Bulimia nervosa & obsessive-compulsive disorder

1. Bulimia nervosa & obsessive-compulsive disorder By Lisa Ko

2. Bulimia Nervosa is an eating disorder marked by a cycle of binge eating followed by inappropriate methods of controlling weight such as vomiting, fasting, compulsive exercising, or inducing bowel movements through the intake of medications such as laxatives, diuretics, or enemas. (“Faces of Abnormal Psychology”) What is bulimia nervosa?

3. Most individuals with Bulimia Nervosa take in an enormous amount of food up to 20,000 calories once a week or even several times a day, which is also known as binge eating. They feel like they have lost control over their actions and are compelled to continue eating. After binge eating, they report a sense of relief and calm for a short period of time, which later on turns into anger and self-loathing, fearing that they would gain weight. This eventually leads them to unhealthy ways of weight control. It is mostly women that suffer from Bulimia Nervosa and they are not necessarily underweight, meaning that they have average or slightly above average weight. It is found that Bulimia Nervosa affects women ten times more than men. (“Faces of Abnormal Psychology”) Symptoms of bulimia nervosa

4. In order to be diagnosed with Bulimia Nervosa, a person must meet the following criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM) established by the American Psychiatric Association • Repetition of binge eating and feeling lost control over eating • Weight control through vomiting, excessive exercising, fasting, or misusing laxatives, diuretics, enemas or other medications • Binge eating and purging occurs at least twice a week for at least three months • Self-evaluation influenced by body shape and weight to a great extent • Does not occur during episodes of anorexia nervosa (an eating disorder with extremely restrictive eating behaviors) (“Bulimia nervosa”) Diagnosis criteria for bulimia nervosa

5. URL: http://www.youtube.com/watch?v=Um2vbpZa0_I Video of patient with bulimia nervosa

6. etiology of bulimia nervosa

7. A region of the brain called hypothalamus, which is responsible for regulating the sense of hunger and food intakes, shows reduced functioning among individuals who suffer from Bulimia Nervosa. • Certain chemicalsin the brain such as serotonin contribute to the occurrence of binge eating and purging. • Women who have a sister or mother with Bulimia Nervosa tend to be affected by the condition as well, which shows that genes and family history can play a role in the development of Bulimia Nervosa. (Ehrlich) Biological causes of bulimia nervosa

8. Kendler et al. (1991) examined 2000 female twins in order to determine whether genetics influence the development of Bulimia Nervosa. He found a concordance rate of 23 percent in MZ (monozygotic) twins whereas 9 percent in DZ (dizygotic) twins, which showed that MZ twins have a higher risk of affecting each other with Bulimia Nervosa than DZ twins. • Carraso (2000) found that individuals with Bulimia Nervosa have lower levels of serotonin. The study showed that increased serotonin levels stimulate the medial hypothalamus and decrease food intake. (Crane 163) Research studies

9. Traumatic events such as physical or sexual abuse can lead to the development of Bulimia Nervosa • Individuals with emotional problems such as low self-esteem, perfectionism, anger management problems, depression, and anxiety disorders including obsessive-compulsive disorder (OCD) have a higher risk of getting affected by Bulimia Nervosa • They tend to misuse food in order to overcome these emotional problems (“Bulimia nervosa”) Cognitive causes of bulimia nervosa

10. According to Bruch (1962),most individuals with Bulimia Nervosa suffer from the delusion that they are fat. In other words, they overestimate their body size and thus are compelled to control their body weight. • The body-image distortion hypothesis established by Slade and Brodie (1994) suggest that most individuals who suffer from Bulimia Nervosa have low self-esteem and are uncertain of the size and shape of their body. (Crane 163) Research study

11. Peer pressures, family attitudes and media play a significant role in causing Bulimia Nervosa because they often fuel a need for thinness, especially among young women. (Natenshon) • Athletes such as gymnasts, runners and wrestlers are at a higher risk of getting affected by Bulimia Nervosa because they are often encouraged to lose weight and are restricted eating for better performance by their coaches and parents. (“Bulimia nervosa”) • Bulimia Nervosa is more common in countries or regions where food is abundant than those where food is scarce. • The west is more influenced by Bulimia Nervosa than the east, but certain countries in the east such as South Korea and Japan are increasingly affected.(“Faces of Abnormal Psychology) Socio-cultural causes of bulimia nervosa

12. Jaeger et al. (2002) conducted a study in order to find cross-cultural differences in body dissatisfaction. 1751 medical and nursing students across 12 nations, including western and non-western countries participated. It was a natural experiment and a self-report method was used. The participants were shown a series of 10 body silhouettes in order to assess body dissatisfaction. Their height and weight were also measured. Westernized countries showed higher levels of body dissatisfaction than those of non-western countries, which showed the influenced of media. Since western countries are more exposed to idealized body images, they are more likely to show body dissatisfaction. It was also found that body dissatisfaction is independent of self-esteem and BMI (height and weight). (Crane 165) Research study

