{"id":721,"date":"2020-08-10T15:36:37","date_gmt":"2020-08-10T15:36:37","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/abnormalpsych\/?post_type=chapter&#038;p=721"},"modified":"2024-07-01T17:32:01","modified_gmt":"2024-07-01T17:32:01","slug":"bulimia-nervosa","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/chapter\/bulimia-nervosa\/","title":{"raw":"Bulimia Nervosa and Binge-Eating Disorder","rendered":"Bulimia Nervosa and Binge-Eating Disorder"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning Objectives<\/h3>\r\n<ul>\r\n \t<li>Describe the characteristics, complications, and health outcomes of bulimia nervosa<\/li>\r\n \t<li>Explain binge eating disorder<\/li>\r\n<\/ul>\r\n<\/div>\r\nPeople suffering from <strong>bulimia nervosa<\/strong> engage in binge eating behavior that is followed by an attempt to compensate for a large amount of consumed food. Purging the food by inducing vomiting or through the use of laxatives are two common compensatory behaviors. Some affected individuals engage in excessive amounts of exercise to compensate for their binges.\r\n\r\nPeople with bulimia nervosa may be slightly underweight, normal weight, or overweight.\r\n\r\nSymptoms include the following:\r\n<ul class=\"ul_default\">\r\n \t<li class=\"generic-container\">chronically inflamed and sore throat<\/li>\r\n \t<li class=\"generic-container\">swollen salivary glands in the neck and jaw area<\/li>\r\n \t<li class=\"generic-container\">worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acid<\/li>\r\n \t<li class=\"generic-container\">acid reflux disorder and other gastrointestinal problems<\/li>\r\n \t<li class=\"generic-container\">intestinal distress and irritation from laxative abuse<\/li>\r\n \t<li class=\"generic-container\">severe dehydration from purging of fluids<\/li>\r\n \t<li class=\"generic-container\">electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals), which can lead to stroke or heart attack<\/li>\r\n<\/ul>\r\nBulimia is associated with many adverse health consequences that can include kidney failure, heart failure, and tooth decay. In addition, these individuals often suffer from anxiety and depression, and they are at an increased risk for substance abuse (Mayo Clinic, 2012b).\r\n\r\nThe lifetime prevalence rate for bulimia nervosa is estimated at around 1% for women and less than 0.5% for men (Smink, van Hoeken, &amp; Hoek, 2012). The rates of bulimia increased during the 1980s and early 1990s and have remained stable since then.\u00a0Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors.\r\n<div class=\"textbox exercises\">\r\n<h3>Dig Deeper: Bulimia<\/h3>\r\n[caption id=\"attachment_2007\" align=\"aligncenter\" width=\"484\"]<img class=\"wp-image-2007\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/09\/16144335\/princess-diana-397649_1920-1024x683.jpg\" alt=\"Princess Diana dancing with John Travolta in an elegant black dress.\" width=\"484\" height=\"322\" \/> <strong>Figure 1<\/strong>. Princess Diana spoke openly about her struggles with bulimia.[\/caption]\r\n\r\n&nbsp;\r\n\r\nAn iconic fashion figure and celebrity, Princess Diana was a prominent public figure that was open about how bulimia affected her life. Read <a href=\"https:\/\/www.eatingdisorderhope.com\/blog\/bulimia-princess-dianas-ed\" target=\"_blank\" rel=\"noopener\">this article about how Princess Diana struggled and how she attempted to use bulimia as a coping mechanism<\/a> to deal with some of her life stressors.\r\n\r\n<\/div>\r\n<div class=\"textbox examples\">\r\n<h3>Watch It<\/h3>\r\nWatch this video to review the basics about anorexia and bulimia, and contrast those with the obsessive-compulsive related body dysmorphic disorder.\r\n\r\n<iframe src=\"https:\/\/www.youtube.com\/embed\/eMVyZ6Ax-74?start=260\" width=\"800\" height=\"470\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe>\r\n\r\nYou can <a href=\"https:\/\/oerfiles.s3-us-west-2.amazonaws.com\/Psychology\/Transcriptions\/EatingandBodyDysmorphicDisordersCrashCoursePsychology33.txt\" target=\"_blank\" rel=\"noopener\">view the transcript for \"Eating and Body Dysmorphic Disorders: Crash Course Psychology #33\" here (opens in new window)<\/a>.\r\n\r\n<\/div>\r\n<div class=\"textbox key-takeaways\">\r\n<h3>Key Takeaways: Bulimia Nervosa<\/h3>\r\n<iframe src=\"https:\/\/lumenlearning.h5p.com\/content\/1291229056700018878\/embed\" width=\"1088\" height=\"637\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><script src=\"https:\/\/lumenlearning.h5p.com\/js\/h5p-resizer.js\" charset=\"UTF-8\"><\/script>\r\n\r\n<\/div>\r\n<h2>Binge-Eating Disorder<\/h2>\r\nBinge-eating disorder (BED) is the most prevalent eating disorder, affecting approximately 2.8% of females and 1% of males.