Individual Programmatic Assessment:

Bulimia Nervosa

Psychological disorders occur frequently. A common psychological disorder selected for the purpose of this paper is bulimia nervosa. Bulimia nervosa has several therapeutic interventions that can help when treating the disorder. Therapeutic interventions can be helpful, but have different measures of effectiveness. The measures of effectiveness consist of validity, efficacy, symptom, behavior management, and recidivism. These measures should be identified, prior to deciding which therapeutic interventions can be most helpful to the individuals diagnosed with the psychological disorder. Many common symptoms are associated with bulimia nervosa. Rates of symptom reduction or management have been reported with the three treatments. Furthermore, the neurophysiological underpinnings of diseases and disorders have to be identified, along with the contemporary attitudes towards the three treatments chosen.

Psychological Disorder: Bulimia Nervosa

Bulimia nervosa is known as an eating disorder. This disorder typically affects females and is most often done by binge-and-purge eating patterns. This eating disorder brings about the effects of bingeing and purging, and using laxative. People, suffering from bulimia nervosa, frequently eat a lot of food at one time. A short period after eating the food, the person, then, attempts to remove the food from his or her system by vomiting, through medication that creates bowl movements, or by working out. Excess working out has been known to lead one to throw up. People diagnosed with bulimia nervosa, often lack self-esteem. Many are self-conscious about their body image and preoccupied by food. Majority of individuals, suffering from bulimia nervosa, have normal weight or believe that they have weight problems. Bulimia is associated with other illnesses, as well. For example, some suffer from depression. Bulimia nervosa shares many characteristics of anorexia nervosa. Anorexia nervosa is a psychological eating disorder that impacts many people, as well. However, instead of purging or bingeing, people with anorexia nervosa, simply, do not eat. People, diagnosed with bulimia nervosa, have a difficult time maintaining a set weight like other individuals. Furthermore, more critically, they are able to hide the fact that they have bulimia nervosa. If bulimia nervosa goes untreated, it can create critical issues, along with a nutritional downfall."Bulimia nervosa can be extremely harmful to the body.The recurrent binge-and-purge cycles can damage the entire digestive system and purging behaviors can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions" (NEDA, 2012).

The cause of bulimia nervosa has not been, accurately, identified. Researchers have discovered that genes and psychological factors may be the main reasons why individuals are guided down the path of being diagnosed with bulimia nervosa. Genes can contribute to the diagnosis of bulimia nervosa because genes can cause people to have a higher or lower risk of being diagnosed with bulimia, according to their brothers and sisters or parents. Bulimia nervosa is, often, created by stress. Stress can come from outside or inside factors. For example, stress can be contributed by their parents or families because of pressure. The pressure can be based on one's under-achievements or, simply, expectations on the behalf of the parents or siblings on the individual. This pressure can create stress, which causes a change in an individual's self-esteem and behavior. The individual may gain an inability to control behavior or try to push themselves above and beyond to try to minimize the stress from the outside sources. Stress can cause people to gain negative emotions like anger, disappointment, or sadness. Bulimia can also be caused by peer pressure or abuse. Peer pressure, frequently, occurs by friends. The abuse can be sexual, verbal, or non-verbal. All types of abuse can make individuals believe that they are not worthy enough or can create depression, due to their psychological changes from abuse.

Three Therapeutic Interventions

Bulimia nervosa has many therapeutic interventions. Three examples of therapeutic interventions that can treat bulimia nervosa include selective serotonin reuptake inhibitors (SSRIs), cognitive behavioral therapy, and yoga. SSRIs have been shown to treat eating disorders. Antidepressants may be used to treat bulimia nervosa as well. For example, Fluoxetine can be used to reduce the bingeing effect that comes with bulimia nervosa. Fluoxetine is a SSRI, known as Prozac. It is the only anti-depressant to gain approval from FDA. Other examples of SSRIs that can be used to treat bulimia nervosa are sertraline and luvox. SSRIs have been good in helping to treat bulimia nervosa. The main weakness of SSRIs is that it can lack efficacy. The major side effects of SSRIs for bulimia are the suicidal thoughts that can come with it, especially for the younger individuals. Studies have noted that SSRIs can produce suicidal thoughts for teenagers and children, especially. The amount of SSRIs taken must be observed, just like every other drug. Individuals, taking SSRIs, should be observed to make sure that they are not put in a critical mindset. In many cases, SSRIs do not hold an advantage in minimizing bingeing and purging from bulimia nervosa more than the cognitive behavioral therapy (UMM, 2014).

