Running head: BULIMIA NERVOSA

Bulimia Nervosa Bailey Ameen Northern Oklahoma College

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Since the year 1960, there have been many interpretations of eating disorders. Bulimia Nervosa started out being an overlooked syndrome. Some researchers would even categorized Bulimia Nervosa with physical and mental disorders (Casper, 1983; Habermas, 1990; Stein & Laako, 1988; Stunkard, 1993; Ziolko & Schrader, 1985). In 1967 a man by the name of Alexander Guiora thought of the name dysorexia. He thought of this because it involves both anorectic and bulimic actions (Guiora). There have been many studies from 1960 to 1979 to determine what Bulimia Nervosa actually is. Peter Beumont and his co-workers conducted a study in 1977. They studied a series of South African Patients with anorexia nervosa. Together they were able to identify the difference between ones who were only dieting and others who were often vomit and purge. A case in 1970 described by Rudolph H. Ehrensing and Elliot L. Weitzman was about how anorexia nervosa in which bulimia acted as a symptom. Their hypothesis was that patients feel fat when they are cachetic, i.e., have a distorted body image because with their poor reality testing, the fantast of eating until gorged and becoming fat seems real (Ehrensing, 1970; Weitzman, 1970). In 1973 Hilde Bruch, reported bulimia in about 25% of her cases with primary anorexia nervosa. A result of a study on 58 college women who wanted their bodies to be perfected ended in the researchers finding new criteria for bulimarexia. Fist the women have an uncontrollable desire for food and proceeds to consume too much which she will end up vomiting. The women complain of being too fat even though they are not. Lastly, they feel helpless and despair. This study became a turning point for the history of eating disorders. Pregnancy and eating disorders has become a subject that hardly any attention has been given. This literature reviewed article studies both anorexia and bulimia nervosa while the

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patient is going through pregnancy. The information that is known suggests that there are serious medical issues that can occur while the mother is pregnant with her infant. Patients with bulimia nervosa have been known to be shy with their disorder while they are pregnant to their medical provider. Hollifield and Hobdy, 1990, suggest that the literature has only focused on the medical and physical consequences of eating disorders on pregnancies. The purpose of this review is to suggest some treatment strategies to be used by psychotherapists, who have a pregnant patient with an eating disorder. Hollifield and Hobdy (1990), did a study on three bulimic women that became pregnant while in therapy. They reported that the women felt guilty about their bulimic behavior, but continued to binge and purge throughout their pregnancy. The patients had never informed their obstetrician about their eating disorder. Results with the three women were that all the birth weights were normal; however, one women began binging and purging immediately after delivery. Hollifield and Hobdy concluded that persons involved in the delivery of both physical and psychological heath care to the bulimic woman must challenge the assumption that bulimia ceases or diminishes once the pregnancy is confirmed and must consider the medical implications of continuing bulimic practices in the pregnant women, (Hollifield and Hobdy, 1990). Future directions for people who make up this population, suggests that medical providers should offer an anonymous computer screening program. This will make the patient more likely to describe their disorder. The fundamental body-image disorder with of patients with anorexia nervosa was suggested first by Hilde Bruch. Bruch described three key symptoms which she views as the significance in the development of anorexia nervosa: a disturbance of delusional proportions in

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the body image and body concept, a disturbance in the accuracy of perception of stimuli arising in the body and a paralyzing sense of ineffectiveness.. (Bruch) This article will talk about the experimental attempts about the three key feature Bruch has mentioned , particularly disturbed size awareness. The study first required the subjects to estimate their own physical widths, and a measure of their BPI. Conducted by Gerald Russel and Peter Slade, their outcome came to conclude that the normal females in the study were more accurate in estimating body-widths, while the patients with anorexia overestimated by an average of between 27 and 58%. (Slade and Russell, 1973) One experiment involved a metal mirror which could be bent to distort body image. The subjects task was to reset the mirror to create a more accurate image of themselves. This experiment was used to study obese subjects. A distorted picture is then taken, as well as a slidephotograph. Once again the patient is to choose the one that best suits their view of their body. Bulimia Nervosas Diagnostic Criteria, according to the DSM-5 includes: Recurrent episodes of binge eating. An episode of binge eating is characterized by: eating in a discrete period of time, an amount of food that is abnormal to what normal individuals will consume, and a sense of lack of control over eating during the episode, which is a feeling that one cannot stop eating or control what or how much one is eating, (American Psychiatric Association, 2013) Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications; fasting, or excessive exercise, (American Psychiatric Association, 2013). The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months, (American Psychiatric Association, 2013)

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A Day in the Life of a Person Diagnosed with Bulimia Nervosa It is morning and I am starting my daily routine. My throat is usually sore when I wake up from purging the previous day. Typically I do not look at myself as I get ready for school, but sometimes when I do look at myself I am disgusted. After I am done getting ready, I immediately head to the kitchen and make myself some breakfast. At this point I will binge eat until my stomach physically cannot take in any more food. I will drink plenty of fluids so that when it is time to do my self-induced vomiting, the food will come out easier. When I am done purging, I will feel horrible about myself, and dash out the door, not even saying goodbye to my mother. If my mother knew of what I was doing it would tear her apart, so I try and cover up the sounds of my horrible act. After school I will still feel ashamed of what I had done that morning and I will be stressed from being around people all day, so eating is the only way to escape. I see a bakery on the way home, so I will use my allowance and buy several pastries. After devouring all those delicious sweets, I figure why not just continue this binge and go to the nearest deli. Once I had scarfed down my sandwich, the only thing I could think of is why did I just do that? I continue on to the public restroom, and throw up everything I just ate in that short amount of time. When I get home, my mother will be making dinner for our family. By then Im extremely depressed by my actions and embarrassed about my blood shot eyes. I head to my room and try to get myself together. I then will head to dinner with my family. I will binge eat because I will be extremely hungry and I will try to try to get rid of my depression. After throwing up my dinner, I will then go to the kitchen and grab many snacks and sneak them up to my room. My day ends with purging.

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References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Franko, D.L., & Walton, B.E. (1993). Pregnancy and eating disorders: A review and clinical implications. International Journal of Eating Disorders, 13 (1), 41-48. Slade, P (1985). A review of body-image in anorexia nervosa and bulimia nervosa. Journal of Psychiatric Research, 19 (2-3), 255-265. Vandereycken, W. (1994). Emergence of bulimia nervosa as a separate diagnositc entity: Review of the literature from 1960 to 1979. International Journal of Eating Disorders, 16 (2), 105-116.