulimia. Expectations of increased self-worth and social confidence were linked to eating problems. (RJM)

  6. Impact of fasting on food craving, mood and consumption in bulimia nervosa and healthy women participants.

    Science.gov (United States)

    Moreno-Domínguez, Silvia; Rodríguez-Ruiz, Sonia; Fernández-Santaella, M Carmen; Ortega-Roldán, Blanca; Cepeda-Benito, Antonio

    2012-11-01

    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.

  7. How Schools Can Help Combat Student Eating Disorders. Anorexia Nervosa and Bulimia.

    Science.gov (United States)

    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…

  8. Eating Disorders. What Parents Need to Know About Anorexia and Bulimia.

    Science.gov (United States)

    Our Children, 1998

    1998-01-01

    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…

  9. Anorexia nervosa versus bulimia nervosa : differences based on retrospective correlates in a case-control study

    NARCIS (Netherlands)

    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

  10. Anorexia and Bulimia: An Inventory of Public Awareness and Popular Questions.

    Science.gov (United States)

    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…

  11. When Dieting Becomes Dangerous: A Guide to Understanding and Treating Anorexia and Bulimia.

    Science.gov (United States)

    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…

  12. Wait Not, Want Not: Factors Contributing to the Development of Anorexia Nervosa and Bulimia Nervosa.

    Science.gov (United States)

    Murray, Trish

    2003-01-01

    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…

  13. Anorexia nervosa and bulimia nervosa: A meta-analysis of executive functioning.

    Science.gov (United States)

    Hirst, Rayna B; Beard, Charlotte L; Colby, Katrina A; Quittner, Zoe; Mills, Brent M; Lavender, Jason M

    2017-12-01

    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.

  14. Assessment and Treatment of Anorexia Nervosa and Bulimia in School Age Children.

    Science.gov (United States)

    Peters, Carole; And Others

    1984-01-01

    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…

  15. Dialectical Behavior Therapy of Anorexia and Bulimia Nervosa among Adolescents: A Case Series

    Science.gov (United States)

    Salbach-Andrae, Harriet; Bohnekamp, Inga; Pfeiffer, Ernst; Lehmkuhl, Ulrike; Miller, Alec L.

    2008-01-01

    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.…

  16. Low Self-Esteem as a Treatment Issue in the Psychotherapy of Anorexia and Bulimia.

    Science.gov (United States)

    Baird, Pryor; Sights, Judith R.

    1986-01-01

    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)

  17. Familial Contributions to the Etiology and Course of Anorexia Nervosa and Bulimia.

    Science.gov (United States)

    Strober, Michael; Humphrey, Laura Lynn

    1987-01-01

    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…

  18. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Harrington, Brian C; Jimerson, Michelle; Haxton, Christina; Jimerson, David C

    2015-01-01

    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.

  19. New recommendations for management of eating disorders (anorexia nervosa, bulimia nervosa from NICE

    Directory of Open Access Journals (Sweden)

    Vitaliy Bezsheiko

    2017-08-01

    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.

  20. Dancing on the Sidewalk: Reflections on Working with Women with Weight Preoccupations and Bulimia.

    Science.gov (United States)

    Mack, Heidi

    1997-01-01

    Bulimia and other eating disorders are coping strategies to avoid or mask distressing emotions. Outdoor adventure activities can be intense emotional experiences that help young women find new strategies to deal with their "trigger" emotions in the absence of food. Metaphors are consciously built into adventure activities to facilitate…

  1. Bulimia nervosa – its prevalence, symptoms and treatment with special attention to oral health

    Directory of Open Access Journals (Sweden)

    Agata Osińska

    2016-09-01

    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.

  2. Neural response to catecholamine depletion in remitted bulimia nervosa: Relation to depression and relapse.

    Science.gov (United States)

    Mueller, Stefanie Verena; Mihov, Yoan; Federspiel, Andrea; Wiest, Roland; Hasler, Gregor

    2017-07-01

    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.

  3. Altered insula response to sweet taste processing after recovery from anorexia and bulimia nervosa

    Science.gov (United States)

    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.

    2014-01-01

    Objective 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. Method Subjects recovered from anorexia and bulimia were studied to avoid confounding effects of altered nutritional state. Functional magnetic resonance imaging measured brain response to repeated tastes of sucrose and sucralose to disentangle neural processing of caloric and non-caloric sweet tastes. Whole-brain functional analysis was constrained to anatomical regions of interest. Results Compared to matched control women (n=14), women recovered from anorexia (n=14) had diminished (F(1,27)=7.79, p=0.01) and women recovered from bulimia (n=14) had exaggerated (F(1,27)=6.12, p=0.02) right anterior insula hemodynamic response to tastes of sucrose. Furthermore, anterior insula responses to sucrose compared to sucralose was exaggerated in recovered subjects (lower in women recovered from anorexia and higher in women recovered from bulimia). Conclusions The anterior insula integrates sensory/reward aspects of taste in the service of nutritional homeostasis. For example, 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. PMID:23732817

  4. Características morfofuncionais do trânsito orofaríngeo na bulimia: revisão de literatura Morphofunctional characteristics of the oropharyngeal tract in bulimia: review of literature

    Directory of Open Access Journals (Sweden)

    Catarina Matos Brito Santos

    2010-04-01

    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.

  5. The prevalence of DSM-IV personality pathology among individuals with bulimia nervosa, binge eating disorder and obesity

    NARCIS (Netherlands)

    De Jonge, PV; Van Furth, EF; Lacey, JH; Waller, G

    2003-01-01

    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

  6. Bulimia nervosa patient diagnosed with previously unsuspected ADHD in adulthood: clinical case report, literature review, and diagnostic challenges.

    Science.gov (United States)

    Ioannidis, Konstantinos; Serfontein, Jaco; Müller, Ulrich

    2014-05-01

    There is increasing literature suggesting a link between attention-deficit hyperactivity disorder (ADHD) and eating disorders (EDs), especially bulimia nervosa. ADHD is under-diagnosed in girls and children of high intelligence are typically missed. We identified a case of a 23-year-old woman suffering from severe bulimia nervosa and previously unsuspected ADHD in adulthood; we diagnosed and treated her with extended-release methylphenidate. We performed a literature review on the ADHD and bulimia nervosa comorbidity. We discuss the reasons why her ADHD remained undiagnosed and the difficulties in diagnosing ADHD in patients with EDs. We suggest that identifying comorbid ADHD is crucial for these patients and argue for the use of a structured interview, collateral history and investigation of onset of symptoms to establish a diagnosis of ADHD in adults with bulimia nervosa. Comorbidities and overlap of symptomatology need to be taken into account. Copyright © 2013 Wiley Periodicals, Inc.

  7. Static and dynamic body image in bulimia nervosa: mental representation of body dimensions and biological motion patterns.

    Science.gov (United States)

    Vocks, Silja; Legenbauer, Tanja; Rüddel, Heinz; Troje, Nikolaus F

    2007-01-01

    The aim of the present study was to find out whether in bulimia nervosa the perceptual component of a disturbed body image is restricted to the overestimation of one's own body dimensions (static body image) or can be extended to a misperception of one's own motion patterns (dynamic body image). Participants with bulimia nervosa (n = 30) and normal controls (n = 55) estimated their body dimensions by means of a photo distortion technique and their walking patterns using a biological motion distortion device. Not only did participants with bulimia nervosa overestimate their own body dimensions, but also they perceived their own motion patterns corresponding to a higher BMI than did controls. Static body image was correlated with shape/weight concerns and drive for thinness, whereas dynamic body image was associated with social insecurity and body image avoidance. In bulimia nervosa, body image disturbances can be extended to a dynamic component. (c) 2006 by Wiley Periodicals, Inc.

  8. Low density and high affinity of platelet [3H]paroxetine binding in women with bulimia nervosa.

    Science.gov (United States)

    Ekman, Agneta; Sundblad-Elverfors, Charlotta; Landén, Mikael; Eriksson, Tomas; Eriksson, Elias

    2006-06-15

    Impaired serotonin transmission has been suggested to be implicated in the pathophysiology of bulimia nervosa. As an indirect measure of brain serotonergic activity, the binding of tritiated ligands to platelet serotonin transporters has been studied in bulimia nervosa as well as in other putatively serotonin-related psychiatric disorders. In this study, the density and affinity of platelet serotonin transporters were assessed in 20 women meeting the DSM-IV criteria for bulimia nervosa and in 14 controls without previous or ongoing eating disorder using [(3)H]paroxetine as a ligand. In comparison to controls, women with bulimia nervosa had a significantly reduced number of platelet binding sites (B(max) = 721 +/- 313 vs. 1145 +/- 293 fmol/mg protein) and an increase in the affinity for the ligand demonstrated by a lower dissociaton constant (K(d) = 33 +/- 10 vs. 44 +/- 10 pM). A significant correlation between B(max) and K(d) values was found in patients but not in controls. Our results support the notion that bulimia nervosa is associated with a reduction in platelet serotonin transporter density. In addition, our study is the first to report that this reduced transporter density in women with bulimia nervosa is accompanied by an increase in the affinity of the transporter for the ligand.

  9. The Effectiveness of Acceptance and Commitment Therapy on Improving Body Image of Female Students with Bulimia Nervosa

    Directory of Open Access Journals (Sweden)

    Moslem Abbasi

    2015-04-01

    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

  10. Mood spectrum comorbidity in patients with anorexia and bulimia nervosa.

    Science.gov (United States)

    Miniati, Mario; Benvenuti, Antonella; Bologna, Elena; Maglio, Alessandra; Cotugno, Biagio; Massimetti, Gabriele; Calugi, Simona; Mauri, Mauro; Dell'Osso, Liliana

    2016-10-20

    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 < 0.05), 'psychomotor retardation' (5.4 ± 5.6 vs 8.9 ± 3.8; p = 0.003), 'psychotic features' (2.0 ± 1.8 vs 4.1 ± 1.6; p = 0.001), 'neurovegetative symptoms' (5.0 ± 2.6 vs 7.7 ± 1.7; p = 0.001); (b) MOODS-SR manic/hypomanic component: 'psychomotor activation' (4.3 ± 3.6 vs 7.4 ± 3.1; p = 0.002), 'mixed instability' (1.0 ± 1.5 vs 2.0 ± 1.6; p < 0.05), 'mixed irritability' (2.5 ± 1.8 vs 3.7 ± 1.6; p < 0.05), 'inflated self-esteem' (1.1 ± 1.4 vs 2.1 ± 1.6; p < 0.05), and 'wastefulness/recklessness' (1.0 ± 1.4 vs 2.0 ± 1.2; p = 0.009). MOODS-SR identifies subthreshold mood signs/symptoms among patients with AN-R, and BN and with no Axis I comorbidity for mood disorders, and provides a better

  11. Abdominal aortic occlusion and vascular compromise secondary to acute gastric dilatation in a patient with bulimia.

    Science.gov (United States)

    Elsharif, M; Doulias, T; Aljundi, W; Balchandra, S

    2014-11-01

    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.

  12. Management of anorexia and bulimia nervosa: An evidence-based review

    Science.gov (United States)

    Chakraborty, Kaustav; Basu, Debasish

    2010-01-01

    Anorexia nervosa and bulimia nervosa are primarily psychiatric disorders characterized by severe disturbances of eating behavior. Eating disorders are most prevalent in the Western culture where food is in abundance and female attractiveness is equated with thinness. Eating disorders are rare in countries like India. Despite a plethora of management options available to the mental health professionals, no major breakthrough has been achieved in recent years. Nutritional rehabilitation along with some form of re educative psychotherapy remains the mainstay of management of anorexia nervosa. In bulimia nervosa, both fluoxetine and cognitive behavior therapy have been found to be effective. Although the above-mentioned management options have been in use for decades, the active ingredient is still to be ascertained. PMID:20838508

  13. Just Desserts? Exploring Constructions of Food in Women's Experiences of Bulimia.

    Science.gov (United States)

    Churruca, Kate; Ussher, Jane M; Perz, Janette

    2017-08-01

    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.

  14. [Psychodynamik focal therapy of bulimia nervosa for female adolescents and young adults].

    Science.gov (United States)

    Reich, Günter; Horn, Hildegard; Winkelmann, Klaus; Kronmüller, Klaus-Thomas; Stefini, Anette

    2014-01-01

    A manual for a disorder oriented psychodynamic treatment of bulimia nevosa and atypical bulimia nervosa of female adolescents and young adults is presented. This manual is applied in a therapy project, which started in 2007. The work on conflicts and structural dysfunctions is meant to lead to the removal or alleviation of the symptoms and an improvement of eating behavior and body image. The bulimic symptoms are contextualized and focussed according to the conflicts and ego-structural deficits of the patients. Typical patterns of interpersonal relationships, transference, conflict, defence and structural problems as well as therapeutic steps are described. The typical psychosocial situation of female adolescence and young adult age is taken into account. Special emphasis is laid on the limitedness of the therapy to 60 sessions and the active structuring of the final phase of he therapy by the therapist.

  15. Sociocultural factors in the development of bulimia nervosa in a blind woman: a case report.

    Science.gov (United States)

    Simeunovic Ostojic, Mladena; Hansen, Annemarie M J

    2013-04-01

    Although several cases of eating disorders in visually impaired women have been reported, there has been little research on the development of body image and disordered eating in the blind. Overall, it is argued that blind women are protected from developing body dissatisfaction because of having had little or no exposure to thin-ideal images, and that if they do develop an eating disorder, this would be linked to other risk factors. In the one reported case of bulimia nervosa in a blind woman, body image concerns were even absent. We report a single case of bulimia nervosa in a 28-year-old congenitally blind woman whose presentation was typical, including body dissatisfaction and drive for thinness. The present case underscores the need to also consider an etiological role of perceived sociocultural pressure and thin-ideal internalization in promoting body dissatisfaction and eating disorders in visually impaired women. Copyright © 2012 Wiley Periodicals, Inc.

  16. Bulimia nervosa symptomatology and body image disturbance associated with distance running and weight loss.

    Science.gov (United States)

    Gleaves, D H; Williamson, D A; Fuller, R D

    1992-01-01

    To investigate the hypothesis that problems characteristic of eating disorders may often be associated with distance running, 20 women who had lost weight through distance running were compared with a control group who did not exercise and had not lost weight and a comparison group of bulimia nervosa patients. Dependent variables were measures of depression, bulimia nervosa symptomatology, and body image disturbance. No differences were found between the runner group and the normal controls. Bulimics differed from runners and controls on most measures. Thus, the results did not support the proposition that weight loss through running leads to problems related to eating and body image. The failure to find disturbances in body image in runners suggests that body image disturbances are not a direct result of weight loss, as suggested by some theorists. PMID:1422651

  17. Effectiveness of individualized, integrative outpatient treatment for females with anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Freudenberg, Cara; Jones, Rebecca A; Livingston, Genvieve; Goetsch, Virginia; Schaffner, Angela; Buchanan, Linda

    2016-01-01

    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.

  18. [Mental disorders among relatives of patients with anorexia nervosa and bulimia nervosa].

    Science.gov (United States)

    Wagner, Angela; Wöckel, Lars; Bölte, Sven; Radeloff, Daniel; Lehmkuhl, Gerd; Schmidt, Martin H; Poustka, Fritz

    2008-05-01

    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.

  19. [Typology of disordered eating behaviour (anorexia nervosa with bulimia and vomitomanic disturbances) in children and adolescents].

    Science.gov (United States)

    Balakireva, E E; Kozlova, I A; Iakupova, L P; Savost'ianova, O L

    2004-01-01

    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.

  20. An Update on Genetic and Serotoneric Biomarker Findings in Bulimia Nervosa

    DEFF Research Database (Denmark)

    Sjögren, Magnus

    2017-01-01

    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...... are summarized. Results: Heritability, twin and targeted genetic studies support a gene contribution to the risk of BN. Although there are conflicting findings, 5HTTLPR polymorphism has been found to be linked to BN, especially to the emotional symptoms of the disorder. Several biomarker studies find support...

  1. Initial assessment and early treatment options for anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Powers, P S

    1996-12-01

    This article presents the essential aspects of assessment of patients with anorexia nervosa or bulimia nervosa. The evaluation of the athlete with a suspected eating disorder is described. The choice of appropriate type and site of treatment is discussed. Throughout the article there is an emphasis on methods that can be useful in assisting the patient to acknowledge his or her illness and participate in treatment. The need to focus simultaneously on psychological and relationship issues and nutritional status is stressed.

  2. Negative affect and neural response to palatable food intake in bulimia nervosa.

    Science.gov (United States)

    Bohon, Cara; Stice, Eric

    2012-06-01

    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.

  3. Neuropathy and myopathy in two patients with anorexia and bulimia nervosa.

    OpenAIRE

    Alloway, R.; Reynolds, E H; Spargo, E; Russell, G F

    1985-01-01

    Two adolescent patients with eating disorders and severe weight loss presented with neuromyopathy. The first was female and had a twenty months' history of bulimia nervosa with weight loss and episodic gorging and vomiting. The second was male with a two-year history of anorexia nervosa characterised by vegetarianism and increasing food restriction. Both had severe wasting and asymmetrical weakness of proximal limb muscles. The first patient deteriorated on refeeding and became temporarily pa...

  4. Restricción alimentaria y bulimia nerviosa : ¿Un vínculo causal?

    OpenAIRE

    Mora Giral, Marisol; Raich, Rosa María

    1994-01-01

    Hemos revisado la evidencia disponible sobre la relación entre dieta y bulimia, particularmente los estudios que sugieren un vínculo causal entre estas dos variables: estudios longitudinales, modelos causales y evidencia experimental. Hemos examinado también modelos, hipótesis y teorías que den soporte teórico a esta relación

  5. Oral health considerations in anorexia and bulimia nervosa. 2. Multidisciplinary management and personalized dental care.

    Science.gov (United States)

    Bassiouny, Mohamed A; Tweddale, Elizabeth

    2017-01-01

    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.

  6. Anorexia nervosa and bulimia nervosa - a psychotherapeutic cognitive-constructivist approach.

    Science.gov (United States)

    Abreu, Cristiano Nabuco de; Cangelli Filho, Raphael

    2017-06-01

    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.

  7. BULIMIA, ADICCIÓN ALIMENTICIA Y LOS COLORES DE LAS FRUTAS

    Directory of Open Access Journals (Sweden)

    Daniel Jácome Roca

    2009-12-01

    Full Text Available

    Resumen

    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

    Abstract

    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

  8. Relationship-focused therapy for bulimia and binge eating: Introduction to the special section.

    Science.gov (United States)

    Thompson-Brenner, Heather

    2016-06-01

    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).

  9. The impact of bulimia nervosa on oral health: A review of the literature.

    Science.gov (United States)

    Rosten, A; Newton, T

    2017-11-01

    Eating disorders are a potentially life-threatening group of mental disorders, which affect a patient's relationship with food and their body. This manifests itself through chaotic and disordered eating habits. One such eating disorder is bulimia nervosa, which has a lifetime prevalence of 1%. While there is consensus that bulimic behaviour directly causes dental erosion due to vomiting and acidic food choices, there is less clear evidence for a direct link between bulimia nervosa and dental caries, although there does still appear to be an association. Reduced salivary flow rate is a common feature among bulimics, but this is often due to anti-depressant medication rather than dietary habits or vomiting, and the effects are largely limited to unstimulated whole salivary flow rate and don't affect stimulated whole salivary flow rate. Parotid enlargement is present in a number of cases but this tends to be a minority. Further research is required given the limitations of current studies, especially gender imbalances among the populations studied and a lack of clear focus on bulimia nervosa.

  10. Risk factors for bulimia nervosa: a controlled study of parental psychiatric illness and divorce.

    Science.gov (United States)

    Boumann, C E; Yates, W R

    1994-01-01

    Twenty five women with normal-weight bulimia nervosa were compared with 25 age- and weight-matched women without bulimia nervosa on measures of parental psychiatric illness. Case and control probands, as well as their parents, completed the Family History Research Diagnostic Criteria (FH-RDC) interview and a battery of self-report instruments. Case probands and controls were divided into two groups based on evidence for parental psychiatric illness. The assignment of parental psychiatric illness was made by (a) a positive parental history of alcoholism or depression from the FH-RDC; or (b) evidence of parental major depression, alcoholism, or personality disorder from the self-report measures. Parental psychiatric illness occurred significantly more frequently for case probands compared to the control probands (64% vs. 24%, odds ratio = 5.6, 95% Cl = 1.7-19.2). Parental psychiatric illness was also associated with parental divorce (Fisher's exact p = .023) and a trend toward lower ratings of paternal but not maternal relationship by case probands. This study suggests parental psychiatric illness may be a risk factor for bulimia nervosa and may contribute to environmental effects through increased rates of divorce and impaired paternal relationships.

  11. Taste Reward Circuitry Related Brain Structures Characterize Ill and Recovered Anorexia Nervosa and Bulimia Nervosa

    Science.gov (United States)

    Frank, Guido K.; Shott, Megan E.; Hagman, Jennifer O.; Mittal, Vijay A.

    2013-01-01

    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

  12. [Subjective family image in anorexia nervosa and bulimia nervosa in adolescence: a controlled study].

    Science.gov (United States)

    Karwautz, A; Haidvogl, M; Wagner, G; Nobis, G; Wöber-Bingöl, C; Friedrich, M H

    2002-11-01

    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.

