A Qualitative Investigation of the Relapse Experiences of Women with Bulimia Nervosa

This study presents a qualitative analysis of relapse experiences of 26 women with bulimia nervosa who were recruited from Overeaters Anonymous. Using focus groups and individual interviews, participants reported conditions that activated binge eating and/or purging as triggers and described their attempts to manage triggers as an intense effort to arbitrate between high-risk circumstances and their capacity to avoid binging and purging. Responses revealed two broad categories of triggers: (1) internal emotional states and (2) interpersonal relationships. Sixty-one percent of the triggers were related to internal emotional states, whereas dealing with interpersonal relationships accounted for 39%.     

A qualitative investigation of the relapse experiences of women with bulimia nervosa

This study presents a qualitative analysis of relapse experiences of 26 women with bulimia nervosa who were recruited from Overeaters Anonymous. Using focus groups and individual interviews, participants reported conditions that activated binge eating and/or purging as triggers and described their attempts to manage triggers as an intense effort to arbitrate between high-risk circumstances and their capacity to avoid binging and purging. Responses revealed two broad categories of triggers: (1) internal emotional states and (2) interpersonal relationships. Sixty-one percent of the triggers were related to internal emotional states, whereas dealing with interpersonal relationships accounted for 39%.     

Bulimic vomiting alters pain tolerance and mood

Bulimia, a disorder of episodic binging and purging, remains without a known etiology. A case report is presented of a patient who attributed bulimic episodes to efforts at inducing euphoria. Experimental pain tolerance was increased by bulimic vomiting, blocked by naloxone, but not by saline. Vomiting was also associated with falls in depression and anxiety. Plasma ACTH and cortisol, putative markers for beta-endorphin, also rose following vomiting. It is hypothesized that in some bulimics, the disorder arises by virtue of an addiction to one's own internally released endogenous opioid peptides.     

Normal brain tissue volumes after long-term recovery in anorexia and bulimia nervosa.

BACKGROUND: Individuals who are ill with anorexia (AN) and bulimia nervosa (BN) often have increased cerebrospinal fluid (CSF) volumes and decreased total gray and white matter volumes. It is unclear whether such disturbances persist after recovery from an eating disorder. METHODS: Magnetic resonance imaging was performed on 40 women who were long-term recovered (>1 year no binging, purging, or restricting behaviors, normal weight, and menstrual cycles, not on medication) from restricting or binge/purging type AN or BN and 31 healthy control women (CW). Voxel-based morphometry (VBM) was used for data analysis. RESULTS: Recovered AN and BN subgroups were similar to CW in terms of cerebrospinal fluid (CSF) volume as well as total or regional gray or white matter volume. CONCLUSIONS: These findings suggest that structural brain abnormalities are reversible in individuals with eating disorders after long-term recovery.     

The Influence of Heritability, Neuroticism, Maternal Warmth and Media Use on Disordered Eating Behaviors: A Prospective Analysis of Twins

The relative impact of genetic and social influences on disordered eating behaviors (DEB) including binging, purging, excessive dieting and negative self-evaluations about weight remain an issue of debate. The current study sought to examine the relative influence of genetic and social influences on DEB. A 7-year prospective analysis of 580 monozygotic (MZ) and dizygotic (DZ) twins was conducted. Estimates of heritability of DEB were obtained using the DF Analysis Model. Regression equations revealed the relative predictive value of sibling's DEB, neurotic personality, maternal warmth and television and video game exposure on DEB. Heritability estimates for DEB were 0.40 for females and 0.48 for males. Among MZ and DZ twin pairs, female sex, neurotic personality and a genetic variable component, but not maternal warmth or school related problems, predicted DEB. Contrary to the expectations of media effects theory, greater media use was associated with lower DEB among DZ twins and had no influence on MZ twins. These results indicate that DEB is highly heritable and that personality variables may play an important role in the formation of DEB. This suggests that it is important to control for genetic variables when analyzing risk factors for DEB.     

