The Detrition Of Bulimia Nervosa Essay

The Detrition Of Bulimia Nervosa Essay

Bulimia Nervosa is an eating disorder that affects millions of people around the world mentally and physically. Bulimia is the act of binge eating than using an unhealthy method to get rid of the food such as purging or using laxatives. I have chosen this topic because I was one of those millions affected by this disorder. Like many others, I could never bring myself to do any sort of research about the effects it may cause. There are many major issues with this disorder that affect a person physically, socially, psychologically and financially. The Detrition Of Bulimia Nervosa Essay. In addition, bulimia nervosa can also affect one’s family and society. However, through all the negativity, there are coping strategies and community resources to help all individual.

Firstly, there are a handful of dangerous and life-threatening problems associated with bulimia. Some physical health effects include dental problems, electrolyte abnormalities, intestinal problems, scarred hands from excessive vomiting, esophagus issues and the list can go on. For example, a dental problem that is most likely to occur is tooth decay. For instance, when a person goes through a purging episode, the acid from one’s stomach will start to cause the tooth enamel to break down. On the other hand, bulimia can also affect a person’s social interactions.

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Many people who suffer from this disorder can also suffer from depression, anxiety or PTSD. Bulimia can quickly take over a person’s life, it becomes hard for the individual to bring themselves to any kind of social event or environment where there will be food. For example, I have personally found myself canceling events and plans weekly because there would be food around. It ruined my social interactions. Another aspect of a person’s life that bulimia can affect is their psychological health. Majority of people that suffer from bulimia live in fear constantly. For instance, they may become fearful of whether or not all of the food will be purged and fearful of increased weight gain. The fear of food and weight gain can quickly add stress and anxiousness during their daily life. In addition, this may cause the individual to become irritable and cranky towards others and themselves.The Detrition Of Bulimia Nervosa Essay.  Apart from one’s daily life is employment. Sadly, employment can also affect a person suffering from bulimia by draining them physically and mentally. In order to do a job, you need to be physically awake and ready to do the tasks given. In addition, you would need to be mentally stable in order to work with coworkers or clients and patients depending on their occupation.

However, people who deal with bulimia become fatigue from purging and feel consumed by food and weight. So, they may not be able to perform their tasks efficiently or properly. Furthermore, bulimia can also become a burden on an individual’s financial state. For instance, a portion of bulimia is the act of binge eating up to 20,000 calories a day. So, this can become costly since food does cost money. For example, I personally have spent hundreds of dollars in just a few weeks trying to feed my disorder. It can also become costly if something were to happen to an individual. Bulimia can send an individual to the hospital multiple times or treatment centers.

Secondly, there is a great deal of impact on the individual suffering from bulimia’s family and society. When someone’s family is involved in their life, they want nothing but the absolute best and healthiest life possible. However, bulimia can quickly or gradually tear a family apart. In most cases, a family will feel a mix of emotions such as hopelessness because they can’t make them stop or responsible for not noticing. In addition, they can feel tension, guilt, anger or frustration. Comparatively, bulimia can also have an impact on our society. From the moment that we are born, we are surrounded by advertisement, social media, and television. It is inevitable that we will grow up comparing ourselves to others around us. The more we progress in life, the more we feel a certain significant value in physical appearance such as body image. Additionally, in our society, we attach a thin body image with happiness.

As if we reach our goal all of our problems will disappear. Furthermore, this creates unhealthy habits physically and mentally. Lastly, as a PSW, I would feel an enormous amount of empathy for my client and their family. I would give each of the different kinds of coping strategies and coping mechanisms. As for the client, I would tell them that the first thing you need to do is confide into someone you trust. The Detrition Of Bulimia Nervosa Essay. Everyone will always need someone whether it be a parent, friend or spousal that he or she can depend on to immediately relieve them of some amount of stress. In addition, I would tell them to keep a journal with them, and every time they feel like they have an urge to binge and purge, write every single thought and feeling you have about it and yourself. Even if they do cave in and binge and purge, write everything down. The moment you feel like relapsing again, read the journal. So, once they read the amount of guilt and depression, it can help prevent another episode. As for the family, I would let them know that the best thing they can do is be supportive. Instead of getting angry, they need to understand the disorder.

