Bulimia

1. Bulimia Amanda C., Gloria M., Lucero M., Sergio M., Ashley L., Yamiris R., Ashley T., Michael F., Cassie P., Austin B., Emilee W., Felicia H.

2. Evaluate Psyc Research

3. Bruch (1962) • The body-image distortion hypotheses: • Patients with eating disorders suffer from the belief that they are fat. They usually overestimate their body size. • Some patients reflect their emotion appraisal rather than their perceptual experience.

4. Slade and Brodie (1994) • suggest that those who suffer from an eating disorder are in fact uncertain about their size and shape of their own body.

5. Polivy and Herman (1985) • Dieters and non-dieters were asked to take part in a taste test, • They were given a chocolate milkshake and then 3 different types of ice cream. • They were told to eat as much as they wanted, • Dieters ate more than non-dieters

6. Kendler et. al (1991) A twin study • 2000 female twins were studied to show support for genetic diathesis for eating disorders. • 23% concordance rate in monozygotic twins and 9% is dizygotic twins • Differences can be attributed to the way the data was gathered and varying definitions of the disorder. • Self-reporting was not always reliable

7. Jaeger et. al (2002) • Aim was to investigate body dissatisfaction • 1751 medical and nursing students were sampled across 12 nations • Culture was not controlled by researchers • Participants were shown body silhouettes (also culturally varied) to asses body dissatisfaction • Also asked for a self report which obtained data on personal body dissatisfaction, self-esteem, dieting, and behavior • Body max index (height and weight) was measured as well • Differences were found in the cultures • Western countries had the highest body dissatisfaction • This supports the theory that bulimia is due to how culture portrays the ideal body image

8. Discuss the interaction of biological, cognitive, and sociocultural factors

9. Eating disorders – Bulimia • Affective - feelings of inadequacy, guilt, shame • Behavioral - binge eating, vomiting after eating, laxative use, excessive exercising • Cognitive - distorted perception of body, perfectionism • Somatic - irregular menstrual cycle, tooth enamel erosion, gastrointestinal problems, risk of heart palpitations • Affects 2-3% of women • Roughly 5 million experience an eating disorder in US • Some symptoms reported in up to 40% of college women in US (Keel et al., 2006) • 5.79% for women aged 15-29 in Japan

10. Kendler et al. (1991)

11. Mazzeo & Bulik (2009) • Aim: The experimenters’ goal was to explore the relationbetween perfectionism and psychopathology, including eatingdisorders. • correlation method/survey: Using logistic regression, the experimenters calculatedodds ratios for the associations between perfectionism subscalescores and psychiatric disorders in 1,010 female twins who completedthe Multidimensional Perfectionism Scale and participated indiagnostic interviews.  • Finding: Elevated concern over mistakeswas associated with anorexia and bulimia nervosa but not withother psychiatric disorders. Doubts about actions was associatedwith eating and anxiety disorders. Multivariable models confirmedthat higher scores on the subscales for concern over mistakesand doubts about actions were most strongly associated witheating disorders. • conclusion: The aspect of perfectionism capturedby scores on a subscale measuring concern over mistakes maybe particularly associated with eating disorders and not genericallypredictive of psychopathology.

12. Social Learning Theory

13. Interactions • If person has a genetic disposition to suffer from bulimia in their family, but if they cognitively have a strong self image and high self esteem they may never experience it. • This relationship is also present at the sociocultural level of analysis, where if a person has a strong self image and high self-esteem the schema set by society will not affect him or her.

14. Describe symptoms and prevalence

16. Symptoms • Repeatedly eating large amounts of food in a short period of time. • Frequently getting rid of the calories you've eaten by making yourself • vomit, excessive fasting, exercising too much, or misusing laxatives, diuretics, ipecac syrup, or enemas. • Feeling a loss of control over how much you eat. • Having binge-purge cycles. • Feeling ashamed of overeating and very fearful of gaining weight. • Basing your self-esteem and value upon your body shape and weight.

17. Signs of Bulimia • Is very secretive about eating and does not eat around other people. • Has frequent weight changes. May lose large amounts of weight in short periods of time. • Has irregular menstrual cycles. • Seems preoccupied with exercise and often talks of dieting, weight, and body shape • Seems to be overusing laxatives and diuretics. • Has low levels of potassium or other blood electrolyte imbalances. • Looks sick. • Sore gums or mouth sores. • Dry/loose skin. • Thin or dull hair. • Swollen salivary glands. • Bloating or fullness. • Lack of energy. • Teeth marks on the backs of the hands or calluses on the knuckles from self-induced vomiting. • Feels depressed, anxious, or guilty.

