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weight gains

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 BN- ppl with BN are thought to be overconcnered with weight gain and body appearance- they judge their self worth mainly by their weight and shape. They also have low self esteem and cuz weight and shape are somewhat more controllable than other feature of the self they tend to focu son weight and shape hoping their effots in this area will make them feel better  They try to follow a rigid pattern of eating that has strict rules regarding how much to eat, what kinds of food to eat and when to eat. These rules are broken and the lapse escalates into a binge. After the binge feelings of disgust and fear of becoming fat build up leading to compensatory actions such as vomiting.  Although purging temporarily reduces the anxiety from having eaten too much this cycle lowers the persons self esteem which triggers still more binging and purging vicious cycle that maintains desired body weight but has serious medical consequences  Patients with BN typically binge when they encounter stress and experience negative moods  Bulimia ppl reported more negative moods in the hour just prior to their bineges. The binge may therefore function as a means of regulating negative moods  Evidence also supports the idea that purging is reinforced by anxiety reduction. Ppl with bulimia report increased levels of anxiety when they eat a meal and are not allowed to purge.  Similarly anxiety levels decline after purging TREATMENT OF EATING DISORDERS  The person typically denies that he or she has a problem. For this reason the majority of ppl with eating disorders – up to 90% of them are not in treatment and those who are in treatment are often respectful.  Some ppl with bulimia only wind up in treatment cuz their dentist has spotted one key indicator- the erosion of teeth enamel as a result of the stomach acid coming into contact with the teeth during vomiting  Hospitalization is frequently required to treat ppl with anorexia so that the patients ingestion of food can be gradually increased and carefully monitored.  Weight loss can be severe that intravenous feeding is necessary to save the patients life  For anorexia and bulimia both biological and psychological interventions have been employed Biological Treatments  Cuz BN is often comorbid with depression it has been treated with various antidepressants. Instead has focused on fluoxetine (Prozac)  Fluoxetine was shown to be superior to a placebo in reducing binge eating and vomiting; it also decreased depression and lessened distorted attitudes toward food and eating  Confirm the efficacy of a variety of antidepressants in reducing purging and sometimes even bringing about complete remission  On the negative side many more patients drop out of drug therapy in studies on bulimia than drop out of the kind of cognitive –behavioural interventions  In the multi centre fluoextine study cited almost one third of the patients dropped out before the end of the 8 week treatment primarily cuz of the side effects of the drug.  This figure compares with dropout rates of under 5% with cognitive behavioural therapy. Moreover most patients relapse when various kinds of antidepressant medication are withdrawn  two strategies in combination seem to improve long term outcome in BN: treatment with cognitive behaviour therapy and changing to an alternative antidepressant  drugs have also been used in attempts to treat AN. Unfortunately they have not been very successful. Attempts to treat anorexics weight drugs have proven to be simplistic and to date no drug or class of drugs has emerged as an effective agent to treat patients with this disorder. No drug has led to significant weight gain, changed core features of anorexia or even added significant benefit to a standard impatient treatment program psychological treatment of AN  there is little in the way of controlled research on psychological interventions for AN  therapy for anorexia is generally believed to be a two tiered process. The immediate goal is to help the patient gain weight in order to avoid medical complications and the possibility of death.  Operant-conditioning beh therapy
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