[footnote]Galmiche M, D\u00e9chelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000-2018 period: a systematic literature review. <em>American Journal of Clinical Nutrition<\/em> (2019) 109:1402\u201313. doi: 10.1093\/ajcn\/nqy342[\/footnote] Binge-eating disorder (BED) is characterized by recurrent episodes of binge eating that are not combined with compensatory methods to avoid weight gain. Thus, the majority of\u00a0binge-eating disorder (BED) cases are overweight or obese.\u00a0Unlike bulimia, BED binges are not followed by purging.[footnote]Cury MEG, Berberian A, Scarpato BS, Kerr-Gaffney J, Santos FH and Claudino AM (2020) Scrutinizing Domains of Executive Function in Binge Eating Disorder: A Systematic Review and Meta-Analysis. <em>Frontiers in Psychiatry<\/em> 11:288. doi: 10.3389\/fpsyt.2020.00288[\/footnote]. Of those patients affected, research estimates that 28.4% of people with current BED are receiving treatment and 43.6% of people with BED will receive treatment at some point in their lives.[footnote]Statistics &amp; Research on Eating Disorders. National Eating Disorders Association. (2020, May 8). https:\/\/www.nationaleatingdisorders.org\/statistics-research-eating-disorders.[\/footnote]\r\n\r\nBinge eating is the core symptom of BED; however, not everyone who binge eats has BED. An individual may occasionally binge eat without experiencing many of the negative physical, psychological, or social effects of BED. This example may be considered an eating problem (or not), rather than a disorder. Precisely defining binge eating can be problematic; however, binge eating episodes in BED are generally described as having the following potential features:\r\n<ul>\r\n \t<li>eating much faster than normal, perhaps in a short space of time<\/li>\r\n \t<li>eating until feeling uncomfortably full\r\n\r\n[caption id=\"attachment_3381\" align=\"alignright\" width=\"222\"]<img class=\"wp-image-3381\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/16222844\/1024px-Finished_meal_empty_plate_at_Highgate_Cricket_Club_Crouch_End_plan_view-300x300.jpg\" alt=\"A dirty plate and utensils after a meal. \" width=\"222\" height=\"222\" \/> <strong>Figure 2<\/strong>. Binge-eating is characterized by over-consuming large amounts of food in a short amount of time. Unlike bulimia, it is not followed by purging, but it does often result in feelings of shame or frustration.[\/caption]<\/li>\r\n \t<li>eating a large amount when not hungry<\/li>\r\n \t<li>subjective loss of control over how much or what is eaten<\/li>\r\n \t<li>binges may be planned in advance, involving the purchase of special binge foods, and the allocation of a specific time for binging, sometimes at night<\/li>\r\n \t<li>eating alone or secretly due to embarrassment over the amount of food consumed<\/li>\r\n \t<li>there may be a dazed mental state during the binge<\/li>\r\n \t<li>not being able to remember what was eaten after the binge<\/li>\r\n \t<li>feelings of guilt, shame, or disgust following a food binge<\/li>\r\n<\/ul>\r\nIn contrast to bulimia nervosa, binge-eating episodes are not regularly followed by activities intended to prevent weight gain, such as self-induced vomiting, laxative or enema misuse, or strenuous exercise. BED is characterized more by overeating than dietary restriction and over concern about body shape. Obesity is common in persons with BED, as are depressive features, low self-esteem, stress, and boredom.\r\n<h2>Treatments for Bulimia and Binge-Eating Disorder<\/h2>\r\nThere are several supported psychosocial treatments for bulimia. CBT, which involves teaching a person to challenge automatic thoughts and engage in behavioral experiments (for example, in session eating of \"forbidden foods\"), has a small amount of evidence supporting its use.\r\n\r\nSeeking treatment early for eating disorders is essential as people with eating disorders are at higher risk for suicide and medical complications. People with eating disorders can often have other mental disorders (such as depression or anxiety) or problems with substance use. Complete recovery is possible.\u00a0Treatment plans are tailored to individual needs and may include one or more of the following:\r\n<ul class=\"ul_default\">\r\n \t<li class=\"generic-container\">individual, group, and\/or family psychotherapy<\/li>\r\n \t<li class=\"generic-container\">medical care and monitoring<\/li>\r\n \t<li class=\"generic-container\">nutritional counseling<\/li>\r\n \t<li class=\"generic-container\">medications<\/li>\r\n<\/ul>\r\n<h3>Psychotherapies<\/h3>\r\n[caption id=\"attachment_3384\" align=\"alignleft\" width=\"285\"]<img class=\"wp-image-3384\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/16223500\/2674297554_fdc1aafb28_c-300x225.jpg\" alt=\"A notebook with time stamps, meals eaten and cravings recorded. \" width=\"285\" height=\"214\" \/> <strong>Figure 3.