13. Treatments for bulimia nervosa

14. Since most individuals with Bulimia Nervosa suffer from depression as well, the most effective biomedical treatments for Bulimia Nervosa are drugs such as tricyclic antidepressants and SSRIs (Selective Serotonin Reuptake Inhibitors). SSRIs include Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), and Fluvoxamine (Luvox). Although Luvox may be more effective, Prozac is the only antidepressant that is approved by the Food and Drug Administration to treat Bulimia Nervosa. (Ehrlich) Biomedical treatment for bulimia nervosa

15. McGilley and Pryor (1998) conducted a study based on the effects of SSRI (Prozac) on patients who suffer from Bulimia Nervosa. They found reduction of vomiting in 29 percent of those who received the drug compared to 5 percent in those given a placebo. Higher dosages of the drug also led to a significant reduction of binge eating (67 percent) as well as vomiting (56 percent). (Crane 180) Research study

16. Cognitive Behavioral Therapy (CBT) is the most widely used individual treatment for Bulimia Nervosa. It helps patients control eating, but avoid dieting, which is the main cause of binge eating. They are asked to record what they eat and how they feel about it. They are also told to report what causes binge eating and purging. During the treatment, they not only learn how to deal with symptom triggers, but also learn various cognitive techniques that help them improve self-esteem and develop expressions of feelings. (Crane 180) individual treatment for bulimia nervosa

17. According to Wilson (1996), Cognitive Behavioral Therapy (CBT) is superior to medication (drugs) alone and its combination with medication is also more effective than medication alone. He found that 50 percent of the patients who receive CBT stop binge eating and purging, but the other 50 percent either show partial improvement or none. (Crane 181) Research study

18. Group therapy is also a widely used treatment for Bulimia Nervosa. It was introduced by Minuchin in his family systems model, which is based on the assumption that an individual’s abnormal behavior is closely related to the dysfunction within the family. The aim of Minuchin’s family therapy is to help the family form a healthier system. Group therapy is effective for long and involved treatments combined with other components. (Crane 181) Group treatment for bulimia nervosa

19. Schmidt et al. (2007) compared Cognitive Behavioral Therapy (CBT) and family therapy in a group of 85 adolescents that suffered from Bulimia Nervosa. He found that both methods significantly reduced binge eating and purging over a period of 12 months, but that CBT was more effective by the fact that it reduced binge eating in a faster rate. • The most effective way of treating Bulimia Nervosa is Cognitive Behavioral Therapy (CBT) combined with medications such as tricyclic antidepressants and SSRIs. (Crane 181) Research study

20. Obsessive-Compulsive Disorder (OCD) is an anxiety disorder characterized by a repetition of unwanted thoughts or uncontrollable behaviors people feel driven to perform. Although most individuals who suffer from OCD recognize that their obsessive thoughts and compulsive behaviors are irrational, they do not have any control over them and thus are irresistible to them. They often carry out the behaviors in order to overcome the obsessive thoughts. However, this only provides them temporary relief and refusing to perform the behaviors can cause them great anxiety. (Berger) (Robinson) What is obsessive-compulsive disorder (ocd)?

21. Individuals with OCD possess certain obsessions such as fearing contamination or dirt, organizing everything in order and symmetry, having aggressive or horrific impulses, or carrying sexual images or thoughts. In order to overcome these obsessive thoughts, they perform various behaviors compulsively such as washing and cleaning, counting, checking, demanding reassurances, performing the same action repeatedly, or keeping things in order. (“Obsessive-compulsive disorder) Symptoms of obsessive-compulsive disorder

22. According to the Diagnostic and Statistical Manual of Mental Disorders, an individual must meet the following criteria to be diagnosed with Obsessive-Compulsive Disorder Obsessions are indicated by the following: • Repetitive and persistent thoughts, impulses, or images, which then lead to anxiety and distress • The thoughts impulses, or images are not simply concerns about real-life issues • The individual tries to overcome the thoughts, impulses, or images through other thoughts or actions • The individual is aware that the thoughts, impulses, or images are the results of his or her own mind Compulsions are indicated by the following: • Repetitive behaviors the individual feels driven to perform in response to an obsession • The aim of the behaviors is the prevention or reduction of distress or dreadful event (Greenberg) Diagnosis criteria for obsessive-compulsive disorder