  13. Ato e deriva pulsional na clínica da anorexia-bulimia

    Directory of Open Access Journals (Sweden)

    Cristina Moreira Marcos

    2015-01-01

    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.

  14. Food Addiction and Bulimia Nervosa: New Data Based on the Yale Food Addiction Scale 2.0.

    Science.gov (United States)

    de Vries, Sarah-Kristin; Meule, Adrian

    2016-11-01

    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.

  15. Bulimia nerviosa a través de la percepción del profesional Bulimia nervosa across the perception of the professional

    Directory of Open Access Journals (Sweden)

    J.M. Perea-Baena

    2007-11-01

    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.

  16. "Diagnostic shift" from eating disorder not otherwise specified to bulimia nervosa using DSM-5 criteria: a clinical comparison with DSM-IV bulimia.

    Science.gov (United States)

    MacDonald, Danielle E; McFarlane, Traci L; Olmsted, Marion P

    2014-01-01

    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.

  17. Eating and weight/shape criticism as a specific life-event related to bulimia nervosa: a case control study.

    Science.gov (United States)

    Gonçalves, Sonia Ferreira; Machado, Bárbara César; Martins, Carla

    2014-01-01

    The present study aims to evaluate the occurrence of life events preceding the onset of eating problems in bulimia nervosa patients. A case-control design was used involving the comparison of 60 female subjects who meet DSM-IV criteria for bulimia nervosa with 60 healthy control subjects and 60 subjects with other psychiatric disorders. The RFI (Fairburn et al., 1998) subset of factors that represent exposure to life events in the 12 months immediately before the development of eating problems was used. Women with bulimia nervosa reported higher rates of major stress, criticism about eating, weight and shape and also a great number of antecedent life events during the year preceding the development of eating problems than the healthy control group. However, when compared with the general psychiatric control group only the exposure to critical comments about weight, shape, or eating emerged as a specific trigger for bulimia nervosa. Our findings support the fact that eating and shape/weight criticism in the year preceding the development of eating disturbance seems to be specifically related to bulimia nervosa.

  18. Altered structural and effective connectivity in anorexia and bulimia nervosa in circuits that regulate energy and reward homeostasis.

    Science.gov (United States)

    Frank, G K W; Shott, M E; Riederer, J; Pryor, T L

    2016-11-01

    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 (Panorexia and bulimia 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.

  19. Women with bulimia nervosa exhibit attenuated secretion of glucagon-like peptide 1, pancreatic polypeptide, and insulin in response to a meal

    DEFF Research Database (Denmark)

    Naessén, Sabine; Carlström, Kjell; Holst, Jens Juul

    2011-01-01

    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....

  20. Recurrent aborted sudden cardiac death with seizures and rhabdomyolysis due to bulimia-induced hypokalemia: report of one case.

    Science.gov (United States)

    Finsterer, Josef; Stöllberger, Claudia

    2014-06-01

    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.

  1. An fMRI Study of Self-Regulatory Control and Conflict Resolution in Adolescents With Bulimia Nervosa

    Science.gov (United States)

    Marsh, Rachel; Horga, Guillermo; Wang, Zhishun; Wang, Pengwei; Klahr, Kristin W.; Berner, Laura A.; Walsh, B. Timothy; Peterson, Bradley S.

    2012-01-01

    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

  2. Temperamental dimensions of the TEMPS-A in females with co-morbid bipolar disorder and bulimia.

    Science.gov (United States)

    Rybakowski, Janusz K; Kaminska, Katarzyna; Charytonik, Jolanta; Akiskal, Kareen K; Akiskal, Hagop S

    2014-08-01

    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.

  3. Body image dissatisfaction and its relationship with nutritional status, body fat, and anorexia and bulimia symptoms in adolescents

    OpenAIRE

    Cilene Rebolho Martins; Andreia Pelegrini; Silvana Corrêa Matheus; Edio Luiz Petroski

    2010-01-01

    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...

  4. A longitudinal investigation of mortality in anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Franko, Debra L; Keshaviah, Aparna; Eddy, Kamryn T; Krishna, Meera; Davis, Martha C; Keel, Pamela K; Herzog, David B

    2013-08-01

    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.

  5. Effect of management of patients with Anorexia and Bulimia nervosa on symptoms and impulsive behavior.

    Science.gov (United States)

    Sernec, Karin; Tomori, Martina; Zalar, Bojan

    2010-12-01

    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.

  6. Bulimia y estrategias de afrontamiento en adolescentes escolarizadas de la ciudad de Pereira, Colombia

    Directory of Open Access Journals (Sweden)

    Marly Johana Bahamón Muñetón

    2012-01-01

    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.

  7. Predictors of early change in bulimia nervosa after a brief psychoeducational therapy.

    Science.gov (United States)

    Fernàndez-Aranda, Fernando; Alvarez-Moya, Eva M; Martínez-Viana, Cristina; Sànchez, Isabel; Granero, Roser; Penelo, Eva; Forcano, Laura; Peñas-Lledó, Eva

    2009-06-01

    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.

  8. Neuropathy and myopathy in two patients with anorexia and bulimia nervosa.

    Science.gov (United States)

    Alloway, R; Reynolds, E H; Spargo, E; Russell, G F

    1985-10-01

    Two adolescent patients with eating disorders and severe weight loss presented with neuromyopathy. The first was female and had a twenty months' history of bulimia nervosa with weight loss and episodic gorging and vomiting. The second was male with a two-year history of anorexia nervosa characterised by vegetarianism and increasing food restriction. Both had severe wasting and asymmetrical weakness of proximal limb muscles. The first patient deteriorated on refeeding and became temporarily paralysed. Both had a purpuric rash and haematological abnormalities. They made a complete recovery on a mixed diet: vitamin supplements were given to the first but not to the second patient.

  9. Neuropathy and myopathy in two patients with anorexia and bulimia nervosa.

    Science.gov (United States)

    Alloway, R; Reynolds, E H; Spargo, E; Russell, G F

    1985-01-01

    Two adolescent patients with eating disorders and severe weight loss presented with neuromyopathy. The first was female and had a twenty months' history of bulimia nervosa with weight loss and episodic gorging and vomiting. The second was male with a two-year history of anorexia nervosa characterised by vegetarianism and increasing food restriction. Both had severe wasting and asymmetrical weakness of proximal limb muscles. The first patient deteriorated on refeeding and became temporarily paralysed. Both had a purpuric rash and haematological abnormalities. They made a complete recovery on a mixed diet: vitamin supplements were given to the first but not to the second patient. Images PMID:3863893

  10. Therapist adherence is associated with outcome in cognitive-behavioral therapy for bulimia nervosa

    DEFF Research Database (Denmark)

    Folke, Sofie; Daniel, Sarah Ingrid Franksdatter; Gondan, Matthias

    2017-01-01

    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...

  11. Avaliação da microbiota bucal de pacientes com anorexia nervosa e bulimia nervosa

    OpenAIRE

    Brito, Graziella Nuernberg Back [UNESP

    2009-01-01

    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...

  12. Binge Eating Disorder and Its Relationship to Bulimia Nervosa and Obesity

    OpenAIRE

    LaCaille, Lara Schultz

    2002-01-01

    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 ...

  13. Una perspectiva sociológica de la anorexia y la bulimia

    OpenAIRE

    Cisneros Britto, Pilar

    2001-01-01

    Tanto la anorexia como la bulimia son trastornos con un marcado contenido social, de ellas se culpa a los medios y a los modelos de extrema delgadez. El colectivo que más lo sufre es el de jóvenes adolescentes, que tienen una visión distorsionadas de sí mismas que corresponde con un concepto o figura artificialmente construida. Se estudia el modelo corporal y su evolución histórica, los distintos cánones de belleza, la relación inversa entre la clase social y la obesidad, el hecho de vivir e...

  14. Distinguishing Between Risk Factors for Bulimia Nervosa, Binge Eating Disorder, and Purging Disorder.

    Science.gov (United States)

    Allen, Karina L; Byrne, Susan M; Crosby, Ross D

    2015-08-01

    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

  15. [Prevention and Treatment of Eating Disorders: The Health Care Network Anorexia and Bulimia nervosa].

    Science.gov (United States)

    Weigel, Angelika; Gumz, Antje; Kästner, Denise; Romer, Georg; Wegscheider, Karl; Löwe, Bernd

    2015-07-01

    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.

  16. ANOREXIA E BULIMIA NA ADOLESCÊNCIA: EXPRESSÃO DO MAL-ESTAR NA CONTEMPORANEIDADE

    OpenAIRE

    Refosco, Lísia da Luz; Macedo, Mônica Medeiros Kother

    2011-01-01

    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...

  17. Hypovitaminosis D3, Leukopenia, and Human Serotonin Transporter Polymorphism in Anorexia Nervosa and Bulimia Nervosa

    Directory of Open Access Journals (Sweden)

    Anna Tasegian

    2016-01-01

    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.

  18. Electrocortical processing of food and emotional pictures in anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Blechert, Jens; Feige, Bernd; Joos, Andreas; Zeeck, Almut; Tuschen-Caffier, Brunna

    2011-06-01

    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.

  19. Regional grey matter volume abnormalities in bulimia nervosa and binge-eating disorder.

    Science.gov (United States)

    Schäfer, Axel; Vaitl, Dieter; Schienle, Anne

    2010-04-01

    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.

  20. Subjective binge eating with compensatory behaviors: a variant presentation of bulimia nervosa.

    Science.gov (United States)

    Watson, Hunna J; Fursland, Anthea; Bulik, Cynthia M; Nathan, Paula

    2013-03-01

    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.

  1. [Nasogastric tube feeding in bulimia. Controlled study with follow-up at 3 months].

    Science.gov (United States)

    Rigaud, Daniel; Brayer, Véronique; Biton-Jélic, Violaine; Païs, Vanessa; Pennacchio, Hélène; Brun, Jean-Marcel

    2007-10-01

    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.

  2. Micronutrient deficiencies and supplementation in anorexia and bulimia nervosa: a review of literature.

    Science.gov (United States)

    Setnick, Jessica

    2010-04-01

    Anorexia and bulimia nervosa are characterized by unbalanced eating patterns that include inadequate dietary intake of various nutrients. Conservation mechanisms resulting from starvation and/or self-prescribed nutrient supplements can result in laboratory values that appear within normal limits. These artificially inflated values drop to dangerous levels in some patients once rehydration and refeeding begin. Electrolyte status must be closely monitored during this time to prevent complications. Other micronutrient deficiencies can be corrected with adequate dietary intake, but patients with eating disorders are unlikely to consume such an adequate diet immediately upon entering treatment, so they may benefit from supplementation. Depleted nutrient stores require longer supplementation than acute inadequacies in nutrient intake. This review compiles the findings reported to date regarding micronutrient deficiencies and supplementation for patients with anorexia and bulimia. Because of the widely varying eating practices from patient to patient and the current lack of data controlling for nutrient self-supplementation, nutrition assessment performed by a nutrition professional via food intake history may be more practical than laboratory tests and more accurate than current food intake for determining potential micronutrient deficiencies.

  3. Frontocingular dysfunction in bulimia nervosa when confronted with disease-specific stimuli.

    Science.gov (United States)

    Joos, Andreas A B; Saum, Barbara; Zeeck, Almut; Perlov, Evgeniy; Glauche, Volkmar; Hartmann, Armin; Freyer, Tobias; Sandholz, Angelika; Unterbrink, Thomas; van Elst, Ludger Tebartz; Tüscher, Oliver

    2011-01-01

    Bulimia nervosa (BN) is characterized by dysregulation of impulse control, in other words, uncontrolled eating. Functional neuroimaging studies have been sparse and have used variable methodologies. Thirteen medication-free female BN patients and 13 female healthy controls were investigated by functional magnetic resonance imaging using a disease-specific food paradigm. Stimuli were rated after the scanning procedure. Bulimia nervosa patients showed increased fear ratings and a trend for increased disgust. Magnetic resonance imaging data of 10 BN patients could be analysed. Three BN patients had to be excluded from the analysis because of minimal blood oxygen level dependent signals. Compared with healthy controls, BN patients showed less activation of the anterior cingulate cortex, which extended into the lateral prefrontal cortex. Furthermore, the right temporal pole showed decreased reactivity. This study substantiates a key role of lateral prefrontal dysfunction in BN, a brain region involved in impulse control. Furthermore, the anterior cingulate cortex, which plays a key role in emotion processing, is dysfunctional. A major limitation of this study is the small sample size. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.

  4. Cognitive-behavioral therapy for bulimia nervosa and atypical bulimic nervosa: effectiveness in clinical settings.

    Science.gov (United States)

    Waller, Glenn; Gray, Emma; Hinrichsen, Hendrik; Mountford, Victoria; Lawson, Rachel; Patient, Eloise

    2014-01-01

    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.

  5. Clinical, psychopathological and personality correlates of interoceptive awareness in anorexia nervosa, bulimia nervosa and obesity.

    Science.gov (United States)

    Fassino, Secondo; Pierò, Andrea; Gramaglia, Carla; Abbate-Daga, Giovanni

    2004-01-01

    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

  6. Estudo sobre a anorexia e bulimia nervosa em universitárias

    Directory of Open Access Journals (Sweden)

    Alex Aigner de Souza

    Full Text Available Detectar as prevalências indicativas de Anorexia e Bulimia em estudantes universitárias, considerando estado civil, curso, IMC, depressão e atividade física. Aplicaram-se em 352 alunas o Eating Attitudes Test (EAT-26 e o Body Shape Questionnaire (BSQ. O curso de nutrição apresentou maior prevalência positiva de Anorexia (20,2%, as pessoas com depressão (23,2% e praticantes de atividade física (19,2%. A Terapia Ocupacional e não praticantes apresentaram maior prevalência negativa. Quanto à Bulimia, as pessoas obesas (35,7% e com sobre peso (21,1% apresentaram preocupação grave com a imagem corporal; as pessoas abaixo do peso não apresentaram (93,8%. O curso de nutrição apresentou maior prevalência indicativa de Anorexia; e pessoas com depressão tendem a resultados piores nos dois instrumentos.

  7. Aggression and impulsivity with impulsive behaviours in patients with purgative anorexia and bulimia nervosa.

    Science.gov (United States)

    Zalar, Bojan; Weber, Urška; Sernec, Karin

    2011-03-01

    The study aimed to compare purgative anorexia and bulimia nervosa patients in regard of their level of aggression and impulsivity traits, as well as dynamics of selected impulsive behaviours over time-course of eating disorder treatment. 30 females with purgative anorexia nervosa, 33 females with purgative bulimia nervosa and 31 controls were included. Impulsive behaviours were assessed upon hospital admission, discharge, and three and six months after, using the internal ward questionnaire. Aggression and impulsivity traits were evaluated three months after discharge using Buss-Durkee Hostility Inventory and Barratt Impulsiveness Scale, 11th Revision. In all patients, the expressed impulsive behaviours were most frequent upon admission, when bingeing, striking and quarrelling were more expressed in bulimic patients. Later, patient groups did not differ regarding any impulsive behaviour. These all substantially resolved till discharge, and showed further decline at later assessments. All patients had a higher level of aggression and impulsivity traits and lower overt and higher covert aggression than controls. Patient groups had similar within group distribution of aggression and impulsivity intensity levels. Regarding individual dimensions of these traits no difference was found between them, except for the higher level of suspiciousness in anorectic individuals. Purgative anorectic and bulimic patients show similar dynamics of impulsive behaviours which substantially decline over time-course of eating disorder treatment. They both present similarly heightened levels of aggression and impulsivity traits, with some minor differences regarding their individual dimensions, possibly reflecting higher overt aggression in bulimic and higher covert aggression in anorectic patients.

  8. Hypovitaminosis D3, Leukopenia, and Human Serotonin Transporter Polymorphism in Anorexia Nervosa and Bulimia Nervosa.

    Science.gov (United States)

    Tasegian, Anna; Curcio, Francesco; Dalla Ragione, Laura; Rossetti, Francesca; Cataldi, Samuela; Codini, Michela; Ambesi-Impiombato, Francesco Saverio; Beccari, Tommaso; Albi, Elisabetta

    2016-01-01

    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.

  9. [Temperament and character profiles of female adolescent patients with anorexia and bulimia nervosa].

    Science.gov (United States)

    Hueg, Anne; Resch, Franz; Haffner, Johann; Poustka, Luise; Parzer, Peter; Brunner, Romuald

    2006-03-01

    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.

  10. [Attachment patterns, self-esteem, gender schema in anorexia and bulimia nervosa].

    Science.gov (United States)

    Józefik, Barbara; Iniewicz, Grzegorz; Ulasińska, Romualda

    2010-01-01

    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.

  11. Therapeutic Alliance and Treatment Adherence in Two Interventions for Bulimia Nervosa: A Study of Process and Outcome

    Science.gov (United States)

    Loeb, Katharine L.; Wilson, G. Terence; Labouvie, Erich; Pratt, Elizabeth M.; Hayaki, Jumi; Walsh, B. Timothy; Agras, W. Stewart; Fairburn, Christopher G.

    2005-01-01

    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…

  12. Altered structural and effective connectivity in anorexia and bulimia nervosa in circuits that regulate energy and reward homeostasis

    Science.gov (United States)

    Frank, G K W; Shott, M E; Riederer, J; Pryor, T L

    2016-01-01

    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. PMID:27801897

  13. Predictors of 12-Month Outcome in Bulimia Nervosa and the Influence of Attitudes to Shape and Weight.

    Science.gov (United States)

    Fairburn, Christopher G.; And Others

    1993-01-01

    Patients with bulimia nervosa were treated with either cognitive behavioral, behavioral, or a form of interpersonal psychotherapy for 19 sessions in an 18-week period. Assessments were made at pretreatment; posttreatment; and 4-, 8-, and 12-month follow-up. The nature of the relationship between attitudinal disturbance and outcome was complex and…

  14. Review of Studies on the Relationships between Anorexia Nervosa, Bulimia Nervosa Tendency, Self Image, Body Image, and Sex-role

    OpenAIRE

    鈴木, 真理江

    1995-01-01

    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.

  15. Psychiatric Disorders Associated with the Onset and Persistence of Bulimia Nervosa and Binge Eating Disorder during Adolescence.

    Science.gov (United States)

    Zaider, Talia I.; Johnson, Jeffrey G.; Cockell, Sarah J.

    2002-01-01

    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…

  16. Subtyping Women with Bulimia Nervosa along Dietary and Negative Affect Dimensions: Further Evidence of Reliability and Validity

    Science.gov (United States)

    Stice, Eric; Bohon, Cara; Marti, C. Nathan; Fischer, Kathryn

    2008-01-01

    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…

  17. The Production of "Everything You Always Wanted to Know about Anorexia and Bulimia, but Were Afraid to Ask".

    Science.gov (United States)

    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…

  18. Fractures in patients with anorexia nervosa, bulimia nervosa, and other eating disorders--a nationwide register study

    DEFF Research Database (Denmark)

    Vestergaard, Peter; Emborg, Charlotte; Støving, René K

    2002-01-01

    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...

  19. Association of CNR1 and FAAH endocannabinoid gene polymorphisms with anorexia nervosa and bulimia nervosa: evidence for synergistic effects.

    Science.gov (United States)

    Monteleone, P; Bifulco, M; Di Filippo, C; Gazzerro, P; Canestrelli, B; Monteleone, F; Proto, M C; Di Genio, M; Grimaldi, C; Maj, M

    2009-10-01

    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.

  20. As terapias cognitivo-comportamentais no tratamento da bulimia nervosa: uma revisão

    Directory of Open Access Journals (Sweden)

    Tatiana A. Bertulino da Silva

    2015-06-01

    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.

  1. [EDNOS is an eating disorder of clinical relevance, on a par with anorexia and bulimia nervosa].

    Science.gov (United States)

    Dingemans, A E; van Furth, E F

    2015-01-01

    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

  2. Analysis of multi-instrumental assessment of eating disorders: comparison between Anorexia and Bulimia.

    Science.gov (United States)

    Juli, Maria-Rosaria

    2012-09-01

    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

  3. Predictors for good therapeutic outcome and drop-out in technology assisted guided self-help in the treatment of bulimia nervosa and bulimia like phenotype.

    Science.gov (United States)

    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

    2015-03-01

    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.

  4. Intentional hypoglycemia to control bingeing in a patient with type 1 diabetes and bulimia nervosa.

    Science.gov (United States)

    Moosavi, Mandana; Kreisman, Stuart; Hall, Lacresha

    2015-02-01

    Most cases of eating disorders associated with type 1 diabetes mellitus are categorized as diabulimia, a disorder of withholding insulin treatment to lose weight through sustained hyperglycemia. In this paper, we report a unique case of a patient with both type 1 diabetes and bulimia nervosa who has an atypical way of controlling her bingeing by keeping her blood sugars low. This pattern of intentionally sustained hypoglycemia has not been previously described in the literature to the best of our knowledge. Knowing various presentations of eating disorders in patients with type 1 diabetes can provide healthcare workers with enhanced ability in recognizing and educating at-risk patients, in the hope of preventing serious hypoglycemia or complications. Furthermore, a patient's awareness of complications associated with suboptimal control of diabetes, whether by overdosing or underdosing their insulin regimen, might lead to avoidance of disordered eating behaviours. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

  5. Evaluation of a functional treatment for binge eating associated with bulimia nervosa.

    Science.gov (United States)

    Giddings, T D; Miltenberger, R G

    2010-01-01

    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.