<\/strong> Keeping track of what you eat and how you feel throughout the day can be helpful and insightful.[\/caption]\r\n\r\nPsychotherapies such as a family-based therapy called the Maudsley approach, where parents of adolescents with anorexia nervosa assume responsibility for feeding their child, appear to be very effective in helping people gain weight and improve eating habits and moods. This and other types of family-based treatments (FBT) are particularly helpful for younger adolescents to gradually take more control of their eating habits after learning more about the consequences of their eating choices.\r\n\r\nTo reduce or eliminate binge-eating and purging behaviors, people may undergo CBT, which is another type of psychotherapy that helps a person learn how to identify distorted or unhelpful thinking patterns and recognize and change inaccurate beliefs.\u00a0By using CBT, people record how much food they eat and periods of vomiting with the purpose of identifying and avoiding emotional fluctuations that bring on episodes of bulimia on a regular basis. People undergoing CBT who exhibit early behavioral changes are most likely to achieve the best treatment outcomes in the long run. Researchers have also reported some positive outcomes for interpersonal psychotherapy and dialectical behavior therapy.\r\n<h3>Medications<\/h3>\r\nAntidepressants of the selective serotonin reuptake inhibitors (SSRI) class may have a modest benefit in treating bulimia. This includes fluoxetine, which is FDA approved, for the treatment of bulimia. Other antidepressants such as sertraline may also be effective against bulimia. Topiramate may also be useful, but has greater side effects. Compared to placebo, the use of a single antidepressant has been shown to be effective.\r\n\r\nCombining medication with counseling can improve outcomes in some circumstances. Some positive outcomes of treatments can include abstinence from binge eating, a decrease in obsessive behaviors to lose weight and in-shape preoccupation, less severe psychiatric symptoms, and a desire to counter the effects of binge eating as well as an improvement in social functioning and reduced relapse rates.\r\n<div class=\"textbox exercises\">\r\n<h3>Case Study: Reeya<\/h3>\r\nReeya is a young Indian woman in her early 20s born in Britain. She was diagnosed with bulimia nervosa in her late teens and later came into contact with an urban eating disorder specialist in the hospital as an outpatient.\r\n\r\nReeya\u2019s mother passed away when she was\u00a0a toddler. Thereafter, she moved in with her grandparents. Her father remarried\u00a0a short time later and she moved back in with her father and step-mother. She did not get along with her step-mother. She described her relationship with her parents (father and step-mother) as \u201chostile\u201d and recounted\u00a0pervasive family pressure in terms of high expectations around education, marriage, and career.\r\n\r\nReeya attended an all-girls grammar school and described it as being quite competitive. She\u00a0could not recall having had\u00a0any difficulties with body image or eating\u00a0prior to the age of 16. When she was in year 12, she recalled feeling quite large and began to weigh herself. At that time,\u00a0Reeya and her friend began a\u00a0Weightwatchers\u00a0diet plan to lose weight for a big ball at the school. Reeya went from being 55\u00a0kg (121 lbs) to 47\u00a0kg (103 lbs) and felt a sense of happiness, pride, and achievement, even though her BMI measured slightly underweight. She regained the weight when going to college.\r\n\r\nReeya went to university at age 18\u00a0and described her living circumstances there as stressful and lonely. She pursued a course that was dominated by young women and she did not get along with her flatmates. She recounted her first year of university as being the hardest year of her life. Reeya discussed feeling quite self-conscious about her appearance when she started university. She described developing an increasing pre-occupation with weight, concerns over body image, daily intake restriction, and then overeating\/binges in the evenings, followed by occasional purging.\r\n\r\nReeya sought help through her supportive boyfriend who accompanied her to the doctor as a first point of access.[footnote]Channa, S., Lavis, A., Connor, C. et al. Overlaps and Disjunctures: A Cultural Case Study of a British Indian Young Woman\u2019s Experiences of Bulimia Nervosa. Cult Med Psychiatry 43, 361\u2013386 (2019). https:\/\/doi.org\/10.1007\/s11013-019-09625-w[\/footnote]\r\n\r\n<\/div>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/95c6a4f6-3374-467f-bb0e-a83f8810ecba\r\n\r\n<\/div>\r\n<div class=\"textbox examples\">\r\n<h3>Watch It<\/h3>\r\nThis video provides an overview of binge-eating disorder.