Amanda C., Gloria M., Lucero M., Sergio M., Ashley L., Yamiris
R., Ashley T., Michael F., Cassie P., Austin B., Emilee W., Felicia
H. Bulimia
Slide 2
Evaluate Psyc Research
Slide 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.
Slide 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.
Slide 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
Slide 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
Slide 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
Slide 8
Discuss the interaction of biological, cognitive, and
sociocultural factors
Slide 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
Slide 10
Kendler et al. (1991)
Slide 11
Mazzeo & Bulik (2009) Aim: The experimenters goal was to
explore the relation between perfectionism and psychopathology,
including eating disorders. correlation method/survey: Using
logistic regression, the experimenters calculated odds ratios for
the associations between perfectionism subscale scores and
psychiatric disorders in 1,010 female twins who completed the
Multidimensional Perfectionism Scale and participated in diagnostic
interviews. Finding: Elevated concern over mistakes was associated
with anorexia and bulimia nervosa but not with other psychiatric
disorders. Doubts about actions was associated with eating and
anxiety disorders. Multivariable models confirmed that higher
scores on the subscales for concern over mistakes and doubts about
actions were most strongly associated with eating disorders.
conclusion: The aspect of perfectionism captured by scores on a
subscale measuring concern over mistakes may be particularly
associated with eating disorders and not generically predictive of
psychopathology.
Slide 12
Social Learning Theory
Slide 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.
Slide 14
Describe symptoms and prevalence
Slide 15
Slide 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.
Slide 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.
Slide 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.
Slide 19
Analyze etiologies (Cognitive)
Slide 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.
Slide 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.
Slide 22
Analyze Etiologies (Biological)
Slide 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.
Slide 24
Analyze Etiologies (sociocultural)
Slide 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.
Slide 26
Explain cultural and gender variations
Slide 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
Slide 28
Examine biomedical, individual, and group treatment
Slide 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
individuals 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
Slide 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)
Slide 31
Weight Restoration/Nutrition Education First goal of treatment
is to start gaining a normal weight A healthy diet plan is
created
Slide 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)
Slide 33
Biomedical/ Biological Tricyclic antidepressants and SSRIs 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 hasnt 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.
Slide 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.
Slide 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.
Slide 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. Spannuth family 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.Spannuth Understanding the
familys 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.
Slide 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.
Slide 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 persons needs
Slide 39
Cognitive/Behavioral therapy: Uses strategic techniques to
modify underlying factors of why someone has bulimia- its 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
Slide 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
Slide 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
Slide 42
AdvantagesDisadvantages 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.
Slide 43
Discuss the relationship between etiology and therapeutic
approach
Slide 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 dont 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).
Slide 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.