18. Prevalence • In the United States, the prevalence of bulimia nervosa is 1%.[4] Lifetime prevalence is 0.5% for males and 1.5% for females. Those who are diagnosed with bulimia nervosa spend approximately 8.3 years with an episode. Approximately 65.3% of patients with bulimia have a body mass index (BMI) between 18.5-29.9 and only 3.5% have a BMI less than 18.5. • Bulimia nervosa is more common among those whose occupation or hobbies require gaining and/or losing weight rapidly, such as wrestlers and competitive bodybuilders.[5] Athletes in certain sports (eg, runners and gymnasts, are particularly prone to eating disorders.[6] The female athlete triad of eating disorders, hypothalamic amenorrhea, and osteoporosis is now well recognized and is particularly common in sports where slimness and body shape are of great importance, such as gymnastics, long distance running, diving, and figure skating. Eating disorders are also being recognized as a problem in predominantly male sports such as cycling, weight lifting, and wrestling. Certain vocations such as acting, modeling, and ballet dancing[7] also appear to be associated with higher risk for these disorders.

19. Analyze etiologies (Cognitive)

20. Body-Image Distortion Hypothesis (Bruch 1962) • Many eating disorder patients suffer from the delusion that they are fat. • Research confirmed they( patients) overestimate their body size, however the studies also showed that the degree of distortion varies considerably with contextual factors, including the precise nature of the instructions given to the subjects. • Some reports given by patients reflect their emotional appraisal instead of their perceptual experience. • Slade and Brodie (1994): suggest that people with eating disorders are in fact uncertain about the size and shape of their body , and that when they are compelled to make a judgement they err on the side of reporting an overestimation of their body size.

21. Cognitive disinhibition • Occurs because of dichotomous thinking- an all –or-nothing approach of judging oneself. Bulimics follow a very strict dieting rules in order to reach the weight that they feel is ideal. When they break their own rules, they tend to binge eat. Thoughts about eating(cognitions) act to release all dietary restrictions(disinhibition). • Polivy and Herman (1985) studied this by carrying out a study where dieters and non-dieters were asked to take part in a taste test. Before the test they were given a chocolate milkshake. After drinking the milkshake they were given three types of ice cream to sample. They were told they could eat as much as they liked. Dieters ate significantly more than non-dieters. • The cognitive explanation that people who suffer from eating disorders suffer from perceptual distortion and maladaptive cognitive patterns is more descriptive than explanatory, as it does not explain how these distortions arise.

22. Analyze Etiologies (Biological)

23. Bulimia Nervosa • Has biological factors that attribute to the disorder. Serotonin, a hormone and neurotransmitter, found in many tissues, including blood platelets, intestinal mucosa, the pineal body, and the central nervous system; it has many physiologic properties including inhibition of gastric secretion, stimulation of smooth muscles, and production of vasoconstriction, defined by medical-dictionary.thefreedictionary.com, appears to play a role in bulimia. Increased serotonin levels stimulate the medical hypothalamus and decrease food intake. • Carraso (2000) found lower levels of serotonin in patients with bulimia. • Smith et at. (1990) found that when serotonin levels wre reduced in recovered bulimic patients, they engaged cognitive patterns related to eating disorders, such as feeling fat. • Also Strober (2000) found that first-degree relativesw of women with bulimia nerversoa are 10 times more likely than average to develop the disorder.

24. Analyze Etiologies (sociocultural)

25. MEDIA!!!! • Due to Media, people have become accustomed to extremely rigid and uniform standards of beauty. People constantly compare themselves to other people which can affect their self esteem. • Many eating disorders begin when a young woman who is not actually overweight comes to believe that she NEEDS to go on a diet. • The media helps shape a strong cultural pressure towards thinness. • Young girls are subjected to distorted models of an ideal body shape through their dolls. Sanders and Bazalgette (1993) analysed the body shape of three of the most popular dolls available for young girls by measuring their height,hips, waist and bust. They then transformed these measurements to apply to a women of average height and found that relative to real women, the dolls all had tiny hips and waists, and greatly exaggerated inside leg measurements. • By the age of 12, body shape can be a major criterion in self evaluation and in the evaluation of others. There are numerous sources of social pressures • Men are also falling under these pressures. In 1993, a MORI survey of adult males in the UK showed that one third of men had been on a diet, and nearly two thirds of the men believed that if they had change in shape, they would become more sexually attractive.

