Cognitive Behavior Treatment Analyzing Bulimia Behaviors

Some of the earliest records of bulimic behavior were recorded in ancient Egyptian and Roman cultures. In ancient Egypt, there was a strong belief that the most prominent reason for disease and deaths was due to the food that was eaten. Therefore, it was common for physicians to recommend vomiting, one of the most distinguished characteristics of bulimia nervosa, to their patients. Bulimic behavior was common in Roman culture for completely different reasons. The people, especially the royals, valued overeating and feasts. To prevent from getting sick, the people would resort to vomiting so frequently, it became a habit.

Although bulimic behaviors had been noticed in ancient times, it wasn’t until the 19th century that the history of the disorder of bulimia nervosa truly began. In 1873, William Gull first started noticing that his patients were losing their appetite without signs of gastric problems. His claims were followed by those of Ernes Charles Lasegue, who also described the same symptoms in his female patients. In 1874, Gull described this condition as anorexia nervosa, a condition found in males and females due to a physical condition affecting the brain. To truly understand the history of bulimia nervosa, it is important to acknowledge that, at that time, bulimia nervosa was considered as a form of anorexia nervosa, not a separate disorder; therefore, the symptoms of bulimia nervosa were categorized as anorexia nervosa. It was not until the 20th century that bulimia nervosa took its own course. In 1903, Pierre Janet noticed that some of the behaviors he noticed in his anorexia patients were not matching up with typical symptoms. Some of his patients were excessively eating, something that anorexia patients are not fond of. This revelation started farther research of these bulimic behaviors. In 1930, bulimia nervosa was characterized as a disorder, and 40 years later it was established as a distinct disorder from anorexia nervosa. Finally, in 1979, Gerald Russel wrote the first scientific paper about bulimia nervosa and how its symptoms show its distinctiveness from anorexia nervosa. From the time that the disorder was acknowledged by the American Psychiatric Association in 1980, to now, bulimia nervosa has evolved in many ways. Although the symptoms of the disorder remain mostly the same, one of the biggest factors that revolves around modern bulimia nervosa is that patients have a fear of becoming fat. This fear has led to an increase in the occurrence of bulimia nervosa in western, urbanized countries in recent times.

Characteristics

After years of research, case studies, and speculation, there are many distinct characteristics of bulimia nervosa. Approximately eight million people on Earth exhibit some signs of bulimia nervosa. Although it is possible for men to experience bulimic behavior, bulimia nervosa is common mostly in young women and it has been found that out of those wanting treatment, 90% of the people are women. Researchers have discovered that the most common age for bulimia nervosa is anywhere from middle to late adolescence, as that is time that women are most conscious about their body images.

Although the reasons and symptoms vary from each person, people with bulimia nervosa all show some of the same signs. There is a consistent fear among the patients of becoming abnormally large, gaining too much weight, or just becoming fat in general. This fear shows that many of the patients have a negative self-image and consistently criticize themselves over how they look and how others perceive them. They have a sense of guilt when they eat and are constantly feeling at a loss of control with their bodies. Due to their external and internal shame, many bulimic patients have difficulty forming solid relationships with people surrounding them. It’s been found that bulimic patients have poor social skills because they’re consumed with negative thoughts about how people will perceive them. Patients with bulimia nervosa are often able to hide their symptoms, as it is a mostly emotionally distressing disorder. Bulimic patients are known for binge eating, using food as one of their mechanisms of coping with their emotions. The guilt they feel after binge eating, leads to forced vomiting and other ways to get rid of all the food from their system. This includes, but is not limited to, excessive vomiting, continuous exercise, and drug abuse. These negative coping methods cause emotional and physical stress to the patients, and lead to many health difficulties, like abnormal stomach pains and gastric and digestive problems.

Causes

Even after many years of research, there is still lots of speculation about the causes of bulimia nervosa. A single cause of bulimia nervosa hasn’t been decided upon, rather, multiple causes seem to attribute to this disorder. One main cause that seems to persist through most patient cases is the desire to be thin. The patients have high expectations from themselves, and often feel as if their body image is not living up to those expectations. Frequently, physical changes during puberty can lead to rapid onset of weight gain and cause females to form a negative self-image. Although this is a prominent cause, there are many other factors revolving bulimia nervosa such as severe life events or chronic difficulties.

