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Sunday, 1 December 2013

Eating Disorders: Bulimia nervosa - Treatments In Conventional Medicine Perspective

Bulimia nervosa is defined as a medical condition of  consuming a large amount of food in a short amount of time or one setting (binge eating), followed by self induced vomiting, taking a laxative or diuretic and/or excessive exercise, etc. to compensate for the binge. Bulimia nervosa also effects almost 90% of female. Unlike anorexia nervosa, people suffering from bulimia nervosa are usually normal or slightly over weight.
Treatments
A. In Conventional Medicine Perspective 
A.1. Non medication Therapies
1. Group therapy
In the study to evaluate the Guided self-help versus cognitive-behavioral group therapy in the treatment of bulimia nervosa, showed that A mixed-effects linear regression analysis indicated that subjects in both treatment conditions showed a significant decrease over time in binge eating and vomiting frequencies, in the scores of the EDI subscales, and in the BDI. Both treatment modalities led to a sustained improvement at follow-up. A separate analysis of the completer sample showed significantly higher remission rates in the self-help condition (74%) compared with the CBT condition (44%) at follow-up(45).
.
2. Cognitive behavioral guided self-help
In the study of 123 individuals (mean age = 37.2; 91.9% female, 96.7% non-Hispanic White) were randomized, including 10.6% with bulimia nervosa (BN), 48% with binge eating disorder (BED), and 41.4% with recurrent binge eating in the absence of BN or BED. Baseline, posttreatment, and 6- and 12-month follow-up data, showed that Cognitive behavioral guided self-help is a viable first-line treatment option for the majority of patients with recurrent binge eating who do not meet diagnostic criteria for BN or anorexia nervosa(46).

3. Psychoeducational therapy
In the assessment of 241 seeking-treatment females with bulimia nervosa completed an exhaustive assessment and were referred to a six-session psychoeducational group, Regression analyses of treatment response were performed. Childhood obesity, lower frequency of eating symptomatology, lower body mass index, older age, and lower family's and patient's concern about the disorder were predictors of poor abstinence. Suicidal ideation, alcohol abuse, higher maximum BMI, higher novelty seeking and lower baseline purging frequency predicted dropouts. Predictors of early symptom changes and dropouts were similar to those identified in longer CBT interventions(47).

4. Psychodynamic therapy
In the examined 14 bulimic clients' experiences of individual psychodynamic psychotherapy through semistructured interviews, which were analyzed using qualitative methods. The results showed that the psychodynamic approach was a challenge to most of the clients. Yet, most clients profited from therapy both symptomatically and with regard to interpersonal relations and affect regulation. There were, however, marked differences in the clients' experiences. One subgroup rather quickly felt that the therapy met their needs, another initially felt challenged by the approach and the therapeutic attitude but ultimately succeeded in using this particular kind of therapy. A third group remained predominantly critical of their therapies. The clinical implications and possible explanations of the results are discussed(48).


5. Relational theory
In the article to explain how the psychology of women can inform group treatment by translating relational theory (RT) into practice within a short-term outpatient bulimia group. First, the article provides a brief overview of a relational understanding of women's psychological development, the etiology and maintenance of bulimia nervosa, and group psychotherapy. Then, clinical vignettes illustrate the application of RT in practice through discussion of four main healing factors at work in the different stages of the group. Through promoting validation, self-empathy, mutuality, and empowerment, the leader helps group members identify and change relational patterns that have kept them connected with food and disconnected from themselves and others. The goal of treatment is to help members move toward mutually empathic and empowering relationships inside and outside the group(49).

6. Cognitive-Behavioral therapy(CBT)
In the study to examine the potential efficacy of CBT for eating disorder individuals with bulimic symptoms who do not meet full criteria for bulimia nervosa. Twelve participants with subthreshold bulimia nervosa were treated in a case series with 20 sessions of CBT. Ten of the 12 participants (83.3%) completed treatment. Intent-to-treat abstinent percentages were 75.0% for objectively large episodes of binge eating (OBEs), 33.3% for subjectively large episodes of binge eating (SBEs), and 50% for purging at end of treatment. At one year follow-up, 66.7% were abstinent for OBEs, 41.7% for SBEs, and 50.0% for purging(50).

7.  Etc.
 
A.2. Medical treatments
Fluoxetine (Prozac), a type of selective serotonin reuptake inhibitor (SSRI, the only antidepressant approved by the Food and Drug Administration may help to ease the symptoms of bulimia.

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Sources
(45) http://www.ncbi.nlm.nih.gov/pubmed/15101068
(46) http://www.ncbi.nlm.nih.gov/pubmed/20515207
(47) http://www.ncbi.nlm.nih.gov/pubmed/19501787
(48) http://www.ncbi.nlm.nih.gov/pubmed/21198236
(49) http://www.ncbi.nlm.nih.gov/pubmed/9766090
(50) http://www.ncbi.nlm.nih.gov/pubmed/22290037