Bulimic Group Research Articles

Social Work Practice with a Bulimic Population: A Comparative Evaluation of Purgers and Nonpurgers

The traditional definition of bulimia has focused on persons who engage in purging behavior. Limited research has been conducted on bulimics, either obese or non-obese, who do not purge. These nonpurging bulimics are often frustrated in their attempts to obtain treatment because their condition is not sufficiently serious to warrant treatment. Because the incidence of bulimia in the general population is high, social workers are likely to see clients who are struggling with this problem. This study compared groups of purging and nonpurging bulimics who had received cognitive-behavioral treatment in a social work practice. It measured change on a number of dimensions related to eating behaviors, feelings, and life functioning. The study found few, if any, significant differences between purging and nonpurging bulimics 2 to 5 years following treatment. Although all groups showed significant improvement at follow-up, some bulimic symptoms remained. In addition, the disordered eating patterns of obese and non-obese bulimics were similar across weight categories. The results suggest that out-of-control eating behavior, not purging, may be the key distinguishing feature of bulimia and that greater attention must be directed at relapse prevention and aftercare once treatment has been completed.

The relationship between childhood sexual abuse and subsequent onset of bulimia nervosa

Seventy-two young adult women identified by the Bulimic Investigatory Test, Edinburgh (BITE) as having a high probability of suffering from bulimia nervosa were compared with 72 matched controls who did not display bulimic symptoms. Both groups were given measures of sexual abuse history, dissociation, and early family mealtime experiences. Rates of self-reported sexual abuse after the age of 12 with an adult relative as the perpetrator were significantly greater in the women diagnosed as bulimic. Nonsignificant but high rates of sexual abuse prior to age 12 were also found for this group. Dissociative experiences were also significantly more common in the bulimic group overall, and higher still for bulimic women who reported sexual abuse as children. Bulimic women had more negative and unusual mealtime experiences than nonbulimic women. Results suggest that sexual abuse may be related to the subsequent onset of bulimia nervosa for some women.

A double-blind placebo-controlled glucose challenge in bulimia nervosa: Psychological effects

Nineteen bulimic women and 22 age-matched controls were randomly assigned to receive 25 g of glucose or a placebo injection under double-blind conditions. Blood samples of glucose, insulin, and glucagon, and psychometric assessments of mood and food cravings were obtained 10 min before, and 0, 5, 10, 20, 30, 40, and 60 min after injection. Blood levels of the large neutral amino acids (LNAAs) tryptophan, tyrosine, leucine, valine, phenylalanine, and ileucine were determined at 10 min before and 60 min after the injection. Bulimic subjects were found to report more symptoms of distressed mood throughout the entire monitoring period than controls. Five minutes following glucose ingestion the self-reports of depression, fatigue, anxiety, and bewilderment rose to a level among the bulimic subjects that was above that at baseline, and was higher than that of bulimia nervosa (BN) subjects receiving placebo. No comparable change in mood was observed among controls. Blood glucose levels were correlated with mood in the bulimic group, but not in controls. In addition, the glucose injection induced a heightened urge to binge in the bulimic group (compared to placebo at 10 and 60 min), whereas reducing food cravings (for sweets) in the controls (at 5 min). When collapsed across time and injection condition, the blood glucose level of bulimics was lower than that of controls. There were no differences in insulin response between the groups. The bulimic group was found to have lower baseline levels of blood tryptophan, whereas no differences in the tryptophan/LNAA ratio were observed either at baseline or following glucose. There was a reduced glucagon response to glucose among the BN group with controls. These results are discussed in terms of abnormalities in bulimics' psychological responses to elevations in blood glucose.

Evaluation of immunocompetence and nutritional status in patients with bulimia nervosa

Nutritional status of patients suffering from bulimia nervosa was evaluated by anthropometric, hematological, and immunological parameters in comparison with a healthy control group. Anthropometry showed no signs of malnutrition in either group. Bulimic patients showed a significant decrease in most of the routine clinical indexes related to red blood cells. Lymphocyte subsets CD2 and CD4 in bulimic patients were lower than in controls, whereas CD8 remained unmodified, leading to a lower CD4:CD8 in bulimic patients. The decreases in CD2 and CD4 numbers might be linked to an impaired cell-mediated immune function, as evaluated by the response to skin tests. The B lymphocyte subset was increased in the bulimic group. Innate immunity was impaired in the bulimic patients. Although anthropometric and most of the routine clinical parameters were within the normal range, these results might suggest that the depleted immune function accounts for a subclinical malnutrition status in bulimic patients.

