The incidence of bulimia nervosa has increased significantly in the second half of the twentieth century and its occurrence is more than twice that of anorexia nervosa. Due to its complex nature, successful treatment requires an interdisciplinary approach with nutritional, psychological, medical, pharmacological and dental therapies. Despite bulimia nervosa's growing incidence, many health care professionals fail to detect the condition in their patients. In addition, professionals lack adequate training in interdisciplinary health care delivery. As part of a larger federally funded Interdisciplinary Health Care for Rural Areas Project, the purpose of this study was to conduct focus groups with patients' and providers' to examine professional skill needs in four domains including the detection, intervention, assessment and interdisciplinary treatment of bulimia nervosa. Based on thematic analysis of transcripts from four focus groups, both the patient and professional participants indicated a need for more professional training in all four domains. The professional participants especially lacked an understanding of the interdisciplinary health care model. In addition, participants indicated interest in the use of online case based learning opportunities when available to advance their knowledge about bulimia nervosa.
Key words: Bulimia Nervosa, Interdisciplinary Health Care, Skill Assessment, Online Continuing Education, Focus Groups
Bulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating and inappropriate compensatory methods to prevent weight gain. Individuals with bulimia nervosa have a psychopathological fear of weight gain in which self-evaluation is overly influenced by a thin, yet culturally desirable, body shape. (1,2) This condition primarily affects girls and young women and is associated with significant morbidity and mortality. (3) The prevalence of bulimia nervosa among US adult women is estimated at 1.1%-2.8% (4) with approximately 3% to 10% of US adolescent and college women afflicted. (5) The incidence of bulimia has increased significantly in the second half of the twentieth century (4,6) and its occurrence is more than twice that of anorexia nervosa. (4)
Despite its growing incidence, many health care professionals fail to detect bulimia nervosa in their patients due to inadequate training. In fact, the diagnosis is frequently missed by many portal of entry professionals such as primary care physicians (7,8) obstetric gynecology physicians (8) and oral health professionals. (9) The lack of training makes detection especially difficult since patients commonly present with nonspecific complaints, have non-specific laboratory abnormalities, (10) appear normal in body weight and frequently deny their disordered behavior due to feelings of guilt and shame. (11) Failure to recognize early signs of eating disorders is a grave concern since delayed treatment is associated with increased morbidity and mortality. (12,13)
Treatment for bulimia nervosa is often long and difficult, with the majority of patients only reducing their symptoms over a ten year period. (14) Due to its complex nature, successful treatment requires an interdisciplinary approach with nutritional, psychological, medical, pharmacological and dental therapies. (2,15,16) The interdisciplinary model of care "involves a stable team where each member makes her/his own contribution that will in turn enrich and become enriched by contributions from the group, whose members will try to find a common language." (17) Treatment success is dependent upon the cohesion, consistency and shared responsibilities of the team. (17) Unfortunately, a comprehensive interdisciplinary model is not used frequently in the treatment of bulimia nervosa. Instead, professionals often use a fragmented multidisciplinary approach or choose not to refer their patients all together. …