  6. Dieting in bulimia nervosa is associated with increased food restriction and psychopathology but decreased binge eating.

    Science.gov (United States)

    Lowe, Michael R; Witt, Ashley A; Grossman, Stephanie L

    2013-08-01

    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.

  7. Bulimia and anorexia nervosa in winter depression: lifetime rates in a clinical sample.

    Science.gov (United States)

    Gruber, N P; Dilsaver, S C

    1996-01-01

    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

  8. A Dutch day treatment program for anorexia and bulimia nervosa in comparison with internationally described programs.

    Science.gov (United States)

    Lammers, M W; Exterkate, C C; De Jong, C A J

    2007-03-01

    A Dutch day treatment program for patients with anorexia and bulimia nervosa is described and compared to intensive day treatment programs for patients with eating disorders outlined in international literature. The 5-day program is described in terms of its general characteristics, intended outcome and specific treatment interventions. Along these parameters it is compared to the programs found in a systematic literature search of day hospitalization programs for eating disorders. Global inspection shows a lot of similarities between all the programs. Looking more closely, also many important differences exist (concerning, e.g. treatment duration, intensity of treatment, theoretical orientation, goals of treatment and weight gain regime). Because of the differences, it is hard to compare outcome data between centres. Besides, on many of these dimensions, the literature does not yet tell us unambiguously what is best for our patients. Therefore, it is necessary to keep the dialogue between treatment centres going. 2007 John Wiley & Sons, Ltd and Eating Disorders Association

  9. Aripiprazole in anorexia nervosa and low-weight bulimia nervosa: case reports.

    Science.gov (United States)

    Trunko, Mary Ellen; Schwartz, Terry A; Duvvuri, Vikas; Kaye, Walter H

    2011-04-01

    There has been much interest in the use of atypical antipsychotics in anorexia nervosa (AN). However, newer, more weight-neutral medications have not been studied in AN, and there are no reports of the use of antipsychotics in bulimia nervosa (BN). We report on the treatment of eight patients (five with AN and three with BN) with aripiprazole for time periods of four months to more than three years. All individuals had reduced distress around eating, fewer obsessional thoughts about food, weight and body image, significant lessening of eating-disordered behaviors, and gradual weight restoration where appropriate. Depression, generalized anxiety, and cognitive flexibility improved as well. In summary, these findings support the need to perform controlled trials of aripiprazole in AN and BN. Copyright © 2010 Wiley Periodicals, Inc.

  10. Bulimia nervosa symptoms in the multimodal treatment study of children with ADHD.

    Science.gov (United States)

    Mikami, Amori Yee; Hinshaw, Stephen P; Arnold, L Eugene; Hoza, Betsy; Hechtman, Lily; Newcorn, Jeffrey H; Abikoff, Howard B

    2010-04-01

    We investigated body image dissatisfaction and bingeing/purging characteristics of bulimia nervosa (BN) in the ongoing prospective follow-up of the Multimodal Treatment Study of Children with attention-deficit/hyperactivity disorder (ADHD). Participants were 337 boys and 95 girls with ADHD and 211 boys and 53 girls forming a local normative comparison group (LNCG), reassessed in midadolescence (mean age, 16.4), 8 years after original recruitment. Youth with childhood ADHD showed more BN symptoms in midadolescence than did LNCG youth, and girls demonstrated more BN symptoms than did boys, with effect sizes between small and medium. Childhood impulsivity, as opposed to hyperactivity or inattention, best predicted adolescent BN symptoms, particularly for girls. Among youth with ADHD, treatment received during the follow-up period was not associated with BN pathology. Both boys and girls with ADHD may be at risk for BN symptoms in adolescence because of the impulsivity central to both disorders.

  11. Brain responses to body image stimuli but not food are altered in women with bulimia nervosa.

    Science.gov (United States)

    Van den Eynde, Frederique; Giampietro, Vincent; Simmons, Andrew; Uher, Rudolf; Andrew, Chris M; Harvey, Philippe-Olivier; Campbell, Iain C; Schmidt, Ulrike

    2013-11-15

    Research into the neural correlates of bulimia nervosa (BN) psychopathology remains limited. In this functional magnetic resonance imaging study, 21 BN patients and 23 healthy controls (HCs) completed two paradigms: (1) processing of visual food stimuli and (2) comparing their own appearance with that of slim women. Participants also rated food craving and anxiety levels. Brain activation patterns in response to food cues did not differ between women with and without BN. However, when evaluating themselves against images of slim women, BN patients engaged the insula more and the fusiform gyrus less, compared to HCs, suggesting increased self-focus among women with BN whilst comparing themselves to a 'slim ideal'. In these BN patients, exposure to food and body image stimuli increased self-reported levels of anxiety, but not craving. Our findings suggest that women with BN differ from HCs in the way they process body image, but not in the way they process food stimuli.

  12. Safety of pharmacotherapy options for bulimia nervosa and binge eating disorder.

    Science.gov (United States)

    Bello, Nicholas T; Yeomans, Bryn L

    2018-01-01

    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.

  13. Food cravings discriminate between anorexia and bulimia nervosa. Implications for "success" versus "failure" in dietary restriction.

    Science.gov (United States)

    Moreno, Silvia; Warren, Cortney S; Rodríguez, Sonia; Fernández, M Carmen; Cepeda-Benito, Antonio

    2009-06-01

    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.

  14. Investigation of Oxytocin Secretion in Anorexia Nervosa and Bulimia Nervosa: Relationships to Temperament Personality Dimensions.

    Science.gov (United States)

    Monteleone, Alessio Maria; Scognamiglio, Pasquale; Volpe, Umberto; Di Maso, Virginia; Monteleone, Palmiero

    2016-01-01

    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.

  15. Anorexia, bulimia, and obesity: shared decision making deficits on the Iowa Gambling Task (IGT).

    Science.gov (United States)

    Brogan, Amy; Hevey, David; Pignatti, Riccardo

    2010-07-01

    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.

  16. Stigmatizing Attitudes and Beliefs About Anorexia and Bulimia Nervosa Among Italian Undergraduates.

    Science.gov (United States)

    Caslini, Manuela; Crocamo, Cristina; Dakanalis, Antonios; Tremolada, Martina; Clerici, Massimo; Carrà, Giuseppe

    2016-12-01

    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.

  17. Latent class analysis of eating and impulsive behavioral symptoms in Taiwanese women with bulimia nervosa.

    Science.gov (United States)

    Tseng, Mei-Chih Meg; Hu, Fu-Chang

    2012-01-01

    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.

  18. Behavioral responses to catecholamine depletion in unmedicated, remitted subjects with bulimia nervosa and healthy subjects.

    Science.gov (United States)

    Grob, Simona; Stern, Jair; Gamper, Lara; Moergeli, Hanspeter; Milos, Gabriella; Schnyder, Ulrich; Hasler, Gregor

    2015-04-01

    Bulimia nervosa (BN) has been associated with dysregulation of the central catecholaminergic system. An instructive way to investigate the relationship between catecholaminergic function and psychiatric disorder has involved behavioral responses to experimental catecholamine depletion (CD). The purpose of this study was to examine a possible catecholaminergic dysfunction in the pathogenesis of bulimia nervosa. CD was achieved by oral administration of alpha-methyl-para-tyrosine (AMPT) in 18 remitted female subjects with BN (rBN) and 31 healthy female control subjects. The study design consisted of a randomized, double blind, placebo-controlled crossover, single-site experimental trial. The main outcome measures were bulimic symptoms assessed by the Eating Disorder Examination-Questionnaire. Measures were assessed before and 26, 30, 54, 78, 102 hours after the first AMPT or placebo administration. In the experimental environment (controlled environment with a low level of food cues) rBN subjects had a greater increase in eating disorder symptoms during CD compared with healthy control subjects (condition × diagnosis interaction, p < .05). In the experimental environment, rBN subjects experienced fewer bulimic symptoms than in the natural environment (uncontrolled environment concerning food cues) 36 hours after the first AMPT intake (environment × diagnosis interaction, p < .05). Serum prolactin levels increased significantly, and to a comparable degree across groups, after AMPT administration. This study suggests that rBN is associated with vulnerability for developing eating disorder symptoms in response to reduced catecholamine neurotransmission after CD. The findings support the notion of catecholaminergic dysfunction as a possible trait abnormality in BN. © 2014 Society of Biological Psychiatry Published by Society of Biological Psychiatry All rights reserved.

  19. An exploratory assessment of theory of mind and psychological impairment in patients with bulimia nervosa.

    Science.gov (United States)

    Laghi, Fiorenzo; Cotugno, Armando; Cecere, Francesco; Sirolli, Arianna; Palazzoni, David; Bosco, Francesca M

    2014-11-01

    This study aimed to investigate psychosocial functioning and different dimensions of theory of mind (ToM) in people with bulimia nervosa (BN) and Eating Disorder Not Otherwise Specified-BN type (EDNOS-BN). Psychosocial functioning and ToM were assessed in a sample of young adult females, 16 BN and 16 EDNOS-BN outpatients and 16 healthy controls (HCs). They were assessed using the Eating Disorder Inventory-Symptom Checklist-2 (EDI-2 SC) for evaluating psychological traits associated with eating disorders; the Symptom Checklist-90-Revised (SCL-90-R) for evaluating psychopathological status; and the Theory of Mind Assessment Scale (Th.o.m.a.s.), a semi-structured interview aimed at assessing a person's different dimensions of ToM. The BN and EDNOS-BN groups exhibited worse performance than the control group on all dimensions of the SCL-90-R, and on all dimensions of the EDI-2 SC. The only difference for perfectionism was that BN obtained higher scores than EDNOS-BN group. Our results also revealed an impairment of third-person and second-order ToM in patients with bulimia (BN and EDNOS-BN) with respect to control subjects. These preliminary data have important implications for future empirical work, in that they provide valuable information regarding the importance of investigating the various facets of ToM ability separately, in order to provide a more detailed profile of ToM functioning in the clinical samples. © 2013 The British Psychological Society.

  20. Randomized controlled trial of a treatment for anorexia and bulimia nervosa

    Science.gov (United States)

    Bergh, Cecilia; Brodin, Ulf; Lindberg, Greger; Södersten, Per

    2002-01-01

    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

  1. Gustatory and olfactory sensitivity in patients with anorexia and bulimia in the course of treatment.

    Science.gov (United States)

    Aschenbrenner, Katja; Scholze, Ninette; Joraschky, Peter; Hummel, Thomas

    2008-12-01

    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.

  2. [Prevalence of anorexia nervosa, bulimia nervosa and other eating disorders in adolescent girls in Reus (Spain)].

    Science.gov (United States)

    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

    2008-01-01

    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.

  3. Bulimia nerviosa

    Science.gov (United States)

    ... de un trastorno de la conducta alimentaria durante la vida. Independientemente del trastorno de la conducta alimentaria que ... de la composición biológica y los sucesos en la vida de una persona. Esta combinación incluye tener genes ...

  4. 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

    Directory of Open Access Journals (Sweden)

    Marisa Edith Oviedo Romero

    2012-06-01

    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.

  5. Refluxo laringofaríngeo e bulimia nervosa: alterações vocais e larínegas Laryngopharyngeal reflux and bulimia nervosa: laryngeal and voice disorders

    Directory of Open Access Journals (Sweden)

    Carla Aparecida Cielo

    2011-04-01

    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

  6. 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

    Directory of Open Access Journals (Sweden)

    Serafina Castro-Zamudio

    2016-08-01

    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.

  7. Examining the relationship between selective attentional bias for food- and body-related stimuli and purging behaviour in bulimia nervosa.

    Science.gov (United States)

    Albery, Ian P; Wilcockson, Thomas; Frings, Daniel; Moss, Antony C; Caselli, Gabriele; Spada, Marcantonio M

    2016-12-01

    Previous research exploring cognitive biases in bulimia nervosa suggests that attentional biases occur for both food-related and body-related cues. Individuals with bulimia were compared to non-bulimic controls on an emotional-Stroop task which contained both food-related and body-related cues. Results indicated that bulimics (but not controls) demonstrated a cognitive bias for both food-related and body-related cues. However, a discrepancy between the two cue-types was observed with body-related cognitive biases showing the most robust effects and food-related cognitive biases being the most strongly associated with the severity of the disorder. The results may have implications for clinical practice as bulimics with an increased cognitive bias for food-related cues indicated increased bulimic disorder severity. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Femininity, Feminine Gender Role Stress, Body Dissatisfaction, and their Relationships to Bulimia Nervosa and Binge Eating Disorder

    OpenAIRE

    Romero, Nancy M.

    2008-01-01

    Femininity, Feminine Gender Role Stress, Body Dissatisfaction, and their Relationships to Bulimia Nervosa and Binge Eating Disorder Nancy Romero Abstract Research suggests that the associations between femininity, body image and eating disorders are intricate. How these constructs are linked to each other still needs to be determined. The purpose of this study was to gain a deeper understanding of these links, examining the mediational relationship among these constructs. Also...

  9. Empirical Comparison of Two Psychological Therapies: Self Psychology and Cognitive Orientation in the Treatment of Anorexia and Bulimia

    OpenAIRE

    Bachar, Eytan; Latzer, Yael; Kreitler, Shulamit; Elliot M. Berry

    1999-01-01

    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 sym...

  10. Getting better byte by byte: a pilot randomised controlled trial of email therapy for bulimia nervosa and binge eating disorder.

    Science.gov (United States)

    Robinson, Paul; Serfaty, Marc

    2008-03-01

    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

  11. Cognitive-Behavioral and Psychodynamic Therapy in Female Adolescents With Bulimia Nervosa: A Randomized Controlled Trial.

    Science.gov (United States)

    Stefini, Annette; Salzer, Simone; Reich, Günter; Horn, Hildegard; Winkelmann, Klaus; Bents, Hinrich; Rutz, Ursula; Frost, Ulrike; von Boetticher, Antje; Ruhl, Uwe; Specht, Nicole; Kronmüller, Klaus-Thomas

    2017-04-01

    The authors compared cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) for the treatment of bulimia nervosa (BN) in female adolescents. In this randomized controlled trial, 81 female adolescents with BN or partial BN according to the DSM-IV received a mean of 36.6 sessions of manualized disorder-oriented PDT or CBT. Trained psychologists blinded to treatment condition administered the outcome measures at baseline, during treatment, at the end of treatment, and 12 months after treatment. The primary outcome was the rate of remission, defined as a lack of DSM-IV diagnosis for BN or partial BN at the end of therapy. Several secondary outcome measures were evaluated. The remission rates for CBT and PDT were 33.3% and 31.0%, respectively, with no significant differences between them (odds ratio [OR] = 0.90, 95% CI = 0.35-2.28, p = .82). The within-group effect sizes were h = 1.22 for CBT and h = 1.18 for PDT. Significant improvements in all secondary outcome measures were found for both CBT (d = 0.51-0.82) and PDT (d = 0.24-1.10). The improvements remained stable at the 12-month follow-up in both groups. There were small between-group effect sizes for binge eating (d = 0.23) and purging (d = 0.26) in favor of CBT and for eating concern (d = -0.35) in favor of PDT. CBT and PDT were effective in promoting recovery from BN in female adolescents. The rates of remission for both therapies were similar to those in other studies evaluating CBT. This trial identified differences with small effects in binge eating, purging, and eating concern. Clinical trial registration information-Treating Bulimia Nervosa in Female Adolescents With Either Cognitive-Behavioral Therapy (CBT) or Psychodynamic Therapy (PDT). http://isrctn.com/; ISRCTN14806095. Copyright © 2017 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  12. Increased Subjective Distaste and Altered Insula Activity to Umami Tastant in Patients with Bulimia Nervosa.

    Science.gov (United States)

    Setsu, Rikukage; Hirano, Yoshiyuki; Tokunaga, Miki; Takahashi, Toru; Numata, Noriko; Matsumoto, Koji; Masuda, Yoshitada; Matsuzawa, Daisuke; Iyo, Masaomi; Shimizu, Eiji; Nakazato, Michiko

    2017-01-01

    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.

  13. Increased Subjective Distaste and Altered Insula Activity to Umami Tastant in Patients with Bulimia Nervosa

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    Rikukage Setsu

    2017-09-01

    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.

  14. Differential neural responses to food images in women with bulimia versus anorexia nervosa.

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    Samantha J Brooks

    Full Text Available 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.

  15. Therapeutic alliance in Enhanced Cognitive Behavioural Therapy for bulimia nervosa: probably necessary but definitely insufficient.

    Science.gov (United States)

    Raykos, Bronwyn C; McEvoy, Peter M; Erceg-Hurn, David; Byrne, Susan M; Fursland, Anthea; Nathan, Paula

    2014-06-01

    The present paper assessed therapeutic alliance over the course of Enhanced Cognitive Behavioural Therapy (CBT-E) in a community-based sample of 112 patients with a diagnosis of bulimia nervosa (BN) or atypical BN. Temporal assessment of alliance was conducted at three time points (the start, middle and end of treatment) and the relationship between alliance and treatment retention and outcome was explored. Results indicated that the alliance between patient and therapist was strong at all stages of CBT-E, and even improved in the early stages of treatment when behaviour change was initiated (weekly in-session weighing, establishing regular eating, and ceasing binge-eating and compensatory behaviours). The present study found no evidence that alliance was related to treatment retention or outcomes, or that symptom severity or problematic interpersonal styles interacted with alliance to influence outcomes. Alliance was also unrelated to baseline emotional or interpersonal difficulties. The study provides no evidence that alliance has clinical utility for the prediction of treatment retention or outcome in CBT-E for BN, even for individuals with severe symptoms or problematic interpersonal styles. Early symptom change was the best predictor of outcome in CBT-E. Further research is needed to determine whether these results are generalizable to patients with anorexia nervosa. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  16. Testing the DSM-5 severity indicator for bulimia nervosa in a treatment-seeking sample.

    Science.gov (United States)

    Dakanalis, Antonios; Clerici, Massimo; Riva, Giuseppe; Carrà, Giuseppe

    2017-03-01

    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.

  17. Attention Network Dysfunction in Bulimia Nervosa - An fMRI Study.

    Science.gov (United States)

    Seitz, Jochen; Hueck, Manuel; Dahmen, Brigitte; Schulte-Rüther, Martin; Legenbauer, Tanja; Herpertz-Dahlmann, Beate; Konrad, Kerstin

    2016-01-01

    Recent evidence has suggested an increased rate of comorbid ADHD and subclinical attentional impairments in bulimia nervosa (BN) patients. However, little is known regarding the underlying neural mechanisms of attentional functions in BN. Twenty BN patients and twenty age- and weight-matched healthy controls (HC) were investigated using a modified version of the Attention Network Task (ANT) in an fMRI study. This design enabled an investigation of the neural mechanisms associated with the three attention networks involved in alerting, reorienting and executive attention. The BN patients showed hyperactivation in parieto-occipital regions and reduced deactivation of default-mode-network (DMN) areas during alerting compared with HCs. Posterior cingulate activation during alerting correlated with the severity of eating-disorder symptoms within the patient group. Conversely, BN patients showed hypoactivation during reorienting and executive attention in anterior cingulate regions, the temporo-parietal junction (TPJ) and parahippocampus compared with HCs, which was negatively associated with global ADHD symptoms and impulsivity, respectively. Our findings demonstrate altered brain mechanisms in BN associated with all three attentional networks. Failure to deactivate the DMN and increased parieto-occipital activation required for alerting might be associated with a constant preoccupation with food or body image-related thoughts. Hypoactivation of executive control networks and TPJ might increase the likelihood of inattentive and impulsive behaviors and poor emotion regulation. Thus, dysfunction in the attentional network in BN goes beyond an altered executive attentional domain and needs to be considered in the diagnosis and treatment of BN.

  18. Tc-99m labeled triethelene tetraamine polysterene resin gastric emptying studies in bulimia patients

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    Shih Weijen; Castellanos, F.X.; Domstad, P.A.; DeLand, F.H.; Humphries, L.; Digenis, G.A.

    1987-07-01

    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.

  19. Patient baseline interpersonal problems as moderators of outcome in two psychotherapies for bulimia nervosa.

    Science.gov (United States)

    Gomez Penedo, Juan Martin; Constantino, Michael J; Coyne, Alice E; Bernecker, Samantha L; Smith-Hansen, Lotte

    2018-01-19

    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.

  20. Social comparison and its relation to body dissatisfaction in bulimia nervosa: evidence from eye movements.

    Science.gov (United States)

    Blechert, Jens; Nickert, Till; Caffier, Detlef; Tuschen-Caffier, Brunna

    2009-10-01

    To determine the role of social comparison for body dissatisfaction in bulimia nervosa (BN). Previous research suggested that exposure to media content idealizing thin body shape decreases body satisfaction, particularly in women with eating disorder symptoms. This might be due to the negative outcome of social comparisons with media models, and women with eating disorders might be particularly susceptible because they engage in upward social comparison more frequently than women without these symptoms. However, no study has yet explored both upward (i.e., toward more attractive others) and downward (i.e., toward less attractive others) social comparisons and their impact on body dissatisfaction in a clinical eating disorder and healthy controls. We presented patients with BN (n = 20) and healthy controls (HC) (n = 22) with slides comprising a digitized image of their own body alongside comparison bodies with higher and lower body mass indices (BMIs) while measuring their eye movements. As hypothesized, patients with BN fixated longer on comparison bodies with lower BMIs than controls, with the reverse pattern for high BMI bodies. This gaze pattern suggests that upward comparisons were more prevalent in the BN group. Furthermore, upward comparisons were related to a drop in body satisfaction in the BN group. Disadvantageous social comparison strategies might be related to body dissatisfaction and therefore to the maintenance of BN.

