Academic journal article American Journal of Psychotherapy

Family-Based Therapy for Adolescents with Bulimia Nervosa

Academic journal article American Journal of Psychotherapy

Family-Based Therapy for Adolescents with Bulimia Nervosa

Article excerpt

Bulimia nervosa is occurring with increasing frequency among adolescents. Yet, no studies have examined effective treatments for this patient population. Involving the family in the treatment of adolescents with anorexia nervosa has proven to he helpful. A small series of cases has demonstrated that family-based treatment might also he beneficial for adolescents with bulimia nervosa. Moreover, treatment studies for adolescents with anorexia nervosa have demonstrated that family-based treatment does benefit binge eating/purging anorexies. Therefore, preliminary evidence seems to support the use of family-based treatment for adolescent bulimia nervosa. In this article, we review our current knowledge of family-based treatment for adolescents with an eating disorder, and present a case that has completed treatment in order to demonstrate the outline and main interventions of this manualized treatment. While this case demonstrates the successful resolution of bulimia in an adolescent female, at least in the short term, the efficacy of family-based treatment for this patient population is yet to be determined, and is currently being examined in a randomized controlled study at The University of Chicago.

INTRODUCTION

Bulimia nervosa (BN) is a highly prevalent disorder characterized by binge-eating episodes, feelings of loss of control, guilt and remorse, fear of fatness, and repeated attempts to lose weight through dieting and/or compensatory behaviors, such as self-induced vomiting, laxative or diuretic abuse (1). BN has a peak age of onset around 18 years of age, and exerts a profound impact on the lives of many young women, men, and their families. BN is a major source of psychiatric morbidity and causes impairment in several areas of functioning. For instance, in adults, clinical features include high rates of depression and anxiety, personality disorders, disturbances in social functioning, alcohol and drug abuse, and suicide attempts. While there is scant data on adolescents with BN, the few available reports seem to indicate that these patients experience significantly lower self-esteem than adolescents without an eating disorder (2). In addition, adolescent bulimic patients report significantly more suicidal ideation and suicide attempts than other adolescents. Rates of sexual abuse also appear to be higher in BN than in other psychiatric groups (3), although this issue has not sufficiently been explored in young patients. Beyond psychiatric morbidity, preoccupation with food and body weight can impair social, school, and work functioning.

BN is also associated with significant medical complications, morbidity, and mortality. As many as one quarter of patients may require hospitalization for medical reasons (4). While body weight is usually within normal range, BN can be life threatening due to the physiological effects of recurrent binge eating and vomiting. Hypokalemia is common; while hypocalcemia, hypomagnesemia, hypophosphatemia, esophageal irritation and bleeding, Mallory-Weiss tears, gastric rupture, and large-bowel abnormalities have all been noted (5). Dental caries, periodontal disease, and menstrual irregularities are common. The use of Ipecac to induce vomiting can cause emetine cardiomyopathy, hepatic toxicity, or peripheral myopathy (6). Medical instability, exacerbated by the fact that most patients tend to deny the severity of their conditions, causes a mortality risk.

Past studies of dieting and binge-eating behaviors in community samples have shown that 10-50% of adolescent girls and boys frequently engage in binge-eating behavior (7). Applying stringent diagnostic criteria, studies have found 2-5% of adolescent girls surveyed qualify for a diagnosis of BN (8, 9). BN in premenarchal girls is particularly disconcerting (10). In contrast to adolescent anorexia nervosa (AN), where there is evidence that cases with early-onset illness have a better prognosis than those with late-onset illness (11), the same is not true for BN. …

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