Brandy, a 21-year-old female college student, suffers from bulimia. Brandy is constantly anxious about how others perceive her. This causes extreme stress and she binges on food uncontrollably to cope. Her bulimia is also evident in other traits, like her tendency to eat excessively after her binges. This is despite her good body weight. This paper will explore the causes of the disorder and how to best treat it.
Brandy’s History
Brandy was unable to keep up the high standards that her parents set throughout her entire life. Brandy believes that her parents expect too much from her because they are disappointed in Sarah, her older sister, who failed at school and became overweight. She also rebelled against her family. Brandy believes that they want Brandy to succeed over Sarah as a result of the failures of their parenting. Brandy’s parents made Brandy serve in the church and take advanced classes. She was also required to be on their track team. Brandy was determined to please her parents and strived to excel in these activities. She was obsessed with perfection and worried about making mistakes. Brandy’s perfectionist tendencies were reinforced by her parents who would often compare Brandy to Sarah and tell her how proud they are of her when she achieved a milestone. Brandy was so focused on her parents’ perfection that she couldn’t handle the stress, As she grew older the chances of impressing them increased.
Causal Research
Brandy’s condition of bulimia neurosa can be traced back to her perfectionist nature that she developed during her childhood trying to please people. This made her extremely anxious about how her parents perceived her and then to others. It influenced her entire life. Because she was constantly trying and failing, she became anxious and began to eat a lot to alleviate the stress. These two empirical studies support the idea that bulimia can be caused by perfectionist tendencies.
Bardone Cone, Boyd, & Weishuhn (2009, etiological studies) were the first to investigate the relationship between adaptive and maladaptive perfectionism and bulimic disorders in African American female college students. This research study also sought to develop an interactive model that would allow us to see how different levels, perceptions and weight interact and impact bulimic symptoms. The researchers recruited 97 African American women, most of whom were at least halfway through their bachelor’s degrees and averaged 19 years old, to pursue these two goals. The study was conducted by asking the 97 women to complete two questionnaires. Although the first group had 70 participants, the second was completed by only 70 (Bardone Cone and colleagues, 2009). The questionnaires sought to determine perfectionism or impulsivity and other behavior that might be related to eating or drug abuse in the participants (Bardone Cone and colleagues, 2009). The first test was used in order to assess the level of bulimic disorder in participants. The second test was used in order to predict changes in symptoms. This study revealed that only maladaptive perfectionionism was associated with bulimic symptoms. It was not adaptive perfectionism. Maladaptive perfectionism, when combined with the woman’s belief that she is overweight, can lead to more severe bulimic symptoms. Perfectionism, even the negative, is a key factor in the development of bulimia. Bardone Cone and colleagues (2009) found that women with higher BMIs were more likely to develop bulimia. However, the researchers concluded that being overweight combined with maladaptive perfectionists was more significant. Lastly, Bardone-Cone, et al.
(2009) concluded that counseling African American women on bulimia is essential to reduce their weight problems. However, they should also be counseled on how to manage their self-perceptions about their weight.
Egan Watson McEvoy Fursland, Fursland & Nathan (2013) conducted the second etiological analysis. This study examined how anxiety influences the relationship between perfectionism’s empirically strong connection and eating disorders. Based on extensive empirical research, Egan et al. (2013) designed this experiment. They found that perfectionism is a major risk factor and maintenance factor for eating disorder. This was determined by 370 patients who were associated with a specialist for eating disorders in Australia. Of these, 18% had anorexia and 41% had bulimia. The remaining 41% were diagnosed as having bulimia. The study excluded people who didn’t meet the DSM-IV criteria for eating disorders and those with binge eating disorder. These participants were between 16-71 years of age, with an average of 25.04 years (Egan et al. 2013, 2013). The study’s design was to have the participants take 2-3 sessions of an eating disorder assessment from a clinical psychologist. Assessments included clinical interviews, self reports and Mini International Neuropsychiatric Interviews. Participants were also measured for their body mass index. Egan and colleagues (2013) used the EDE and MINI diagnostic interviews to measure perfectionism and anxiety. The study’s results showed that anxiety plays a part in mediating the strong relationship between perfectionism, eating disorders, and allowing them to compare the partially and fully mediated models.
Egan et.al. (2013) concluded that the best way to treat eating disorders is to treat anxiety and perfectionism. It can also be used to reduce eating disorders like eating disorders like bulimia. Egan et.al. (2013) made this conclusion even though their main focus was on anxiety. But they also found out more about the role perfectionism plays in eating and anxiety disorders. Egan et al. (2013) concluded that perfectionism was more important than anticipated and is a powerful factor in many disorders. Their research shows why perfectionism is so significant in bulimia.