26. Explain cultural and gender variations

27. Usually the girls… • All across the world people suffer from bulimia, it appears in all cultures, and it effects both genders. • The most propionate place where it appears is in the Western Hemisphere, mainly America. • The racial ethnicity it most appears in is Caucasian. While this is still the most propionate, it is slowly changing to more and more racial ethnicity is developing this disorder. • Bulimia usually occurs around the age of the 13, or later in the teen years. • It appears mainly in Females, 95 to 98%, Males 2 to 5 % • The rate of bulimia tripled between 1988 to 1993. • Around 150,00 women die from “diet related causes” which include Bulimia

28. Examine biomedical, individual, and group treatment

29. Psychotherapy • Therapy/Talk therapy/Counseling • Talk about the condition and related issues (depression, stress, etc.) • Talk Therapy • Cognitive behavioral therapy • Based on the idea that the individual’s thoughts determine behavior • Helps to identify unhealthy and/or negative beliefs and behaviors • Family Based Therapy • Family is involved to ensure that healthy patterns are followed • Can help resolve possible family conflicts causing the disorder

30. Medications • Anti-Depressants help to reduce the symptoms of bulimia • The only anti-depressant authorized by the Food and Drug Administration to treat bulimia is fluoxetine (Prozac) which is a type of selective serotonin reuptake inhibitor (SSRI)

31. Weight Restoration/Nutrition Education • First goal of treatment is to start gaining a normal weight • A healthy diet plan is created

32. Hospitilization • Severe bulimia and health complications need hospital treatment • Specialized eating disorder clinics offer intensive inpatient treatment • Remuda Ranch: • Patients engage in group therapy, individual therapy, and experimental treatments • Experimental treatments include: art, body imaging, and equine (horse care, grooming procedures, saddlery, Harness and basic riding)

33. Biomedical/ Biological – • Tricyclic antidepressants and SSRI’s have been investigated in order to treat bulimia.  • McGilly and Pryor (1998) conducted trials where they found that SSRI (Prozac) had very promising results. This trial was described as: “A study with 382 patients conducted by a collaborative study group and published in 1992 found reduction of vomiting in 29 percent of those receiving the drug compared to 5 per cent in those given a placebo” (Crane and Hannibal). The study also showed a reduced amount of binge eating (67 per cent) and purging (56 per cent) when the drug had been taken. • The use of Prozac is considered an acceptable and successful treatment option for those suffering from bulimia. Though there are some biological effects on the existence of bulimia; • The hormone ghrelin has been found to have an immense effect on the prevalence of bulimia because it controls the feelings of hunger and it slows the metabolism of individuals who suffer from any eating disorder (bulimia and anorexia). However, there hasn’t been any research on ways to reduce these levels. • But, other factors such as depression may be one cause for bulimia, and there are biomedical approaches to reduce the consistent need to binge eat and purge thereafter. • Suffering from bulimia with signs of depression they could resort to using Prozac as a biomedical approach to curing their disease. Depression is under the biological etiology because some of the hormones that females have may intensify their depression and thus their needs to binge eat and purge.

34. Individual therapy/ Cognitive • Usually deals with the cognitive functions of the individual and their perception. • Cognitive etiologies for bulimia revolve around “core beliefs, attitudes, and ideas of the bulimia individual and the reinforcement and condition of the core behaviors, binging and purging, in onset and maintenance of bulimia nervosa”. • Development of bulimia strongly correlates with simple cognitive functions such as, memory, judgment and attention. These factors usually affect “body dissatisfaction and distortions”.

35. Individual therapy/ Cognitive • Most individuals suffering bulimia do not seek counseling or treatment; however, those who do seek help are treated with CBT. • This treatment consists of doctors addressing “the cognitive aspects of bulimia, such as obsession with body weight, dichotomous thinking and negative self-image in combination with behavioral components of the disease such as binge eating and vomiting” (Crane and Hannibal). • The aim for this specific therapy is to reinstate control over eating while avoiding any type of dieting because this is known as a trigger for binge eating.  The patients are supposed to record everything they eat and how they feel about it, they are also instructed to record what triggers the need to binge eat and vomit. The patients will then “receive extensive feedback during therapy, and they are taught to identify and deal with symptom triggers (Crane and Hannibal). • Patients learn to improve self-esteem, increase their expressions of feelings an avoid any negative thoughts. • Wilson (1996) found that CBT is extremely successful, and if medication as well as CBT is incorporated into the treatment the success rate doubles. However, Wilson found that overall only 50 per cent of the patients will fully recover.

