Cognitive Behavioural Psychotherapist.
CBT is the best treatment for bulimia nervosa as it directly targets the basic characteristics of this condition, including binge eating, incorrect compensatory behaviors, and an obsessive preoccupation with body shape and weight.. Three phases are covered in about twenty weekly sessions of CBT for bulimia nervosa.
Bulimia nervosa is a prevalent cause of physical and mental disorders in young women, making its treatment crucial. Mitchell and Crow (2006) have proposed that patients will develop swollen salivary glands, significant tooth corrosion, hand and mouth injuries, and severe stomach pain. They can also experience an imbalance in electrolytes, specifically in the case of hydrogen chloride, sodium, potassium, and calcium, which can be fatal if left untreated.
Not only may sufferers experience physical ailments, but they can also suffer from a variety of severe psychological and social insecurities that can significantly diminish their quality of life. Bulimia nervosa often appears with other disorders like drug addiction, OCD, and depression, which can make diagnosis and treatment more difficult (O’Brien & Vincent, 2003).
Wilson and Fairburn (1998) suggest that there are many ways to treat bulimia nervosa, such as medication, the process of interpersonal psychotherapy (Fairburn and Jones, 1993), the process of dialectical behavior therapy (Chen et al., 2008), and cognitive-behavioral therapy.
Everyone experiences hunger. We must eat in order to exist. There are substantial individual variances, nevertheless, as there are present with all of human behavior. Some people eat more than others. Some people gain weight more quickly than others. Some people harm themselves by eating excessively or inadequately. As a result, individuals run the risk of harming their health and becoming ill. The main topics of this section are bulimia nervosa and anorexia nervosa. Although it is simple to refer to them as separate illnesses, many patients exhibit symptoms of both.
In actuality, bulimia frequently emerges following months or years of anorexia symptoms (Garner et al., 1983). Women are found to be 10 times more likely than males to experience these kinds of disorders, despite the major fact that men make up almost a quarter of binge eaters (Weltzin et al., 2005). These illnesses commonly manifest in teens who are still living at home since they are consistently considered adult issues. Eating disorder sufferers frequently sacrifice their interpersonal connections, health, and everyday functioning for the purpose of satisfying their obsessions with food, weight, and appearance.
“Impact activities” (Polivy, 1996).In the event that a person overeats, binges, abuses different laxatives, or controls their food intake, these behaviours are viewed as symptoms rather than issues. This is due to the fact that many people with eating disorders use their eating disorders as a specific coping method to deal with trauma, stress, poor self-esteem, separation troubles, emotional anguish, and other concerns (Vanderlinden and Vandereyken, 1997).
Treatment goals
Relapse and Recovery
Recovery is a process, not an event. Learning to observe behavioral changes reduces repetition.
Relapse warning signs:
Signs of improvement:
In bulimia, binge eating replaces the normal daily pattern of eating three to four meals. Frequently, “the binge” happens in a frantic and covert manner. The beginning of a binge is often joyful and invigorating. The remainder of the bingeing is uncomfortable and self-punishing. Because bingeing reduces anxiety briefly, it is very addictive.
Onset
Characteristics and associated qualities
Bulimia is one of the most rapidly expanding neuroses in the western world, and its prevalence is difficult to determine accurately. In contrast to anorexia, which is a condition that is readily apparent, the bulimic can be an expert at concealment. Due to increased media attention and coverage, more bulimics are attending treatment, and our awareness of the prevalence of this condition is increasing.
Bulimia is a common example of how neurotic symptoms are expressed with a cultural component. A lot of females have unhealthy fixations with regards to weight and attractiveness. The slim lady exudes an air of intelligence, diligence, and self-awareness.
Obesity is linked to greed, indifference, and failure. Every period has its own specific conception of the ideal form of the female. These days, a tall, thin body mostly reflects this appeal. People who lack confidence and also lack self-esteem are more prone to becoming focused on the quest for such a kind of perfection. Due to unfounded weight concerns, girls as young as nine and ten are seeking therapy at different eating disorder institutions and clinics.
Understanding the aim and addictive traits of bulimia is vital since it is a fascinating occurrence. Binge eating ensures repeated intake of large amounts of food, which is a great tranquillizer. The person feels more agitated, irritated, and loses their level of control before bingeing.
These sentiments intensify when there is recent food restriction, which is typical. There is proof that cutting down on carbs causes the serotonin levels in the brain to rise. Anxiety and dysphoric feelings have been related to the low level of the chemical serotonin related to the brain. Before the process of binge eating, one patient described herself as “a cat on a hot tin roof.” The need to eat increases, and the longer the binge is delayed, the worse the binge will be.
The binge starts out exhilarating and very enjoyable. A person becomes more at ease and more comfortable as the meal goes on.
But as soon as guilt starts to creep in, the person keeps eating, not for comfort but as a kind of punishment. The binge experience is therefore nuanced and diverse. It is initially thrilling, then calming, and then shameful.
For some, bingeing is a very liberating experience. The binge eater not only escapes her nutritional cage, but she also symbolically escapes the petty disappointments and oppressions of daily life.
Bingeing is a frantic and undignified behavior, and it’s humiliating for patients to reveal its brutish and animalistic nature.
People who are unable to stop their compulsive eating and who refuse to accept their inevitable weight gain are faced with a frightening choice. Vomiting is an attractive and instant way of dealing with weight gain. Now, the patient is able to continue bingeing while retaining her desired thinness. She may indulge without gaining weight.