Research on Treatment
Cognitive Behavioral Therapy or CBT is the best option to treat bulimia nervosa. Cognitive Behavioral Therapy, also known as CBT, is a more effective treatment than antidepressants for treating eating disorders like bulimia. It is particularly beneficial for those with bulimia. Waller Gray. Hinrichsen. Mountford. Lawson. And Patient (2014) stated that CBT involves three key areas to treat this disorder. It teaches about the negative effects of diets and binging. Cognitive therapy addresses highly dysfunctional beliefs, corrects incorrect body shapes and sizes, and changes the way we view eating.
It also teaches you how to avoid binging and purging. This stage addresses the stress cues that can trigger binge-eating and helps to deal with the anxiety, depression, and other side effects that may result (Barlow, et. al., 2018,). These stages can all be dealt with in 20 hour sessions. This is dependent on the patient’s improvement rate (Waller, 2014.
These research studies will analyze CBT in order to show its effectiveness in treatingbulimia nervosa.
Waller Gray Hinrichsen. Gray. Hinrichsen. Mountford. Lawson. Patient (2014) carried out the first treatment study. Their goal was to find out if CBT’s effectiveness in treating bulimia isa can be transferred to everyday clinics. Waller, Gray, Hinrichsen, Mountford, Lawson, and Patient (2014) conducted this research because they doubted the generalizability of CBT for bulimia. There were 78 women in the study who had bulimia. Of these, 55 had bulimia. Another 23 had an eating disorder not otherwise specified (EDNOS), which included binging and purging. Notable facts include that 9 participants were on antidepressants prior to undergoing CBT, and that a significant number of them had a comorbidity. The average age was 27.8 for all the women.
The study’s design required that the women underwent CBT, undergo eating pathology and depression assessments, as well as keeping track of how often they purged and binged during the treatment. Waller, et.al. (2014) provided CBT supervision for 20 sessions. This included cognitive restructuring and education on the disorder. There were also behavioral experiments to modify coping strategies and to address comorbidities. The Eating Disorders Inventory and Beck Depression Inventory were used in the study. CBT treatment was also included with analysis of participants’ recovery from bulimia. Waller, and colleagues (2014) concluded that CBT was effective in treating bulimia. CBT proved to be just as effective in treating bulimia nervosa symptoms in clinical settings than it was in research studies. Only half of participants experienced remission and significant decreases were observed in eating disorder characteristics and depression. The researchers also demonstrated that CBT improved participants’ moods, eating perceptions and behaviors (Waller et.al. 2014).
Waller and colleagues (2014) point out that the study’s weakness was that CBT was administered by highly trained clinicians with a high level of expertise in eating disorders. Researchers conclude that the trial’s lack of a control group or therapy validation to confirm that CBT was being administered by clinicians is due to its nature. They can do little to correct it. Although these limitations are apparent, their research proves that CBT is effective in treating bulimia.
Peterson Berg, Crosby and Lavender, Accurso and Ciao, Smith and Ciao conducted a second study to examine and compare the effects of Integrative Cognitive Affective Therapy and Cognitive Behavioral Therapy Enhanced on patients with bulimia nervosa. Peterson and colleagues (2017) examined the effects of both treatments on patients with bulimia. Peterson et.al. (2017) recruited 80 participants. The average age of the participants was 27.3 years, their BMI was 23.9kg, and most were Caucasian women. These women were collected from North Dakota or Minnesota hospitals. Of the 72.5% who were diagnosed with bulimia-nervosa, 27.5% showed bulimia symptoms that were not consistent with the DSM-IV criteria. The study was intended to randomly place participants in one of two CBT-E sessions or ICAT sessions. Each session lasted fifty minutes and was done over 17 weeks. To assess participants’ progress through each treatment, there were four methods.
Peterson et al. (2017) used this method at the end and during the follow-up of 4 months.
Peterson et.al. (2017) used the Difficulties Emotion Regulating Scale (DERS), which was used by participants as a way to determine their emotional regulation difficulties. Peterson et.al. (2017) used the Structural Analysis of Social Behavior Intrex Questionnaire to assess changes in self-directed behaviours. Peterson, and others (2017) used the Selves Interview to determine how participants view themselves and what they want.
The study results showed no significant differences in indirect effects of CBT-E and ICAT on participants psychology. The study found that patients’ future outcome in their bulimia are affected by how they cope with the stress of treatment. Final conclusion: Both treatments proved equally effective in treatingbulimia.