Eating Disorder research has highlighted the role of neuropsychological functioning, informing the treatment of Anorexia Nervosa. There is ambiguity in the data relating to cognitive impairment in Bulimia Nervosa, with the latest review providing inconclusive results. Executive function impairments in the area of set shifting and inhibition reported in BN are proposed to relate to traits of compulsivity and impulsivity. Other psychological disorders have also demonstrated executive function impairments. Among anxiety disorders, only PTSD and OCD have strong evidence of executive function deficits while a number of studies point towards executive function deficits in depression. This thesis aims to investigate the specificity of cognitive impairments seen in a group of female outpatients with bulimia nervosa, using a clinical comparison group of anxious and/or depressed female outpatients. Methods A systematic review was conducted to address a gap in the anxiety disorder literature and assess the neuropsychological profile of panic disorder. In order to address the main study aims, a comparison between a group of patients with BN and an anxious depressed group was conducted on neuropsychological measures of the Trail Making Test, Wisconsin Card Sorting Test, Hayling and Brixton tasks, Stroop and Verbal Fluency. In addition, psychological symptoms were assessed using SCL-90-R, Yale- Brown Obsessive Compulsive Scale and the Self-liking Self Competence scale. Social problems solving skills were assessed as a potential real world effect of executive function difficulties associated with eating disorders. The relationships between psychological and neuropsychological variables were investigated. Results The systematic review concluded that there was limited evidence of specific impairment in short term memory in panic disorder. The empirical study indicated no group differences on the above neuropsychological measures. Groups also did not differ on NART estimated IQ or self reported psychological symptoms. No relationships were found between psychological symptoms and neuropsychological measures. Few individual participants were found to be impaired on neuropsychological measures in either group. However, those impaired in the BN group were exclusively impaired on the non-perseverative errors and categories completed variables of the WCST, which is thought to be related to impulsivity. Conclusion These findings suggest that the neuropsychological profile of bulimia is broadly similar to that of an anxious and/or depressed clinical group on measures of set shifting and inhibition. Although there was evidence of a deficit in inhibition among patients with bulimia further investigation is required.

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.

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.

No description available.

No description available.

Diss. (sammanfattning) Stockholm : Karolinska institutet 2006. / Härtill 4 uppsatser.

VALE, Antonio Maia Olsen do. Comportamento alimentar anormal e práticas inadequadas para controle de peso entre adolescentes do sexo feminino de Fortaleza. 2002. 129 f . Dissertação (Mestrado em Saúde Pública)-Universidade Federal do Ceará, Fortaleza, 2002. / Submitted by denise santos (denise.santos@ufc.br) on 2011-10-31T12:52:21Z No. of bitstreams: 1 2002_dis_amovale.pdf: 372471 bytes, checksum: 8e09fd83f72ad8264a8ea6797d2f7be8 (MD5) / Approved for entry into archive by Eliene Nascimento(elienegvn@hotmail.com) on 2011-11-01T13:34:30Z (GMT) No. of bitstreams: 1 2002_dis_amovale.pdf: 372471 bytes, checksum: 8e09fd83f72ad8264a8ea6797d2f7be8 (MD5) / Made available in DSpace on 2011-11-01T13:34:30Z (GMT). No. of bitstreams: 1 2002_dis_amovale.pdf: 372471 bytes, checksum: 8e09fd83f72ad8264a8ea6797d2f7be8 (MD5) Previous issue date: 2002 / Objectives: characterize eating habits and possible risk factors associated with Eating Disorders, amongst female adolescents in Fortaleza-CE, Brazil. Methodology: transversal study, with 652 women between 14 and 20 years of age, students of the second year of Middle-level education. The Bulimic Investigatory Test Edinburgh (BITE), the Body Shape Questionnaire (BSQ) and the Eating Attitudes Test (EAT-26) were used. Results: 73.6% of the subjects are out of risk for development of an Eating Disorder, 25.2% are at risk and in 1.2% a strong possibility of eating disorder in course was found. The proportion of adolescents who showed risky habits was greater in private schools (p<0.05). According to the EAT-26, 9% of the sample showed a score (>=21) which characterizes them as being at risk and practicing pathological eating habits. The BSQ indicated that 36.2% of the adolescents showed concern with their body image (BI); of these, 61% (n=236) were concerned to a degree considered mild, 26.3% showed a moderate concern and 12.7% showed serious concern with BI. Students at public and private schools demonstrated a similar desire to be thin, but adolescents from private schools more frequently used inappropriate practices in order to reach that wish. Conclusion: Adolescents who demonstrate eating disorders in their clinical form, are a rare phenomenon in public and private schools in Fortaleza, whilst the symptoms of eating disorder, either isolated or in small groups, occur with relevant frequency amongst the population studied. / Objetivo: caracterizar práticas alimentares e os possíveis fatores de risco associados aos Transtornos Alimentares, entre estudantes adolescentes do sexo feminino de Fortaleza-CE. Métodos: estudo transversal, com 652 mulheres de 14 a 20 anos, estudantes do 2º ano do segundo grau. Foram utilizados o Bulimic Investigatory Test Edinburgh (BITE), o Body Shape Questionaire (BSQ) e o Eating Attitudes Test (EAT-26). Resultados: Das adolescentes, 73,6% estão fora de risco para o desenvolvimento de um Transtorno Alimentar, 25,2% delas estão em situação de risco e em 1,2% foram encontrados indicativos para a ocorrência de um transtorno alimentar. A proporção de adolescentes que apresentaram práticas de risco foi superior nas escolas particulares (p<0,05). Segundo o EAT-26, 9% da amostra apresentam uma pontuação (>=21) que caracteriza um estado de situação de risco, além de atitudes alimentares patológicas. O BSQ apontou que 36,2% das adolescentes apresentam preocupação com a imagem corporal; destas 61% tiveram uma preocupação considerada de grau leve, 26,3% apresentaram uma moderada preocupação e 12,7% apresentaram uma grave preocupação com a imagem corporal. A proporção de adolescentes que apresentam preocupação com a imagem corporal em colégios particulares (43%) foi superior à proporção das que estudam em colégios públicos (32,3%), ou seja, a ocorrência de adolescentes com alteração de imagem corporal é maior nos colégios particulares (p<0,05). As estudantes de colégios públicos e particulares demonstraram um desejo similar de serem magras, mas as adolescentes de colégios particulares usam de forma mais freqüente práticas inapropriadas para alcançar este desejo. Conclusão: Adolescentes que apresentam todos os critérios diagnósticos para caracterizar um transtorno alimentar são uma ocorrência rara em escolas públicas e privadas de Fortaleza, enquanto que os sintomas de transtorno alimentar, apresentando-se em pequena mas preocupante quantidade, ocorrem numa freqüência relevante entre a população estudada.