So, I would ask them to do research about all aspects of it. Although it can be scary, it can also bring perspective. Without the knowledge, a family could become angry quickly and not understand how to handle the situation. I would also recommend the family to start a healthy life with the client. Sometimes, a healthier lifestyle with a balanced diet and exercise can show the client that life can be amazing and they can feel absolutely amazing without having food and weight be their entire life. Lastly, I would tell the family to be patient. An eating disorder doesn’t go away overnight. Their loved ones depend on them to be there for them even if they don’t fully understand. Furthermore, for all eating disorders, community resources can be very helpful.

In conclusion, bulimia nervosa is an eating disorder that affects all aspects of an individual’s life. These can include physical health, social interactions, psychological well-being, financial state, employment and impact on family and society. No matter how long one person has been doing it, it is a dangerous and life-threatening disorder that can quickly take over your life physically and mentally. However, no matter the circumstances, recovery is always a viable option. In a life of comparison, addiction, and danger choose to be healthy and the best you possible. The Detrition Of Bulimia Nervosa Essay.

Up to 1% of young women may have bulimia nervosa, characterised by an intense preoccupation with body weight, uncontrolled binge-eating episodes, and use of extreme measures to counteract the feared effects of overeating. People with bulimia nervosa may be of normal weight, making it difficult to diagnose. After 10 years, about half of people with bulimia nervosa will have recovered fully, one third will have made a partial recovery, and 10% to 20% will still have symptoms.

Methods and outcomes

We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for bulimia nervosa in adults? What are the effects of discontinuing treatment in people with bulimia nervosa in remission? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

Results

We found 27 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

Conclusions

In this systematic review we present information relating to the effectiveness and safety of the following interventions: cognitive behavioural therapy (CBT; alone or plus exposure/response prevention enhancement), cognitive orientation therapy, dialectical behavioural therapy, discontinuing fluoxetine in people with remission, guided self-help cognitive behavioural therapy, hypnobehavioural therapy, interpersonal psychotherapy, mirtazapine, monoamine oxidase inhibitors (MAOIs), motivational enhancement therapy, pharmacotherapy plus psychotherapy, pure or unguided self-help cognitive behavioural therapy, reboxetine, selective serotonin reuptake inhibitors (SSRIs), topiramate, tricyclic antidepressants (TCAs), and venlafaxine.The Detrition Of Bulimia Nervosa Essay.

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Key Points

Up to 1% of young women may have bulimia nervosa, characterised by an intense preoccupation with body weight, uncontrolled binge-eating episodes, and use of extreme measures to counteract the feared effects of overeating.

  • People with bulimia nervosa may be of normal weight, making it difficult to diagnose.

  • Obesity has been associated with both an increased risk of bulimia nervosa and a worse prognosis, as have personality disorders and substance misuse.

  • After 10 years, about half of people with bulimia nervosa will have recovered fully, one third will have made a partial recovery, and 10% to 20% will still have symptoms.

Cognitive behavioural therapy for bulimia nervosa (CBT-BN) may improve clinical problems of bulimia nervosa compared with no treatment, and may be as effective in reducing symptoms as interpersonal psychotherapy at 1 year, or as other psychological treatments, or antidepressants. However, we found no RCTs meeting eligibility criteria comparing the efficacy of interpersonal psychotherapy with waiting list control.

  • We don’t know whether other psychological therapies such as cognitive orientation therapy, hypnobehavioural therapy, dialectical behavioural therapy, or motivational enhancement therapy are more effective than a waiting list control at improving symptoms, as we found only a few trials.

  • We found insufficient evidence to support enhancing CBT-BN with exposure and response prevention (ERP). The Detrition Of Bulimia Nervosa Essay.

