Bulimia Nervosa
This category contains 23 posts

Ambivalence and Eating Disorders: Inpatient Treatment, Belonging, and Identity

When Tetyana Tweeted and “Tumblr-ed” (is there a better name for putting something on Tumblr?) a quote from a qualitative research article about ambivalence and eating disorders, I knew I would want to write a blog post about it. Of course, life happened, and so this post is coming a little later than I had intended. Nonetheless, I am happy to be sharing a post about a fresh article by Karin Eli (2014) about eating disorders and ambivalence in the inpatient hospital setting. The article itself is published through PLOS One and so is also open access, in case you are interested in reading the original.

The Study

This article is about one aspect of a larger longitudinal study Eli conducted in Israel between 2005 and 2011. The broader study explores the “sensory experiences” (embodied feelings, sensations, and perceptions) of individuals with eating disorders and how these relate to identity. This paper considers one part of participants’ broader stories of having eating disorders; specifically, how individuals with eating disorders experienced inpatient hospitalization.

Eli conducted interviews with 13 participants. …

Polar Opposites? The Social Construction of Bulimia and Anorexia Nervosa

Some might argue that bulimia nervosa is more “hidden” than anorexia nervosa — it is not always obvious that someone is suffering from bulimia (though, I would argue, it is not always obvious that someone is suffering from any eating disorder). Even when it is “discovered,” BN is often placed in opposition with AN — as if the two were polar opposites.

Indeed, attempts to define a phenotype (a set of observable traits or characteristics) for AN and BN tend to oppose the two and to suggest that the people who develop AN are inherently different from those who develop BN. While I believe there is some scientific evidence for personality differences between the two, the degree of diagnostic crossover and symptom variability in eating disorders makes me feel like this split is at the very least overly simplistic.

What is interesting is how BN has come to occupy a very different place in our collective social imagination than AN. We know that preconceived notions about what it means to be an individual with an eating disorder in general can …

Clinical Utility of Weight Suppression in Bulimia Nervosa Treatment – Part II

In this post I will continue my discussion on weight suppression in bulimia nervosa (click here to read Part I). Just in case you happen to be reading the posts out of sequence, I will summarize the main points of that entry:

  1. Weight suppression is the difference between one’s current body weight and highest adult body weight.
  2. It has been found that individuals with BN are on average well below their highest historical weights (i.e. they are weight suppressed).
  3. Many studies have consistently found positive associations between WS and the onset and maintenance of BN symptoms.


Because most individuals with BN have undergone significant weight loss, this makes them susceptible to weight regain — much like obese individuals usually regain the weight they have lost. Indeed, evidence suggests that weight suppression predicts weight gain in individuals with BN during inpatient (Lowe et al., 2006) and outpatient treatment (Carter et al., 2008).

In contrast, other measures of weight history, such as highest or lowest body mass index (BMI)

HW vs. CW: Weight Suppression in Bulimia Nervosa – Part I

HW. CW. LW. GW1. GW2. GW3. UGW.

If you have (or have had) an eating disorder (or dieted and used online forums), chances are you know what those acronyms mean. And if you have browsed blogs written by eating disorder sufferers, chances are you have come across these acronyms too. After all, they are a prominent feature of many such blogs.

If you are lost, I’ll fill you in: the acronyms stand for Highest Weight, Current Weight, Lowest Weight, Goal Weight 1/2/3, and Ultimate Goal Weight (UGW). Unsurprisingly, most individuals with eating disorders, much like dieters, like to keep track of their weight loss — that is, the difference between the highest weight, HW, and the current weight, CW.

Researchers call this difference weight suppression (WSmore specifically, the highest adult body weight) and one’s current weight). It can be thought of as the extent to which an individual has reduced their weight through dieting. It is usually calculated based on self-reported highest adult body weights. (So those …

Bingeing Because Food is Yummy: A Stepping Stone Toward Recovery from Anorexia and Bulimia?

This may sound counterintuitive at first, but I’m thankful for two aspects of my eating disorder, which I believe helped me make the choice to aim towards recovery: the development of binge eating after chronic food restriction and the physical inability to purge through self-induced vomiting. Like many individuals diagnosed with anorexia nervosa that go on to develop binge eating, I tended to choose high-fat foods and sweets as my “go-to” food items. I had always enjoyed such foods and was a notorious junk food aficionado as a young girl (way before any eating disorder symptoms developed). Once the bingeing behavior started, I couldn’t stop.

Sitting with the discomfort after a binge made me seriously consider whether this was something I could maintain for any lengthy period of time, and that’s when I started getting help. In a sense, I believe my affection for sweet foods, and propensity to binge on them, was a “life saver” of sorts. I also think these behaviors got me used to eating foods that I had deemed “forbidden” while I was restricting. With this forced confrontation, I …

Cognitive-Behavioural Therapy for Bulimia Nervosa in the “Real World”: What’s the Evidence?

Cognitive-behavioural therapy (CBT) is commonly described as the evidence-based treatment for bulimia nervosa. But do the findings from nearly perfectly crafted trials, with stringently followed protocols and “ideal” participants apply to the “real world”? How generalizable are the findings from carefully selected participants to clinical populations where, for one, the prevalence of psychiatric comorbidities is relatively high?