  1. Is attention to detail a similarly strong candidate endophenotype for anorexia nervosa and bulimia nervosa?

    Science.gov (United States)

    Roberts, Marion E; Tchanturia, Kate; Treasure, Janet L

    2013-08-01

    To investigate whether attention to detail is a similarly strong candidate endophenotype of anorexia (AN) and bulimia nervosa (BN), and to explore the incidence and clinical correlates of attention to detail. A total of 266 women (including AN, BN, recovered AN, unaffected sisters of AN/BN & control women) undertook a thorough clinical assessment and were administered two neuropsychological measures of attention to detail (Group Embedded Figure Test; Rey-Osterrieth Complex Figure). Superior attention to detail was found across all AN groups including recovered AN and unaffected AN sisters. Those with BN and their unaffected sisters showed a profile more consistent with poor global integration. The combined effect of superior attention to detail and poor global integration ("weak coherence") was present in 42.3% of active cases and corresponded with a more severe illness, elevated obsessive-compulsive symptoms, and a higher likelihood of comorbid clinical anxiety and self-harm. Attention to detail is a stronger candidate endophenotype of AN compared to BN, where poor global integration may be more relevant. The unique contribution of both aspects of weak coherence (superior attention to detail/poor global integration) requires further exploration and understanding in both eating disorders. Integrating cognitive remediation of these traits into treatment for the subset of patients it is relevant for may improve outcome.

  2. Can the reinforcing value of food be measured in bulimia nervosa?

    Science.gov (United States)

    Schebendach, Janet; Broft, Allegra; Foltin, Richard W; Walsh, B Timothy

    2013-03-01

    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.

  3. Enhanced ghrelin secretion in the cephalic phase of food ingestion in women with bulimia nervosa.

    Science.gov (United States)

    Monteleone, Palmiero; Serritella, Cristina; Scognamiglio, Pasquale; Maj, Mario

    2010-02-01

    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.

  4. A Meta-analysis on Resting State High-frequency Heart Rate Variability in Bulimia Nervosa.

    Science.gov (United States)

    Peschel, Stephanie K V; Feeling, Nicole R; Vögele, Claus; Kaess, Michael; Thayer, Julian F; Koenig, Julian

    2016-09-01

    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.

  5. Differential Neural Responses to Food Images in Women with Bulimia versus Anorexia Nervosa

    Science.gov (United States)

    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.

    2011-01-01

    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

  6. Food Addiction in Bulimia Nervosa: Clinical Correlates and Association with Response to a Brief Psychoeducational Intervention.

    Science.gov (United States)

    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

    2016-11-01

    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.

  7. Is technology assisted guided self-help successful in treating female adolescents with bulimia nervosa?

    Science.gov (United States)

    Wagner, Gudrun; Wagner, Gudrun; Penelo, Eva; Nobis, Gerald; Mayerhofer, Anna; Schau, Johanna; Spitzer, Marion; Imgart, Hartmut; Karwautz, Andreas

    2013-01-01

    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.

  8. Autonomous motivation: a predictor of treatment outcome in bulimia-spectrum eating disorders.

    Science.gov (United States)

    Mansour, Sandra; Bruce, Kenneth R; Steiger, Howard; Zuroff, David C; Horowitz, Sarah; Anestin, Annelie S; Sycz, Lindsay

    2012-05-01

    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.

  9. Ecological momentary assessment of stressful events and negative affect in bulimia nervosa.

    Science.gov (United States)

    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

    2014-02-01

    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.

  10. Online discussion groups for bulimia nervosa: an inductive approach to Internet-based communication between patients.

    Science.gov (United States)

    Wesemann, Dorette; Grunwald, Martin

    2008-09-01

    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.

  11. Eating-related concerns, mood, and personality traits in recovered bulimia nervosa subjects: a replication study.

    Science.gov (United States)

    Stein, D; Kaye, W H; Matsunaga, H; Orbach, I; Har-Even, D; Frank, G; McConaha, C W; Rao, R

    2002-09-01

    Limited data suggest that eating-related concerns and behaviors, disturbances in mood, and altered temperament persist following recovery from bulimia nervosa (BN). In order to replicate and extend such findings, 11 women who were long-term recovered from BN (>1 year with no binging, purging, or restricting behaviors, normal weight, and regular menstrual cycles) were compared with 15 healthy volunteer women on the Eating Disorders Invertory-2 (EDI-2), the Beck Depression Inventory, the State Trait Anxiety Inventory, and the Multidimensional Personality Questionnaire (MPQ). Compared with the control women, the recovered BN women showed elevated levels of the EDI-2 subscales of Drive for Thinness, Body Dissatisfaction, Ineffectiveness, Perfectionism, and Social Insecurity, greater depression and anxiety, elevated levels of the MPQ Stress Reaction dimension and the higher-order factor of Negative Emotionality, and lower levels of the MPQ Well Being and Closeness dimensions. Core eating and weight-related concerns, dysphoric affect, social discomfort, and personality traits indicative of perfectionism persist following long-term recovery from BN. Copyright 2002 by Wiley Periodicals, Inc.

  12. The role of depression and impulsivity in the psychopathology of bulimia nervosa.

    Science.gov (United States)

    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

    2014-01-01

    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.

  13. A behavioral-genetic investigation of bulimia nervosa and its relationship with alcohol use disorder

    Science.gov (United States)

    Trace, Sara Elizabeth; Thornton, Laura Marie; Baker, Jessica Helen; Root, Tammy Lynn; Janson, Lauren Elizabeth; Lichtenstein, Paul; Pedersen, Nancy Lee; Bulik, Cynthia Marie

    2013-01-01

    Bulimia nervosa (BN) and alcohol use disorder (AUD) frequently co-occur and may share genetic factors; however, the nature of their association is not fully understood. We assessed the extent to which the same genetic and environmental factors contribute to liability to BN and AUD. A bivariate structural equation model using a Cholesky decomposition was fit to data from 7,241 women who participated in the Swedish Twin study of Adults: Genes and Environment. The proportion of variance accounted for by genetic and environmental factors for BN and AUD and the genetic and environmental correlations between these disorders were estimated. In the best-fitting model, the heritability estimates were 0.55 (95% CI: 0.37; 0.70) for BN and 0.62 (95% CI: 0.54; 0.70) for AUD. Unique environmental factors accounted for the remainder of variance for BN. The genetic correlation between BN and AUD was 0.23 (95% CI: 0.01; 0.44), and the correlation between the unique environmental factors for the two disorders was 0.35 (95% CI: 0.08; 0.61), suggesting moderate overlap in these factors. Findings from this investigation provide additional support that some of the same genetic factors may influence liability to both BN and AUD. PMID:23790978

  14. Predictors and moderators of psychological changes during the treatment of adolescent bulimia nervosa.

    Science.gov (United States)

    Ciao, Anna C; Accurso, Erin C; Fitzsimmons-Craft, Ellen E; Le Grange, Daniel

    2015-06-01

    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.

  15. Can the reinforcing value of food be measured in bulimia nervosa?

    Science.gov (United States)

    Schebendach, Janet; Broft, Allegra; Foltin, Richard W.; Walsh, B. Timothy

    2013-01-01

    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 2,100 ml 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. PMID:23178173

  16. Reactivity to 35% carbon dioxide in bulimia nervosa and panic disorder.

    Science.gov (United States)

    Woznica, Andrea; Vickers, Kristin; Koerner, Naomi; Fracalanza, Katie

    2015-08-30

    The inhalation of 35% carbon dioxide (CO₂) induces panic and anxiety in people with panic disorder (PD) and in people with various other psychiatric disorders. The anxiogenic effect of CO₂ in people with eating disorders has received sparse attention despite the fact that PD and bulimia nervosa (BN) have several common psychological and neurobiological features. This study compared CO₂-reactivity across three groups of participants: females with BN, females with PD, and female controls without known risk factors for enhanced CO₂-reactivity (e.g., social anxiety disorder, first degree relatives with PD). Reactivity was measured by self-reported ratings of panic symptomatology and subjective anxiety, analyzed as both continuous variables (change from room-air to CO₂) and dichotomous variables (positive versus negative responses to CO₂). Analyses of each outcome measure demonstrated that CO₂-reactivity was similar across the BN and PD groups, and reactivity within each of these two groups was significantly stronger than that in the control group. This is the first study to demonstrate CO₂-hyperreactivity in individuals with BN, supporting the hypothesis that reactivity to this biological paradigm is not specific to PD. Further research would benefit from examining transdiagnostic mechanisms in CO₂-hyperreactivity, such as anxiety sensitivity, which may account for this study's results. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. Visual selective attention in body dysmorphic disorder, bulimia nervosa and healthy controls.

    Science.gov (United States)

    Kollei, Ines; Horndasch, Stefanie; Erim, Yesim; Martin, Alexandra

    2017-01-01

    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.

  18. Psychosocial factors associated with bulimia nervosa during pregnancy: An internal validation study.

    Science.gov (United States)

    Watson, Hunna J; Von Holle, Ann; Knoph, Cecilie; Hamer, Robert M; Torgersen, Leila; Reichborn-Kjennerud, Ted; Stoltenberg, Camilla; Magnus, Per; Bulik, Cynthia M

    2015-09-01

    The aim of this paper was to internally validate previously reported relations (Knoph Berg et al., Aust N Z J Psychiatry, 42, 396-404, 2008) between psychosocial factors and bulimia nervosa (BN) outcomes during pregnancy. This study is based on the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Participants were women enrolled during pregnancy (N = 69,030). Internal validity was evaluated by way of bootstrapped parameter estimates using the overall sample and a split sample calibration approach. Bootstrap bias estimates were below the problematic threshold, and extend earlier findings (Knoph Berg et al., Aust N Z J Psychiatry, 42, 396-404, 2008) by providing support for the validity of the models at the population level of all pregnant women in Norway. Bootstrap risk ratios indicated that prevalence, incidence, and remission of BN during pregnancy were significantly associated with psychosocial factors. The split sample procedure showed that the models developed on the training sample did not predict risks in the validation sample. This study characterizes associations between psychosocial exposures and BN outcomes among pregnant women in Norway. Women with lifetime and current self-reported psychosocial adversities were at a much higher risk for BN during pregnancy. Psychosocial factors were associated with BN remission during pregnancy, inviting the prospect of enhancing therapeutic interventions. We consider the findings in the context of reproducibility in science. © 2014 Wiley Periodicals, Inc.

  19. Changes in body image during cognitive-behavioral treatment in women with bulimia nervosa.

    Science.gov (United States)

    Peterson, Carol B; Wimmer, Suzann; Ackard, Diann M; Crosby, Ross; Cavanagh, Lisa C; Engbloom, Sara; Mitchell, James E

    2004-05-01

    The purposes of this study were: (1) to examine multidimensional aspects of body image of individuals with bulimia nervosa (BN) at pre-treatment, post-treatment, and at follow-up, compared to a group of participants without BN; and (2) to investigate whether measures of body image predicted outcome at post-treatment and follow-up. The clinical sample consisted of 109 females with BN who were enrolled in a 12-week cognitive-behavioral group treatment program. Participants were assessed at baseline, at the completion of treatment, and at 1- and 6-month follow-up visits. The 82 females who comprised the non-bulimic sample were assessed at comparable time intervals. At baseline, the participants with BN reported greater body dissatisfaction and overestimated body size to a significantly greater degree than the comparison group, and reported a significantly smaller ideal size relative to perceived size. Results at the end of treatment indicated significant improvement in self-reported attitudinal disturbance and size overestimation, with continued reductions at follow-up. Logistic regression analyses did not demonstrate a predictive relationship between body image measures at baseline and outcome at post-treatment or follow-up, or between post-treatment and follow-up. Implications for treatment include specifying the source of body image-related distress and enhancing treatment efforts for perceptual and attitudinal aspects of body image.

  20. Electrophysiological evidence for an attentional bias in processing body stimuli in bulimia nervosa.

    Science.gov (United States)

    Mai, Sandra; Gramann, Klaus; Herbert, Beate M; Friederich, Hans-Christoph; Warschburger, Petra; Pollatos, Olga

    2015-05-01

    Empirical evidence suggests abnormalities in the processing of body stimuli in bulimia nervosa (BN). This study investigated central markers of processing body stimuli by means of event-related potentials in BN. EEG was recorded from 20 women with BN and 20 matched healthy controls while watching and evaluating underweight, normal and overweight female body pictures. Bulimics evaluated underweight bodies as less unpleasant and overweight bodies as bigger and more arousing. A higher P2 to overweight stimuli occurred in BN only. In contrast to controls, no N2 increase to underweight bodies was observed in BN. P3 was modulated by stimulus category only in healthy controls; late slow waves to underweight bodies were more pronounced in both groups. P2 amplitudes to overweight stimuli were correlated with drive for thinness and body dissatisfaction. We present novel support for altered perceptual and cognitive-affective processing of body images in BN on the subjective and electrophysiological level. Copyright © 2015 Elsevier B.V. All rights reserved.

  1. Does habituation really happen? Investigation of psycho-biological responses to body exposure in bulimia nervosa.

    Science.gov (United States)

    Trentowska, Monika; Svaldi, Jennifer; Blechert, Jens; Tuschen-Caffier, Brunna

    2017-03-01

    Body exposure is a common and effective treatment for body image disturbance in bulimia nervosa (BN). However, little is known about treatment mechanisms. Based on models of emotional processing and neurovisceral integration, we expected to observe a) initial activation and b) habituation of cognitive-affective and autonomic responding within one and between two standardized body exposure sessions. A group of 13 women with BN and 13 healthy controls (HC) were repeatedly exposed to their bodies. Prior to and after treatment with three individualized mirror exposure sessions participants received a session of standardized exposure to videographic recordings of their body. Subjective ratings of body-related emotions and thoughts were assessed repeatedly throughout the standardized exposure sessions and autonomic responses were recorded continuously. Subjective and sympathetic responses were activated initially in both groups. Cognitive-affective responses habituated within the standardized sessions in both groups, whereas between the standardized sessions habituation was only found in women with BN. Increasing sympathetic responses were found within the sessions in both groups. The results support cognitive-affective habituation during body exposure in BN and to a lesser extent in HC. Autonomic responses however did not show a corresponding pattern and did not distinguish between groups. Implications for body exposure research and practice are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Tratamento da bulimia nervosa: síntese das evidências

    Directory of Open Access Journals (Sweden)

    Bacaltchuk Josué

    1999-01-01

    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.

  3. Impact of anorexia, bulimia and obesity on the gynecologic health of adolescents.

    Science.gov (United States)

    Seidenfeld, M E; Rickert, V I

    2001-08-01

    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.

  4. Implicit learning on a probabilistic classification task in adults and adolescents with Bulimia Nervosa.

    Science.gov (United States)

    Labouliere, Christa D; Terranova, Kate; Steinglass, Joanna; Marsh, Rachel

    2016-06-01

    Dysfunction in frontostriatal circuits likely contributes to impaired regulatory control in Bulimia Nervosa (BN), resulting in binge-eating and purging behaviors that resemble maladaptive habits. Less is known about the implicit learning processes of these circuits, which may contribute to habit formation. We compared 52 adolescent and adult females with BN to 55 healthy matched-controls during performance of a probabilistic classification learning task, one form of implicit learning. Groups were compared in accuracy and response times, using mixed-models with block, age, and diagnosis as predictors, corrected for multiple comparisons with confounds covaried. BN participants showed differences in performance on a probabilistic classification learning task that varied by age. Adolescents with BN initially performed as accurately as healthy adolescents, but showed poorer perseverance over time. Adults with BN initially performed less accurately than healthy adults, but improved to perform equivalently. Symptom severity was associated with poorer accuracy in both adults and adolescents with BN. Frontostriatal dysfunction may underlie abnormalities in regulatory control and probabilistic classification learning in BN, likely contributing to the dysregulation of implicitly learned, maladaptive binge-eating and purging behaviors. Such dysfunction in BN may progress with increasing age, first manifesting in poor regulatory control over behaviors and then expanding to implicit learning processes that may underlie habitual behaviors. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Smoking status and psychosocial factors in binge eating disorder and bulimia nervosa.

    Science.gov (United States)

    Chao, Ariana M; White, Marney A; Grilo, Carlos M

    2016-04-01

    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.

  6. Patients with bulimia nervosa do not show typical neurodevelopment of cognitive control under emotional influences.

    Science.gov (United States)

    Dreyfuss, Michael F W; Riegel, Melissa L; Pedersen, Gloria A; Cohen, Alexandra O; Silverman, Melanie R; Dyke, Jonathan P; Mayer, Laurel E S; Walsh, B Timothy; Casey, B J; Broft, Allegra I

    2017-08-30

    Bulimia nervosa (BN) emerges in the late teen years and is characterized by binge eating and related compensatory behaviors. These behaviors often co-occur with periods of negative affect suggesting an association between emotions and control over eating behavior. In the current study, we examined how cognitive control and neural processes change under emotional states of arousal in 46 participants with (n=19) and without (n=27) BN from the ages of 18-33 years. Participants performed a go/nogo task consisting of brief negative, positive and neutral emotional cues and sustained negative, positive and neutral emotional states of arousal during functional magnetic resonance imaging (fMRI). Overall task performance improved with age for healthy participants, but not for patients with BN. These age-dependent behavioral effects were paralleled by diminished recruitment of prefrontal control circuitry in patients with BN with age. Although patients with BN showed no difference in performance on the experimental manipulations of negative emotions, sustained positive emotions related to improved performance among patients with BN. Together the findings highlight a neurodevelopmental approach towards understanding markers of psychopathology and suggest that sustained positive affect may have potential therapeutic effects on maintaining behavioral control in BN. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  7. Negative reinforcement eating expectancies, emotion dysregulation, and symptoms of bulimia nervosa.

    Science.gov (United States)

    Hayaki, Jumi

    2009-09-01

    Research suggests that emotion dysregulation or difficulties in the modulation of emotional experience constitute risk for eating disorders. Recent work has also highlighted the role of certain eating-related cognitions, specifically expectations of negative emotional reinforcement from eating, in the development of disturbed eating patterns. However, it is unclear whether these expectancies are merely a dimension of a general inability to regulate emotions effectively or rather a unique cognitive-affective risk factor for the development of an eating disorder. This study examines the unique contribution of eating expectancies to symptoms of bulimia nervosa (BN) after controlling for two dimensions of emotion dysregulation (alexithymia and experiential avoidance) previously implicated in the phenomenology of eating disorders. Participants were 115 undergraduate women who self-reported demographics, alexithymia, experiential avoidance, eating expectancies, and symptoms of BN. Eating expectancies uniquely contributed 12.4% of the variance in symptoms of BN, F(2, 108) = 11.74, p eating to provide emotional relief may be especially susceptible to disordered eating. Findings are discussed in terms of emotional risk models and clinical interventions for BN.

  8. Serotonin alterations in anorexia and bulimia nervosa: new insights from imaging studies.

    Science.gov (United States)

    Kaye, Walter H; Frank, Guido K; Bailer, Ursula F; Henry, Shannan E; Meltzer, Carolyn C; Price, Julie C; Mathis, Chester A; Wagner, Angela

    2005-05-19

    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.

  9. The effect of driven exercise on treatment outcomes for adolescents with anorexia and bulimia nervosa.

    Science.gov (United States)

    Stiles-Shields, Colleen; DclinPsy, Bryony Bamford; Lock, James; Le Grange, Daniel

    2015-05-01

    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 < .004); however, baseline DE did not significantly predict any of the evaluated outcomes for adolescents with BN (ps < .05). The results of this secondary exploratory data suggest that DE is prevalent for 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.

  10. Altered sensitization patterns to sweet food stimuli in patients recovered from anorexia and bulimia nervosa.

    Science.gov (United States)

    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

    2015-12-30

    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.

  11. Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder in Midlife and Beyond.

    Science.gov (United States)

    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

    2015-08-01

    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.

  12. Trail making task performance in inpatients with anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Vall, Eva; Wade, Tracey D

    2015-07-01

    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.

  13. The Impact of Alexithymia on Emotion Dysregulation in Anorexia Nervosa and Bulimia Nervosa over Time.

    Science.gov (United States)

    Brown, Tiffany A; Avery, Jade C; Jones, Michelle D; Anderson, Leslie K; Wierenga, Christina E; Kaye, Walter H

    2018-03-01

    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.

  14. Anorexia nervosa versus bulimia nervosa: differences based on retrospective correlates in a case-control study.

    Science.gov (United States)

    Machado, Bárbara C; Gonçalves, Sónia F; Martins, Carla; Brandão, Isabel; Roma-Torres, António; Hoek, Hans W; Machado, Paulo P

    2016-06-01

    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.

  15. Differential neural responses to food images in women with bulimia versus anorexia nervosa.

    Science.gov (United States)

    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

    2011-01-01

    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.