Another therapeutic intervention for treatment of bulimia nervosa is cognitive behavioral therapy (CBT). Cognitive behavioral therapy has been identified as the most effective type of psychotherapy for adults with bulimia nervosa (Treating Bulimia Nervosa, 2006). Cognitive behavioral therapy aims to relieve bad thoughts or self-esteem that people create about one self. It can help individuals to decrease or remove stress and try to get back on a healthy, positive lifestyle. According to NAMI (2012), cognitive behavioral therapy is a type of treatment that centers on the relationships between thoughts, feelings, and behaviors. By identifying patterns of thinking that can cause self-destruction, destructive behavior, and the perspectives that can create these ideas, individuals suffering from mental illness can change their trends in thinking to help them cope (NAMI, 2012). Cognitive behavioral therapy starts with several sessions that expand for five months or beyond. After undergoing 10 sessions of cognitive behavioral therapy and there are not changes in the symptoms of bulimia nervosa, it is recommended that the individuals start taking medication (Treating Bulimia Nervosa, 2006). Cognitive behavioral therapy is valid and accurate. It is able to minimize the symptoms that are linked to bulimia nervosa within three stages, in the majority of circumstances. The three stages of cognitive behavioral therapy focus on maintenance, implementation of alternatives, and changing the negative trends even after maintenance. The first stage brings forth new strategies to get rid of binge eating. New eating strategies are introduced. The second stage offers other alternatives to eating, as well; continuing on to establishing healthier nutritional habits then, dieting is removed. Throughout cognitive behavioral therapy, the focus is on discovering the mind process of the person to try to determine why there is an issue with eating. The final stage identifies the trends of eating, after maintenance (Fairburn et al., 1993).

The last therapeutic intervention, selected, that can be used to treat bulimia nervosa is yoga or meditation. Yoga or meditation is on the list of alternatives methods for treating bulimia nervosa. According to UMM (2014),

Stress reduction technique as well as mind-body, such as yoga and meditation, often helps one begin to be more aware of one's body and have a more positive body image. The results of a one 6-week clinical trial proved that guided imagery allow people with bulimia to reduce bingeing and vomiting, while allowing one to feel more comfortable withoneself, and feel better about their bodies and eating.
Yoga is a spiritual process that involves breath control, meditation, and shifts in body posture. Meditation is the process of using images or collecting one's thoughts or identifying behavior to establish good peace of mind. Meditation can be used to treat bulimia nervosa by decreasing the amount of symptoms of the disorder. Meditation helps people to realize their weaknesses and try to overcome them, psychologically more than physically. For bulimia nervosa, meditation can be used to manage one's food tolerance and calm their negative perspectives and behavior. Meditation allows people to focus on their thoughts and try to change them to be guided into a more positive path of life. Meditation has been shown to help self-esteem, confidence, and can minimize one's bingeing cycles. The bad thing about meditation is that the changes are not often long-term. Mediation can bring about improvement in a short time. It is hard to keep people from bingeing or vomiting long-term. It is not a very accurate or effective strategy for bulimia nervosa.