One factor that seems to be a leading cause of bulimia nervosa is negative childhood experiences. Many bulimic patients grew up with negative family pressure. Their families are usually disorganized and not expressive. The mothers tend to be domineering, wanting their daughters to fit the perfect body image, and the parents are demanding and compare their children to other children in society. A recent case study focuses on childhood mealtime experiences, with the main purpose of exploring why food is the main attractant to bulimic patients. The participants in the case study were 128 college females, split into 3 groups: bulimic, repeat dieter, and non-bulimic. All the participants took the Childhood Family Mealtime Questionnaire. Through this test it was revealed that bulimic patients experienced negative early mealtime experiences. They went through high levels of stress during meals and often there were conflicts among family members during these meals. Their families would associate beauty with weight, and frequently encouraged their daughters to diet. The food during the meals was used as reward or punishments to these females, thus explaining why food played such a large role in these bulimic females.

Another factor that can cause bulimia nervosa in females is cultural and societal pressure. Different cultures have varying views about body-images and these can affect the way people view themselves. One case study explored cultural influences revolving bulimia nervosa by studying a 23-year-old Chinese woman, who was hospitalized after eating compulsively. The woman went through traumatizing depression after her father was in a car accident, however, the researchers seemed to believe that the main cause of disorder was that she discovered she was adopted. The woman didn’t have fat phobia, so the main cause of her disorder seemed to be her fear of abandonment and her family’s strict cultural influence. Her parents wanted her adoption and illness to be a secret to society, so the woman’s life was greatly affected by the way her family treated her due to their belief in collectivism in Chinese culture. Thus, this case study reveals that the desire to be thin is not always the cause behind bulimia nervosa.

Treatments

Although there hasn’t been one single proven treatment for bulimia nervosa, there have been many explored treatment options, each with different results. Treatments like nondirective therapy, pill placebo, manualized psychodynamic therapy, and stress management are used frequently, however, they do not produce long-term results. All treatment experiments are graded by the National Institute for Clinical Excellence (NICE) from A to C, C being an expert approved experiment. According to NICE, the only experiment to date which has received a grade A is the Cognitive Behavior Treatment (CBT). From the experiments that used CBT, it was proven that 30% to 40% of the patients were symptom free afterwards and CBT reduced 60% to 80% of the patients’ bulimic episodes. Although this treatment did not work for everyone, it still produced significant results.

According to critics, CBT focuses too much on reducing symptoms, and not enough on the inner attitudes of the patients. For this reason, researchers experimented with Interpersonal Psychotherapy (IPT). This treatment focused on interpersonal functioning and produced results at a much slower rate than CBT. Another treatment option is Dialectical Behavior Therapy. This treatment proved to be very effective in reducing emotional turmoil and symptoms. However, the down-side to this experiment is that it requires too much effort from the researchers and the patients because it requires six months of single therapy, six months of group therapy, and 24-hour phone coaching every day. Other treatments focus on the amount of people involved in the treatment.

For example, treatments like Guided Self-Help (GSH) focus on patients who cannot afford other, more expensive treatments and helps them learn how to treat themselves. Though this treatment is less effective, it still helps reduce symptoms in some patients. The Group Training Program was another experiment; however, it was focused on learning from others and exploring others’ minds. The purpose was to normalize experiences for everyone through multiple single and group sessions. The results of the experiment showed significant improvement in symptoms, however, it also showed that there is no difference between single therapy and group therapy; thus, this treatment is an alternate to CBT. Lastly, family based treatment is another treatment which focuses on individuals other than the patient. The purpose was to educate the family about the illness and teach them the stages of breaking the bulimic habits of the patient. This treatment was proven effective, however, it proved that the treatment is effective not only when limited to family, but also when close friends and significant others of the patient help as well.