Although several writers have emphasized the habit-like characteristics of bulimia nervosa, no study has investigated the extent to which bulimia responds to treatment specifically for habit disorders. Habit reversal is a general treatment plan which teaches individuals to regain lost awareness of all aspects of a habit. The habit is then interrupted at the earliest movement in the chain by a physically competing response. Habit reversal (Azrin & Nunn, 1973) has been effective in treating other habits (e.g., stuttering, tics, bruxism). In the present study, habit reversal was adapted for the treatment of bulimia. In response to newspaper advertisements, ten females (aged 21-26) with a minimum of two binges/week were included in the study. Bingeing and vomiting ranged from .5/day to 3.57/day during baseline; duration of the disorder ranged from one to eight years. In a multiple-baseline, across-subjects design, subjects were randomly assigned to begin treatment following 14 days of baseline data collection. Subjects self-monitored and reported daily binge eating, vomiting, fasting and laxative use. Daily social contacts and athletic activities were self-monitored and reported as secondary dependent measures. A blood chemistry analysis to assess metabolic functioning, the Beck Depression Inventory (BDI) and the Symptom Checklist 90-Revised (SCL-90R) were administered pre- and post-treatment. Two subjects reported cessation of bulimic episodes during baseline data collection apparently as a result of self-monitoring and frequent phone contacts. A rapid and substantial reduction in the target behaviors for the subjects who received treatment was reported following presentation of habit reversal (mean bingeing reduction=66.7%; mean vomiting reduction=52.0%). As reports of bingeing and vomiting decreased, concomitant increase in reported social contacts and athletic activities was observed in five of seven subjects without treatment for social behavior. Scores on the BDI and SCL-90 R did not change as a function of treatment. However, the self-reported frequency of binge eating during treatment correlated positively with psychopathology (r=.95, p

Seit Jahren wird trotz der stetigen Modernisierung der medizinischen Versorgungsleistungen ein Anstieg der stationären Einweisungen in den psychiatrischen Kliniken registriert. Dabei nutzt eine kleine Gruppe von Patienten, die sogenannten Heavy User, den Großteil der zur Verfügung stehenden therapeutischen Ressourcen. Diese explorative Studie beschreibt eine Gruppe von erwachsenen, weiblichen Heavy Usern (n=23) mit restriktiver bzw. bulimischer Anorexie oder Bulimie, die mindestens drei stationäre Aufnahmen in einer psychiatrischen Klinik aufwiesen. Als Vergleich dient eine Kontrollgruppe von weiblichen Nicht-Heavy Usern (n=13) mit maximal einem stationären Voraufenthalt. Die Ergebnisse zeigen, dass Heavy User mit der Hauptdiagnose einer Essstörung spezifische soziodemographische, diagnostische und psychopathologische als auch Persönlichkeitsmerkmale aufweisen, die eine rechtzeitige Identifizierung dieser Patientengruppe ermöglichen könnten. Der Heavy Use wird als multifaktorielles Geschehen verdeutlicht und die Notwendigkeit einer frühen Identifikation und Intervention betont. Da die bisherigen Studienergebnisse sehr uneinheitliche Resultate lieferten, sind weitere Untersuchungen dieser Patientengruppe unerlässlich. Die Entwicklung alternativer und individueller Therapieansätze ist angezeigt, um passende Versorgungsangebote für diese therapieresistenten Patienten zu schaffen. / Despite the constant modernization of medical services, an increase of inpatient readmissions in psychiatric services has been noted for years. Patients who show a higher extent of use of inpatient medical treatment are known as heavy users. This explorative study describes a group of female adult heavy users (n=23) with at least three inpatient treatments and compares the findings with a control group of female non-heavy user patients (n=13) with a maximum of one previous admission, both suffering from restrictive or purging-type anorexia nervosa or bulimia nervosa. The results of this paper show that heavy users diagnosed with an eating disorder, appear to have individual sociodemographic, diagnostic and psychopathological characteristics as well as particular personality traits, which seemingly contribute to heavy service use and could be taken into consideration for early identification of this treatment resistant group of patients. The findings stress the heavy use as a multifactorial phenomenon and emphasize the need of early identification and intervention. Since prior studies show inhomogenous results, further qualitative analysis is necessary to develop alternative and individual treatment strategies for heavy users.