青少年在网上时间、体象满意度和饮食习惯的关联研究

背景:现时互联网在日常生活中扮演着重要角色,尤其是对青少年,他们更关心自己的脸型和体型.尽管有传统媒体对体象满意度影响的大量研究,但很少关注到新媒体(网络)的影响,而且几乎没有青少年在网上时间和体象满意度之间关系的研究.目标:旨在研究7-12年级泰国学生在网上时间、体象满意度和饮食习惯的关系.方法:对来自泰国曼谷6所中学的620名学生进行随机抽样调查.采用自制的媒体和互联网使用行为问卷,青少年和成人的体像自信量表(BESAA)泰国版,肌肉强壮量表(DMS只用于男性),Rosenberg自尊量表泰国版,26项饮食态度测试泰国版(EAT-26)和饮食习惯带来肥胖风险问卷进行测量.结果:受试平均年龄为15.7 (1.9)岁,其中男性246名(39.7％),女性374名(60.3％).从互联网和社交网络获得体象和饮食行为相关内容的上网时间,与身体意象满意度负相关(r=-0.096,p=0.17&r=-0.097,p=0.016),与不恰当的饮食态度/行为、贪食、自我诱导式呕吐、使用泻药/利尿剂,对强壮肌肉获取关注的行为/态度的控制正相关.同时也与饮食习惯带来的肥胖风险相关(r=0.109,p=0.006&r=0.102,p=0.011).结论:上网时间,尤其是花在改善自我形象上的活动、饮食态度及行为,都与体象满意度下降和不良饮食习惯相关.     

Psychodynamic group treatment of young adult bulimic women: preliminary positive results

This paper presents preliminary results of symptomatic and behavioral changes and psychodynamic observations for 9 young adult bulimic women treated with psychodynamic group psychotherapy. Pre/post group test results showed significant improvement on all measures of eating pathology, on the EDI ineffectiveness item and the Janis-Field feelings of inadequacy scale as well as on the total score of the Hopkins Symptom checklist. These results were consistent with independent clinical conclusions and with verbal reports of improvements in binging and purging behaviour. Clinical content shed light on the role of the parents, especially the father, in the development of body-image, sense of adequacy and self-esteem, life goals and feminine identification. The authors conclude that clinical observations to date have yielded interesting psychodynamic hypotheses and the initial symptomatic improvements warrant cautious therapeutic optimism.     

Depression and suicidality in eating disorders

The first 95 patients admitted to an inpatient Eating Disorders Program and diagnosed as having bulimia (binge eating only), bulimarexia (binging and purging), and anorexia nervosa (food restriction only) were evaluated for depression, suicidality, and family history. Major depression was found in 80% of patients; 20% had made suicide attempts in their life; and 40% of those attempting suicide made potentially lethal attempts. Patients with anorexia and bulimarexia tended to be younger, single, and Protestant. Patients with bulimarexia had overeating, oversleeping, more preoccupation with suicide, and more depression in their mothers. Patients with anorexia had more relatives with anorexia and bulimarexia, and patients with bulimia had more relatives with obesity. These findings suggest that eating disorders are unique disorders and not variants of affective disorder or alcoholism.     

A cognitive behavioural group approach for the treatment of bulimia nervosa--a preliminary study

A group treatment for bulimia nervosa based on a cognitive behavioural approach is described. Eight women with a self reported average of 14 binging episodes per week attended a weekly group for 15 weeks. The techniques used in the group are described. Outcome measures included self reported frequency of binging episodes, eating attitudes, depression and anxiety. These were assessed both pre and post treatment. In addition binge frequency was assessed at 3 and 6 month follow up. Binging frequency decreased over the treatment period to an average of 1.1 per week and of 1.9 per week at 6 month follow up. Significant changes in eating attitudes, and a reduction in depression and anxiety were obtained over the treatment period. Although this study was not controlled it may represent a promising step towards the development of a cost-effective treatment for this common condition.     

Treatment of bulimia with phenelzine. A double-blind, placebo-controlled study

Twenty bulimic women of normal weight participated in a double-blind trial studying the effects of a monoamine oxidase inhibitor (MAOI). Nine women received phenelzine sulfate and 11 received placebo. Although phenelzine's side effects were a problem, the phenelzine-treated patients reported significantly fewer binges per week and had a lower Eating Attitudes Test score. Five of the nine phenelzine-treated patients ceased binging entirely and the other four reduced their binge frequency by at least 50%; none of the 11 placebo-treated patients stopped binging and only two reduced their binge frequency by 50% or more. These data demonstrate that phenelzine is significantly more effective than placebo in the treatment of bulimic women of normal weight and suggest a place for MAOIs in the treatment of bulimic patients capable of maintaining a tyramine-free diet.     