23. URL: http://www.youtube.com/watch?v=Rn1OYlYzgm8 Video of patient with obsessive-compulsive disorder

24. etiology of obsessive-compulsive disorder

25. Malfunction of Serotonin, which is a neurotransmitter that is involved in various biological processes such as mood, aggression, sleep, appetite and pain, can lead to OCD. • Abnormalities within certain parts of the brain such as the orbital cortex, the Basal Ganglia and Thalmus contribute to the development of OCD. • Individuals who have a family member with OCD tend to be affected as well. In other words, genes and family history may cause OCD. (“Causes of OCD”) Biological causes of obsessive-compulsive disorder

26. Nestadt et al. (2000) conducted a study based on the influence of genetics on the development of OCD. Eighty OCD patients and their first-degree relatives were examined. They found that the lifetime prevalence of OCD was significantly higher among individuals who have a relative with the disorder. In other words, they came to the conclusion that OCD is a familial disorder. (Nestadt) Research study

27. Individuals with depression have a higher risk of getting affected by OCD. • The individual may remain alert of an obsessive thought, which he or she believes is dangerous, and thus repeat a certain behavior. • Ex) Constantly looking out the window after hearing that there is a burglar in the neighborhood • Compulsive behaviors may be a learned process, meaning that the individual may be carrying out the behaviors repetitively because he or she has learned that they can reduce anxiety through past experiences. Cognitive causes of obsessive-compulsive disorder

28. Coles et al. (2012) designed a study to test whether interference or distress contribute to the development of OCD. Through the study, they provided the symptoms of OCD and the factors that lead to the full-blown disorder. They found that increases in stress level as well as the amount of attention paid to one’s thoughts played a significant role in the transition to OCD. (Coles) Research study

29. Parental overprotection contributes to inflated responsibility and OCD symptoms. (Smari) • Traumatic life events such as the death of a loved one, the loss of a pet, a divorce in the family, a move to a new place or to a new school also lead to the development of OCD. Socio-cultural causes of obsessive-compulsive disorder

30. Smári, J., RúrikMartinsson, D., and Einarsson, H. (2010) carried out a study with 570 young adults to determine whether parental overprotection influences the developments of OCD of not. They found that overprotection leads to inflated responsibility and OCD symptoms, which showed that the inadequacy between offer and need for parental control plays a significant role in the development of OCD. (Smari) Research study

31. Berger, Fred K. "Obsessive-compulsive Disorder." PubMed Health. U.S. National Library of Medicine, 7 Mar. 2012. Web. 29 Jan. 2013. • "Bulimia Nervosa." Mayo Clinic. Mayo Foundation for Medical Education and Research, 03 Apr. 2012. Web. 21 Jan. 2013. • "Causes of OCD." Anxiety Care UK. Anxiety Care UK, n.d. Web. 29 Jan. 2013. • Crane John, and Hannibal Jette. Psychology: Course Companion. Oxford University Press, 2009. Print. • "Faces of Abnormal Psychology." McGraw-Hill Higher Education. The McGraw-Hill Companies, n.d. Web. 21 Jan. 2013. • Greenberg, William M. "Obsessive-Compulsive Disorder." Medscape. WebMD LLC, 4 Dec. 2012. Web. 29 Jan. 2013. • Meredith, Coles. "Initial Data Characterizing the Progression from Obsessions and Compulsions to Full-Blown Obsessive Compulsive Disorder." Initial Data Characterizing the Progression from Obsessions and Compulsions to Full-Blown Obsessive Compulsive Disorder 3.6 (2012): 685-93. EBSCO. Web. 20 Jan. 2013. • Natenshon, Abigail. "Bulimia Nervosa." EmpoweredParents. N.p., n.d. Web. 29 Jan. 2013. • Nestadt, Gerald. "A Family Study of Obsessive-compulsive Disorder." JAMA Psychiatry. American Medical Association, Apr. 2000. Web. 30 Jan. 2012. • "Obsessive-compulsive Disorder." Mayo Clinic. Mayo Foundation for Medical Education and Research, 15 Dec. 2010. Web. 29 Jan. 2013. • Robinson, Lawrence. "Obsessive-Compulsive Disorder (OCD)." Helpguide.org. Helpguide.org, Nov. 2012. Web. 29 Jan. 2013. • Smari, Jakob. "Rearing Practices and Impulsivity/hyperactivity Symptoms in Relation to Inflated Responsibility and Obsessive-compulsive Symptoms." Rearing Practices and Impulsivity/hyperactivity Symptoms in Relation to Inflated Responsibility and Obsessive-compulsive Symptoms 51.5 (2010): 392-97. EBSCO. Web. 16 Jan. 2013. • Smith, Melinda, and Jeanne Segal. "Bulimia Nervosa." Helpguide.org. Helpguide.org, Nov. 2012. Web. 21 Jan. 2013. Works cited

32. Thank you