This study examined the effectiveness of a systemic cybernetic counselling approach with 3 females with bulimia nervosa. Bulimia nervosa is a relatively recent diagnosed condition (1980). Thus, little is known about the efficacy of different treatment approaches. The systemic cybernetic counselling approach (White; de Shazer) which informs family therapy represents a potentially powerful form of treatment in that it allows a complex construction of the problem. The research design employed a multiple (3) single case study approach with embedded units of analyses. The 3 women, aged 17 to 27, were seen over a 2-3 month period for 4-8 one hour sessions. Predicted patterns of non-equivalent dependent variables were compared with empirically based patterns over time. Continuous (including pre-, post-treatment and long-term follow up) assessment of frequency of bingeing/purging was established as well as ratings on other dependent variables - psychometric measures (Eating Disorders Inventory, Beck Depression Inventory, Coopersmith Self Esteem Inventory), affective self reports and reports by others. Results show that all three clients eliminated bingeing/purging by post-treatment. Two clients maintained this improvement on all dependent measures at long-term follow up. The most marked improvements were associated with the least severe pre-treatment scores. In the case where the whole family attended counselling sessions, the number of sessions was reduced. On the basis of the results, systemic cybernetic counselling procedures hold promise for the successful treatment of bulimia nervosa.

The purpose of the present study was to explore the lived experience of friendships among women who were living with bulimia during adolescence. Researchers have found that friendships are influential to the complex and multi-factoral etiology of bulimia. Friendships influence adolescent girls’ self-esteem, body image, dieting, body dissatisfaction, and eating disorder symptoms, through bullying and peer teasing, appearance conversations, and group dieting. While living with bulimia, women have reported interpersonal problems, such as feeling unsupported within their relationships, having fewer friends compared to women who have not lived with bulimia, and isolating themselves from others. There has been limited exploration surrounding the experiences of friendships while living with bulimia, particularly during adolescence. Interpretative phenomenological analysis guided the exploration of three young women’s experience of friendships while they lived with bulimia during adolescence. These women ranged in age from 21 to 25 years. They were recruited via purposive sampling and data were generated through photo elicitation and in-depth interviews. The analyzed data formed one over-arching theme: Tension, which appeared throughout the three super-ordinate themes: The Self-in-Relation to Friends while Living with Bulimia, Friendships in the Shadow of Bulimia, and Internal Conflicts in the Relational Self. These themes were discussed within the context of the current literature followed by recommendations for future research, considerations for mental health professionals, and a conclusion, which included words of wisdom from the participants.

La presa de decisions, entesa com la capacitat d’escollir entre diferent alternatives, és una funció neuropsicològica que ha esdevingut un tema de recerca important dins dels trastorns mentals. S’han trobat dèficits en la presa de decisions en pacients amb lesions de l'escorça prefrontal ventromedial, així com en diversos trastorns mentals com ara els trastorns de la conducta alimentària. Els pacients amb aquests trastorns mostren una incapacitat per prendre decisions avantatjoses i una preferència pel reforç immediat, tot i les conseqüències negatives posteriors. D'altra banda, estudis recents han trobat que alguns trets de la personalitat com la impulsivitat estan relacionats amb la presa de decisions. L'objectiu d'aquest estudi és explorar la presa de decisions en una mostra de pacients amb trastorns de la conducta alimentària i estudiar la relació entre la personalitat i la presa de decisions. Hem dividit la mostra de pacients amb trastorns alimentaris en un grup restrictiu i un grup bulímic-purgatiu. La mostra estava formada per 84 pacients i 38 subjectes control sans. La Iowa Gambling Task es va utilitzar per avaluar la presa de decisions, i la Barratt Impulsiveness Scale (BIS-11), el Temperament and Character Inventory-Revised (TCI-R), el Cuestionario de Sensibilidad al Castigo y Sensibilidad a la Recompensa (SPSRQ), i la Frost Multidimensional Perfectionism Scale (FMP) es van utilitzar per avaluar els trets de la personalitat. Els resultats van confirmar un dèficit en la presa de decisions en pacients amb trastorns alimentaris i van mostrar que la impulsivitat correlacionava negativament amb la IGT només en el grup bulímic-purgatiu, mentre que el perfeccionisme correlacionava positivament amb la IGT només en el grup restrictiu. Aquests resultats suggereixen que el dèficit en la presa de decisions es podria explicar per diferents mecanismes en el grup restrictiu i en el grup bulímic-purgatiu. / Decision-making, defined as the capacity to make decisions about a course of action, is a cognitive function which has become a major research topic within mental disorders. Impairment in decision-making has been found in patients with ventromedial prefrontal cortex lesions, as well as in several mental disorders such as eating disorders. Patients with these disorders show an inability to make advantageous decisions and a preference for immediate reward in spite of future negative consequences. Moreover, recent studies found that some personality traits such us impulsivity are related to decision-making. The aim of this study is to explore decision-making in a sample of eating disorder patients and to examine the relation between personality and decision-making. We divided the eating disorders sample into restricting and binge/purging groups. The sample consisted of 84 patients and 38 healthy control subjects. The Iowa Gambling Task was used to assess decision-making, and the Barrat Impulsiveness Scale (BIS-11), the Temperament and Character Inventory-Revised (TCI-R), the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ), and the Frost Multidimensional Personality Scale (FMPS) were used to assess personality traits. Results confirmed a deficit in decision-making in eating disorder patients and showed that impulsivity was negatively correlated with IGT only in the binge-purging group, whereas perfectionism was positively correlated with IGT only in the restricting group. These intriguing results suggest that decision-making impairment might be explained by different mechanisms in restricting and binge/purging disorders.