Personality-related characteristics in restricting versus binging and purging eating disordered patients

The current study sought to examine differences in personality-related characteristics between restricting anorexia nervosa (RAN), binging/purging anorexia (BPAN), and purging bulimia nervosa (BN) patients. Scores on the Temperament and Character Inventory (TCI) and on the Dutch Eating Behaviour Questionnaire (DEBQ) were compared for 166 RAN, 78 BPAN, and 151 BN patients. Bingers/purgers showed a higher score for restrained, external and emotional eating and a lower score for a subscale of "self-directedness" compared to patients who never binge and purge. Personality differences were most marked between RAN and BN patients, while personality characteristics of BPAN patients tended to be similar to those of BN patients. BN patients showed higher scores on "novelty seeking" and the subscales "exploratory excitability," "impulsivity," and "extravagance," and lower scores on "self-directedness," compared to restricting patients. Moreover RAN patients also showed higher scores on subscales of character dimensions, compared to BN patients. The higher the scores on novelty seeking, the lower the scores on several character scales, which has important implications for the reinforcement of behavior and the treatment of eating disorders.     

Bulimia: independence of antibulimic and antidepressant properties of desipramine

The purpose of this study was to identify variables useful for predicting a positive response to the tricyclic antidepressant desipramine, amongst bulimic subjects. Using a randomized double-blind cross-over design, 24 normal weight bulimics completed a 15-week protocol in which they received either desipramine (150 mg/day) for six weeks, no drug for three weeks, followed by placebo for six weeks, or the reverse sequence. At weeks 0, 2, 4, 6, 9, 11, 13, and 15, each subject was assessed using the EDI, SCL-90, POMS and binge records. The DST, Diagnostic Interview Schedule (DIS), and a personal and family medical-psychiatric history questionnaire were administered at initial assessment, while plasma desipramine levels were obtained at weeks 4 and 13. Responders were defined in terms of both binge frequency reduction, and decrease in depressive symptoms. In the sample of 24 subjects, desipramine was significantly more effective than placebo in reducing the frequency of weekly binging and vomiting, as well as causing a reduction in the fatigue scale of the POMS. No significant effect of the drug was obtained on the EDI or the SCL-90. In terms of reduction in binge frequency, seven responders were identified; another seven were found to be borderline responders, while 10 were labeled as non-responders. The three groups did not differ in terms of their initial scores on the SCL-90, POMS, DST, DIS results, or psychological subscales of the EDI. However, responders were found to have lower EDI bulimia subscale scores, but a higher frequency of purging episodes than were non-responders. Eight patients were identified as borderline responders with respect to depressive symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)     

Psychotherapy of bulimia nervosa: what is effective? A meta-analysis.

The present paper assesses the state of the art of psychotherapy of bulimia nervosa. Five hundred and fifty publications available up to April 1990 were systematically screened. Included in subsequent analysis were all studies with samples of five or more bulimic patients which used operational diagnostic criteria, and reported results of binging and vomiting or other means of purging quantitatively. Only 18 independent studies with a total of 433 patients in 24 treatments and 61 patients in 6 control groups fulfilled these criteria. Therapy outcome across studies was assessed meta-analytically. Therapy process across studies was assessed through ratings of interventions used (behavioural, cognitive, educational, humanistic, psychodynamic techniques and symptom-, conflict-, and relationship-orientation), setting and dose parameters. Settings were out-patients only, mostly group or individual. Most studies were on short-term therapies and follow-ups. Stepwise regression analysis revealed no definite advantage of one setting or therapeutic approach over another. Thirty-six per cent of variance was explained by the number of treatment sessions in combination with relationship orientation.     

Brain activation during the perception of distorted body images in eating disorders

Eating disorder (ED) patients have severe disturbances in the perception of body shape and weight. The authors investigated brain activation patterns during the perception of distorted body images in various subtypes of ED. Participants comprised 33 patients with EDs (11 with restricting-type anorexia nervosa (AN-R), 11 with binging–purging type anorexia nervosa (AN-BP), 11 with bulimia nervosa (BN)) and 11 healthy women. Functional magnetic resonance imaging was used to examine cerebral response to morphed images of subjects' own bodies, as well as that of another woman. The amygdala was significantly activated in AN-R patients, AN-BP patients, and healthy women in response to their own fat-image, but this did not occur in BN patients. The prefrontal cortex (PFC) was significantly activated in AN-BP patients and healthy women, but not in AN-R and BN patients. Our results showed that the various EDs are different with respect to significant activation of the amygdala and PFC during the processing of participants' own fat-image. Brain activation pattern differences between the various EDs may underlie cognitive differences with respect to distorted body image, and therefore might reflect a general failure to represent and evaluate one's own body in a realistic fashion.     