  16. Orofacial manifestations in outpatients with anorexia nervosa and bulimia nervosa focusing on the vomiting behavior.

    Science.gov (United States)

    Lourenço, Maria; Azevedo, Álvaro; Brandão, Isabel; Gomes, Pedro S

    2017-11-25

    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.

  17. Understanding the Relation between Anorexia Nervosa and Bulimia Nervosa in a Swedish National Twin Sample

    Science.gov (United States)

    Bulik, Cynthia M; Thornton, Laura; Root, Tammy L.; Pisetsky, Emily M.; Lichtenstein, Paul; Pedersen, Nancy L.

    2010-01-01

    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

  18. Selective Visual Attention during Mirror Exposure in Anorexia and Bulimia Nervosa.

    Science.gov (United States)

    Tuschen-Caffier, Brunna; Bender, Caroline; Caffier, Detlef; Klenner, Katharina; Braks, Karsten; Svaldi, Jennifer

    2015-01-01

    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.

  19. Depression or depressiveness in patients diagnosed with Anorexia Nervosa and Bulimia Nervosa - pilot research.

    Science.gov (United States)

    Dêbska, Ewa; Janas, Adam; Bañczyk, Wojciech; Janas-Kozik, Małgorzata

    2011-09-01

    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.

  20. Are there differences in the attitudinal body image between adolescent anorexia nervosa and bulimia nervosa?

    Science.gov (United States)

    Ruuska, J; Kaltiala-Heino, R; Rantanen, P; Koivisto, A M

    2005-06-01

    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.

  1. Prevalence, comorbidities and outpatient treatment of anorexia and bulimia nervosa in German children and adolescents.

    Science.gov (United States)

    Jaite, Charlotte; Hoffmann, Falk; Glaeske, Gerd; Bachmann, Christian J

    2013-06-01

    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.

  2. Eating disorders during the adolescence: personality characteristics associated with anorexia and bulimia nervosa.

    Science.gov (United States)

    Barajas Iglesias, Belén; Jáuregui Lobera, Ignacio; Laporta Herrero, Isabel; Santed Germán, Miguel Ángel

    2017-10-24

    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.

  3. Hard exercise, affect lability, and personality among individuals with bulimia nervosa.

    Science.gov (United States)

    Brownstone, Lisa M; Fitzsimmons-Craft, Ellen E; Wonderlich, Stephen A; Joiner, Thomas E; Le Grange, Daniel; Mitchell, James E; Crow, Scott J; Peterson, Carol B; Crosby, Ross D; Klein, Marjorie H; Bardone-Cone, Anna M

    2013-12-01

    The current study explores the personality traits of compulsivity (e.g., sense of orderliness and duty to perform tasks completely) and restricted expression (e.g., emotion expression difficulties) as potential moderators of the relation between affect lability and frequency of hard exercise episodes in a sample of individuals with bulimic pathology. Participants were 204 adult females recruited in five Midwestern cities who met criteria for threshold or subthreshold bulimia nervosa (BN). Compulsivity was found to significantly moderate the relation between affect lability and number of hard exercise episodes over the past 28 days, such that among those with high compulsivity, level of affect lability was associated with the number of hard exercise episodes; whereas, among those with low compulsivity, affect lability was not associated with the number of hard exercise episodes. The same pattern of findings emerged for restricted expression; however, this finding approached, but did not reach statistical significance. As such, it appears that affect lability is differentially related to hard exercise among individuals with BN depending upon the level of compulsivity and, to a more limited extent, restricted expression. These results suggest that, for individuals with BN with either compulsivity or restricted expression, focusing treatment on increasing flexibility and/or verbal expression of emotions may help in the context of intense, fluctuating affect. © 2013.

  4. Differences and similarities between bulimia nervosa, compulsive buying and gambling disorder.

    Science.gov (United States)

    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

    2015-03-01

    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.

  5. Psicofisiología del ansia por la comida y la bulimia nerviosa

    Directory of Open Access Journals (Sweden)

    Sonia Rodríguez

    2007-01-01

    Full Text Available El ansia por la comida es una experiencia normal no asociada necesariamente a conductas alimentarias patológicas. Sin embargo, en ocasiones, este deseo irresistible de consumir un determinado alimento puede convertirse en un antecedente inmediato del atracón. Los factores que tradicionalmente se han propuesto como posibles desencadenantes del atracón han sido los afectos negativos y la práctica de dietas restrictivas. No obstante, la mayoría de estudios realizados basados en medidas verbales no han podido establecer relaciones causales entre dichos factores y el atracón. Actualmente, estudios experimentales basados en medidas psicofisiológicas están permitiendo conocer cuáles son los mecanismos motivacionales implicados en el ansia por la comida, así como las complejas interacciones entre restricción, emoción, ansia y atracón. El presente trabajo resume los avances en el campo de la investigación básica que están abriendo nuevas vías para la prevención y el tratamiento psicológico de la bulimia nerviosa.

  6. Psychosocial Factors Associated with Bulimia Nervosa during Pregnancy: An Internal Validation Study

    Science.gov (United States)

    Watson, Hunna J.; Von Holle, Ann; Knoph, Cecilie; Hamer, Robert M.; Torgersen, Leila; Reichborn-Kjennerud, Ted; Stoltenberg, Camilla; Magnus, Per; Bulik, Cynthia M.

    2014-01-01

    Objective The aim of this paper was to internally validate previously reported relations (1) between psychosocial factors and bulimia nervosa (BN) outcomes during pregnancy. Method This study is based on the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Participants were women enrolled during pregnancy (N = 69,030). Internal validity was evaluated by way of bootstrapped parameter estimates using the overall sample and a split sample calibration approach. Results Bootstrap bias estimates were below the problematic threshold, and extend earlier findings(1) by providing support for the validity of the models at the population level of all pregnant women in Norway. Bootstrap risk ratios indicated that prevalence, incidence, and remission of BN during pregnancy were significantly associated with psychosocial factors. The split sample procedure showed that the models developed on the training sample did not predict risks in the validation sample. Discussion This study characterizes associations between psychosocial exposures and BN outcomes among pregnant women in Norway. Women with lifetime and current self-reported psychosocial adversities were at a much higher risk for BN during pregnancy. Psychosocial factors were associated with BN remission during pregnancy, inviting the prospect of enhancing therapeutic interventions. We consider the findings in the context of reproducibility in science. PMID:25346291

  7. Characteristics of suicide attempts in anorexia and bulimia nervosa: a case-control study.

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    Sébastien Guillaume

    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.

  8. Selective Visual Attention during Mirror Exposure in Anorexia and Bulimia Nervosa.

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    Brunna Tuschen-Caffier

    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.

  9. Acompanhamento da evolução dos distúrbios de imagem corporal em pacientes com bulimia nervosa, ao longo do tratamento multiprofissional Longitudinal assessment of body image disturbances in patients with bulimia nervosa submitted to multidisciplinary treatment

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    Fernanda Timerman

    2010-01-01

    Full Text Available OBJETIVO: Aumentar a compreensão sobre os distúrbios da imagem corporal em pacientes com bulimia nervosa e sua evolução após o tratamento multidisciplinar. MÉTODOS: Onze mulheres responderam dois questionários de imagem corporal (Body Attitudes Questionnaire e Escala de Figuras de Stunkard antes e após o tratamento e preencheram o diário alimentar, utilizado para a análise de sintomas de bulimia nervosa. RESULTADOS: Tanto no pré quanto no pós-tratamento o índice de massa corporal médio se encontrava na faixa de eutrofia. Cerca de 57,0% da amostra teve remissão total dos sintomas de bulimia nervosa. Em relação à imagem corporal, na escala de Stunkard, o tamanho da figura escolhida como ideal aumentou e houve redução da insatisfação corporal após o tratamento. Não houve redução significativa da superestimativa do tamanho corporal, porém no início do tratamento 57,1% das pacientes já não superestimavam seu tamanho. Em relação ao questionário de atitudes, notou-se diminuição das seguintes variáveis: depreciação corporal; sentir-se gorda; sensação de ter gordura nos membros inferiores e importância pessoal do corpo. CONCLUSÕES: O tratamento foi eficaz em alguns aspectos atitudinais, porém deve ser aprimorado em outros, como a distorção perceptual.OBJECTIVE: Increase the comprehension of body image disturbances in patients with bulimia nervosa and its evolution after treatment, multidisciplinary. METHODS: Eleven women answered two body image questionnaires (Body Attitudes Questionnaire and Stunkard's Figure Scale before and after treatment and filled a food diary used to analyze the frequency of bulimia nervosa symptoms. RESULTS: The mean body mass index was found at normal weight category before and after treatment. Approximately 57.0% of the sample had total remission of bulimia nervosa symptoms. In relation to body image based on Stunkard's scale, the size of the figure chosen as ideal increased and body

  10. The impact of exposure to images of ideally thin models in TV commercials on eating behavior: an experimental study with women diagnosed with bulimia nervosa.

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    Rühl, Ilka; Legenbauer, Tanja; Hiller, Wolfgang

    2011-09-01

    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.

  11. Body images of patients with anorexia nervosa, bulimia nervosa and female control subjects: a comparison with male ideals of female attractiveness.

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    Benninghoven, Dieter; Raykowski, Lena; Solzbacher, Svenja; Kunzendorf, Sebastian; Jantschek, Günter

    2007-03-01

    Body images of female patients with anorexia nervosa and bulimia nervosa were assessed against females without eating disorders and compared with male ideals of female attractiveness. A computer program was applied to examine body images of 62 patients with anorexia nervosa, 45 patients with bulimia nervosa, and 40 female and 39 male control subjects. Body size overestimation was most distinct in the two patient groups. Self-ideal discrepancy was highest in bulimia nervosa. Estimation of the society's ideal female body in all three female groups did not differ from men's perception of the most attractive female body. Congruence of ideals of female attractiveness in patients, female, and male control subjects and described differences between patients and female controls support the theory that body image disturbance is a problem of processing self-referential information regarding body image rather than a problem of processing body image related information per se.

  12. Disfonia e bulimia: avaliação dos sintomas e sinais vocais e laríngeos Dysphonia and bulimia: evaluation of vocal and laryngeal signs and symptoms

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    Cynthia Priscila Ferreira

    2009-01-01

    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.

  13. Em defesa da clínica: a construção do caso aplicada à clínica da anorexia e bulimia

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    Alexandre Costa Val

    2012-01-01

    As anorexias e bulimias, habitualmente, são quadros graves que causam impasses na condução do tratamento. Esta pesquisa tem como objetivo formalizar e investigar a metodologia da Construção do Caso Clínico, baseada na teoria psicanalítica, como instrumento de acompanhamento, de esclarecimento e intervenção na condução de situações clínicas concretas de pacientes com sintomas anoréxicos e bulímicos atendidos no Núcleo de Investigação de Anorexia e Bulimia da Universidade Federal de Minas Ge...

  14. A Randomized Controlled Comparison of Integrative Cognitive-Affective Therapy and Cognitive-Behavioral Therapy-Enhanced for Bulimia Nervosa

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    Wonderlich, Stephen A.; Peterson, Carol B.; Crosby, Ross D.; Smith, Tracey L.; Klein, Marjorie H.; Mitchell, James E.; Crow, Scott J.

    2016-01-01

    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

  15. Body image distortions in bulimia nervosa: investigating body size overestimation and body size satisfaction by fMRI.

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    Mohr, Harald Matthias; Röder, Christian; Zimmermann, Jan; Hummel, Dennis; Negele, Alexa; Grabhorn, Ralph

    2011-06-01

    Body image distortion is a key symptom of eating disorders. In behavioral research two components of body image have been defined: attitudes towards the body and body size estimation. Only few fMRI-studies investigated the neural correlates of body image in bulimia; those are constrained by the lack of a direct distinction between these different body image components. The present study investigates the neural correlates of two aspects of the body image using fMRI: satisfaction rating and size estimation of distorted own body photographs in bulimia nervosa patients (15) and controls (16). Patients were less satisfied with their current body shape than controls and preferred to be thinner. The amount of insula activity reflects the pattern of the satisfaction rating for patients and controls. Patients also overestimated their own body size. For control subjects, an activated cluster in lateral occipital cortex was sensitive for body size distortions, whereas bulimic patients did not demonstrate such a modulation. Furthermore, bulimic subjects did not recruit the middle frontal gyrus (MFG) in contrast to controls during the body size estimation task, maybe indicating a reduced spatial manipulation capacity. Therefore, this activation pattern of lateral occipital cortex and MFG might be responsible for body size overestimation in bulimia. The present results show that bulimic patients exhibit two distinct deficits in body image representations similar to anorectic patients and that specifically associated neuronal correlates can be identified. Concludingly, our study support psychotherapeutic strategies specifically targeting these two aspects of body image distortions. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Do Mortality Rates in Eating Disorders Change over Time? A Longitudinal Look at Anorexia Nervosa and Bulimia Nervosa

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    Franko, Debra L.; Keshaviah, Aparna; Eddy, Kamryn T.; Krishna, Meera; Davis, Martha C.; Keel, Pamela K.; Herzog, David B.

    2014-01-01

    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

  17. Alterations in brain structures related to taste reward circuitry in ill and recovered anorexia nervosa and in bulimia nervosa.

    Science.gov (United States)

    Frank, Guido K; Shott, Megan E; Hagman, Jennifer O; Mittal, Vijay A

    2013-10-01

    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.

  18. The Effectiveness of Acceptance and Commitment Based Training on the Maladaptive Schemas of Female Students with Bulimia Nervosa

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    Moslem Abbasia

    2015-06-01

    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

  19. Técnicas projetivas na avaliação de aspectos psicopatológicos da anorexia e bulimia

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    Peres,Rodrigo Sanches; Santos,Manoel Antônio dos

    2011-01-01

    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 ...

  20. Empirical comparison of two psychological therapies. Self psychology and cognitive orientation in the treatment of anorexia and bulimia.

    Science.gov (United States)

    Bachar, E; Latzer, Y; Kreitler, S; Berry, E M

    1999-01-01

    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.

  1. A psychological typology of females diagnosed with anorexia nervosa, bulimia nervosa or binge eating disorder

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    Bernadetta Izydorczyk

    2015-11-01

    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.

  2. Beliefs of women concerning causes and risk factors for bulimia nervosa.

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    Mond, Jonathan M; Hay, Phillipa J; Rodgers, Bryan; Owen, Cathy; Beumont, Pierre J V

    2004-06-01

    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.

  3. Evaluation of the DSM-5 Severity Specifier for Bulimia Nervosa in Treatment-Seeking Youth.

    Science.gov (United States)

    Dakanalis, Antonios; Colmegna, Fabrizia; Zanetti, Maria Assunta; Di Giacomo, Ester; Riva, Giuseppe; Clerici, Massimo

    2017-05-16

    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.

  4. Addicted to palatable foods: comparing the neurobiology of Bulimia Nervosa to that of drug addiction.

    Science.gov (United States)

    Hadad, Natalie A; Knackstedt, Lori A

    2014-05-01

    Bulimia nervosa (BN) is highly comorbid with substance abuse and shares common phenotypic and genetic predispositions with drug addiction. Although treatments for the two disorders are similar, controversy remains about whether BN should be classified as addiction. Here, we review the animal and human literature with the goal of assessing whether BN and drug addiction share a common neurobiology. Similar neurobiological features are present following administration of drugs and bingeing on palatable food, especially sugar. Specifically, both disorders involve increases in extracellular dopamine (DA), D1 binding, D3 messenger RNA (mRNA), and ΔFosB in the nucleus accumbens (NAc). Animal models of BN reveal increases in ventral tegmental area (VTA) DA and enzymes involved in DA synthesis that resemble changes observed after exposure to addictive drugs. Additionally, alterations in the expression of glutamate receptors and prefrontal cortex activity present in human BN or following sugar bingeing in animals are comparable to the effects of addictive drugs. The two disorders differ in regards to alterations in NAc D2 binding, VTA DAT mRNA expression, and the efficacy of drugs targeting glutamate to treat these disorders. Although additional empirical studies are necessary, the synthesis of the two bodies of research presented here suggests that BN shares many neurobiological features with drug addiction. While few Food and Drug Administration-approved options currently exist for the treatment of drug addiction, pharmacotherapies developed in the future, which target the glutamate, DA, and opioid systems, may be beneficial for the treatment of both BN and drug addiction.

  5. Oral care behavior after purging in a sample of women with bulimia nervosa.

    Science.gov (United States)

    Conviser, Jenny H; Fisher, Sheehan David; Mitchell, Kristin B

    2014-04-01

    Bulimia nervosa (BN) is a mental health disorder associated with serious dental problems. The authors surveyed patients with a diagnosis of BN about their oral health behaviors after purging and their perspectives on barriers to patient-initiated discussion of eating disorders (EDs) with oral health professionals (OHPs). A convenience sample of women with BN who were receiving treatment at major ED treatment centers (those centers that are members of the Academy of Eating Disorders, Deerfield, Ill.) completed a 45-item, self-reported online survey that the authors use to assess oral care behaviors after purging, dental problems and barriers to communication with their dentists. Inclusion criteria were being 18 years or older, female and a U.S. resident, as well as having a clinical diagnosis of BN. A sample of 292 women began the survey, and 201 (68.8 percent) completed the survey. The survey results indicated that 32.5 percent of participants reported brushing their teeth immediately after purging, which is contraindicated. Although 92.4 percent of participants acknowledged having dental problems, only 29.2 percent of these participants discussed their BN with a dentist. The survey results show that although participants with BN had a high level of concern about their oral health and a high incidence of oral health problems, less than one-third considered their OHPs to be the most helpful source of oral health information. OHPs must be educated about how to approach patients when an ED is suspected, develop practice protocols for discussing secondary prevention with patients and develop practice policies about disclosing ED (for example, purging) to a parent or guardian.

  6. [Triggers of bulimia and compulsion attacks: validation of the "Start" questionnaire].

    Science.gov (United States)

    Rigaud, D; Jiang, T; Pennacchio, H; Brémont, M; Perrin, D

    2014-09-01

    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%, Pfood, the major triggers were high energy-density food (77%) and comfort 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%; Pemotional, as strong triggers for binge eating 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.

  7. Brain volumetric abnormalities in patients with anorexia and bulimia nervosa: a voxel-based morphometry study.

    Science.gov (United States)

    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

    2013-09-30

    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.

  8. Attention Network Dysfunction in Bulimia Nervosa - An fMRI Study.

    Directory of Open Access Journals (Sweden)

    Jochen Seitz

    Full Text Available Recent evidence has suggested an increased rate of comorbid ADHD and subclinical attentional impairments in bulimia nervosa (BN patients. However, little is known regarding the underlying neural mechanisms of attentional functions in BN.Twenty BN patients and twenty age- and weight-matched healthy controls (HC were investigated using a modified version of the Attention Network Task (ANT in an fMRI study. This design enabled an investigation of the neural mechanisms associated with the three attention networks involved in alerting, reorienting and executive attention.The BN patients showed hyperactivation in parieto-occipital regions and reduced deactivation of default-mode-network (DMN areas during alerting compared with HCs. Posterior cingulate activation during alerting correlated with the severity of eating-disorder symptoms within the patient group. Conversely, BN patients showed hypoactivation during reorienting and executive attention in anterior cingulate regions, the temporo-parietal junction (TPJ and parahippocampus compared with HCs, which was negatively associated with global ADHD symptoms and impulsivity, respectively.Our findings demonstrate altered brain mechanisms in BN associated with all three attentional networks. Failure to deactivate the DMN and increased parieto-occipital activation required for alerting might be associated with a constant preoccupation with food or body image-related thoughts. Hypoactivation of executive control networks and TPJ might increase the likelihood of inattentive and impulsive behaviors and poor emotion regulation. Thus, dysfunction in the attentional network in BN goes beyond an altered executive attentional domain and needs to be considered in the diagnosis and treatment of BN.

  9. Attention Network Dysfunction in Bulimia Nervosa - An fMRI Study

    Science.gov (United States)

    Dahmen, Brigitte; Schulte-Rüther, Martin; Legenbauer, Tanja; Herpertz-Dahlmann, Beate; Konrad, Kerstin

    2016-01-01

    Objective Recent evidence has suggested an increased rate of comorbid ADHD and subclinical attentional impairments in bulimia nervosa (BN) patients. However, little is known regarding the underlying neural mechanisms of attentional functions in BN. Method Twenty BN patients and twenty age- and weight-matched healthy controls (HC) were investigated using a modified version of the Attention Network Task (ANT) in an fMRI study. This design enabled an investigation of the neural mechanisms associated with the three attention networks involved in alerting, reorienting and executive attention. Results The BN patients showed hyperactivation in parieto-occipital regions and reduced deactivation of default-mode-network (DMN) areas during alerting compared with HCs. Posterior cingulate activation during alerting correlated with the severity of eating-disorder symptoms within the patient group. Conversely, BN patients showed hypoactivation during reorienting and executive attention in anterior cingulate regions, the temporo-parietal junction (TPJ) and parahippocampus compared with HCs, which was negatively associated with global ADHD symptoms and impulsivity, respectively. Discussion Our findings demonstrate altered brain mechanisms in BN associated with all three attentional networks. Failure to deactivate the DMN and increased parieto-occipital activation required for alerting might be associated with a constant preoccupation with food or body image-related thoughts. Hypoactivation of executive control networks and TPJ might increase the likelihood of inattentive and impulsive behaviors and poor emotion regulation. Thus, dysfunction in the attentional network in BN goes beyond an altered executive attentional domain and needs to be considered in the diagnosis and treatment of BN. PMID:27607439

  10. Highly increased risk of type 2 diabetes in patients with binge eating disorder and bulimia nervosa.

    Science.gov (United States)

    Raevuori, Anu; Suokas, Jaana; Haukka, Jari; Gissler, Mika; Linna, Milla; Grainger, Marjut; Suvisaari, Jaana

    2015-09-01

    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.