Use of implosive therapy scenes to assess the fears of women with bulimia in two response modes

The present study utilized implosive therapy scenes to assess fear reactions to cues hypothesized to be instrumental in the development and maintenance of bulimia. Twenty-three normal-weight purging women with bulimia and 26 female control subjects rated their anxiety while imagining that they were the characters in eight audiotaped scenes. The bulimic group reported significantly more anxiety than did the control subjects overall ( p p p p

Seasonal patterns of bulimia nervosa

The aim of this research was to determine whether a seasonal pattern to symptoms of bulimia nervosa could be identified. In study 1, seasonal patterns of binge-purge frequency and mood were compared between 31 patients with bulimia nervosa and 31 age-matched normal comparison subjects, using a modified (to include binge and purge items) version of the Seasonal Pattern Assessment Questionnaire. Study 2 involved a cross-sectional examination of binge and purge frequency and of depressive symptoms in 197 patients with bulimia nervosa assessed at various months of the year over a 4-year period. In both the retrospective and cross-sectional studies, binge behavior was found to be highly associated with photoperiod. According to the modified Seasonal Pattern Assessment Questionnaire, purging behavior and mood also varied seasonally among patients with bulimia nervosa. However, purging behavior and severity of depression did not appear to be related to photoperiod in the cross-sectional study. The rate of seasonal affective disorder (syndromal and subsyndromal) defined by the Seasonal Pattern Assessment Questionnaire was higher among the bulimic group than the comparison subjects, but not as high as has been reported for depression in bulimia nervosa. The results strongly support the interpretation that symptoms of bulimia nervosa primarily associated with food intake patterns are influenced by seasonal variation, and this effect may be mediated by light availability.

Average total energy expenditure in anorexia nervosa, bulimia nervosa, and healthy young women

The double-labeled water method was used to measure average daily total energy expenditure (EE) in 11 healthy normal-weight women classified as unrestrained eaters, in 8 patients with anorexia nervosa, and in 8 patients with bulimia nervosa. The body mass index was 20.0 ± 1.3 kg/m 2 in the control group, 15.2 ± 5.6 kg/m 2 in the anorectic groups, and 19.7 ± 1.9 kg/m 2 in the bulimic group. EE was measured over a 2-week period during which weight remained constant in all groups and was 2357 ± 504 kcal/day for the controls, 2510 ± 920 kcal/day for the bulimics, and 2899 ± 656 kcal/day for the anorectics. Differences were not significant among groups. Physical activity was recorded in diaries by all subjects. Anorectic patients showed significantly more activity than all other groups. The data suggest that EE is high in anorectic patients as a consequence of physical activity.

Physiological and psychological responses to a glucose challenge in bulimia

Twenty females meeting DSM-III criteria for bulimia, and 12 age- and sex-matched controls underwent a 60-min intravenous glucose tolerance test. Blood samples were taken at −10, 0, 5, 10, 20, 30, 45, and 60 min after the glucose injection. At these times, subjects completed a mood rating scale [Profile of Mood States (POMS)] and a subjective self-report questionnaire addressing both food cravings and thirst, as well as the urge to binge and subjective control over food intake. Blood levels of tryptophan, tyrosine, valine, leucine, phenylalanine, and isoleucine were measured at 0 and 60 min after the injection. Although equivalent at baseline, the blood glucose levels of bulimics at 5 min and insulin/glucagon ratio at 20, 30, and 45 min following injection were reduced in comparison to controls. Blood valine levels were also lower among the bulimic group. There were no differences between the bulimics and normal controls at baseline on subjective self-report measures of urge to binge, control over food intake, carbohydrate (CHO) craving or fatigue. following the glucose injection, however, the observed physiological differences between the two groups were accompanied by increased subjective cravings for sweets and fruits, an enhanced urge to binge, and less subjective control over food intake for bulimics as compared with controls. The bulimics also reported increased fatigue in response to glucose, whereas controls reported feeling less fatigued. The results suggest that abnormal physiological responses to blood glucose are accompanied by alterations in both food cravings and mood, which may promote binging among bulimic patients.

Circadian pattern of large neutral amino acids, glucose, insulin, and food intake in anorexia nervosa and bulimia nervosa

Insulin, glucose, and large neutral amino acids (LNAA) were studied in 10 patients with anorexia nervosa, 13 patients with bulimia nervosa, and 15 healthy controls. Blood samples were collected at hourly intervals during the day and at two-hour intervals during the night over a 24-hour period. Ad libitum caloric and relative carbohydrate intake was significantly reduced in the anorectic and bulimic patients. Elevated concentrations of β-hydroxybutyric acid (BHBA) were seen in the bulimic group, and low triiodothyronine (T 3) concentrations in the anorectic group. Mean plasma glucose and insulin concentrations were significantly lowered in both groups. The tryptophan (Trp) to LNAA ratio was reduced in anorectic, but not in bulimic patients. These findings suggest that Trp influx into the brain is reduced in anorectic patients, possibly impairing central serotonergic function.