\r\n\r\n<iframe src=\"\/\/plugin.3playmedia.com\/show?mf=5576126&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=_pVzhM_lxdg&amp;video_target=tpm-plugin-mvs9lkns-_pVzhM_lxdg\" width=\"800px\" height=\"450px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe>\r\n\r\nYou can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/UnderstandingBingeEatingDisorder_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for \"Understanding Binge Eating Disorder\" here (opens in new window)<\/a>.\r\n\r\n<\/div>\r\n<div class=\"textbox key-takeaways\">\r\n<h3>Key Takeaways: Binge Eating Disorder<\/h3>\r\n<iframe src=\"https:\/\/lumenlearning.h5p.com\/content\/1291229058034769758\/embed\" width=\"1088\" height=\"637\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><script src=\"https:\/\/lumenlearning.h5p.com\/js\/h5p-resizer.js\" charset=\"UTF-8\"><\/script>\r\n\r\n<\/div>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/a30a4f22-6a45-4dab-82e4-b345876be224\r\n\r\n<\/div>\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Glossary<\/h3>\r\n<div><\/div>\r\n<strong>binge eating disorder:\u00a0<\/strong>type of eating disorder characterized by binge eating and associated distress\r\n\r\n<strong>bulimia nervosa:\u00a0<\/strong>type of eating disorder characterized by binge eating followed by purging\r\n\r\n<\/div>","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning Objectives<\/h3>\n<ul>\n<li>Describe the characteristics, complications, and health outcomes of bulimia nervosa<\/li>\n<li>Explain binge eating disorder<\/li>\n<\/ul>\n<\/div>\n<p>People suffering from <strong>bulimia nervosa<\/strong> engage in binge eating behavior that is followed by an attempt to compensate for a large amount of consumed food. Purging the food by inducing vomiting or through the use of laxatives are two common compensatory behaviors. Some affected individuals engage in excessive amounts of exercise to compensate for their binges.<\/p>\n<p>People with bulimia nervosa may be slightly underweight, normal weight, or overweight.<\/p>\n<p>Symptoms include the following:<\/p>\n<ul class=\"ul_default\">\n<li class=\"generic-container\">chronically inflamed and sore throat<\/li>\n<li class=\"generic-container\">swollen salivary glands in the neck and jaw area<\/li>\n<li class=\"generic-container\">worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acid<\/li>\n<li class=\"generic-container\">acid reflux disorder and other gastrointestinal problems<\/li>\n<li class=\"generic-container\">intestinal distress and irritation from laxative abuse<\/li>\n<li class=\"generic-container\">severe dehydration from purging of fluids<\/li>\n<li class=\"generic-container\">electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals), which can lead to stroke or heart attack<\/li>\n<\/ul>\n<p>Bulimia is associated with many adverse health consequences that can include kidney failure, heart failure, and tooth decay. In addition, these individuals often suffer from anxiety and depression, and they are at an increased risk for substance abuse (Mayo Clinic, 2012b).<\/p>\n<p>The lifetime prevalence rate for bulimia nervosa is estimated at around 1% for women and less than 0.5% for men (Smink, van Hoeken, &amp; Hoek, 2012). The rates of bulimia increased during the 1980s and early 1990s and have remained stable since then.\u00a0Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors.<\/p>\n<div class=\"textbox exercises\">\n<h3>Dig Deeper: Bulimia<\/h3>\n<div id=\"attachment_2007\" style=\"width: 494px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-2007\" class=\"wp-image-2007\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/09\/16144335\/princess-diana-397649_1920-1024x683.jpg\" alt=\"Princess Diana dancing with John Travolta in an elegant black dress.\" width=\"484\" height=\"322\" \/><\/p>\n<p id=\"caption-attachment-2007\" class=\"wp-caption-text\"><strong>Figure 1<\/strong>. Princess Diana spoke openly about her struggles with bulimia.<\/p>\n<\/div>\n<p>&nbsp;<\/p>\n<p>An iconic fashion figure and celebrity, Princess Diana was a prominent public figure that was open about how bulimia affected her life. Read <a href=\"https:\/\/www.eatingdisorderhope.com\/blog\/bulimia-princess-dianas-ed\" target=\"_blank\" rel=\"noopener\">this article about how Princess Diana struggled and how she attempted to use bulimia as a coping mechanism<\/a> to deal with some of her life stressors.<\/p>\n<\/div>\n<div class=\"textbox examples\">\n<h3>Watch It<\/h3>\n<p>Watch this video to review the basics about anorexia and bulimia, and contrast those with the obsessive-compulsive related body dysmorphic disorder.