  11. Autoantibodies against α-MSH, ACTH, and LHRH in anorexia and bulimia nervosa patients

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    Fetissov, Sergueï O.; Hallman, Jarmila; Oreland, Lars; af Klinteberg, Britt; Grenbäck, Eva; Hulting, Anna-Lena; Hökfelt, Tomas

    2002-01-01

    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

  12. Prevalence, incidence, and natural course of anorexia and bulimia nervosa among adolescents and young adults.

    Science.gov (United States)

    Nagl, Michaela; Jacobi, Corinna; Paul, Martin; Beesdo-Baum, Katja; Höfler, Michael; Lieb, Roselind; Wittchen, Hans-Ulrich

    2016-08-01

    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.

  13. Characterization and correlates of exercise among adolescents with anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Nagata, Jason M; Carlson, Jennifer L; Kao, Jessica M; Golden, Neville H; Murray, Stuart B; Peebles, Rebecka

    2017-12-01

    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 <50) at presentation was associated with team sport participation (adjusted odds ratio [AOR] 1.66, 95% confidence interval [CI] 1.02-2.72) and hours of exercise per week (AOR 1.05, 95% CI 1.02-1.09), controlling for diagnosis, sex, age, duration of illness, rate of weight loss, and percent median body mass index (%mBMI). 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.

  14. Sensory modulation disorder symptoms in anorexia nervosa and bulimia nervosa: A pilot study.

    Science.gov (United States)

    Brand-Gothelf, Ayelet; Parush, Shula; Eitan, Yehudith; Admoni, Shai; Gur, Eitan; Stein, Daniel

    2016-01-01

    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.

  15. Anorexia and bulimia nervosa: virtual diffusion of the disease as a lifestyle

    Science.gov (United States)

    Lladó, Gina; González-Soltero, Rocío; Blanco Fernández de Valderrama, María José

    2017-06-05

    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.

  16. Empirically derived personality subtyping for predicting clinical symptoms and treatment response in bulimia nervosa.

    Science.gov (United States)

    Haynos, Ann F; Pearson, Carolyn M; Utzinger, Linsey M; Wonderlich, Stephen A; Crosby, Ross D; Mitchell, James E; Crow, Scott J; Peterson, Carol B

    2017-05-01

    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.

  17. The role of impulsivity, inattention and comorbid ADHD in patients with bulimia nervosa.

    Directory of Open Access Journals (Sweden)

    Jochen Seitz

    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.

  18. Avaliação laríngea e vocal de pacientes com bulimia Laryngeal and vocal analysis in bulimic patients

    Directory of Open Access Journals (Sweden)

    Cynthia P. Ferreira

    2010-08-01

    Full Text Available A Bulimia Nervosa é um transtorno mental, de acordo com o sistema de classificação DSM-IV. OBJETIVO: Descrever os sinais vocais e laríngeos de pacientes com diagnóstico de bulimia e em indivíduos sem a doença. MATERIAIS E MÉTODOS: Estudo caso-controle. Vinte e duas mulheres foram avaliadas com idade entre 18 a 34 anos, sendo 11 mulheres com diagnóstico de bulimia, com o subtipo purgativo, e 11 mulheres do grupo controle. Ambos os grupos foram submetidos à avaliação otorrinolaringológica e fonoaudiológica. Na análise estatística foram realizados os testes qui-quadrado e Kruskall-Wallis considerando o valor de significância de 5%. RESULTADOS: Na avaliação otorrinolaringológica, os pacientes com bulimia apresentaram uma maior prevalência de alterações laríngeas quando comparado com o grupo controle (p=0,000. Na avaliação perceptivo-auditiva da voz, o grupo com bulimia apresentou maiores alterações nos parâmetros GRBSI (p=0,000 e A (p=0,022 da escala GRBASI, quando comparados ao grupo controle. Os valores de jitter, shimmer, QPF e QPA foram maiores no grupo com bulimia com diferença estatística (p=0,033. Os valores de frequência fundamental e PHR não se diferiram entre os grupos. CONCLUSÃO: Os pacientes com bulimia apresentaram maiores alterações laríngeas, perceptivo-auditivas e acústicas da voz quando comparados ao grupo controle.Bulimia is an eating disorder classified as a mental disorder according to DSM-IV. AIMS: The aim of the study was to evaluate vocal and laryngeal abnormalities in patients with bulimia compared to a control group. MATERIALS & METHODS: Study control group. Twenty-two women were evaluated, with an age range of 18 to 34 years old. Eleven diagnosed with purging bulimia and 11 in the control group. Both groups underwent an otolaryngological, perception and acoustic evaluation. The statistic analysis was done through a chi-square test and a Kruskall-Wallis non-parametric test, considering 5

  19. Stigmatizing attitudes and beliefs about bulimia nervosa: gender, age, education and income variability in a community sample.

    Science.gov (United States)

    McLean, Siân A; Paxton, Susan J; Massey, Robin; Hay, Phillipa J; Mond, Jonathan M; Rodgers, Bryan

    2014-05-01

    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.

  20. Exploring experience of family relations by patients with anorexia nervosa and bulimia nervosa using a projective family test.

    Science.gov (United States)

    Fäldt Ciccolo, Erica B

    2008-08-01

    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.

  1. Position of the American Dietetic Association: Nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and other eating disorders.

    Science.gov (United States)

    2006-12-01

    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.

  2. Seasonal patterns of birth for subjects with bulimia nervosa, binge eating, and purging: results from the National Women's Study.

    Science.gov (United States)

    Brewerton, Timothy D; Dansky, Bonnie S; O'Neil, Patrick M; Kilpatrick, Dean G

    2012-01-01

    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.

  3. Cortisol responses on the dexamethasone suppression test among women with Bulimia-spectrum eating disorders: associations with clinical symptoms.

    Science.gov (United States)

    Bruce, Kenneth R; Steiger, Howard; Israël, Mimi; Groleau, Patricia; Ng Ying Kin, N M K; Ouellette, Anne-Sophie; Sycz, Lindsay; Badawi, Ghislaine

    2012-08-07

    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.

  4. Mental Health Literacy and Eating-Disordered Behavior: Beliefs of Adolescent Girls Concerning the Treatment of and Treatment-Seeking for Bulimia Nervosa

    Science.gov (United States)

    Mond, J. M.; Marks, P.; Hay, P. J.; Rodgers, B.; Kelly, C.; Owen, C.; Paxton, S. J.

    2007-01-01

    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…

  5. Investigating the use of CD-Rom CBT for bulimia nervosa and binge eating disorder in an NHS adult outpatient eating disorders service.

    Science.gov (United States)

    Graham, Lisa; Walton, Mark

    2011-07-01

    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.

  6. A Needs Assessment for Health Care Professionals in the Detection, Intervention and Interdisciplinary Treatment of Bulimia Nervosa Using Focus Group Methodology

    Science.gov (United States)

    Hague, Anne; Kovacich, Joann

    2007-01-01

    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…

  7. Association between A218C polymorphism of the tryptophan-hydroxylase-1 gene, harm avoidance and binge eating behavior in bulimia nervosa.

    Science.gov (United States)

    Monteleone, Palmiero; Tortorella, Alfonso; Martiadis, Vassilis; Serino, Ismene; Di Filippo, Carmela; Maj, Mario

    2007-06-21

    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.

  8. Daily and Momentary Mood and Stress Are Associated with Binge Eating and Vomiting in Bulimia Nervosa Patients in the Natural Environment

    Science.gov (United States)

    Smyth, Joshua M.; Wonderlich, Stephen A.; Heron, Kristin E.; Sliwinski, Martin J.; Crosby, Ross D.; Mitchell, James E.; Engel, Scott G.

    2007-01-01

    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),…

  9. Family interactions in bulimia nervosa. I: Study design, comparisons to established population norms, and changes over the course of an intensive day hospital treatment program.

    Science.gov (United States)

    Woodside, D B; Shekter-Wolfson, L; Garfinkel, P E; Olmsted, M P; Kaplan, A S; Maddocks, S E

    1995-03-01

    This paper presents the results of a study examining self-reported family functioning by patients with bulimia nervosa (BN) and their parents before and after treatment for the eating symptoms of BN. Ratings of family functioning improved significantly over the course of treatment. There was no evidence of excessive denial or social desirability in the families.

  10. Anorexia and Bulimia Nervosa in Same-Sex and Opposite-Sex Twins : Lack of Association With Twin Type in a Nationwide Study of Finnish Twins

    NARCIS (Netherlands)

    Raevuori, Anu; Kaprio, Jaakko; Hoek, Hans W.; Sihvola, Elina; Rissanen, Aila; Keski-Rahkonen, Anna

    2008-01-01

    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,

  11. The Use of Videogames as Complementary Therapeutic Tool for Cognitive Behavioral Therapy in Bulimia Nervosa Patients.

    Science.gov (United States)

    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

    2015-12-01

    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

  12. An empirical comparison of atypical bulimia nervosa and binge eating disorder

    Directory of Open Access Journals (Sweden)

    L.F. Fontenelle

    2005-11-01

    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.

  13. A randomized controlled trial of family therapy and cognitive behavior therapy guided self-care for adolescents with bulimia nervosa and related disorders.

    Science.gov (United States)

    Schmidt, Ulrike; Lee, Sally; Beecham, Jennifer; Perkins, Sarah; Treasure, Janet; Yi, Irene; Winn, Suzanne; Robinson, Paul; Murphy, Rebecca; Keville, Saskia; Johnson-Sabine, Eric; Jenkins, Mari; Frost, Susie; Dodge, Liz; Berelowitz, Mark; Eisler, Ivan

    2007-04-01

    To date no trial has focused on the treatment of adolescents with bulimia nervosa. The aim of this study was to compare the efficacy and cost-effectiveness of family therapy and cognitive behavior therapy (CBT) guided self-care in adolescents with bulimia nervosa or eating disorder not otherwise specified. Eighty-five adolescents with bulimia nervosa or eating disorder not otherwise specified were recruited from eating disorder services in the United Kingdom. Participants were randomly assigned to family therapy for bulimia nervosa or individual CBT guided self-care supported by a health professional. The primary outcome measures were abstinence from binge-eating and vomiting, as assessed by interview at end of treatment (6 months) and again at 12 months. Secondary outcome measures included other bulimic symptoms and cost of care. Of the 85 study participants, 41 were assigned to family therapy and 44 to CBT guided self-care. At 6 months, bingeing had undergone a significantly greater reduction in the guided self-care group than in the family therapy group; however, this difference disappeared at 12 months. There were no other differences between groups in behavioral or attitudinal eating disorder symptoms. The direct cost of treatment was lower for guided self-care than for family therapy. The two treatments did not differ in other cost categories. Compared with family therapy, CBT guided self-care has the slight advantage of offering a more rapid reduction of bingeing, lower cost, and greater acceptability for adolescents with bulimia or eating disorder not otherwise specified.

  14. Anorexia and bulimia nervosa in same-sex and opposite-sex twins: lack of association with twin type in a nationwide study of Finnish twins.

    Science.gov (United States)

    Raevuori, Anu; Kaprio, Jaakko; Hoek, Hans W; Sihvola, Elina; Rissanen, Aila; Keski-Rahkonen, Anna

    2008-12-01

    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.

  15. Técnicas projetivas na avaliação de aspectos psicopatológicos da anorexia e bulimia Projective techniques in the assessment of psychopathology of patients with anorexia and bulimia

    Directory of Open Access Journals (Sweden)

    Rodrigo Sanches Peres

    2011-08-01

    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

  16. 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

    Directory of Open Access Journals (Sweden)

    Cilene Rebolho Martins

    2010-01-01

    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

  17. Randomized Clinical Trial of Family-Based Treatment and Cognitive-Behavioral Therapy for Adolescent Bulimia Nervosa.

    Science.gov (United States)

    Le Grange, Daniel; Lock, James; Agras, W Stewart; Bryson, Susan W; Jo, Booil

    2015-11-01

    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.

  18. Reduced resting-state functional connectivity of the somatosensory cortex predicts psychopathological symptoms in women with bulimia nervosa.

    Science.gov (United States)

    Lavagnino, Luca; Amianto, Federico; D'Agata, Federico; Huang, Zirui; Mortara, Paolo; Abbate-Daga, Giovanni; Marzola, Enrica; Spalatro, Angela; Fassino, Secondo; Northoff, Georg

    2014-01-01

    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.

  19. Bilateral necrotizing sialometaplasia of the hard palate in a patient with bulimia: a case report and review of the literature.

    Science.gov (United States)

    Janner, Simone F M; Suter, Valerie G A; Altermatt, Hans Jörg; Reichart, Peter A; Bornstein, Michael M

    2014-05-01

    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.

  20. Empirical Comparison of Two Psychological Therapies: Self Psychology and Cognitive Orientation in the Treatment of Anorexia and Bulimia

    Science.gov (United States)

    Bachar, Eytan; Latzer, Yael; Kreitler, Shulamit; Berry, Elliot M.

    1999-01-01

    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

  1. Loneliness mediates the relationship between emotion dysregulation and bulimia nervosa/binge eating disorder psychopathology in a clinical sample.

    Science.gov (United States)

    Southward, Matthew W; Christensen, Kara A; Fettich, Karla C; Weissman, Jessica; Berona, Johnny; Chen, Eunice Y

    2014-12-01

    Emotion dysregulation has been linked to binge eating disorder (BED) and bulimia nervosa (BN) although the mechanisms by which it affects BN/BED psychopathology are unclear. This study tested loneliness as a mediator between emotion dysregulation and BN/BED psychopathology. A treatment-seeking sample of 107 women with BN or BED was assessed for loneliness (UCLA Loneliness Scale), emotion dysregulation (Difficulties in Emotion Regulation Scale), and BN/BED psychopathology (Eating Disorder Examination) before treatment. Hierarchical linear regressions and bootstrapping mediation models were run. Greater overall emotion dysregulation was associated with greater BN/BED psychopathology, mediated by loneliness (95 % CI 0.03, 0.09). Emotion dysregulation, however, did not mediate between loneliness and BN/BED psychopathology (95 % CI −0.01, 0.01). Targeting loneliness may effectively treat emotional aspects of BN/BED in women.

  2. Cognitive behaviour therapy response and dropout rate across purging and nonpurging bulimia nervosa and binge eating disorder: DSM-5 implications.

    Science.gov (United States)

    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

    2013-11-07

    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.

  3. Anxiety and compulsion patterns in the maintenance of bingeing/purging behaviours by individuals with bulimia nervosa.

    Science.gov (United States)

    Thomas, M; Lovell, A

    2015-02-01

    Bulimia nervosa, if not treated or if treated unsuccessfully, can develop into a severe and enduring eating disorder. Analysis of self-management of Seed-BN indicates that individuals frequently experience significant negative mental health issues and a complex relationship with medication management. Two discrete patterns of coping strategies to prevent deterioration in distressing symptoms were in evidence, controlled vomiting, which was related to the management of anxiety, and uncontrolled vomiting due to more dominant self-management of compulsive acts. The implications for nursing revolve around accurate assessment of vomiting and subsequent engagement by the individual with their coping strategies in relation to perceived deterioration in distressing symptoms. This paper reports on the results of a study into the self-reported coping strategies employed by a small sample (n = 12) of individuals diagnosed with bulimia nervosa purging sub-type, severe and enduring eating disorder (Seed-BN), referred to an outpatient clinic for psychotherapy. Data collection focused on the vomiting activities of participants through analysis of their self-management from diary extracts, which recorded vomiting patterns. Participants all experienced significant mental health issues, had complex histories of BN over a prolonged period, difficulties maintaining relationships, and many had an additional history of substance misuse including dependence on prescription drugs. The study findings indicated two different self-management strategies, anxiety containment and compulsion maintenance. There was a clear association between anxiety and controlled weekly vomiting patterns compared with compulsion and daily vomiting patterns. The implications for nursing practice relate to the potential for assessment of differences in vomiting patterns to indicate self-management status and subsequent interventions focusing on either anxiety or compulsive patterns. © 2014 John Wiley & Sons Ltd.

  4. Bulimia nerviosa y trastornos de la personalidad. Una revisión teórica de la literatura

    Directory of Open Access Journals (Sweden)

    Maite Gargallo Masjuán

    2003-01-01

    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.

  5. Reduced resting state functional connectivity of the somatosensory cortex predicts psychopathological symptoms in women with bulimia nervosa

    Directory of Open Access Journals (Sweden)

    Luca eLavagnino

    2014-08-01

    Full Text Available BackgroundAlterations 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. MethodsSixteen 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. ResultsBN patients showed a decreased resting state functional connectivity both within the somatosensory network (t=9.0, df=1, P=0.005 and with posterior cingulate cortex (PCC and two visual areas (the right middle occipital gyrus and the right cuneus(P=0.05 corrected for multiple comparison. The region in the right middle occipital gyrus is implicated in body processing and is known as extrastriate body area, or EBA. The rs-FC of the left paracentral lobule with the EBA 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. ConclusionsOur findings show a specific alteration of the rs-FC of the somatosensory cortex in BN patients, which correlates with eating disorder symptoms. 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.

  6. Treatment of bulimia nervosa with topiramate in a randomized, double-blind, placebo-controlled trial, part 2: improvement in psychiatric measures.

    Science.gov (United States)

    Hedges, Dawson W; Reimherr, Frederick W; Hoopes, Scott P; Rosenthal, Norman R; Kamin, Marc; Karim, Rezaul; Capece, Julie A

    2003-12-01

    We conducted a 10-week, randomized, double-blind, placebo-controlled trial to examine the efficacy of topiramate in the treatment of bulimia nervosa. Primary efficacy analyses showed that topiramate treatment significantly reduced days on which patients binged and/or purged. This article describes further analyses investigating topiramate's effect on psychological symptoms associated with disordered eating. Patients with DSM-IV bulimia nervosa were randomly assigned to receive topiramate (N = 35) or placebo (N = 34) for 10 weeks. Topiramate treatment was started at 25 mg/day and titrated by 25 to 50 mg/week to a maximum of 400 mg/day. Secondary psychiatric endpoints, including the Eating Disorder Inventory (EDI), Eating Attitudes Test (EAT), Hamilton Rating Scale for Anxiety (HAM-A), Hamilton Rating Scale for Depression (HAM-D), and Patient Global Improvement (PGI) were assessed for change from baseline in the topiramate versus placebo group. Thirty-one patients receiving topiramate and 33 receiving placebo were included in the intent-to-treat analysis. Percent change from baseline on the EDI indicated significantly greater improvement in the topiramate group compared with the placebo group for subscales measuring bulimia/uncontrollable overeating (p =.005), body dissatisfaction (p =.007), and drive for thinness (p =.002). The EAT showed significant improvement in the topiramate group compared with the placebo group for the bulimia/food preoccupation (p =.019) and dieting (p =.031) subscales and the total score (p =.022). For the topiramate group, the reduction in mean HAM-A score was significantly greater (p =.046) than that in the placebo group, while reduction in HAM-D scores was greater in the topiramate group compared with the placebo group but did not reach statistical significance (p =.069). Significantly more patients treated with topiramate compared with placebo reported improvement on the PGI (p =.004). Topiramate treatment improves multiple behavioral

  7. Neuroendocrinology and brain imaging of reward in eating disorders: A possible key to the treatment of anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Monteleone, Alessio Maria; Castellini, Giovanni; Volpe, Umberto; Ricca, Valdo; Lelli, Lorenzo; Monteleone, Palmiero; Maj, Mario

    2018-01-03

    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

  8. Subjective and Objective Binge Eating in Relation to Eating Disorder Symptomatology, Depressive Symptoms, and Self-Esteem Among Treatment-Seeking Adolescents with Bulimia Nervosa

    OpenAIRE

    Fitzsimmons-Craft, Ellen E.; Ciao, Anna C.; Accurso, Erin C.; Pisetsky, Emily M.; Peterson, Carol B.; Byrne, Catherine E.; Le Grange, Daniel

    2014-01-01

    This study investigated the importance of the distinction between objective (OBE) and subjective binge eating (SBE) among 80 treatment-seeking adolescents with bulimia nervosa (BN). We explored relationships among OBEs, SBEs, eating disorder (ED) symptomatology, depression, and self-esteem using two approaches. Group comparisons showed that OBE and SBE groups did not differ on ED symptoms or self-esteem; however, the SBE group had significantly greater depression. Examining continuous variabl...