Bulimia and Object Relations: MMPI and Rorschach Variables

Rorschach and Minnesota Multiphasic Personality Inventory (MMPI) responses from persons vomiting to manage body weight and fat phobia were compared to those from a matched control group to determine the levels of personality structure. These responses were also contrasted with those of representative groups from normal and personality disordered populations. Findings were that the bulimic group's test protocols differed significantly from those of the control group, displaying evidence of serious cognitive slippage and dramatic, emotional and erratic personality structures arrested at the differentiation subphase of ego development. The clinical importance of timely developmental diagnosis and interventions designed to promote object constancy was discussed in light of these findings.

Group Work with Bulimic Adolescent Females in Suburbia

Suburban adolescent females live in environments that are competitive, achievement oriented, and appearance centered. Those adolescent girls in suburban populations who are experiencing bulimic symtomatology are often unwilling to seek help because of feelings of shame over their binge-purge behaviors. Bulimic support groups offering education and supportive intervention allow adolescent bulimic girls in suburbia to self-identify, to examine their body misperceptions and beliefs about food, and to seek ways of living that are not centered on weight management.

Comparison of DSM-III and DSM-III-R bulimia nervosa classifications for psychopathology and other eating behaviors

Although recent studies on bulimia nervosa have yielded lower incidence rates for the disorder when using the DSM-IIIR, rather than the DSM-III criteria, none measured differences in emotional disturbances between those bulimics who meet the revised criteria and those who do not. Young women (50 ballet dancers and 56 nondancers) from a larger study on the complications of amenorrhea were grouped into three categories; nonbulimics, DSM-III bulimics, and DSM-IIIR (revised criteria) bulimics. Women were surveyed for eating disturbance, concurrent psychopathology, past histories of anorexia nervosa, and family history of emotional and eating disorders. Differences between bulimic groups were found for nondancers, as DSM-IIIR bulimics scored significantly higher than nonbulimics on measures of bulimic thought and behaviors, depression, and emotional disturbance. In addition, a significantly higher proportion of DSM-IIIR bulimics than nonbulimics reported that they had had anorexia nervosa in the past and that they had relatives with bulimia nervosa. For dancers, other than the measure of interpersonal distrust, no significant differences were found between the three groups. Results of the study indicate that bulimia nervosa as defined by the revised criteria (DSM-IIIR) is associated with more emotional problems than is bulimia nervosa according to the DSM-III.

Hypnotizability in Bulimia

On the basis of previous research demonstrating higher hypnotic capability and dissociative capacity in hospitalized bulimics as compared to anorexic abstainers and anorexic purgers, (Pettinati, 1985a,b), the present study investigated whether differences in hypnotic capability and dissociative capacity exist between bulimics and nonbulimics in a volunteer sample of university women. The Bulimia Test (BULIT) (Smith & Thelan, 1984) was administered to university student volunteers. Of the subjects, 42 who scored at or above a symptomatic level and the 42 who scored lowest/nonsymptomatic on the BULIT were invited to participate in an individualized interview to confirm appropriate group membership and to view a videotape explaining hypnosis and hypnosis concepts. The Stanford Hypnotic Susceptibility Scale: Form C (SHSS:C) was administered individually by a research assistant blind with respect to Ss' group membership. The final bulimic group (n = 40) demonstrated significantly higher hypnotizability than did the nonbulimic (n = 42) group, however, there was no significant difference on the dissociative factor of hypnotic susceptibility.

Taste perceptions and hedonics in eating disorders

Hedonic and intensity ratings of 20 dairy solutions, with varying levels of fat and sucrose, were obtained before and after treatment for anorectic-restrictors, anorectic-bulimics, normal-weight bulimics, and control subjects. There were no differences between diagnostic groups in ability to rate sweetness intensity; all subjects were able to correctly assess increasing sucrose concentration. During the pretreatment test, both bulimic groups showed elevated intensity ratings of lower fat solutions and solutions which contained no sugar as compared with the other two groups. These differences were not present after treatment. There were differences in hedonic ratings between the anorectic groups and the controls, which persisted even after treatment. Both groups of patients showed an aversion to high fat solutions; anorectic-restrictors also demonstrated an aversion to all solutions which contained no sugar. The stability of these hedonic profiles suggests that these responses may be trait characteristics of anorexia nervosa.

