Bulimia in adolescents: a review

This report reviews the occurrence of bulimia in female adolescents, a relatively common disorder. Features contributing to its occurrence in adolescents and treatment modalities are highlighted. A high degree of suspicion is needed to make the diagnosis and further work is required to clarify the unique aspects of this disorder in adolescents.

Neuropathy and myopathy in two patients with anorexia and bulimia nervosa

Two adolescent patients with eating disorders and severe weight loss presented with neuromyopathy. The first was female and had a twenty months' history of bulimia nervosa with weight loss and episodic gorging and vomiting. The second was male with a two-year history of anorexia nervosa characterised by vegetarianism and increasing food restriction. Both had severe wasting and asymmetrical weakness of proximal limb muscles. The first patient deteriorated on refeeding and became temporarily paralysed. Both had a purpuric rash and haematological abnormalities. They made a complete recovery on a mixed diet: vitamin supplements were given to the first but not to the second patient.

Psychotherapeutic approaches to anorexia nervosa and bulimia: a selected bibliography

The bibliography contains references to 160 articles on psychotherapeutic approaches to anorexia nervosa and bulimia from journals in psychology, psychiatry, medicine, and allied disciplines. All articles were published between 1970 and 1983 and are written in English. A broad spectrum of psychotherapies is represented.

Anorexia nervosa and bulimia: a review of clinical issues

As increasing numbers of teenage and young adult women of all economic and educational backgrounds seek treatment for eating disorders, primarily anorexia nervosa and bulimia, mental health professionals must become knowledgeable about diagnosis and treatment of these conditions. The author's review of the literature focuses on current and often controversial views about diagnosis, incidence, etiology, and treatment of anorexia nervosa and bulimia. Topics discussed include specific diagnostic criteria; biological, psychodynamic, and psychosocial underpinnings; and experimental pharmacologic and psychotherapeutic treatments. Two case studies illustrating general characteristics of anorexia nervosa and bulimia are presented.

Bulimia: theoretical conceptualizations and therapies

Bulimia, a new entry in our system of nomenclature, has become more prevalent during the past decade and has stimulated a considerable amount of research. It still remains a theoretical and therapeutic puzzle in spite of a variety of efforts to conceptualize it. Treatment approaches are multitudinous and sometimes conflicting, partly due to problems in definition of the disorder, and the role of psychoanalysis is still unclear. This paper surveys current information on bulimia with an emphasis on social, psychological and psychoanalytic theories of its causation and their application to treatment.

Anorexia nervosa, parental 'expressed emotion' and dropping out of treatment

The number of dropouts from a long-term treatment study of patients with anorexia nervosa (AN) and bulimia nervosa (BN) was substantial. A variety of social, clinical, parental, and treatment factors were examined for their association with early termination of treatment by the patient or the family. Parents' expressed emotion' (EE) (particularly critical comments), BN, and the type of therapy offered (family or individual) were found to interact in some manner to result in dropping out. Some other aspects of parents' EE were also examined, including a comparison of scores in parental pairs; EE was found to be influenced by social class, and there were significant associations with the patient's symptomatology and social adjustment. There was a strong relationship between mothers' and fathers' scores in parental pairs.

Eating disorders: assessment and treatment

Anorexia and bulimia are eating disorders affecting a significant number of adolescent and young adult women. The core symptoms of both disorders are similar and include a fear of obesity, body image disturbance, erratic eating patterns, and purging. These symptoms produce significant physical and psychologic complications. Both anorexia and bulimia appear to have a common origin in a fear of obesity and dieting. Anorectics, being "successful" dieters, lose a significant amount of weight; whereas bulimics alternate between binges and purges. Treatment for the eating disorders is gradually evolving as clinical research experience accumulates. For anorexia, hospitalization is indicated when weight falls below 15% of ideal, and most investigators agree that therapy for the core symptoms cannot be undertaken until weight is restored. During the impatient stay, a behavior modification program can effectively organize medical, nutritional, and psychologic support, and offers the quickest and most direct route to weight restoration. The nasogastric tube and total parenteral nutrition are used primarily for those who are severely emaciated or who actively resist standard modes of therapy. Inpatient treatment is most effectively and efficiently rendered in a specialized eating disorder unit. Once weight restoration is progressing, behavior therapy for core symptoms is commenced and continued on an outpatient basis. A variety of behavioral techniques are employed, and they are designed primarily to influence anorectic assumptions and beliefs. Although there may be a brief inpatient stay for initiation of treatment, the bulk of therapy for bulimia occurs on an outpatient basis. The available literature indicates that behavioral techniques and antidepressant medication are effective for the symptoms of bulimia. Early identification of core symptoms of both disorders can lead to an initiation of treatment before the core symptoms become ingrained. A potentially more effective intervention lies in efforts to influence the media. As noted, standards for feminine beauty as portrayed in the media have changed significantly over the past 20 years. An attempt at the primary prevention of eating disorders would include efforts to convince the media to change their standards of femininity from cosmetic slimness to a focus on health and physical fitness. These efforts could stem from professional and lay organizations who have the interest and capability to influence policy.

Group therapy with anorexic and bulimic patients: implications for therapeutic intervention

The incidence of anorexia nervosa and bulimia has increased markedly during the last decade. Although numerous studies have appeared regarding the dynamics of the eating-disordered patient, few have attempted to link the unique pathology of these patients to specific psychotherapeutic interventions. This paper is based on the authors' experience as co-therapists with a group of eating-disordered patients over an eight months' period. It addresses itself to therapeutic interventions related to the particular dynamics of bulimics and anorexics.

Satiety responses in eating disorders

Appetite and satiety responses in a test meal paradigm were studied in six anorexia nervosa patients (four had bingeing and purging behaviors) and in nine normal control women. The anorexic patients were distinguished from normal controls by the amounts of food taken and by the pattern of the hunger and fullness responses to the test meal. Possible explanations for these findings are discussed.