  • Pure or unguided self-help CBT is likely to be no more effective than waiting list control at reducing binge eating.

  • The evidence we found for guided self-help CBT is insufficient to judge this intervention because of high attrition in trials.

Some antidepressant drugs (fluoxetine, citalopram, desipramine, and imipramine) may improve symptoms in people with bulimia nervosa compared with placebo.

  • Monoamine oxidase inhibitors (MAOIs) may increase remission rates compared with placebo, but may not reduce bulimic symptoms or depression scores.

  • We don’t know whether other antidepressants (topiramate, mirtazapine, reboxetine, or venlafaxine) can improve symptoms or remission in people with bulimia nervosa.

We don’t know whether continuation of antidepressant treatment may maintain a reduction in vomiting frequency compared with withdrawing treatment in people in remission.

We don’t know if combining pharmacotherapy with psychotherapy enhances outcome. Trials that have suggested combinations may enhance outcomes have been limited in power.

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About this condition
Definition

Bulimia nervosa is an intense preoccupation with body weight and shape, with regular episodes of uncontrolled overeating (binge eating) associated with extreme measures to counteract the feared effects of the overeating. If a person also meets the diagnostic criteria for anorexia nervosa, then the diagnosis of anorexia nervosa takes precedence.Bulimia nervosa can be difficult to identify because of extreme secrecy about binge eating and purgative behaviour. Weight may be normal, but there is often a history of anorexia nervosa or of restrictive dieting. Some people alternate between anorexia nervosa and bulimia nervosa.The Detrition Of Bulimia Nervosa Essay. Nearly all cases of bulimia nervosa identified in a national community survey featured an additional psychiatric disorder, and common comorbidities were mood, anxiety, impulse control, and substance-misuse disorders.Some RCTs included people with subthreshold bulimia nervosa, or with a related eating disorder, binge-eating disorder. Where possible, only results relevant to bulimia nervosa are reported in this review.

Incidence/ Prevalence

In community-based studies, the prevalence of bulimia nervosa is between 0.5% and 1.0% in young women, with an even social-class distribution. About 90% of people diagnosed with bulimia nervosa are women. The numbers presenting with bulimia nervosa in industrialised countries increased during the decade after its recognition in the late 1970s, although the incidence has plateaued or even fallen since then, with an incidence of new diagnoses at 6.6 per 100,000 in 2000. A “cohort effect”, with an increasing incidence, has been reported in community surveys. The prevalence of eating disorders such as bulimia nervosa is lower in non-industrialised populations and varies across ethnic groups. African-American women have a lower rate of restrictive dieting compared with white American women, but they have a similar rate of recurrent binge eating.

Aetiology/ Risk factors

The aetiology of bulimia nervosa is complex, but sociocultural pressures to be thin and the promotion of dieting seem to increase risk. One community-based case-control study compared 102 people with bulimia nervosa versus 204 healthy controls, and found higher rates of obesity, mood disorder, sexual and physical abuse, parental obesity, substance misuse, low self-esteem, perfectionism, disturbed family dynamics, parental weight/shape concern, and early menarche in people with the eating disorder. The Detrition Of Bulimia Nervosa Essay.Heritability is high, ranging from 28% to 83% in one review; although it has been suggested that genotypic variations map onto intermediate phenotypes, such as traits of affective instability and impulsivity, rather than onto a “gross” bulimia nervosa phenotype.