An investigation of the oral pathologies occurring in bulimia nervosa

This study investigated oral pathologies associated with bulimia nervosa and examined the relationship between these pathologies and the bulimic's binge eating, vomiting, and postvomiting oral hygiene. Results revealed a greater prevalence of enamel erosion, dental caries, dentin hypersensitivity, parotid dysfunction, and xerostomia in the bulimic group when compared with a nonbulimic control group. Enamel erosion was related to the duration of vomiting behavior. After 6 months the majority of bulimics exhibited erosion, which increased in severity with time. Tap water rinsing appeared to enhance erosion and cannot be recommended as a postvomiting hygiene practice. Since oral pathology may be the only detectable sign of bulimia nervosa, the information provided by this study facilitates the identification of bulimic patients and provides guidelines for evaluation of oral pathology in bulimia nervosa.

Family dysfunction in normal weight bulimic and bulimic anorexic families

A group of 24 normal weight bulimics and 13 bulimic anorexics were compared with each other and a normal control group (n = 41) on two self-report measures of family functioning (Family Environment Scale and Family Dynamics Survey). The two bulimic groups perceived their families as more dysfunctional than did the normal control group on the dimensions of cohesion, expressiveness, conflict, recreational orientation, emotional support, communication, and need for counseling. There were few significant differences in the family perceptions of the two bulimic groups.

Axis II comorbidity of normal-weight bulimia

The axis II comorbidity of 34 women with active bulimia, 18 women with remitted bulimia, and 20 women with a history of major depression was assessed blind to axis I diagnosis using the Diagnostic Interview for Personality Disorders (DIPD), a semistructured interview of demonstrated reliability. Fifty percent of the active bulimic subjects, 44% of the remitted bulimic subjects, and 35% of the depressed controls met DSM-III criteria for at least one axis II disorder. Despite the generally higher prevalance of axis II pathology in both bulimic groups than depressed controls, these between-group differences did not reach significance. The clinical implications of these findings are discussed.

Growth Hormone Responses to Growth Hormone-Releasing Hormone, Clonidine and Insulin-Induced Hypoglycemia in Normal Weight Bulimic Women

The growth hormone (GH) responses to GH-releasing hormone (GHRH; 1 microgram/kg BW in an i.v. bolus), clonidine (150 micrograms in a single oral dose) and insulin (0.15 IU/kg BW in an i.v. bolus) induced hypoglycemia were evaluated in 7 normal weight bulimic women with regular menstrual cycles and in 7 age- and weight-matched normal women. In addition, the effect of thyrotropin-releasing hormone (TRH; 200 micrograms in an i.v. bolus) on serum thyroid-stimulating hormone (TSH) and GH levels was measured in the same subjects. Tests were carried out in random order on the 22nd days of the following menstrual cycles. A control test with the i.v. administration of normal saline instead of drugs was carried out 2 days after the TRH test. Basal GH levels were significantly higher in bulimic women than in normal controls; despite higher GH levels, bulimic women showed normal circulating concentrations of somatomedin-C (Sm-C). Serum GH levels remained unmodified during the control test. In contrast, the administration of GHRH, clonidine or insulin induced significant GH responses in all subjects. Bulimic and normal women showed comparable responses after GHRH, clonidine or hypoglycemia. The hypoglycemic response to insulin was similar in bulimic and control subjects. The administration of TRH was unable to increase the circulating levels of GH in the normal controls, whereas it significantly increased GH concentrations in 5 of 7 bulimic women.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain T1 measured by magnetic resonance imaging in Bulimia

Using a 1.5 Tesla magnetic imager, we measured T1 in various brain regions for a group of unmedicated bulimics compared with controls

The orodental status of anorexics and bulimics.

This study aims to assess the dental status of anorexics and bulimics by comparison to age-matched controls. One hundred and eight individuals participated, of which 58 had an eating disorder. This group were further subdivided into bulimics who induced vomiting (33), bulimics who did not vomit (7), and anorexics (18). The caries experience (DMFS), plaque levels, gingival inflammation and buffering capacity of saliva were assessed and total vomiting episodes estimated from the product of vomiting frequency and duration. Statistical analysis (one way ANOVA) revealed no significant differences with most of the dental variables between the eating disorder groups and the controls. A linear association (Pearson correlation coefficient) between vomiting frequency, duration or total vomiting episodes and tooth wear was not found, although the frequency of pathological tooth wear is significantly high in the vomiting bulimic group, especially if the total number of vomiting episodes is greater than 1100.