Differences of cortical 5-HT2A receptor binding index with SPECT in subtypes of anorexia nervosa: relationship with personality traits?

OBJECTIVE: Using single photon emission computed tomography and the 5-HT2A receptor antagonist, 123I-5-I-R91150, we explored differences in 5-HT2A binding index in anorexia nervosa patients with and without bulimic features. We also searched for associations between temperament dimensions and cortical 5-HT2) binding. METHOD: About 9 restrictive and 7 bulimic anorexia nervosa patients were examined and cortical 123I-5-I-R91150 binding index values were compared between the two subgroups. Open explorative correlation analysis was used to examine any relationships between binding index values and temperament scores, as assessed with the Temperament and Character Inventory. RESULTS: 5-HT2A binding index was significantly reduced in the parietal cortex in bulimic anorexia nervosa patients in comparison with restrictive anorectics. Further, a positive correlation was documented between reward dependence and parietal 5-HT2A binding index across patients in the two subgroups. DISCUSSION: Restrictive anorexia nervosa patients differ from binging/purging anorexia nervosa patients on the basis of a reduced parietal 5-HT2A binding index in the latter. We speculate that the finding of a positive correlation between parietal 5-HT2A binding and reward dependence might reflect an association between these two variables, at least in anorexia nervosa patients.     

Personality trait risk factors for attempted suicide among young women with eating disorders.

OBJECTIVE: - Clinical observations and a review of the literature led us to hypothesize that certain personality and character traits could provide improved understanding, and thus improved prevention, of suicidal behaviour among young women with eating disorders. METHOD: - The clinical group consisted of 152 women aged between 18 and 24 years, with DSM-IV anorexia nervosa/restrictive type (AN-R = 66), anorexia nervosa/purging type (AN-P = 37), bulimia nervosa/non-purging type (BN-NP = 9), or bulimia nervosa/purging type (BN-P = 40). The control group consisted of 140 subjects. The assessment measures were the Minnesota Multiphasic Personality Inventory-second version (MMPI-2) scales and subscales, the Beck Depression Inventory (BDI) used to control for current depressive symptoms, plus a specific questionnaire concerning suicide attempts. RESULTS: - Suicide attempts were most frequent in subjects with purging behaviour (30.0% for BN-P and 29.7% for AN-P). Those attempting suicide among subjects with eating disorders were mostly students (67.8%). For women with AN-R the scales for 'Depression' and 'Antisocial practices' represented significant suicidal risk, for women with AN-P the scales for 'Hysteria', 'Psychopathic deviate', 'Shyness/Self-consciousness', 'Antisocial Practices', 'Obsessiveness' and 'Low self-esteem' were risk indicators and for women with BN-P the 'Psychasthenia', 'Anger' and 'Fears' scales were risk indicators. CONCLUSION: - This study provides interesting results concerning the personality traits of young women with both eating disorders and suicidal behaviour. Students and those with purging behaviour are most at risk. Young women should be given more attention with regard to the risk of suicide attempts if they: (a). have AN-R with a tendency to self-punishment and antisocial conduct, (b). have AN-P with multiple physical complaints, are not at ease in social situations and have antisocial behaviour, or (c). if they have BN-P and tend to be easily angered with obsessive behaviour and phobic worries. The MMPI-2 is an interesting assessment method for the study of traits indicating a risk of suicidal behaviour in young subjects, after controlling for current depressive pathology.     