In other words, CBT has been shown to be efficacious (i.e., it works in a controlled experimental research trial setting) but is it effective (i.e., does it work in a clinical setting where clients might have multiple diagnoses and complex needs)?

This is precisely the question that Glenn Waller and colleagues sought to answer. They wanted to see whether CBT would work in a “routine clinical setting, where none of the exclusion-and protocol-based constraints […] apply.”


Participants were recruited from a publicly-funded outpatient ED service in the UK. The only exclusion criteria were psychosis, learning difficulties, and inability to communicate in English.

78 adult women (average age: 28; average BMI: 22) entered treatment:

  • 55 with bulimia nervosa (52 purging subtype and 3

Comorbid PTSD and Eating Disorders: Can Treating One Improve The Other?

Women with bulimia nervosa are three times more likely to struggle with PTSD than women without eating disorders, according to a study by Dansky and colleagues (1997). In that study, 37% of individuals with bulimia nervosa had lifetime PTSD, compared to 12% of women without eating disorders. That’s almost two in five.

Treating eating disorders is hard, but treating eating disorders with comorbid conditions is way harder. There is no consensus, it seems, as to what disorder(s) to treat first, or whether they should be treated simultaneously:

Brewerton (2004) suggests that eating problems should be addressed prior to treating PTSD because bingeing and purging contribute to a state of physical and emotional dysregulation. Fairburn (2008), however, suggests that significant comorbid disorders be treated prior to beginning CBT for eating disorders.

The issue is quite complex,

For example, the presence of severe depression, of which hopelessness and difficulty concentrating are core criteria, may present a barrier to treatment of the eating disorder. Furthermore, if eating is used to escape from or avoid intrusive memories or strong emotions, it

Posttraumatic Stress Disorder in Women with Bulimia Nervosa

Posttraumatic stress disorder (PTSD) is 3-5 times more prevalent in individuals with bulimia nervosa (BN) than those without (Dansky et al., 1997). However, the relationship between PTSD and BN–in particular, how PTSD might affect or moderate bulimic symptoms–remains largely unexplored. In a recent study, Trisha Karr and colleagues followed 119 women (20 with PTSD and BN, and 99 with BN only) for a 2 week period to investigate whether participants with comorbid PTSD + BN differed from those with BN only on the:

  1. Levels of negative affect (negative emotional state/mood) and affect variability (fluctuation between negative and positive states)
  2. Frequency of bulimic behaviours
  3. Relationship between emotional states (negative or positive affect) and bulimic behaviours

They used the ecological momentary assessment (EMA) tool to track behaviours and emotional states close to when they occurI’ve blogged about a study using EMA before (‘What’s The Point of Bingeing/Purging? And Why Can’t You Just Stop?’), but briefly,

EMA techniques provide methods by which a research participant can report on symptoms, affect, behaviour and cognitions close in time to experience, and

Bingeing and Purging: Keeping the “Positives” and Eliminating The Negatives?

I have been fascinated and perplexed by reports of the seemingly invigorating and anxiety reducing effects of bingeing and purging (purging by self-induced vomiting). Personally, I cringe at the idea of self-induced vomiting and have always wanted to avoid vomiting at all costs, including during food poisoning. The insight from recent blog entries and the subsequent comments has made an impact on me. I see that the motivation to engage in bingeing/purging (b/p-ing) behavior can be intense and can provide an effective way increase positive affect and reduce stress. The ameliorating effects of b/p-ing remind me of drug addiction, with b/p-ing behavior as the “drug.”  This made me wonder, what happens in the brain to impart such “addiction-like” reinforcement?

I know there are reports of opiate and endorphin release following purging, but to me, this seemed like an effect meant to counter the intense aversion (and discomfort?) of the act of purging itself. Correct me if I’m wrong, but it seems like the feeling of being “empty” should be reinforcing as well. As someone who used to restrict quite a bit, I certainly found that …

Nonpurging Bulimia Nervosa: Where Does It Fit?

When most people think of bulimia nervosa, they think of binge eating and self-induced vomiting. While that is not incorrect, it is not the full picture either. In the current edition of the Diagnostic and Statistical Manual (DSM-IV), there are two subtypes of bulimia nervosa: purging (BN-P) and nonpurging (BN-NP). The difference lies in the types of compensation methods: patients with BN-P engage in self-induced vomiting, or the misuse of laxatives, diuretics, or enemas whereas patients with BN-NP use fasting or excessive exercise to compensate for binge eating.

How common in BN-NP? It is very hard to say. A small population-based study in Finland (less than 3,000 participants) found that 1.7% of the sample that bulimia nervosa, 24% had BN-NP (or 0.4% of the entire sample) (Keski-Rahkonen et al., 2009). (I couldn’t find much else on prevalence of BN-NP.)

Unfortunately, however, there’s been very little research on BN-NP.

So little, in fact, that many have wondered if it make sense to subtype bulimia nervosa patients into purging and nonpurging groups? And are there differences between patients …


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