<\/p>\n<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/eMVyZ6Ax-74?start=260\" width=\"800\" height=\"470\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n<p>You can <a href=\"https:\/\/oerfiles.s3-us-west-2.amazonaws.com\/Psychology\/Transcriptions\/EatingandBodyDysmorphicDisordersCrashCoursePsychology33.txt\" target=\"_blank\" rel=\"noopener\">view the transcript for &#8220;Eating and Body Dysmorphic Disorders: Crash Course Psychology #33&#8221; here (opens in new window)<\/a>.<\/p>\n<\/div>\n<div class=\"textbox key-takeaways\">\n<h3>Key Takeaways: Bulimia Nervosa<\/h3>\n<p><iframe loading=\"lazy\" src=\"https:\/\/lumenlearning.h5p.com\/content\/1291229056700018878\/embed\" width=\"1088\" height=\"637\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><script src=\"https:\/\/lumenlearning.h5p.com\/js\/h5p-resizer.js\" charset=\"UTF-8\"><\/script><\/p>\n<\/div>\n<h2>Binge-Eating Disorder<\/h2>\n<p>Binge-eating disorder (BED) is the most prevalent eating disorder, affecting approximately 2.8% of females and 1% of males.<a class=\"footnote\" title=\"Galmiche M, D\u00e9chelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000-2018 period: a systematic literature review. American Journal of Clinical Nutrition (2019) 109:1402\u201313. doi: 10.1093\/ajcn\/nqy342\" id=\"return-footnote-721-1\" href=\"#footnote-721-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a> Binge-eating disorder (BED) is characterized by recurrent episodes of binge eating that are not combined with compensatory methods to avoid weight gain. Thus, the majority of\u00a0binge-eating disorder (BED) cases are overweight or obese.\u00a0Unlike bulimia, BED binges are not followed by purging.<a class=\"footnote\" title=\"Cury MEG, Berberian A, Scarpato BS, Kerr-Gaffney J, Santos FH and Claudino AM (2020) Scrutinizing Domains of Executive Function in Binge Eating Disorder: A Systematic Review and Meta-Analysis. Frontiers in Psychiatry 11:288. doi: 10.3389\/fpsyt.2020.00288\" id=\"return-footnote-721-2\" href=\"#footnote-721-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a>. Of those patients affected, research estimates that 28.4% of people with current BED are receiving treatment and 43.6% of people with BED will receive treatment at some point in their lives.<a class=\"footnote\" title=\"Statistics &amp; Research on Eating Disorders. National Eating Disorders Association. (2020, May 8). https:\/\/www.nationaleatingdisorders.org\/statistics-research-eating-disorders.\" id=\"return-footnote-721-3\" href=\"#footnote-721-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a><\/p>\n<p>Binge eating is the core symptom of BED; however, not everyone who binge eats has BED. An individual may occasionally binge eat without experiencing many of the negative physical, psychological, or social effects of BED. This example may be considered an eating problem (or not), rather than a disorder. Precisely defining binge eating can be problematic; however, binge eating episodes in BED are generally described as having the following potential features:<\/p>\n<ul>\n<li>eating much faster than normal, perhaps in a short space of time<\/li>\n<li>eating until feeling uncomfortably full\n<div id=\"attachment_3381\" style=\"width: 232px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3381\" class=\"wp-image-3381\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/16222844\/1024px-Finished_meal_empty_plate_at_Highgate_Cricket_Club_Crouch_End_plan_view-300x300.jpg\" alt=\"A dirty plate and utensils after a meal.\" width=\"222\" height=\"222\" \/><\/p>\n<p id=\"caption-attachment-3381\" class=\"wp-caption-text\"><strong>Figure 2<\/strong>. Binge-eating is characterized by over-consuming large amounts of food in a short amount of time. Unlike bulimia, it is not followed by purging, but it does often result in feelings of shame or frustration.<\/p>\n<\/div>\n<\/li>\n<li>eating a large amount when not hungry<\/li>\n<li>subjective loss of control over how much or what is eaten<\/li>\n<li>binges may be planned in advance, involving the purchase of special binge foods, and the allocation of a specific time for binging, sometimes at night<\/li>\n<li>eating alone or secretly due to embarrassment over the amount of food consumed<\/li>\n<li>there may be a dazed mental state during the binge<\/li>\n<li>not being able to remember what was eaten after the binge<\/li>\n<li>feelings of guilt, shame, or disgust following a food binge<\/li>\n<\/ul>\n<p>In contrast to bulimia nervosa, binge-eating episodes are not regularly followed by activities intended to prevent weight gain, such as self-induced vomiting, laxative or enema misuse, or strenuous exercise. BED is characterized more by overeating than dietary restriction and over concern about body shape. Obesity is common in persons with BED, as are depressive features, low self-esteem, stress, and boredom.