Bulimia Nervosa PDF

11/16/23, 11:18 AM Realizeit for Student Bulimia Nervosa Onset and Clinical Course Bulimia nervosa usually begins in late adolescence or early adulthood; 18 or 19 years is the typical age of onset. Binge eating frequently begins during or after dieting. Between binging and purging episodes, client...

11/16/23, 11:18 AM Realizeit for Student Bulimia Nervosa Onset and Clinical Course Bulimia nervosa usually begins in late adolescence or early adulthood; 18 or 19 years is the typical age of onset. Binge eating frequently begins during or after dieting. Between binging and purging episodes, clients may eat restrictively, choosing salads and other low-calorie foods. This restrictive eating effectively sets them up for the next episode of binging and purging, and the cycle continues. Clients with bulimia are aware that their eating behavior is pathologic, and they go to great lengths to hide it from others. They may store food in their cars, desks, or secret locations around the house. They may drive from one fast-food restaurant to another, ordering a normal amount of food at each but stopping at six places in 1 or 2 hours. Such patterns may exist for years until family or friends discover the client’s behavior or until medical complications develop for which the client seeks treatment. Follow-up studies of clients with bulimia show that as many as 25% or more are untreated. Clients with bulimia had 45% full recovery, while 23% remained chronically ill (Call et al., 2017). One-third of fully recovered clients relapse. Clients with a comorbid personality disorder tend to have poorer outcomes than those without. The death rate from bulimia is estimated at 3% or less. Most clients with bulimia are treated on an outpatient basis. Hospital admission is indicated if binging and purging behaviors are out of control, and the client’s medical status is compromised. Most clients with bulimia have near-normal weight, which reduces the concern about severe malnutrition, a factor in clients with anorexia nervosa. Treatment and Prognosis Cognitive–Behavioral Therapy CBT has been found to be the most effective treatment for bulimia. This outpatient approach often requires a detailed manual to guide treatment. Strategies designed to change the client’s thinking (cognition) and actions (behavior) about food focus on interrupting the cycle of dieting, binging, and purging and altering dysfunctional thoughts and beliefs about food, weight, body image, and overall self-concept. Web-based CBT, including face time with a therapist, has been effective as well as traditionally delivered CBT. Smartphone applications (apps) for eating disorder self-management are also promising and highly acceptable to user groups (Kim et al., 2018). Psychopharmacology Since the 1980s, many studies have been conducted to evaluate the effectiveness of medications, primarily antidepressants, to treat bulimia. Drugs, such as desipramine (Norpramin), imipramine https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 1/2 11/16/23, 11:18 AM Realizeit for Student (Tofranil), amitriptyline (Elavil), nortriptyline (Pamelor), phenelzine (Nardil), and fluoxetine (Prozac), were prescribed in the same dosages used to treat depression. In all the studies, the antidepressants were more effective than were the placebos in reducing binge eating. They also improved mood and reduced preoccupation with shape and weight; however, most of the positive results were short term. It may be that the primary contribution of medications are treating the comorbid disorders frequently seen with bulimia. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 2/2