Prognosis

A 10-year follow-up study (50 people with bulimia nervosa from a placebo-controlled trial of mianserin treatment) found that 52% of people receiving placebo had fully recovered, and only 9% continued to experience full symptoms of bulimia nervosa. A larger study (222 people from a trial of antidepressants and structured, intensive group psychotherapy) found that, after a mean follow-up of 11.5 years, 11% still met criteria for bulimia nervosa, whereas 70% were in full or partial remission. Short-term studies found similar results: about 50% of people made a full recovery, 30% made a partial recovery, and 20% continued to be symptomatic. One study (102 women) of the natural course of bulimia nervosa found that 31% continued to have the disorder at 15 months and 15% continued to have the disorder at 5 years. Only 28% received treatment during the follow-up period. A 5-year naturalistic study of 23 people with bulimia nervosa found a 74% remission at 5 years, with a 47% probability of relapse within the 5-year follow-up study in those in remission. There are few consistent predictors of long-term outcome. Good prognosis has been associated with shorter illness duration, a younger age of onset, higher social class, and a family history of alcohol abuse. The Detrition Of Bulimia Nervosa Essay. Poor prognosis has been associated with a history of substance misuse, premorbid and paternal obesity,and, in some studies, a personality disorder. In an evaluation of the response to cognitive behavioural therapy (CBT), outcome was best predicted by early progress (reduction in purging of >70% by session 6). However, a subsequent systematic review of the outcome literature found no consistent evidence to link early intervention with a better prognosis. A systematic review evaluating the cost effectiveness of treatments and prognostic indicators found only 4 consistent pretreatment predictors of poor outcome for treatment of bulimia nervosa: features of borderline personality disorder, concurrent substance misuse, low motivation for change, and a history of obesity. A consistent post-treatment predictor of a better outcome is an early response to treatment. A more recent systematic review (search date 2009, 3 RCTs, 22 retrospective non-controlled studies) also found features of borderline personality disorder to be associated with treatment withdrawal, but this review included studies of eating disorder (not otherwise specified) and anorexia nervosa as well as bulimia nervosa.

Aims of intervention

To reduce symptoms of bulimia nervosa; to improve general psychiatric symptoms; to improve social functioning and quality of life; to minimise the adverse effects of treatment.

Outcomes

Symptom improvement Frequency of binge eating or bingeing, abstinence from binge eating or bingeing, frequency of behaviours to reduce weight and counter the effects of binge eating, severity of extreme weight and shape preoccupation, severity of general psychiatric symptoms, severity of depression, improvement in social and adaptive functioning, remission rates, relapse rates, withdrawal rates, quality of life, and adverse effects. The Detrition Of Bulimia Nervosa Essay.

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Methods

Clinical Evidence search and appraisal January 2010. The following databases were used to identify studies for this systematic review: Medline 1966 to January 2010, Embase 1980 to January 2010, and The Cochrane Database of Systematic Reviews 2009, Issue 4 (1966 to date of issue). An additional search within The Cochrane Library was carried out for the Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment (HTA). We also searched for retractions of studies included in the review. Abstracts of the studies retrieved from the initial search were assessed by an information specialist. Selected studies were then sent to the contributor for additional assessment, using predetermined criteria to identify relevant studies. Study design criteria for inclusion in this review were: published systematic reviews and RCTs in any language containing >20 individuals of whom >80% were followed up. There was no minimum length of follow-up required to include studies. We included studies described as “open”, “open label”, or not blinded. We included systematic reviews of RCTs and RCTs where harms of an included intervention were studied applying the same study design criteria for inclusion as we did for benefits. We also searched for systematic reviews and RCTs on the harms of topiramate for eating disorders. In addition, we use a regular surveillance protocol to capture harms alerts from organisations such as the FDA and the MHRA, which are added to the reviews as required. The Detrition Of Bulimia Nervosa Essay. To aid readability of the numerical data in our reviews, we round many percentages to the nearest whole number. Readers should be aware of this when relating percentages to summary statistics such as relative risks (RRs) and odds ratios (ORs). We have performed a GRADE evaluation of the quality of evidence for interventions included in this review (see table). The categorisation of the quality of the evidence (high, moderate, low, or very low) reflects the quality of evidence available for our chosen outcomes in our defined populations of interest. These categorisations are not necessarily a reflection of the overall methodological quality of any individual study, because the Clinical Evidence population and outcome of choice may represent only a small subset of the total outcomes reported, and population included, in any individual trial. For further details of how we perform the GRADE evaluation and the scoring system we use, please see our website (www.clinicalevidence.com). The Detrition Of Bulimia Nervosa Essay.

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