<\/p>\n<h2>Treatments for Bulimia and Binge-Eating Disorder<\/h2>\n<p>There are several supported psychosocial treatments for bulimia. CBT, which involves teaching a person to challenge automatic thoughts and engage in behavioral experiments (for example, in session eating of &#8220;forbidden foods&#8221;), has a small amount of evidence supporting its use.<\/p>\n<p>Seeking treatment early for eating disorders is essential as people with eating disorders are at higher risk for suicide and medical complications. People with eating disorders can often have other mental disorders (such as depression or anxiety) or problems with substance use. Complete recovery is possible.\u00a0Treatment plans are tailored to individual needs and may include one or more of the following:<\/p>\n<ul class=\"ul_default\">\n<li class=\"generic-container\">individual, group, and\/or family psychotherapy<\/li>\n<li class=\"generic-container\">medical care and monitoring<\/li>\n<li class=\"generic-container\">nutritional counseling<\/li>\n<li class=\"generic-container\">medications<\/li>\n<\/ul>\n<h3>Psychotherapies<\/h3>\n<div id=\"attachment_3384\" style=\"width: 295px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3384\" class=\"wp-image-3384\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/16223500\/2674297554_fdc1aafb28_c-300x225.jpg\" alt=\"A notebook with time stamps, meals eaten and cravings recorded.\" width=\"285\" height=\"214\" \/><\/p>\n<p id=\"caption-attachment-3384\" class=\"wp-caption-text\"><strong>Figure 3.<\/strong> Keeping track of what you eat and how you feel throughout the day can be helpful and insightful.<\/p>\n<\/div>\n<p>Psychotherapies such as a family-based therapy called the Maudsley approach, where parents of adolescents with anorexia nervosa assume responsibility for feeding their child, appear to be very effective in helping people gain weight and improve eating habits and moods. This and other types of family-based treatments (FBT) are particularly helpful for younger adolescents to gradually take more control of their eating habits after learning more about the consequences of their eating choices.<\/p>\n<p>To reduce or eliminate binge-eating and purging behaviors, people may undergo CBT, which is another type of psychotherapy that helps a person learn how to identify distorted or unhelpful thinking patterns and recognize and change inaccurate beliefs.\u00a0By using CBT, people record how much food they eat and periods of vomiting with the purpose of identifying and avoiding emotional fluctuations that bring on episodes of bulimia on a regular basis. People undergoing CBT who exhibit early behavioral changes are most likely to achieve the best treatment outcomes in the long run. Researchers have also reported some positive outcomes for interpersonal psychotherapy and dialectical behavior therapy.<\/p>\n<h3>Medications<\/h3>\n<p>Antidepressants of the selective serotonin reuptake inhibitors (SSRI) class may have a modest benefit in treating bulimia. This includes fluoxetine, which is FDA approved, for the treatment of bulimia. Other antidepressants such as sertraline may also be effective against bulimia. Topiramate may also be useful, but has greater side effects. Compared to placebo, the use of a single antidepressant has been shown to be effective.<\/p>\n<p>Combining medication with counseling can improve outcomes in some circumstances. Some positive outcomes of treatments can include abstinence from binge eating, a decrease in obsessive behaviors to lose weight and in-shape preoccupation, less severe psychiatric symptoms, and a desire to counter the effects of binge eating as well as an improvement in social functioning and reduced relapse rates.<\/p>\n<div class=\"textbox exercises\">\n<h3>Case Study: Reeya<\/h3>\n<p>Reeya is a young Indian woman in her early 20s born in Britain. She was diagnosed with bulimia nervosa in her late teens and later came into contact with an urban eating disorder specialist in the hospital as an outpatient.<\/p>\n<p>Reeya\u2019s mother passed away when she was\u00a0a toddler. Thereafter, she moved in with her grandparents. Her father remarried\u00a0a short time later and she moved back in with her father and step-mother. She did not get along with her step-mother. She described her relationship with her parents (father and step-mother) as \u201chostile\u201d and recounted\u00a0pervasive family pressure in terms of high expectations around education, marriage, and career.