Eating Disorders
Bulimia Nervosa
Bulimia Nervosa (BN) involves recurring episodes of binge eating, together with compensatory behaviours to prevent weight gain. Often, these binge eating episodes involve the consumption of food that is much more than what most children typically consume. Children and adolescents with Bulimia Nervosa also place excessive attention towards their body shape and weight. Children with BN are also typically of a normal weight range. Between episodes of bingeing and purging, individuals typically restrict their energy consumption, often avoiding certain foods that trigger binge episodes.
Based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), for a child or adolescent to be diagnosed with Bulimia Nervosa, the following criteria should be met:
Ψ Binge eating episodes of large amounts of food within a two hour period, without the ability to control eating
Ψ Compensatory behaviours to prevent weight gain
Ψ These episodes occur at least once a week for 3 months
Ψ Influence of body shape and weight on self-evaluation
Ψ Does not occur exclusively during episodes of Anorexia Nervosa
Exact causes of Bulimia Nervosa are unknown, but risk factors for the disorder include genetics, emotional disturbances, and excessive dieting. Consequences of BN include medical complications similar to AN. Due to the excessive regurgitation involved, “bulimia teeth” (tooth decay and staining) is also a feature associated with BN, along with Russell’s sign, which are callouses on the hand from repeated self-induced vomiting.
Addressing Anorexia Nervosa & Bulimia Nervosa
Interventions for Anorexia Nervosa and Bulimia Nervosa are similar and can often require a team of allied health professionals, including psychiatrists, psychologists, nutritionists, and occupational therapists. Due to the low body weight patients typically present in, refeeding nutrients and calories is often important to ensure that medical complications do not persist.
Psychological methods involve the use of therapy for the child together with the family. These therapeutic methods include family based therapy (FBT), systemic family therapy (SyFT), and enhanced cognitive behavioural therapy (CBT-E).
Family Based Therapy (FBT)
In FBT, the family is engaged to help the child restore their normal eating behaviour in an outpatient setting and has been an effective therapeutic method. Research has also shown that individuals that have undergone FBT go into in-patient settings less often than other therapeutic modalities. This approach takes the stance that families not to blame for the disorder and uses the parent’s expertise of the child to guide therapy. This involves the parents being in charge of meals and establishing healthy eating patterns.
Enhanced Cognitive Behavioural Therapy (CBT-E).
CBT-E is based on the fundamentals of cognitive behavioural therapy that focuses on altering the factors that perpetuate the eating disorder. This involves psychoeducation of the disorder, cognitive and behavioural strategies to modify thoughts and behaviours associated with the eating disorder. It is an intensive form of therapy that requires multiple sessions over four phases, teaching individuals the necessary skills and a maintenance plan to overcome the disorder.