Bulimia nervosa: an ominous variant of anorexia nervosa.
TL;DR: The main aims of treatment are to interrupt the vicious circle of overeating and self-induced vomiting (or purging), and to persuade the patients to accept a higher weight.
Abstract: Thirty patients were selected for a prospective study according to two criteria: (i) an irresistible urge to overeat (bulimia nervosa), followed by self-induced vomiting or purging; (ii) a morbid fear of becoming fat. The majority of the patients had a previous history of true or cryptic anorexia nervosa. Self-induced vomiting and purging are secondary devices used by the patients to counteract the effects of overeating and prevent a gain in weight. These devices are dangerous for they are habit-forming and lead to potassium loss and other physical complications. In common with true anorexia nervosa, the patients were determined to keep their weight below a self-imposed threshold. Its level was set below the patient‘s healthy weight, defined as the weight reached before the onset of the eating disorder. In contrast with true anorexia nervosa, the patients tended to be heavier, more active sexually, and more likely to menstruate regularly and remain fertile. Depressive symptoms were often severe and distressing and led to a high risk of suicide.A theoretical model is described to emphasize the interdependence of the various symptoms and the role of self-perpetuating mechanisms in the maintenance of the disorder. The main aims of treatment are (i) to interrupt the vicious circle of overeating and self-induced vomiting (or purging), (ii) to persuade the patients to accept a higher weight. Prognosis appears less favourable than in uncomplicated anorexia nervosa.
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TL;DR: The Eating Disorder Inventory (EDI) as discussed by the authors is a self-report, multiscale measure designed for the assessment of psychological and behavioral traits common in anorexia nervosa (AN) and bulimia.
Abstract: The development and validation of a new measure, the Eating Disorder Inventory (EDI) is described. The EDI is a 64 item, self-report, multiscale measure designed for the assessment of psychological and behavioral traits common in anorexia nervosa (AN) and bulimia. The EDI consists of eight sub-scales measuring: 1) Drive for Thinness, 2) Bulimia, 3) Body Dissatisfaction, 4) Ineffectiveness, 5) Perfectionism, 6) Interpersonal Distrust, 7) Interoceptive Awareness and 8) Maturity Fears. Reliability (internal consistency) is established for all subscales and several indices of validity are presented. First, AN patients (N = 113) are differentiated from female comparison (FC) subjects (N = 577) using a cross-validation procedure. Secondly, patient self-report subscale scores agree with clinician ratings of subscale traits. Thirdly, clinically recovered AN patients score similarly to FCs on all subscales. Finally, convergent and discriminate validity are established for subscales. The EDI was also administered to groups of normal weight bulimic women, obese, and normal weight but formerly obese women, as well as a male comparison group. Group differences are reported and the potential utility of the EDI is discussed.
4,399 citations
TL;DR: A new transdiagnostic theory of the maintenance of the full range of eating disorders is proposed, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa.
2,659 citations
Cites background from "Bulimia nervosa: an ominous variant..."
...Given that bulimia nervosa was first described relatively recently (American Psychiatric Association, 1980; Russell, 1979), there has been a remarkable amount of research on its treatment....
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TL;DR: It is proposed that binge eating is motivated by a desire to escape from self-awareness, and the escape model is capable of integrating much of the available evidence about binge eating.
Abstract: This article proposes that binge eating is motivated by a desire to escape from self-awareness. Binge eaters suffer from high standards and expectations, especially an acute sensitivity to the difficult (perceived) demands of others. When they fall short of these standards, they develop an aversive pattern of high self-awareness, characterized by unflattering views of self and concern over how they are perceived by others. These aversive self-perceptions are accompanied by emotional distress, which often includes anxiety and depression. To escape from this unpleasant state, binge eaters attempt the cognitive response of narrowing attention to the immediate stimulus environment and avoiding broadly meaningful thought. This narrowing of attention disengages normal inhibitions against eating and fosters an uncritical acceptance of irrational beliefs and thoughts. The escape model is capable of integrating much of the available evidence about binge eating.
2,095 citations
Cites background from "Bulimia nervosa: an ominous variant..."
...…a strategy for taking onels attention off of other, more threatening issues has been proposed in several contexts (Fairburn, Cooper, & Cooper, 1986; Hawkins & Clement, 1984; Herman & Polivy, 1988; Orleans & Barnett, 1984; Russell, 1979; G. T. Smith, Hohlstein, & Atlas, 1989; Thompson et al, 1987)....
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...…depression in the bulimic syndrome (P. J. Cooper & Fairburn, 1986; Devlin & Walsh, 1989; Hatsukami, Mitchell, & Eckert, 1984; Hinz & Williamson, 1987; Laessle, Kittl, Fichter, & Pirke, 1988; Mitchell, Hatsukami, Pyle, & Eckert, 1986a, 1986b; Mizes, 1988; Russell, 1979; Schlesier-Stropp, 1984)....
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...Definitions and Scope of Coverage Bulimia nervosa refers to an eating disorder characterized by frequent bouts of overeating and the habitual use of vomiting or laxatives to compensate for the binges (Russell, 1979)....
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...…a central role in the initial expression of the bulimic syndrome (Abraham & Beumont, 1982; Agras & Kirkley, 1986; Davis et al, 1988; Garfinkel & Garner, 1982; Johnson & Connors, 1987; Polivy & Herman, 1985,1987; Rosen, Tacy, & Howell, 1990; Russell, 1979; Wardle & Beinart, 1981; Williamson, 1990)....