  9. Comparison in decision-making between bulimia nervosa, anorexia nervosa, and healthy women: influence of mood status and pathological eating concerns

    OpenAIRE

    Matsumoto, Junko; Hirano, Yoshiyuki; Numata, Noriko; Matzuzawa, Daisuke; Murano, Shunichi; Yokote, Koutaro; Iyo, Masaomi; Shimizu, Eiji; Nakazato, Michiko

    2015-01-01

    Background Decision-making is reported to be impaired in anorexia nervosa (AN) and bulimia nervosa (BN), but the influence of mood status, pathophysiological eating, and weight concerns on the performance of decision-making ability between AN and BN is still unclear. The aims of this study were to investigate differential impairments in the decision-making process between AN, BN, and healthy controls (HC), and secondly, to explore the role of mood status, such as anxiety, depression, patholog...

  10. Anorexia nervosa, Bulimia nervosa und andere Essstörungen im Kindes- und Jugendalter : Übersicht und Empfehlungen zu Diagnostik und Behandlung

    OpenAIRE

    Pauli, Dagmar

    2013-01-01

    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, ...

  11. Atitudes em relação ao corpo e à alimentação de pacientes com anorexia e bulimia nervosa

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    Aline Cavalcante de Souza

    2014-03-01

    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.

  12. Internet-delivered cognitive-behavioural therapy v. conventional guided self-help for bulimia nervosa: long-term evaluation of a randomised controlled trial.

    Science.gov (United States)

    Wagner, Gudrun; Penelo, Eva; Wanner, Christian; Gwinner, Paulina; Trofaier, Marie-Louise; Imgart, Hartmut; Waldherr, Karin; Wöber-Bingöl, Ciçek; Karwautz, Andreas F K

    2013-02-01

    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.

  13. Age at menarche and digit ratio (2D:4D): relationships with body dissatisfaction, drive for thinness, and bulimia symptoms in women.

    Science.gov (United States)

    Oinonen, Kirsten A; Bird, Jessica L

    2012-03-01

    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 © 2011 Elsevier Ltd. All rights reserved.

  14. Evaluación del autoconcepto, la satisfacción con el propio cuerpo y las habilidades sociales en la anorexia y bulimia nerviosas

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    ELENA GISMERO GONZALEZ

    2001-01-01

    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.

  15. Comorbilidad entre bulimia nerviosa purgativa y trastornos de la personalidad según el Inventario Clínico Multiaxial de Millon (MCMI-II

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    Carmen del Río Sánchez

    2002-01-01

    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

  16. Cost-Effectiveness of Internet-Based Cognitive-Behavioral Treatment for Bulimia Nervosa: Results of a Randomized Controlled Trial.

    Science.gov (United States)

    Watson, Hunna J; McLagan, Nicole; Zerwas, Stephanie C; Crosby, Ross D; Levine, Michele D; Runfola, Cristin D; Peat, Christine M; Moessner, Markus; Zimmer, Benjamin; Hofmeier, Sara M; Hamer, Robert M; Marcus, Marsha D; Bulik, Cynthia M; Crow, Scott J

    2017-12-05

    To evaluate the cost-effectiveness of Internet-based cognitive-behavioral therapy for bulimia nervosa (CBT-BN) compared to face-to-face delivery of CBT-BN. This study is a planned secondary analysis of data from a randomized clinical trial. Participants were 179 adults (98% female, mean age = 28 years) meeting DSM-IV criteria for bulimia nervosa who were randomized to group face-to-face or group Internet-based CBT-BN for 16 sessions during 20 weeks. The cost-effectiveness analysis was conducted from a third-party payor perspective, and a partial societal perspective analysis was conducted to investigate cost-utility (ie, cost per gain in quality-adjusted life-years) and patient out-of-pocket travel-related costs. Net health care costs were calculated from protocol and nonprotocol health care services using third-party payor cost estimates. The primary outcome measure in the clinical trial was abstinence from binge eating and purging, and the trial start and end dates were 2008 and 2016. The mean cost per abstinent patient at posttreatment was $7,757 (95% confidence limit [CL], $4,515, $13,361) for face-to-face and $11,870 (95% CL, $6,486, $22,188) for Internet-based CBT-BN, and at 1-year follow-up was $16,777 (95% CL, $10,298, $27,042) for face-to-face and $14,561 (95% CL, $10,165, $21,028) for Internet-based CBT-BN. There were no statistically significant differences between treatment arms in cost-effectiveness or cost-utility at posttreatment or 1-year follow-up. Out-of-pocket patient costs were significantly higher for face-to-face (mean [95% CL] = $178 [$127, $140]) than Internet-based ($50 [$50, $50]) therapy. Third-party payor cost-effectiveness of Internet-based CBT-BN is comparable with that of an accepted standard. Internet-based dissemination of CBT-BN may be a viable alternative for patients geographically distant from specialist eating disorder services who have an unmet need for treatment. ClinicalTrials.gov identifier: NCT00877786​.

  17. Compulsão alimentar e bulimia nervosa em praticantes de exercício físico

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    Cláudia Raulino Tramontt

    2014-10-01

    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.

  18. 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

    Directory of Open Access Journals (Sweden)

    Cybele Ribeiro Espíndola

    2009-08-01

    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

  19. Video game therapy for emotional regulation and impulsivity control in a series of treated cases with bulimia nervosa.

    Science.gov (United States)

    Fagundo, Ana B; Santamaría, Juan J; Forcano, Laura; Giner-Bartolomé, Cristina; Jiménez-Murcia, Susana; Sánchez, Isabel; Granero, Roser; Ben-Moussa, Maher; Magnenat-Thalmann, Nadia; Konstantas, Dimitri; Lam, Tony; Lucas, Mikkel; Nielsen, Jeppe; Bults, Richard G A; Tarrega, Salomé; Menchón, José M; de la Torre, Rafael; Cardi, Valentina; Treasure, Janet; Fernández-Aranda, Fernando

    2013-11-01

    Although standard psychological treatments have been successful in treating several core features in eating disorders (ED), other characteristics such as emotional regulation or impulsivity appear to be more resistant to change. There is a growing body of evidence to support the efficacy of cognitive remediation for cognitive and emotional difficulties in ED. Playmancer/ Islands is a video game (VG) designed to specifically treat mental disorders, characterized by problems in impulse control. The objective of the game is to increase self-control over emotions, decision making and behaviours. The aim of this study is to describe the results from a consecutive series of nine bulimia nervosa patients who were treated with the VG in addition to cognitive behaviour therapy (CBT). The outcomes included clinical and psychopathological questionnaires, and physiological measures were obtained during the VG. Emotional regulation improved, heart rate variability increased, and respiratory rate and impulsivity measures reduced after the treatment. These findings suggest that VG training may enhance treatment for ED. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.

  20. Eating disorders mental health literacy in Singapore: beliefs of young adult women concerning treatment and outcome of bulimia nervosa.

    Science.gov (United States)

    Chen, Anna; Mond, Jonathan M; Kumar, Rajeev

    2010-02-01

    We examined the eating disorders 'mental health literacy' of young adult women in Singapore. A self-report questionnaire was completed by 255 women recruited from three university campuses. A vignette of a fictional (female) person exhibiting the characteristic features of bulimia nervosa was presented, followed by a series of questions concerning the treatment and outcome of the problem described. A measure of eating disorder symptoms was included in the questionnaire. Consulting a primary care practitioner, counsellor or psychologist; seeking the advice of a (female) family member or friend; getting advice about diet and nutrition; and taking vitamins and minerals were the interventions most often considered helpful. Participants were less positive about the benefits of psychiatristsand were ambivalent about the use of psychotropic medication. Participants' mothers were most often considered helpful as they are an initial source of help. Among participants with a high level of eating disorder symptoms, recognition of an eating problem was poor. A minority of participants believed that treatment would result in full recovery. Aspects of the eating disorders mental health literacy of young Singaporean women may be conducive to low or inappropriate treatment seeking. Health promotion programmes need to target not only at-risk individuals, but also their family members and social circle.

  1. How useful is the DSM-5 severity indicator in bulimia nervosa? A clinical study including a measure of impairment.

    Science.gov (United States)

    Jenkins, Paul E; Luck, Amy; Cardy, Jessica; Staniford, Jessica

    2016-12-30

    The severity criterion used in DSM-5 for bulimia nervosa (BN) was investigated in 214 individuals referred for treatment at a regional eating disorders service in the UK. In addition to comparing eating disorder symptoms, impairment secondary to these symptoms was also assessed. According to guidance in DSM-5, 94 individuals were classified as mild (43.9%), 70 as moderate (32.7%), 32 as severe (15.0%), and 8 as extreme (3.7%) levels of BN severity. Due to small numbers in the latter two groups, it was necessary to combine these to form one 'severe/extreme' group. Analyses on these three groups suggested no group effect on demographic variables but differences were seen on measures of eating pathology, psychological distress, and psychosocial impairment between the mild group and other groups. Individuals in the moderate and severe/extreme groups scored comparably on most measures of pathology and impairment. The results are broadly consistent with past studies on community samples although together question the demarcation between moderate and more severe groups of individuals with BN. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Effectiveness of mindfulness-based cognitive therapy on clinical syndrome and body image in women with bulimia nervosa

    Directory of Open Access Journals (Sweden)

    Marjan Moradi

    2017-08-01

    Full Text Available Introduction: The purpose of present research was to investigate the effectiveness of mindfulness-based cognitive therapy on clinical syndrome and body image in women with bulimia nervosa disorder. Materials and Methods: This is a quasi-experimental study with pre-test, post-test, and control group. The study population consisted of all women who referred to two nutrition and diet therapy clinics in Mashhad between February and May 2015, among which 30 women with inclusion and exclusion criteria were selected as the sample using convenience sampling. The 30 participants were randomly assigned to two 15-person groups. The first group received mindfulness-based cognitive therapy and the second group was the control group that was placed on a waiting list. Binge Eating questionnaire (Gormally, 1982, Fisher’s image inventory and Depression Anxiety Stress Scale (DASS-21 were used to collect data. Data analysis was conducted using analysis of covariance in SPSS. Results: Based on the test results, mindfulness-based cognitive therapy significantly reduced depression (P

  3. Empirically defining rapid response to intensive treatment to maximize prognostic utility for bulimia nervosa and purging disorder.

    Science.gov (United States)

    MacDonald, Danielle E; Trottier, Kathryn; McFarlane, Traci; Olmsted, Marion P

    2015-05-01

    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.

  4. Rapid improvements in emotion regulation predict intensive treatment outcome for patients with bulimia nervosa and purging disorder.

    Science.gov (United States)

    MacDonald, Danielle E; Trottier, Kathryn; Olmsted, Marion P

    2017-10-01

    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.

  5. The emotional and attentional impact of exposure to one's own body in bulimia nervosa: a physiological view.

    Directory of Open Access Journals (Sweden)

    Blanca Ortega-Roldán

    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.

  6. Effects of exposure to food images on physiological reactivity and emotional responses in women with bulimia nervosa.

    Science.gov (United States)

    Yela Bernabé, José Ramon; Gómez Martínez, Maria Ángeles; Cortés Rodríguez, María; Salgado Ruiz, Alfonso

    2013-01-01

    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.

  7. Reciprocal associations between negative affect, binge eating, and purging in the natural environment in women with bulimia nervosa.

    Science.gov (United States)

    Lavender, Jason M; Utzinger, Linsey M; Cao, Li; Wonderlich, Stephen A; Engel, Scott G; Mitchell, James E; Crosby, Ross D

    2016-04-01

    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).

  8. The acute salivary ghrelin response to a psychosocial stress is enhanced in symptomatic patients with bulimia nervosa: a pilot study.

    Science.gov (United States)

    Monteleone, Palmiero; Tortorella, Alfonso; Scognamiglio, Pasquale; Serino, Ismene; Monteleone, Alessio Maria; Maj, Mario

    2012-01-01

    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.

  9. A pilot study examining diagnostic differences among exercise and weight suppression in bulimia nervosa and binge eating disorder.

    Science.gov (United States)

    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

    2015-05-01

    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.

  10. CBT4BN versus CBTF2F: Comparison of Online versus Face-To-FaceTreatment for Bulimia Nervosa

    Science.gov (United States)

    Bulik, Cynthia M.; Marcus, Marsha D.; Zerwas, Stephanie; Levine, Michele D.; Hofmeier, Sara; Trace, Sara E.; Hamer, Robert M.; Zimmer, Benjamin; Moessner, Markus; Kordy, Hans

    2012-01-01

    Cognitive-behavioral therapy (CBT) is currently the “gold standard” for treatment of bulimia nervosa (BN), and is effective for approximately 40–60% of individuals receiving treatment; however, the majority of individuals in need of care do not have access to CBT. New strategies for service delivery of CBT and for maximizing maintenance of treatment benefits are critical for improving our ability to treat BN. This clinical trial is comparing an Internet-based version of CBT (CBT4BN) in which group intervention is conducted via therapeutic chat group with traditional group CBT (CBTF2F) for BN conducted via face-to-face therapy group. The purpose of the trial is to determine whether manualized CBT delivered via the Internet is not inferior to the gold standard of manualized group CBT. In this two-site randomized controlled trial, powered for non-inferiority analyses, 180 individuals with BN are being randomized to either CBT4BN or CBTF2F. We hypothesize that CBT4BN will not be inferior to CBTF2F and that participants will value the convenience of an online intervention. If not inferior, CBT4BN may be a cost-effective approach to service delivery for individuals requiring treatment for BN. PMID:22659072

  11. The emotional and attentional impact of exposure to one's own body in bulimia nervosa: a physiological view.

    Science.gov (United States)

    Ortega-Roldán, Blanca; Rodríguez-Ruiz, Sonia; Perakakis, Pandelis; Fernández-Santaella, M Carmen; Vila, Jaime

    2014-01-01

    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.

  12. Clinical utility of subtyping binge eating disorder by history of anorexia or bulimia nervosa in a treatment sample.

    Science.gov (United States)

    Utzinger, Linsey M; Mitchell, James E; Cao, Li; Crosby, Ross D; Crow, Scott J; Wonderlich, Stephen A; Peterson, Carol B

    2015-09-01

    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.

  13. [Validation of a German-language Version of the Body Checking Questionnaire (BCQ) in Adolescents with Anorexia and Bulimia Nervosa].

    Science.gov (United States)

    Steinfeld, Beate; Bauer, Anika; Waldorf, Manuel; Engel, Nicole; Braks, Karsten; Huber, Thomas J; Vocks, Silja

    2017-01-01

    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.

  14. Preliminary examination of glucagon-like peptide-1 levels in women with purging disorder and bulimia nervosa.

    Science.gov (United States)

    Dossat, Amanda M; Bodell, Lindsay P; Williams, Diana L; Eckel, Lisa A; Keel, Pamela K

    2015-03-01

    This study examined pre- and postprandial glucagon-like peptide 1 (GLP-1) levels in women with bulimia nervosa (BN), purging disorder (PD), and non-eating disorder control women to better understand whether alterations in satiation-related hormones in BN may be linked to binge-eating episodes or other altered ingestive behaviors. Participants included women with BN (n = 19), PD (n = 14), or controls (n = 14). Participants provided subjective ratings for hunger and fullness and plasma samples before and after consumption of a standardized test meal. As expected, GLP-1 levels increased significantly following test meal consumption; however, participants with BN displayed significantly lower GLP-1 levels compared to PD and control participants both before and after consumption of the test meal. There were no significant differences between PD and control participants in GLP-1 levels, but individuals with PD displayed significantly higher levels of fullness throughout the test meal as compared to both control and BN participants. Our findings provide preliminary evidence that reduced GLP-1 levels in individuals with BN may be associated with binge-eating episodes. Additionally, increased fullness in individuals with PD does not appear to be accounted for by exaggerated postprandial GLP-1 release. © 2014 Wiley Periodicals, Inc.

  15. Preliminary Examination of Glucagon-Like Peptide-1 Levels in Women with Purging Disorder and Bulimia Nervosa

    Science.gov (United States)

    Dossat, Amanda M.; Bodell, Lindsay P.; Williams, Diana L.; Eckel, Lisa A.; Keel, Pamela K.

    2014-01-01

    Objective This study examined pre- and post-prandial glucagon-like peptide 1 (GLP-1) levels in women with bulimia nervosa (BN), purging disorder (PD), and non-eating disorder control women to better understand whether alterations in satiation-related hormones in BN may be linked to binge-eating episodes or other altered ingestive behaviors. Method Participants included women with BN (n = 19), PD (n = 14), or controls (n = 14). Participants provided subjective ratings for hunger and fullness and plasma samples before and after consumption of a standardized test meal. Results As expected, GLP-1 levels increased significantly following test meal consumption; however, participants with BN displayed significantly lower GLP-1 levels compared to PD and control participants both before and after consumption of the test meal. There were no significant differences between PD and control participants in GLP-1 levels, but individuals with PD displayed significantly higher levels of fullness throughout the test meal as compared to both control and BN participants. Discussion Our findings provide preliminary evidence that reduced GLP-1 levels in individuals with BN may be associated with binge-eating episodes. Additionally, increased fullness in individuals with PD does not appear to be accounted for by exaggerated post-prandial GLP-1 release. PMID:24590464

  16. Dimensions of Emotion Dysregulation in Anorexia Nervosa and Bulimia Nervosa: A Conceptual Review of the Empirical Literature

    Science.gov (United States)

    Lavender, Jason M.; Wonderlich, Stephen A.; Engel, Scott G.; Gordon, Kathryn H.; Kaye, Walter H.; Mitchell, James E.

    2015-01-01

    Several existing conceptual models and psychological interventions address or emphasize the role of emotion dysregulation in eating disorders. The current article uses Gratz and Roemer’s (2004) multidimensional model of emotion regulation and dysregulation as a clinically relevant framework to review the extant literature on emotion dysregulation in anorexia nervosa (AN) and bulimia nervosa (BN). Specifically, the dimensions reviewed include: (1) the flexible use of adaptive and situationally appropriate strategies to modulate the duration and/or intensity of emotional responses, (2) the ability to successfully inhibit impulsive behavior and maintain goal-directed behavior in the context of emotional distress, (3) awareness, clarity, and acceptance of emotional states, and (4) the willingness to experience emotional distress in the pursuit of meaningful activities. The current review suggests that both AN and BN are characterized by broad emotion regulation deficits, with difficulties in emotion regulation across the four dimensions found to characterize both AN and BN, although a small number of more specific difficulties may distinguish the two disorders. The review concludes with a discussion of the clinical implications of the findings, as well as a summary of limitations of the existing empirical literature and suggestions for future research. PMID:26112760

  17. A history of the identification of the characteristic eating disturbances of Bulimia Nervosa, Binge Eating Disorder and Anorexia Nervosa.

    Science.gov (United States)

    Heaner, Martica K; Walsh, B Timothy

    2013-06-01

    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.

  18. Depictive and metric body size estimation in anorexia nervosa and bulimia nervosa: A systematic review and meta-analysis.

    Science.gov (United States)

    Mölbert, Simone Claire; Klein, Lukas; Thaler, Anne; Mohler, Betty J; Brozzo, Chiara; Martus, Peter; Karnath, Hans-Otto; Zipfel, Stephan; Giel, Katrin Elisabeth

    2017-11-01

    A distorted representation of one's own body is a diagnostic criterion and core psychopathology of both anorexia nervosa (AN) and bulimia nervosa (BN). Despite recent technical advances in research, it is still unknown whether this body image disturbance is characterized by body dissatisfaction and a low ideal weight and/or includes a distorted perception or processing of body size. In this article, we provide an update and meta-analysis of 42 articles summarizing measures and results for body size estimation (BSE) from 926 individuals with AN, 536 individuals with BN and 1920 controls. We replicate findings that individuals with AN and BN overestimate their body size as compared to controls (ES=0.63). Our meta-regression shows that metric methods (BSE by direct or indirect spatial measures) yield larger effect sizes than depictive methods (BSE by evaluating distorted pictures), and that effect sizes are larger for patients with BN than for patients with AN. To interpret these results, we suggest a revised theoretical framework for BSE that accounts for differences between depictive and metric BSE methods regarding the underlying body representations (conceptual vs. perceptual, implicit vs. explicit). We also discuss clinical implications and argue for the importance of multimethod approaches to investigate body image disturbance. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. A review of the father-child relationship in the development and maintenance of adolescent anorexia and bulimia nervosa.

    Science.gov (United States)

    Gale, Christopher J; Cluett, Elizabeth R; Laver-Bradbury, Cathy

    2013-01-01

    There are disproportionately fewer studies examining the role of the father in the development of child and adolescent psychopathology. This is pertinent in the field of eating disorders, where there is a wealth of research related to family influences and the value of family-based interventions. This article reviews the key themes within the literature around the potential impact of the father-child relationship on the development and maintenance of Anorexia and Bulimia Nervosa in young people. The critical review searched relevant health and social care databases, as well as manually searching key journals in the eating disorder field. In these results, 13 studies met the inclusion/exclusion criteria and were critiqued, with 8 being taken forward for discussion. The 8 studies identified key themes within the relationship of the father and child (particularly daughters) around conflict and communication, parental protection and psychological control, emotional regulation and self-esteem, and self-perfectionism. All of these factors appear to influence the child's level of self-determining autonomy, which in turn can impact maladaptive eating attitudes and psychopathology. Tentative recommendations are made around working with fathers to encourage free expression of ideas and foster a sense of autonomy through compromise and collaboration with their adolescent child. Further research around these themes in relation to other family members is also suggested.

  20. Effects of emotional acceptance and rumination on media-induced body dissatisfaction in anorexia and bulimia nervosa.