En el presente estudio se investiga a la anorexia y bulimia nerviosas, realizando un análisis histórico-crítico de fuentes básicamente bibliográficas. Se hizo uso del método histórico abarcando el espacio de tiempo comprendido entre la antigüedad y la época actual, enfatizando en los períodos de mayor relevancia en la aparición y desarrollo de estos trastornos. Se plantea que: (1) la llegada a Occidente de creencias orientales como las sostenidas por el Jainismo (s. IV) y diseminadas a través de órdenes Mendicantes (Edad Media alta); y, (2) los valores de la ética protestante, promovidos a partir de la Reforma, acompañados del desarrollo de la burguesía y el modo de vida capitalista; fueron dos hitos esenciales en el origen y desarrollo de la anorexia y bulimia nerviosas actuales. / The current research covers the study of eating disorders (anorexia nervosa, bulimia nervosa), essentially through a historical-critical analysis of bibliographic sources. It was used the historical method covering the space of time between the antiquity and the actual era, emphasizing on the periods of major relevance in relation to the origin and development of these eating disorders. It is proposed that: (1) the arrival to Occident of oriental beliefs such as those claimed by the Jainism (s. IV a. D.) and disseminated with the Mendicant orders (High Middle Age); and (2) the values of the protestant ethic, promoted since the Reformation, accompanied with the development of the bourgeoisie and the capitalist way of life; were two landmarks in the origin and development of anorexia nervosa and bulimia nervosa, it means in the history of eating disorders.

Thesis (M.S.)--Brigham Young University. Dept. of Recreation Management and Youth Leadership, 2004. / Includes bibliographical references.

Thesis (Ph. D.)--University of Texas at Austin, 2000. / Vita. Includes bibliographical references (leaves 117-129). Available also in a digital version from Dissertation Abstracts.

Thesis (Ph. D.)--York University, 2000. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 61-83). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pNQ59140.

A review of the literature reveals two significant gaps in existing psychological research into eating disorders. First, despite a clear association between dysfunctional family environment and eating psychopathology, little is known about factors that might mediate between the two. Second, cognitive-behavioural treatment is unexpectedly ineffective in anorexia nervosa or in some cases of bulimia nervosa. To fill these gaps, the present research investigated the role of core beliefs in the aetiology and treatment of eating disorders. Given their early origin, core beliefs may plausibly mediate between family environment and eating disorders. In addition, unhealthy core beliefs might explain the resistance to cognitive-behavioural treatment in some instances. The thesis first considers the relationship between unhealthy core beliefs and eating psychopathology in anorexic and bulimic women. This is followed by an examination of core beliefs as an outcome predictor in cognitive-behavioural treatment for eating disorders. Finally, the role of core beliefs as a mediator between dysfunctional family environment and eating disorders is investigated. The results demonstrate high levels of unhealthy core beliefs in both anorexic and bulimic women. These core beliefs also predict the level of symptom reduction following cognitive-behavioural treatment, but only in the bulimic women. While core beliefs play a perfect mediating role in the family interaction-eating disorders link in bulimia nervosa, this relationship is less clear-cut in anorexia nervosa.