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TL;DR: The BSQ provides a means of investigating the role of concerns about body shape in the development, maintenance, and treatment of anorexia nervosa and bulimia nervosa.
Abstract: Concerns about body shape are common among young women in Western cultures, and, in an extreme form, they constitute a central feature of the eating disorders anorexia nervosa and bulimia nervosa. To date there has been no satisfactory measure of such concerns. A self-report instrument, the Body Shape Questionnaire (BSQ) has therefore been developed. The items that constitute this measure were derived by conducting semistructured interviews with various groups of women including patients with anorexia nervosa and bulimia nervosa. The BSQ has been administered to three samples of young women in the community as well as to a group of patients with bulimia nervosa. The concurrent and discriminant validity of the measure have been shown to be good. The BSQ provides a means of investigating the role of concerns about body shape in the development, maintenance, and treatment of anorexia nervosa and bulimia nervosa.
2,071 citations
TL;DR: Only a minority of people who meet stringent diagnostic criteria for eating disorders are seen in mental health care, and the incidence of anorexia nervosa increased over the past century, until the 1970s.
Abstract: Objective
To review the literature on the incidence and prevalence of eating disorders
Methods
We searched Medline using several key terms relating to epidemiology and eating disorders and we checked the reference lists of the articles that we found Special attention has been paid to methodologic problems affecting the selection of populations under study and the identification of cases
Results
An average prevalence rate for anorexia nervosa of 03% was found for young females The prevalence rates for bulimia nervosa were 1% and 01% for young women and young men, respectively The estimated prevalence of binge eating disorder is at least 1% The incidence of anorexia nervosa is 8 cases per 100,000 population per year and the incidence of bulimia nervosa is 12 cases per 100,000 population per year The incidence of anorexia nervosa increased over the past century, until the 1970s
Discussion
Only a minority of people who meet stringent diagnostic criteria for eating disorders are seen in mental health care © 2003 by Wiley Periodicals, Inc Int J Eat Disord 34: 383–396, 2003
1,490 citations
References
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Book•
01 Jan 1973
TL;DR: General Aspects * Orientation and Point of View * Historical and Sociocultural Perspectives * Biological Basis of Eating Disorders * Hunger Awareness and Individuation * Family Frame and Transactions * Body Image and Self-Awareness Obesity
Abstract: General Aspects * Orientation and Point of View * Historical and Sociocultural Perspectives * Biological Basis of Eating Disorders * Hunger Awareness and Individuation * Family Frame and Transactions * Body Image and Self-Awareness Obesity * Diversity of Clinical Pictures * Obesity in Childhood * Obesity in Adolescence * Obesity and Schizophrenia * Thin Fat People Anorexia Nervosa * History of the Concept of Anorexia Nervosa * Psychogenic Malnutrition and Atypical Anorexia Nervosa * Primary Anorexia Nervosa * Anorexia Nervosa in the Male Treatment * The Practical and Psychological Aspects of Weight Change * Evolution of a Psychotherapeutic Approach * Outcome and Outlook
1,430 citations
TL;DR: This study attempts to document and quantify the shift toward a thinner ideal shape for females in the authors' culture over the last 20 years, including data from Playboy centerfolds and Miss America Pageant contestants and a significant increase in diet articles in six popular women's magazines.
Abstract: The cultural pressures on women to be thin and diet have been linked to the expression of serious eating disorders such as anorexia nervosa. The current study attempts to document and quantify the shift toward a thinner ideal shape for females in our culture over the last 20 years. Data from Playboy centerfolds and Miss America Pageant contestants indicated a significant trend toward a thinner standard. Over the same period there was a significant increase in diet articles in six popular women's magazines. These changes occurred within the context of increasing population weight norms for young women. Biosocial implications including the apparent recent increase in anorexia nervosa are discussed.
1,176 citations
TL;DR: Among predictors of an unfavourable outcome were found a relatively late age of onset, a longer duration of illness, previous admissions to psychiatric hospitals, a disturbed relationship between the patient and other members of the family, and premorbid personality difficulties.
Abstract: This is a prognostic study on 41 patients with anorexia nervosa (including three males) who satisfied defined diagnostic criteria. The patients had all been admitted to a metabolic unit where the mainstay of treatment was nursing care aimed at rapid restoration of body weight. A follow-up was conducted after a minimum lapse of four years after each patient's discharge from hospital. The outcome of the patient's illness was expressed in terms of an 'average outcome score' and a 'general outcome'. The series included a relatively high proportion of patients with a long illness who had received previous psychiatric treatment. Their families tended to come from higher social classes; a disturbed relationship with the patient was frequent. Premorbid disturbances in personality development were also common. The immediate response to treatment was excellent, with the majority of the patients returning to a normal weight, but relapses after discharge were common and readmissions were necessary in half the patients. At follow-up, the patients fell into the following defined categories: 'good' (39%), 'intermediate' (27%), 'poor' (29%), died (5%). Most of the patients who failed to recover continued to display the clinical features characteristic of anorexia nervosa. Among predictors of an unfavourable outcome were found a relatively late age of onset, a longer duration of illness, previous admissions to psychiatric hospitals, a disturbed relationship between the patient and other members of the family, and premorbid personality difficulties. It is suggested according to the severity of their illness, rather than on the method of treatment itself. The illness may last several years before eventual improvement or recovery, and a follow-up study must be extended over at least four years to be meaningful. An accurate prediction of eventual outcome is almost impossible, but late recoveries justify an optimistic outlook and continued therapeutic endeavour.
721 citations