PS275 Lecture Notes - Conduct Disorder, Diarrhea, Insular Cortex

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1 Feb 2013
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Bulimia Nervosa
Ms Bs beh is BN. Bulimia from a Greek word means ox hunger.
This disorder involves episodes of rapid consumption of a large amount of food, followed by
compensatory beh such as vomiting, fasting or excessive exercise to prevent weight gain
The DSM defines a binge as eating an excessive amount of food within less than two hours.
BN is not diagnosed if the binging and purging occur only in the context of AN and its
extreme weight loss; the diagnosis in such as case is AN binge eating purging subtype
Binges typically occur in secret may be triggered by stress and the negative emotions it
arouses and continue until the person is uncomfortably full.
Stressors that involve negative social interactions may be particularly potent elicitors of
binges.
Bulimics have high levels of interpersonal sensitivity, as reflected in large increases in self-
criticism following negative social interactions.
Further binge episodes tend to be preceded by poorer than average social experiences, self
concepts and moods
Also reported that the binge episodes are followed by deterioration in self concept, mood state
and social perception
The person who is engaged in a binge often feels a loss of control over the amount of food
being consumed. Foods that can be rapidly consumed, esp sweets such as ice cream or cake
are usually part of a binge. Although research suggests that patients with BN sometimes
ingest an enormous quantity of food during a binge.
Binges are not always as large as the DSM implies and there may be wide variation in the
caloric content consumed by individuals with BN during binges. Patients are usually ashamed
of their binges and try to conceal them. They report that they lose control during a binge even
to the point of experiencing something akin to a dissociative state perhaps losing awareness of
what they are doing of feeling that it is not really they who are binging
After the binge is over disgust, feelings of discomfort and fear of weight gain lead to the 2nd
step of BN—[urging to undo the caloric effects of the binge. As seen with Ms. B purging can
involve induced vomiting and excessive exercise. The use of laxatives and diuretics is
common even though this odes not actually result in weight loss
The DSM diagnoses of BN requires that the episodes of binging and purging occur at least
twice a week for three months
Suggesting that there is a continuum of severity rather than a sharp distinction
Like patients with AN patients with BN are afraid of gaining weight and their self esteem
depends heavily on maintaining normal weight.
Observed that a morbid fear of fat is an essential diagnostic criterion for BN cuz 1) it covers
what clinicians and researchers view as the core psychopathology of BN 2) it makes the
diagnosis more restrictive and 3) it makes the syndrome more closely resemble the related
disorder or AN
as with anorexia two subtypes of BN are distinguished: a purging type and a non purging type
in which the compensatory beh are fasting or excessive exercise. And recent evidence does
not strongly support the validity of this distinction
BN typically begins in late adolescence or early adulthood. About 90% of cases are women
and prevalence among women is thought to be about 1 to 2% of the population.
Find tat lifetime rates for females are approx 1.1% of the population for BN and 0.5% of the
population for AN
Suggests that bulimia is more common than anorexia among adolescents
One study found that by age 18 80% of young women in BC with normal height and weight
indicate that they would like to weight less.
Another study of more than 1,800 females from Ottawa, Hamilton, and T,O between the ages
of 12 and 18 found that 27% has disordered eating attitudes and beh and approx 1 in 7
participants engaged in binge eating with associated loss of control
Comparisons across time suggest that the frequency of BN may be increasing.
Cohort effect- with rates being higher among ppl born after 1960 who alsp tend to have
younger ages of onset
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