Inhibiting weight gain with vomiting, laxative usage, compulsive exercise, and fasting periods all become as important and addicting as the binge itself. These strategies don’t always work, and occasionally the person develops anorexia or gets abnormally thin. Obesity can occasionally result from significant weight gain. Based on their present stage, patients are usually categorised as anorexic or bulimic. The patient’s life becomes more and more focused on her addiction as her bulimia worsens. Family, interests, and jobs eventually take a back seat.
Cognitive-behavioral theory puts a lot of emphasis on the role that thoughts and actions play in perpetuating the eating disorder. The theory implies that the varying values and attitudes that women have about their body shape and weight are a significant contributor to why the disorder occurs. People with bulimia nervosa worry obsessively about what they eat, how much they weigh, and how they look. They strive hard to lose weight and restrict what they consume, and they take extreme measures to avoid gaining weight.
Significant and repetitive types of compensatory and harmful behaviors like fasting, purging, and significant and severe exercise are considered by young women to be effective in preventing the process of weight gain. Purging is a process which directly contributes towards the maintenance of binge eating with the hope of a reduction in anxiety and weight gain in the patient.However, the processes of purging and binge eating exacerbate the condition of depression and also reduce the level of low self-esteem, which promotes an inevitable cycle that significantly leads to a range of binge eating processes and dietary restrictions.
In accordance with the cognitive paradigm, the treatment of bulimia does not only focus on the behaviors of participants that are observable in relation to purging and binge eating. However, it also focuses on the reasons that are underlying this specific condition. So, the treatment for this problem includes the combination of different behavioral and cognitive strategies for the purpose of improving the dysfunctional attitudes and behaviors of the patient, regarding their body, weight, personal perception, and the food they consume, whereas, the food restrictions are substituted with the eating patterns of healthier foods and options (Fairburn, Marcus & Wilson, 1993). Poor self-esteem, a focus on perfectionism, thinking in black-and-white terms, and the ability to handle bad feelings may also be discussed in therapy.
There are similarities among the processes of behavioural and cognitive treatment for bulimia nervosa. The primary objective of the first step is to psycho-educate patients regarding the condition, and the objectives behind this are to focus on the perpetuation of the eating disorder. in this process, patients are also directed towards maintaining their patterns of regular eating and avoiding any kind of purge or temptation of binge eating. The patient and the therapist utilize different and thorough food intake records, talk about the episodes of purging and binge eating, and also focus on the emotions and cognitions that are related to such types of behaviors.
In the second phase, solutions to alleviate dietary constraints, such as expanding food selections, are studied in more detail. Moreover, the empirical strategy is utilized to target and tackle problematic food, weight, and form-related attitudes and avoidance behaviors. The next step has its focus on the maintenance of recovery after the conclusion of treatment. In this specific step, relapse prevention strategies are implemented in preparation for potential future treatment failures.
The evidence that supports behavioral and cognitive therapy for treatment of the disease of bulimia nervosa in young women is significantly well researched. The following are the most significant discoveries that have been made:
CBT has various important and significant influences on all the psychopathological characteristics of bulimia nervosa.
Various studies have represented substantial minimization in the overall occurrence and frequency of the purging problem and binge eating in the inclusion of the changes in the body image and body weight perceptions. In addition, these primary goals are frequently associated with the reduction of the severity of mental and general symptoms, as well as gains in social functioning and self-esteem.
Craighead and Agras (1991) cited around 10 specific controlled investigations, reporting around 79% of the minimization of the average disease of purging along with around 57% of the patients abstaining (Craighead & Agras, 1991). Moreover, the significantly controlled resultant studies that were conducted by Wilson and Fairburn (2002) indicate that around 30 to 50% of the total patients were refraining from purging and binge eating as a result of the completion of all the steps of the treatment and also as a result of the significant reduction in the purging and binge eating, at least to around 80% (Wilson & Fairburn, 2002).
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In accordance with the research, significant inconsistency exists in the efficacy of the current treatment for bulimia nervosa.The previous review of literature suggests that the benefits of the treatment are successfully maintained for around 6 to maximum 12 months after the completion of the therapy. The significantly long follow-up done after the process of CBT has found that around 2/3 of the total patients have not shown any kind of effects or signs related to purging problems or binge eating, and most of the patients have maintained substantial and significant improvements on the measures regarding general mental and social features and functioning (Fairburn et al., 1995).
These results are significant given the short treatment duration (19 sessions and around 18 weeks overall) and the severity of the chronic illness at the start of therapy.
Additionally, CBT has been said to be on par with or superior to all other therapy methods to which it has been compared.
Antidepressant drugs are another therapy for bulimia nervosa that has scientific backing, as demonstrated by research contrasting them to placebo tablets. CBT has been demonstrated to be more successful than antidepressant medication in the case of lowering the primary symptoms of bulimia nervosa, and the combination of the two therapies has produced marginally further advantages than CBT (Whittal, Agras & Gould, 1999).
A number of several psychological therapies, such as supportive psychotherapy, supportive-expressive psychotherapy, stress management therapy, and dialectical behavior therapy, have also been demonstrated to be less successful than CBT (Wilson & Fairburn, 2002). The most noteworthy and significantly exceptional is interpersonal psychotherapy (IPT), whose advantages have been demonstrated to be on par with those of CBT (Fairburn et al., 1993; Agras et al., 2000).
CBT is an excellent treatment for eating disorders. CBT outperformed all active psychological comparisons and interpersonal psychotherapy.
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