Lecture 14: Bulimia Nervosa

Question 1

DMS-5 criteria for BN

Answer 1

• recurrent eps of binge eating (binge eating characterised by):
  
  • eating in discrete period of time (within any 2h period):
    amount of food that is rly big
  • lack of control over eating during ep (what or how
    much)
• recurrent compensatory behs like vomiting, laxatives, other medications, fasting, excessive exercising
• binge eating + innap beh= at least once a week for 3 months
• self-evaluation= influenced by body shape + weight
• specify if:
  
  • in partial remission: some criteria–> met for a
    sustained
    period of time
  • in full remission: none of criteria have been met for
    sustained period of time

Question 2

What are comorbid conditions

Answer 2

• substance abuse
• depression
• suicidality
• personality disorders
• anxiety disorders

Question 3

Assessment: EDI-3

Answer 3

• comprehensive assessment of beh + psychological dimensions characteristic of eating disorders
  
  • drive for thinness
  • bulimia
  • ineffectiveness
  • body dissastisfaction
  • perfectionism
  • impulse regulation
  • social insecurity

Question 4

CBT-E: CBT for BN

Answer 4

• usually 20 weeks
• semi-structured
• problem-oriented
• concerned w/ present + future
• 3 stages of treatment

Question 5

CBT: stage 1 aims

Answer 5

• to establish therapeutic relationship
• educate patient about cog. view– explain need for both beh and cog change
• agree on regular weekly weighing
• physical consequences of binge eating (vomiting, laxatives)
• reduce freq. of overeating
• reduce secrecy, get cooperation from friends

Question 6

CBT: stage 2 aims

Answer 6

• tackling dieting
• problem solving skills
• address cog distortions

Question 7

CBT: stage 3 aims

Answer 7

• 3 interviews at 2 week intervals
• to endure that progress is maintained
• relapse prevention
• focus on maintenance of change

Question 8

what is cog. view of maintenance of BN

Answer 8

• low self-esteem
• extreme concerns about shape and weight
• strict dieting
• binge-eating
• self induced vomiting
• constant cycle of going back to low self esteem

Question 9

why is dieting not helpful

Answer 9

• planned healthy meals= more effective= restores control
• if you restrict yourself to not eating fav food (ex chocolate)= you end up eating more of it (backfires)= thats why you need to confront feared food

Question 10

how does sexual abuse connect to eating disorders

Answer 10

• sexual abused people= hunger, fatigue, sexuality becomes difficult to identify
• might turn to food to relieve stress that have nothing to do with hunger= use body to feel, since you don’t feel inside= don’t have internal feelings, so you want to feel externally
• survivors–> either become fat or thin= try to look unattractive
• other survivors–> diet and starve= make body perfect= feel more in control + powerful
• distract themselves by emotional eating

Question 11

what is ego-dystonic

Answer 11

= thoughts, impulses, behaviours that are unacceptable, distressing, inconsistent with their self-concept

• don’t want to admit it
• AN= ego-dystonic
• BN= isn’t ego-dystonic