Clinical and personality characteristics of adolescents with anorexia nervosa with or without non-suicidal self-injurious behavior

PurposeAbout one-fifth of patients with anorexia nervosa (AN) engage in non-suicidal self-injury (NSSI). This study examined clinical and temperament profile of female adolescents with both disorders (AN+NSSI) as compared with peers with AN only.MethodsA consecutive sample of 73 female adolescents with AN (mean age: 13.77 years), who had been admitted to inpatient or day-hospital services, received clinical, cognitive, and temperament/character evaluations. Of them, 32 met DSM-5 criteria also for NSSI. Assessments included demographics, standard nutrition parameters, Youth Self-Report (YSR), Wechsler Intelligence Scale for Children IV (WISC-IV), Temperament and Character Inventory (TCI), and Global Assessment of Functioning (GAF).ResultsNo differences were detected between AN+NSSI and AN in demographics, body mass index, or age at onset of AN. AN+NSSI had higher rate of binging and purging, higher YSR scores for both internalizing and externalizing psychopathology, lower total IQ, and lower Self-directedness and Cooperativeness scores.ConclusionsThese data suggest that adolescents with AN+NSSI have psychopathological, cognitive and overall character features that differ from patients with AN only. These characteristics may have implications for treatment and outcome.     

Successful self-management of severe bulimia: a case study

A young woman with a nine-year history of bingeing and purging was given instruction in behavioral principles. She then designed and carried out a program that included paced eating of pre-planned meals, following by differential reinforcement of non-purging behaviors, which featured high frequency of reinforcement early in training. Inter-meal "binge-feelings" were treated by reinforcing abstentions. A graded system of contingent exercise also was employed for purging behaviors. Episodes decreased to a low level after one month and were completely absent nine months later. The amelioration of this problem resulted in progress being made for the first time with her emotional problems that were being treated elsewhere by psychodynamic psychotherapy.     

Switching to the bingeing/purging subtype of anorexia nervosa is frequently associated with suicidal attempts

OBJECTIVE: Anorexia nervosa has the highest suicide mortality ratio of psychiatric disorders, suicide being associated with many factors. We assessed the first lifetime occurrence of these factors taking into account their possible overlap. METHOD: Three hundred and four in- and out-patients with anorexia nervosa (DSM-IV) were systematically recruited in three hospitals of Paris suburbs, between December 1999 and January 2003. Patients were assessed by a face-to-face interview (DIGS). Current eating disorder dimensions were measured, and patients interviewed by a trained clinician to assess minimal BMI and, retrospectively, the age at which anorexia nervosa, major depressive disorder, anxiety disorders and switch to bingeing/purging type occurred for the first time, if applicable. RESULTS: Major depressive disorder (p<0.001) and subtype switch from the restrictive to the bingeing/purging type (p<0.001) were the two factors significantly more frequently occurring before suicidal attempts, and remained involved when a multivariate analysis is performed, whether syndromic or dimensional measures are being used. Taking into account lifetime occurrence with a survival analysis, the switch to bingeing/purging type of anorexia appears as a major predictive factor, with a large increase of the frequency of suicidal attempts (OR=15) when compared to patients with neither major depressive disorder nor bingeing/purging type. CONCLUSIONS: Bingeing/purging type of anorexia nervosa is largely associated with suicidal attempts, and may deserve specific attention. If confirmed on a prospectively designed study, these results would argue for early detection and/or more intensive and specific therapeutic intervention on this aspect of bingeing and purging behaviors.     

Associations between negative affect and binge/purge behaviors in women with anorexia nervosa: Considering the role of negative urgency

ObjectiveEvidence implicates negative affect in the occurrence of binge/purge behaviors, although the extent to which theoretically relevant individual difference variables may impact this association remains unclear. Negative urgency, the dispositional tendency to engage in rash action when experiencing negative affect, is a unique facet of impulsivity that may play a key role. Moreover, it was hypothesized that women with anorexia nervosa (AN) who are higher on measures of negative urgency, relative to those lower on negative urgency, would exhibit: 1) greater binge eating and purging frequencies on high negative affect days, and 2) a greater change in negative affect prior to and following binge eating and purging episodes.MethodWomen with AN (n = 82) completed a self-report measure of negative urgency and a 2-week ecological momentary assessment protocol in which they recorded binge eating, purging, and negative affect ratings.ResultsWomen with higher levels of negative urgency exhibited a greater frequency of binge eating and purging; however, in comparison to women low on negative urgency, they: 1) were more likely to binge eat on days corresponding with low-to-moderate negative affect (similar rates of binge eating were observed on high negative affect days), and 2) displayed substantially elevated levels of negative affect across time, and thus, smaller degrees of change in negative affect prior to and following binge eating and purging episodes.DiscussionNegative urgency underlies individual differences in the daily experience of negative affect. Women with AN who are high on negative urgency may have an increased propensity for binge eating and purging via a relatively persistent and heightened state of negative emotions.