    Science.gov (United States)

    Naumann, Eva; Tuschen-Caffier, Brunna; Voderholzer, Ulrich; Schäfer, Johanna; Svaldi, Jennifer

    2016-11-01

    Body dissatisfaction is an important risk and maintaining factor for eating disorders. The aim of the present study was to experimentally test the effects of two emotion regulation strategies - acceptance and rumination - on media-induced body dissatisfaction in eating disorders. After watching pictures of thin models, women with anorexia nervosa (AN; n = 39) and bulimia nervosa (BN; n = 39) were encouraged to either use emotional acceptance or rumination to cope with their feelings. Body dissatisfaction and mood were repeatedly assessed. Acceptance significantly improved body dissatisfaction in women with BN. Rumination led to a significant increase of body dissatisfaction in both eating disorder groups. Results were independent from mood changes. Findings highlight the importance ruminative thinking may have in the aggravation of dissatisfaction with the own body in AN and BN. Results suggest that emotional acceptance is a useful strategy to regulate body dissatisfaction after exposure to thin-ideal media in BN. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Computerized assessment of body image in anorexia nervosa and bulimia nervosa: comparison with standardized body image assessment tool.

    Science.gov (United States)

    Caspi, Asaf; Amiaz, Revital; Davidson, Noa; Czerniak, Efrat; Gur, Eitan; Kiryati, Nahum; Harari, Daniel; Furst, Miriam; Stein, Daniel

    2017-02-01

    Body image disturbances are a prominent feature of eating disorders (EDs). Our aim was to test and evaluate a computerized assessment of body image (CABI), to compare the body image disturbances in different ED types, and to assess the factors affecting body image. The body image of 22 individuals undergoing inpatient treatment with restricting anorexia nervosa (AN-R), 22 with binge/purge AN (AN-B/P), 20 with bulimia nervosa (BN), and 41 healthy controls was assessed using the Contour Drawing Rating Scale (CDRS), the CABI, which simulated the participants' self-image in different levels of weight changes, and the Eating Disorder Inventory-2-Body Dissatisfaction (EDI-2-BD) scale. Severity of depression and anxiety was also assessed. Significant differences were found among the three scales assessing body image, although most of their dimensions differentiated between patients with EDs and controls. Our findings support the use of the CABI in the comparison of body image disturbances in patients with EDs vs. Moreover, the use of different assessment tools allows for a better understanding of the differences in body image disturbances in different ED types.

  2. Executive Functioning and Visuospatial Abilities in Bulimia Nervosa with or without a Previous History of Anorexia Nervosa.

    Science.gov (United States)

    Degortes, Daniela; Tenconi, Elena; Santonastaso, Paolo; Favaro, Angela

    2016-03-01

    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.

  3. The validity of DSM-5 severity specifiers for anorexia nervosa, bulimia nervosa, and binge-eating disorder.

    Science.gov (United States)

    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

    2017-09-01

    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.

  4. Psychological and weight-related characteristics of patients with anorexia nervosa-restricting type who later develop bulimia nervosa

    Directory of Open Access Journals (Sweden)

    Nagata Katsutaro

    2008-02-01

    Full Text Available Abstract Background Patients with anorexia nervosa-restricting type (AN-R sometimes develop accompanying bulimic symptoms or the full syndrome of bulimia nervosa (BN. If clinicians could predict who might change into the bulimic sub-type or BN, preventative steps could be taken. Therefore, we investigated anthropometric and psychological factors possibly associated with such changes. Method All participants were from a study by the Japanese Genetic Research Group for Eating Disorders. Of 80 patients initially diagnosed with AN-R, 22 changed to the AN-Binge Eating/Purging Type (AN-BP and 14 to BN for some period of time. The remaining 44 patients remained AN-R only from the onset to the investigation period. Variables compared by ANOVA included anthropometric measures, personality traits such as Multiple Perfectionism Scale scores and Temperament and Character Inventory scores, and Beck Depression Inventory-II scores. Results In comparison with AN-R only patients, those who developed BN had significantly higher current BMI (p Conclusion The present findings suggest a tendency toward obesity among patients who cross over from AN-R to BN. Low self-directedness and high parental criticism may be associated with the development of BN by patients with AN-R, although the differences may also be associated with depression.

  5. [Family-oriented group therapy in the treatment of female patients with anorexia and bulimia nervosa--a pilot study].

    Science.gov (United States)

    Salbach, Harriet; Bohnekamp, Inga; Lehmkuhl, Ulrike; Pfeiffer, Ernst; Korte, Alexander

    2006-07-01

    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.

  6. The impact of acute stress on the neural processing of food cues in bulimia nervosa: Replication in two samples.

    Science.gov (United States)

    Collins, Brittany; Breithaupt, Lauren; McDowell, Jennifer E; Miller, L Stephen; Thompson, James; Fischer, Sarah

    2017-07-01

    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).

  7. Cortisol awakening response in patients with anorexia nervosa or bulimia nervosa: relationships to sensitivity to reward and sensitivity to punishment.

    Science.gov (United States)

    Monteleone, P; Scognamiglio, P; Monteleone, A M; Perillo, D; Maj, M

    2014-09-01

    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.

  8. Bulimia nervosa and its relation to voice changes in young adults: A simple review of epidemiology, complications, diagnostic criteria and management

    Science.gov (United States)

    Rajiah, Kingston; Mathew, Elizabeth M; Veettil, Sajesh K; Kumar, Suresh

    2012-01-01

    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. PMID:23798933

  9. Altered 5-HT2A Receptor Binding after Recovery from Bulimia-Type Anorexia Nervosa: Relationships to Harm Avoidance and Drive for Thinness

    Science.gov (United States)

    Bailer, Ursula F; Price, Julie C; Meltzer, Carolyn C; Mathis, Chester A; Frank, Guido K; Weissfeld, Lisa; McConaha, Claire W; Henry, Shannan E; Brooks-Achenbach, Sarah; Barbarich, Nicole C; Kaye, Walter H

    2015-01-01

    Several lines of evidence suggest that a disturbance of serotonin neuronal pathways may contribute to the pathogenesis of anorexia nervosa (AN) and bulimia nervosa (BN). This study applied positron emission tomography (PET) to investigate the brain serotonin 2A (5-HT2A) receptor, which could contribute to disturbances of appetite and behavior in AN and BN. To avoid the confounding effects of malnutrition, we studied 10 women recovered from bulimia-type AN (REC AN–BN, >1 year normal weight, regular menstrual cycles, no binging, or purging) compared with 16 healthy control women (CW) using PET imaging and a specific 5-HT2A receptor antagonist, [18F]altanserin. REC AN–BN women had significantly reduced [18F]altanserin binding potential relative to CW in the left subgenual cingulate, the left parietal cortex, and the right occipital cortex. [18F]altanserin binding potential was positively related to harm avoidance and negatively related to novelty seeking in cingulate and temporal regions only in REC AN–BN subjects. In addition, REC AN–BN had negative relationships between [18F]altanserin binding potential and drive for thinness in several cortical regions. In conclusion, this study extends research suggesting that altered 5-HT neuronal system activity persists after recovery from bulimia-type AN, particularly in subgenual cingulate regions. Altered 5-HT neurotransmission after recovery also supports the possibility that this may be a trait-related disturbance that contributes to the pathophysiology of eating disorders. It is possible that subgenual cingulate findings are not specific for AN–BN, but may be related to the high incidence of lifetime major depressive disorder diagnosis in these subjects. PMID:15054474

  10. Identificação de distúrbios da imagem corporal e comportamentos favoráveis ao desenvolvimento da bulimia nervosa em adolescentes de uma Escola Pública do Ensino Médio de Maringá, Estado do Paraná = Identifying body image disorders and behaviors leading to the development of bulimia nervosa in adolescents from a Public High School in Maringá, Paraná State

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    Alice Maria de Souza-Kaneshima

    2008-07-01

    Full Text Available Ciente da importância de estudos de transtornos alimentares em adolescentes, este trabalho identificou a ocorrência de distúrbios da imagem corporal e de bulimia nervosa, em 187 adolescentes. Pelo Body Shape Questionnaire (BSQ, foi demonstrado que 48,13% dos adolescentes apresentaram distúrbios de imagem corporal. A aplicação do Teste de Investigação Bulímica de Edimburgo (BITE demonstrou que 3,74 e 39,04% dos adolescentes apresentaram alto e médio grau de desordem alimentar, respectivamente. Na subescala de gravidade do BITE, verificou-se que 2,67 e 7,49% dos adolescentes apresentaram gravidade alta e moderada de bulimia nervosa. Os resultados demonstram alguns adolescentes com atitudes e comportamentos que favorecem o desenvolvimento da bulimia nervosa, devido à percepção distorcida da própria imagem corporal. Portanto, são necessárias campanhas educacionais para esclarecer que o culto ao corpo está associado a graves transtornos alimentares.Conscious of the importance of studying eating disorders inadolescents, this work identified the onset of body image disorders and bulimia nervosa in 187 adolescents. Using the Body Shape Questionnaire (BSQ, it was shown that 48.13% of adolescents displayed body image disorders. The application of the Bulimic Investigatory Test, Edinbugh (BITE demonstrated that 3.74 and 39.04% of adolescents presented a high or medium level of eating disorder, respectively. In the subscale of BITE severity, it was detected that 2.67 and 7.49% of adolescents showed high and moderated gravity of bulimia nervosa. The results revealed some adolescents with attitudes and behaviors that favor the development of bulimia nervosa, due to a distorted perception of their body image. Therefore, educational campaigns are necessary to clarify that the cult of the body is associated with serious eating disorders.

  11. The influence of factors that define the body image model on the well-being of young women who suffer from anorexia and bulimia and healthy people

    OpenAIRE

    Victoria Carrillo Durán; Alejandro del Moral Agúndez

    2013-01-01

    OBJETIVO DEL ESTUDIO: El modelo estético corporal actual viene determinado por diferentes factores personales y socioculturales, siendo necesario profundizar su influencia e identificar las dimensiones en que se agrupan. METODOLOGÍA: Para eso, se evaluó la actitud de una muestra de 95 mujeres (saludables y enfermas de anorexia y bulimia) frente a la repercusión de su bienestar en determinados factores relacionados con el modelo estético corporal. En segundo lugar, se realizó un análisis facto...

  12. Using latent growth curve modeling in clinical treatment research: An example comparing guided self-change and cognitive behavioral therapy treatments for bulimia nervosa

    OpenAIRE

    Hardy, Sam A; Cornelia Thiels

    2009-01-01

    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 semanale...

  13. Evaluación del autoconcepto, la satisfacción con el propio cuerpo y las habilidades sociales en la anorexia y bulimia nerviosas

    OpenAIRE

    ELENA GISMERO GONZALEZ

    2001-01-01

    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 pre...

  14. The influence of cognitive-behavioural stress management therapy on self-concept personality trait and negative emotions in women with Bulimia nervosa disorder

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    Masiha Eskandari

    2014-03-01

    Full Text Available Background: The etiology of Bulimia nervosa disorder has not been determined yet. The somatic psychological problems need to be addressed in the treatment of these patients. The aim of this study was to determine the influence of cognitive-behavioural stress management training on self-concept personality trait and negative emotions in women with Bulimia nervosa disorder. Methods: The subjects consisted of 50 patients with Bulimia nervosa disorder that were randomly assigned to experimental (25 and control (25 groups. The experimental group received group cognitive behavioural therapy. The BSCT and DASS tests were performed on both groups before and after treatment. The results were analysed by MANCOVA. Results: In terms of self-concept, the results of pre-test and post-test in experimental group were (M: 53.44 and SD: 12.62 and (M:10.48 and SD:14.21, respectively, but for control group, the results of pre-test and post-test were (M: 50.64 and SD: 13.72 and (M: 49.56 and SD:13.75, respectively. In the case of negative emotions; the findings of pre-test and post-test for experimental group were (M: 12.76 and SD: 4.06 and (M:12.08 and SD: 4.06, respectively. However, the results of pre-test and post-test for control group were (M: 27.24 and SD: 4.17, and (M: 26.36 and SD: 4.09, respectively. Within-group comparisons indicated, the pre-test results of self-concept (M: 53.44 and SD: 12.62 were higher than those of the post-test (M: 10.48 and SD:14.21, and the pre-test results of negative emotions in experimental group (M:12.76 and SD:4.06 indicated a little change in the post-test (M:12.08 and SD: 4.06. Conclusion: This study showed that cognitive-behavioural therapy is effective for increasing the self-concept and decreasing negative emotions in patients with Bulimia nervosa disorder (P<0.000.

  15. A season-of-birth/DRD4 interaction predicts maximal body mass index in women with bulimia nervosa.

    Science.gov (United States)

    Levitan, Robert D; Kaplan, Allan S; Davis, Caroline; Lam, Raymond W; Kennedy, James L

    2010-07-01

    We have earlier reported that season of birth interacts with the hypofunctional 7-repeat (7R) allele of the dopamine-4 receptor gene (DRD4) to promote weight gain and obesity in women with seasonal affective disorder (SAD). This study examined whether this gene-environment interaction influences body weight regulation in women with bulimia nervosa (BN). In 188 female probands with BN, we performed an analysis of covariance predicting maximum lifetime body mass index (BMI) using season-of-birth, DRD4 genotype (7R present/absent), and past history of anorexia nervosa (yes/no) as independent variables, and age at maximum weight as the co-variate. Consistent with our SAD study, the birth-season x DRD4 interaction was a significant predictor of maximal BMI. Although in SAD, the spring-birth/7R+ group had markedly elevated maximal BMIs and high rates of obesity, in this BN sample, the fall-birth/7R+ group exhibited the highest BMI values (N=17: mean maximal BMI=28.2 kg/m(2) (SE 0.9) vs 25.2 kg/ m(2) (SE 0.3) for all other probands combined (N=171); p=0.002). The lifetime rate of obesity (BMI>30) was also higher in the fall-birth/7R+ vs 'other' group (29.9 vs 8.8%, respectively, p=0.008). These data offer further evidence that season of birth interacts with the 7R allele of DRD4 to influence body weight regulation in female overeating populations.

  16. Dopamine-related deficit in reward learning after catecholamine depletion in unmedicated, remitted subjects with bulimia nervosa.

    Science.gov (United States)

    Grob, Simona; Pizzagalli, Diego A; Dutra, Sunny J; Stern, Jair; Mörgeli, Hanspeter; Milos, Gabriella; Schnyder, Ulrich; Hasler, Gregor

    2012-07-01

    Disturbances in reward processing have been implicated in bulimia nervosa (BN). Abnormalities in processing reward-related stimuli might be linked to dysfunctions of the catecholaminergic neurotransmitter system, but findings have been inconclusive. A powerful way to investigate the relationship between catecholaminergic function and behavior is to examine behavioral changes in response to experimental catecholamine depletion (CD). The purpose of this study was to uncover putative catecholaminergic dysfunction in remitted subjects with BN who performed a reinforcement-learning task after CD. CD was achieved by oral alpha-methyl-para-tyrosine (AMPT) in 19 unmedicated female subjects with remitted BN (rBN) and 28 demographically matched healthy female controls (HC). Sham depletion administered identical capsules containing diphenhydramine. The study design consisted of a randomized, double-blind, placebo-controlled crossover, single-site experimental trial. The main outcome measures were reward learning in a probabilistic reward task analyzed using signal-detection theory. Secondary outcome measures included self-report assessments, including the Eating Disorder Examination-Questionnaire. Relative to healthy controls, rBN subjects were characterized by blunted reward learning in the AMPT--but not in placebo--condition. Highlighting the specificity of these findings, groups did not differ in their ability to perceptually distinguish between stimuli. Increased CD-induced anhedonic (but not eating disorder) symptoms were associated with a reduced response bias toward a more frequently rewarded stimulus. In conclusion, under CD, rBN subjects showed reduced reward learning compared with healthy control subjects. These deficits uncover disturbance of the central reward processing systems in rBN related to altered brain catecholamine levels, which might reflect a trait-like deficit increasing vulnerability to BN.

  17. The Natural Course of Bulimia Nervosa and Eating Disorder not Otherwise Specified is not Influenced by Personality Disorders

    Science.gov (United States)

    Grilo, Carlos M.; Sanislow, Charles A.; Shea, M. Tracie; Skodol, Andrew E.; Stout, Robert L.; Pagano, Maria E.; Yen, Shirley; McGlashan, Thomas H.

    2013-01-01

    Objective To examine prospectively the natural course of bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS) and to test the effects of personality disorder (PD) comorbidity on the outcomes. Method Ninety-two female patients with current BN (N = 23) or EDNOS (N = 69) were evaluated at baseline enrollment in the Collaborative Longitudinal Personality Disorders Study (CLPS). Eating disorders (EDs) were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders. Personality disorders (PDs) were assessed with the Diagnostic Interview for DSM-IV PD (DIPD-IV). The course of BN and EDNOS was assessed with the Longitudinal Interval Follow-up Evaluation and the course of PDs was evaluated with the Follow-Along version of the DIPD-IV at 6, 12, and 24 months. Results Probability of remission at 24 months was 40% for BN and 59% for EDNOS. To test the effects of PD comorbidity on course, ED patients were divided into groups with no, one, and two or more PDs. Cox proportional regression analyses revealed that BN had a longer time to remission than EDNOS (p < .05). The number of PDs was not a significant predictor of time to remission, nor was the presence of Axis I psychiatric comorbidity or Global Assessment of Functioning scores. Analyses using proportional hazards regression with time-varying covariates revealed that PD instability was unrelated to changes in ED. Conclusions BN has a worse 24-month course (longer time to remission) than EDNOS. The natural course of BN and EDNOS is not influenced significantly by the presence, severity, or time-varying changes of co-occurring PDs, co-occurring Axis I disorders, or by global functioning. PMID:12949923

  18. Nutrient and food group intakes of women with and without Bulimia Nervosa and Binge Eating Disorder during pregnancy

    Science.gov (United States)

    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

    2009-01-01

    Background Little is known concerning the dietary habits of eating disordered women during pregnancy that may lie in the causal pathway of adverse birth outcomes. Objective To examine the nutrient and food group intake of women with bulimia nervosa (BN) and binge eating disorder (BED) during pregnancy and compare their intake to women with no eating disorders. Design Data on 30,040 mother-child pairs are from the prospective Norwegian Mother and Child Cohort Study was used in cross-sectional analyses. Dietary information was collected 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 were conducted using log (means) adjusted for confounding and multiple comparisons. Food group differences were conducted using a Wilcoxon two-sided normal approximation test also adjusting for multiple comparisons. Results Women with BED before and during pregnancy had higher intakes of total energy, total mono-saturated and saturated fat, and lower intakes of folate, potassium, and vitamin C compared to the referent (p<.02). Women with incident BED during pregnancy had higher total energy and saturated fat intake compared to the referent (p=.01). Several differences emerged in food group consumption between women with and without eating disorders including intakes of artificial sweeteners, sweets, juice, fruits and fats. Conclusions Women with BN before and during pregnancy and those with BED before pregnancy exhibit dietary patterns different from women without eating disorders, that are reflective of their symptomatology, and may influence pregnancy outcomes. PMID:18469258

  19. Increased use of antimicrobial medication in bulimia nervosa and binge-eating disorder prior to the eating disorder treatment.

    Science.gov (United States)

    Raevuori, Anu; Lukkariniemi, Laura; Suokas, Jaana T; Gissler, Mika; Suvisaari, Jaana M; Haukka, Jari

    2016-06-01

    We examined the use of antimicrobial medication as a proxy for infections in large patient cohort treated for binge-eating disorder (BED), bulimia nervosa (BN), and anorexia nervosa (AN) over the five-year period preceding eating disorder treatment. Patients (N = 1592) at the Eating Disorder Unit of Helsinki University Central Hospital between 2000 and 2010 were compared with matched general population controls (N = 6368). The study population was linked to the prescription data of antibacterial, antifungal and antiviral medication from the Register on Reimbursed Prescription Medicine. Data were analyzed using regression models. Individuals with BN and BED had received more often antimicrobial medication prescriptions compared to their controls (OR: 1.7, 95% CI: 1.3-2.1; OR: 2.6, 95% CI: 1.4-4.6, respectively), while no significant difference emerged in AN (OR: 0.9, 95% CI: 0.7-1.0, p = 0.10). Of the main drug categories, the respective pattern was seen in antibacterial and antifungal medication, while increased use for antivirals appeared only in BN (OR: 1.6, 95% CI: 1.1-2.3). Measured with the mean number of prescriptions or mean Defined Daily Doses per individual, patients with BN, BED and males with AN had also higher total antimicrobial medication use. Indicating increased infections, we found elevated use of antimicrobial medication in BN, BED and in males with AN. Infections may be consequence of hyperglycemia, weight gain, or dysregulation of intestinal microbiota associated with core eating disorder behaviors. Or the other way round; changes in intestinal microbiota due to infections, inflammation, or antibacterial medications might contribute to eating disorders in multiple ways. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:542-552). © 2016 Wiley Periodicals, Inc.

  20. Significance of overvaluation of shape/weight in binge-eating disorder: comparative study with overweight and bulimia nervosa.

    Science.gov (United States)

    Grilo, Carlos M; Masheb, Robin M; White, Marney A

    2010-03-01

    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.