36. Group therapy Social Cultural • “involve[s] intensive scheduled sessions combined with additional treatment components” (Crane and Hannibal). • There is a psychoanalytical approach to group therapy where family dysfunction is the main focus.. • Families have a tremendous effect on the presence of bulimia. Families observation deal with the little expression of affection or warmth is seen causing tension. • Spannuthfamily systems model promoted by Minuchin has been widely used in family therapy where doctors restructure the family systems to pursue a healthier guideline,“systems because they are made up of interrelated elements or objectives, they exhibit coherent behaviors, they have regular interactions, and they are interdependent on one another. • Understanding the family’s lifestyle and effects as a treatment may help eliminate the need to binge eat and purge • “Schmidt et al. (2007) did a randomized controlled test of CBT and compared it to family therapy in a group of 85 adolescents suffering from bulimia nervosa”(Crane and Hannibal). These approaches together resulted in an extreme reduction of binge eating and vomiting. This study was also successful for it resolved this disease more rapidly than other types of treatment.

37. Group therapy Social Cultural • One of the main causes for Bulimia is socio-cultural factors, due to the media causeing self-inflicted negative view of oneself, the ego and self-esteem are largely affected by this. • McKisack et al. (1997) found that group therapy was extremely successful if the patients had similar characteristics, the therapy “involved intensive scheduled sessions combined with additional treatment components” (Crane and Hannibal). • In terms of socio-cultural factors, group therapy could revolve around the individuals’ perceptions on society and their effect on themselves, having a united opinion may create a more developed understanding of why they are bulimic. • Group therapy could also allow individuals to find ways to ignore advertisements and negative thoughts about their weight, while creating a trusting and friendly environment. This may influence the group to help each other as well as themselves.

38. Discuss the use of eclectic approaches to treatment • Eclectic therapy evaluates the strengths and the limitations of other therapy methods and it personalizes it to one person’s needs

39. Cognitive/Behavioral therapy: • Uses strategic techniques to modify underlying factors of why someone has bulimia- it’s used to break the cycle of binging, dieting and purging • Learn to monitor her thinking and beliefs about food, body shape, and weight. • Recognize the connection between beliefs and behavioral consequences • Goal is to teach behavioral methods are taught, which include self-monitoring, meal planning, stimulus control, and problem solving

40. Interpersonal Group Therapy • This focuses on root causes of the disorder • Many patients with eating disorders are sensitive to criticism psychologist spends more active time and work with an eating disorders group than most other psychotherapy group • The goal is to figure out corrective emotional experiences, so the individual can improve by addressing issues dealing with self-regulation, identity, and personal empowerment

41. Nutritional therapy • Many patients take dietary history, discussion about eating habits, and how they should develop strategies to reduce binge eating • Long term aim to help the person learn about “normal” eating habits

42. Advantages Disadvantages 1. Eclectic approaches have a broader theoretical base and may be more sophisticated than using a single theory. 2. Eclectic approaches offer the psychologist flexibility in treatment. Individual needs are better matched to treatments when more options are available. 3. There are more chances for finding efficacious treatments if two or more treatments are studied in combination. 4. The psychologist using eclectic approaches is not biased toward one treatment. Sometimes eclectic approaches are used in place of a clear theory. Sometimes eclectic approaches are applied inconsistently. 3. There are very few efficacy studies at this stage to support the approach. 4. Eclectic approaches may be too complex for one psychologist.

43. Discuss the relationship between etiology and therapeutic approach

44. Etiology • No single cause of Bulimia. • Low self-esteem, and concerns about weight and/or body image is what triggers one to have Bulimia. • Usually people who suffer from don’t have control of managing their emotions in a healthy way. • Eating may be an emotional release therefore one purges,, and then throws up when they are suffering from depression, anger, stress and/or anxiety. Sometimes the person could suffer from Obsessive Compulsive Disorder (OCD).

45. Therapeutic • Developing a healthy attitude towards the food and your body. • Admitting that you have a problem. • Having someone to talk to. • Being able to stay away from an environment that causes one to stress about the body. Just staying away from people that give the temptation to binge or purge. • Be able to see a professional.