Bulimia
Amanda C., Gloria M., Lucero M., Sergio M.,
Ashley L.,Yamiris R., Ashley T., Michael F., Cassie
P., Austin B., Emilee W., Felicia H.
Evaluate Psyc Research
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.
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.
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
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
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
Discuss the interaction of biological,
cognitive, and sociocultural factors
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
Kendler et al. (1991)
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.
Social Learning Theory
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.
Describe symptoms and prevalence
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.
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.
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.
Analyze etiologies (Cognitive)
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.
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.
Analyze Etiologies (Biological)
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.
Analyze Etiologies (sociocultural)
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.
Explain cultural and gender variations
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
Examine biomedical, individual, and
group treatment
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 individual’s 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
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)
Weight Restoration/Nutrition Education
 First goal of treatment is to start gaining a normal weight
 A healthy diet plan is created
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)
Biomedical/ Biological –
 Tricyclic antidepressants and SSRI’s 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 hasn’t 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.
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”.
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.
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.
 Understanding the family’s 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.
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 selfesteem 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.
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 person’s
needs
Cognitive/Behavioral therapy:
 Uses strategic techniques to modify underlying factors of
why someone has bulimia- it’s 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
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
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
Advantages
 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.
Disadvantages
 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.
Discuss the relationship between
etiology and therapeutic approach
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 don’t 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).
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.