<\/p>\n<p>Reeya attended an all-girls grammar school and described it as being quite competitive. She\u00a0could not recall having had\u00a0any difficulties with body image or eating\u00a0prior to the age of 16. When she was in year 12, she recalled feeling quite large and began to weigh herself. At that time,\u00a0Reeya and her friend began a\u00a0Weightwatchers\u00a0diet plan to lose weight for a big ball at the school. Reeya went from being 55\u00a0kg (121 lbs) to 47\u00a0kg (103 lbs) and felt a sense of happiness, pride, and achievement, even though her BMI measured slightly underweight. She regained the weight when going to college.<\/p>\n<p>Reeya went to university at age 18\u00a0and described her living circumstances there as stressful and lonely. She pursued a course that was dominated by young women and she did not get along with her flatmates. She recounted her first year of university as being the hardest year of her life. Reeya discussed feeling quite self-conscious about her appearance when she started university. She described developing an increasing pre-occupation with weight, concerns over body image, daily intake restriction, and then overeating\/binges in the evenings, followed by occasional purging.<\/p>\n<p>Reeya sought help through her supportive boyfriend who accompanied her to the doctor as a first point of access.<a class=\"footnote\" title=\"Channa, S., Lavis, A., Connor, C. et al. Overlaps and Disjunctures: A Cultural Case Study of a British Indian Young Woman\u2019s Experiences of Bulimia Nervosa. Cult Med Psychiatry 43, 361\u2013386 (2019). https:\/\/doi.org\/10.1007\/s11013-019-09625-w\" id=\"return-footnote-721-4\" href=\"#footnote-721-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a><\/p>\n<\/div>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_95c6a4f6-3374-467f-bb0e-a83f8810ecba\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/95c6a4f6-3374-467f-bb0e-a83f8810ecba?iframe_resize_id=assessment_practice_id_95c6a4f6-3374-467f-bb0e-a83f8810ecba\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<div class=\"textbox examples\">\n<h3>Watch It<\/h3>\n<p>This video provides an overview of binge-eating disorder.<\/p>\n<p><iframe loading=\"lazy\" src=\"\/\/plugin.3playmedia.com\/show?mf=5576126&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=_pVzhM_lxdg&amp;video_target=tpm-plugin-mvs9lkns-_pVzhM_lxdg\" width=\"800px\" height=\"450px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe><\/p>\n<p>You can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/UnderstandingBingeEatingDisorder_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for &#8220;Understanding Binge Eating Disorder&#8221; here (opens in new window)<\/a>.<\/p>\n<\/div>\n<div class=\"textbox key-takeaways\">\n<h3>Key Takeaways: Binge Eating Disorder<\/h3>\n<p><iframe loading=\"lazy\" src=\"https:\/\/lumenlearning.h5p.com\/content\/1291229058034769758\/embed\" width=\"1088\" height=\"637\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><script src=\"https:\/\/lumenlearning.h5p.com\/js\/h5p-resizer.js\" charset=\"UTF-8\"><\/script><\/p>\n<\/div>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_a30a4f22-6a45-4dab-82e4-b345876be224\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/a30a4f22-6a45-4dab-82e4-b345876be224?iframe_resize_id=assessment_practice_id_a30a4f22-6a45-4dab-82e4-b345876be224\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<div class=\"textbox learning-objectives\">\n<h3>Glossary<\/h3>\n<div><\/div>\n<p><strong>binge eating disorder:\u00a0<\/strong>type of eating disorder characterized by binge eating and associated distress<\/p>\n<p><strong>bulimia nervosa:\u00a0<\/strong>type of eating disorder characterized by binge eating followed by purging<\/p>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-721\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li>Modification, adaptation, and original content. <strong>Authored by<\/strong>: Margaret Krone for Lumen Learning. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Hunger and Eating. <strong>Authored by<\/strong>: OpenStax College. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"http:\/\/cnx.org\/contents\/Sr8Ev5Og@5.52:7y4p-I4a@6\/Hunger-and-Eating\">http:\/\/cnx.org\/contents\/Sr8Ev5Og@5.52:7y4p-I4a@6\/Hunger-and-Eating<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em>. <strong>License Terms<\/strong>: Download for free at http:\/\/cnx.org\/contents\/4abf04bf-93a0-45c3-9cbc-2cefd46e68cc@5.48<\/li><li>Binge Eating Disorder. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Binge_eating_disorder\">https:\/\/en.wikipedia.org\/wiki\/Binge_eating_disorder<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Bulimia. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bulimia_nervosa\">https:\/\/en.wikipedia.org\/wiki\/Bulimia_nervosa<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Finished meal. <strong>Authored by<\/strong>: Acabashi. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Finished_meal_empty_plate_at_Highgate_Cricket_Club,_Crouch_End,_plan_view.jpg\">https:\/\/commons.wikimedia.org\/wiki\/File:Finished_meal_empty_plate_at_Highgate_Cricket_Club,_Crouch_End,_plan_view.jpg<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Food journal. <strong>Authored by<\/strong>: Angela. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.flickr.com\/photos\/angelamaphone\/2674297554\">https:\/\/www.flickr.com\/photos\/angelamaphone\/2674297554<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0\/\">CC BY-NC-SA: Attribution-NonCommercial-ShareAlike<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">All rights reserved content<\/div><ul class=\"citation-list\"><li>Eating and Body Dysmorphic Disorders: Crash Course Psychology #33. <strong>Provided by<\/strong>: CrashCourse. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?v=eMVyZ6Ax-74&#038;feature=emb_logo\">https:\/\/www.youtube.com\/watch?v=eMVyZ6Ax-74&#038;feature=emb_logo<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><li>Overlaps and Disjunctures: A Cultural Case Study of a British Indian Young Womanu2019s Experiences of Bulimia Nervosa. <strong>Authored by<\/strong>: Sunita Channa, Anna Lavis, Charlotte Connor, Colin Palmer, Newman Leung &amp; Max Birchwood . <strong>Located at<\/strong>: <a target=\"_blank\" href=\"\"><\/a>. <strong>Project<\/strong>: Culture, Medicine, and Psychiatry volume . <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Understanding Binge Eating Disorder. <strong>Provided by<\/strong>: Walden Behavioral Care. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?v=_pVzhM_lxdg&#038;feature=emb_logo\">https:\/\/www.youtube.com\/watch?v=_pVzhM_lxdg&#038;feature=emb_logo<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">Public domain content<\/div><ul class=\"citation-list\"><li>Eating Disorders. <strong>Provided by<\/strong>: NIH. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.nimh.nih.gov\/health\/topics\/eating-disorders\/index.shtml\">https:\/\/www.nimh.nih.gov\/health\/topics\/eating-disorders\/index.shtml<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/pdm\">Public Domain: No Known Copyright<\/a><\/em><\/li><li>Princess Diana. <strong>Provided by<\/strong>: Pickpic. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.pickpik.com\/princess-diana-john-travolta-princess-of-wales-actor-dancing-reagan-130164\">https:\/\/www.pickpik.com\/princess-diana-john-travolta-princess-of-wales-actor-dancing-reagan-130164<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/pdm\">Public Domain: No Known Copyright<\/a><\/em><\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-721-1\">Galmiche M, D\u00e9chelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000-2018 period: a systematic literature review. <em>American Journal of Clinical Nutrition<\/em> (2019) 109:1402\u201313. doi: 10.1093\/ajcn\/nqy342 <a href=\"#return-footnote-721-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-721-2\">Cury MEG, Berberian A, Scarpato BS, Kerr-Gaffney J, Santos FH and Claudino AM (2020) Scrutinizing Domains of Executive Function in Binge Eating Disorder: A Systematic Review and Meta-Analysis. <em>Frontiers in Psychiatry<\/em> 11:288. doi: 10.3389\/fpsyt.2020.00288 <a href=\"#return-footnote-721-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-721-3\">Statistics &amp; Research on Eating Disorders. National Eating Disorders Association. (2020, May 8). https:\/\/www.nationaleatingdisorders.org\/statistics-research-eating-disorders. <a href=\"#return-footnote-721-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-721-4\">Channa, S., Lavis, A., Connor, C. et al. Overlaps and Disjunctures: A Cultural Case Study of a British Indian Young Woman\u2019s Experiences of Bulimia Nervosa. Cult Med Psychiatry 43, 361\u2013386 (2019). https:\/\/doi.org\/10.1007\/s11013-019-09625-w <a href=\"#return-footnote-721-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":29,"menu_order":5,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"Hunger and Eating\",\"author\":\"OpenStax College\",\"organization\":\"\",\"url\":\"http:\/\/cnx.org\/contents\/Sr8Ev5Og@5.52:7y4p-I4a@6\/Hunger-and-Eating\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"Download for free at http:\/\/cnx.org\/contents\/4abf04bf-93a0-45c3-9cbc-2cefd46e68cc@5.48\"},{\"type\":\"copyrighted_video\",\"description\":\"Eating and Body Dysmorphic Disorders: Crash Course Psychology #33\",\"author\":\"\",\"organization\":\"CrashCourse\",\"url\":\"https:\/\/www.youtube.com\/watch?v=eMVyZ6Ax-74&feature=emb_logo\",\"project\":\"\",\"license\":\"other\",\"license_terms\":\"Standard YouTube 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