Common Symptoms and Rates of Symptom Reduction

Most symptoms of bulimia are reported to be the eating of a large portion of food in a small period of time, purging through vomiting, exercising, vomiting, misuse of medication or supplements, inability to control how much is eating, binge or purge cycles that happen a lot, fear of weight gain, and being ashamed of eating so much (WebMD, 2014). There are many other symptoms that come with bulimia nervosa, as well. Examples include mouth sores, lack of energy, depression, and drug abuse. The risk of receiving recovery for bulimia nervosa is better when bulimia nervosa is targeted earlier for the individual. Rates of symptom reduction have to be identified for the alternative treatments. SSRIs or antidepressant medication has been shown to be very beneficial, when combined with cognitive behavioral therapy (Wilson, 1997). By itself, SSRIs are capable of minimizing the rates of binge-eating, along with purging. However, it has not shown to be very effective at making depression better or remission. Non-placebo SSRIs had over 60% of an impact in reducing the binge-eating processes, taking 8 weeks of treatment (Hay, 2011). Over 40% of individuals, diagnosed with bulimia nervosa, experienced cancellation after a short amount of time of taking the medication or undergoing psychotherapy treatment. Cognitive behavioral therapy has shown to have long-lasting impacts on patients of bulimia nervosa. Individuals, suffering from bulimia nervosa, were shown to be able to maintain results for 6 to 12 months, once treatment is over. Moreover, there has been a long effect that had a mean of about 5.8 years (Fairburn et al., 1995). Cognitive behavioral therapy is known to have the best results out of all of the alternative, therapeutic interventions. There has also been research on the combining of cognitive behavioral therapy with SSRIs. This strategy has been shown to be effective in helping people with bulimia nervosa, reducing the main features of bulimia.

Neurophysiological Underpinnings / Contemporary Attitudes about Treatments

Neurophysiology consists of physiology and neuroscience. It studies the functioning of the nervous system. Diseases and illnesses can be hard to find treatment for. A neurophysiological study takes time to examine it is, often, associated with a variety of studies. Examples include imaging and blood tests. Overall, neurophysiology is used to diagnose diseases and disorders of the nervous system. Areas of the nervous system it helps to diagnose for this is central and peripheral. For example, Bulimia nervosa is one of the mostknown chronic psychiatric disease affecting in particular female adolescents. Within the acute phase of starvation a number of hormonal, neuropsychological and cerebral morphological changes occur (Buhren, Holtkamp, Herpertz-Dahlmann, & Konrad, 2008). Neurophysiology would help to identify these changes and identify the issues of the brain.
SSRIs have created arguments for many researchers or individuals. Several individuals are not for antidepressant medication, believing that the side effects majorly hinder the success of the medications. A lot of people stop taking anti-depressants, due to the side effects. Many feel they are unsafe. Research has shown that cognitive behavioral therapy is the most effective, when treating symptoms. The contemporary attitude towards cognitive behavioral therapy is that it should be used first, before turning to any other treatments. Yoga or meditation is recommended, due to the fact that it does not have a lot of critical side effects, such as when being compared to SSRIs.

Conclusion

Bulimia nervosa is a psychological disorder that causes people to binge and purge. It can alter one's nutritional stance and can also hurt them psychologically, while physically. Bulimia has no full identification for its cause. There are a variety of factors that may have caused individuals to go into becoming bulimic. Three therapeutic interventions that can treat bulimia nervosa are SSRIs, cognitive behavioral therapy, and yoga or meditation. Out of all the interventions, cognitive behavioral therapy is the most effective alternative. SSRIs are medications that can reduce symptoms of bulimia nervosa. Yoga or meditation brings peace and helps individuals to manage their psychological issues. Common symptoms of bulimia are eating a large amount of food over a small period, bingeing, vomiting, medication or supplement misusage, inability to control how much is ate, fear of weight gain, and problems with self-esteem or imagery. Research shows that bulimia nervosa can be better treated with cognitive behavioral therapy or a combine of cognitive behavioral therapy with SSRIs. Neurophysiology's motive is to identify the nervous system and the changes that occur within. Contemporary attitudes support cognitive behavioral therapy over SSRIs. However, researchers also believe that meditation can be a nice type of treatment for bulimia nervosa. Many people fear SSRIs, due to its side effects.