Background: The eating disorder disease known as bulimia nervosa (BN) typically appears between adolescence and early adulthood, with a median onset age of 12. In order to manage weight gain, people with BN often engage in odd compensatory behaviors after episodes of excessive food consumption. Roughly 94% of people with BN either put off or never seek therapy. Even though there are therapies available, certain communities lack access to them. If BN is not treated, it may worsen and result in additional dangerous comorbidities. Οur proposed therapeutic model with the theoretical formulations of an enriched therapeutic perspective named H.E.A.L will be presented. Individuals, couples, and groups are all included, and it incorporates a range of cognitive-behavioral, systemic, attachment theory-based elements and neuropsychotheraputic techniques. The theoretical perspective of the model incorporates findings of neuroscience and neuropsychotherapy, psychodynamic and humanistic approaches (attachment theory, person-centered theory), cognitive therapies, narrative exposure theory and somatic experiencing modalities. H.E.A.L. describes an extended version of the stages of this intergrative model. Case Presentation: This case study will focus on Α, a female aged 23 with Bulimia Nervosa, (moderate severity), and average of 4 - 5 episodes of inappropriate conpensatoty behaviors according to DSM-5. The patient was recommended after a psychiatric evaluation with issues except from psychogenic bulimia, such as anxiety attacks, depressive symptomatology and low levels of functioning. She completed three pre- and post-intervention questionnaires, the Beck Depression Inventory (BDI) Beck Anxiety Inventory (BAI) and GAF Scale. Also the Eating Disorder Examination Questionnaire (EDE-Q) at the beginning of the intervention and at the end, the Eating Disorder Recovery Questionnaire (Dr Greta Noordenbos, Psychological Instiute of Leiden University) After the intervention she showed reduction in Depression Inventory Scores, BAI scores and on the GAF scores. She also reduced bulimic episodes to one per month and she demonstrated changes overall in eating behavior, body image, self-confidence, emotional regulation, and social relationships and partnerships. Conclusions: The patient showed changes in three mental health indicators of depression, anxiety and overall well-being. She also demonstrated a change in the frequency of bulimic episodes, a balanced relationship with nutrition, and overall satisfaction with life.
References
[1]
Aas, I. M. (2011). Guidelines for Rating Global Assessment of Functioning (GAF). AnnalsofGeneralPsychiatry,10, Article No. 2. https://doi.org/10.1186/1744-859x-10-2
[2]
American Psychiatric Association (2022). DiagnosticandStatisticalManualofMentalDisorders. 5th Edition, APA Press.
[3]
Androutsopoulou, A. (2001). The Self‐Characterization as a Narrative Tool: Applications in Therapy with Individuals and Families. FamilyProcess,40, 79-94. https://doi.org/10.1111/j.1545-5300.2001.4010100079.x
[4]
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An Inventory for Measuring Clinical Anxiety: Psychometric Properties. JournalofConsultingandClinicalPsychology,56, 893-897. https://doi.org/10.1037/0022-006x.56.6.893
[5]
Beck, A. T., Rush, A. J., Shaw, B. F. et al. (1979). CognitiveTherapyofDepression. Guilford Press.
[6]
Bowlby, J. (1988). ASecureBase:Parent-ChildAttachmentandHealthyHumanDevelopment. Basic Books.
[7]
Burlingame, G. M., & Strauss, B. (2021). Efficacy of Small Group Treatments: Foundation for Evidence-Based Practice. In M. Barkham, W. Lutz, & L. G. Castonguay (Eds.), BerginandGarfield’sHandbookofPsychotherapyandBehaviorChange:50thAnniversaryEdition (pp. 583-624). Wiley.
[8]
Dummett, N. (2004). Manual for Systemic Cognitive Behavioural Therapy.
[9]
Dummett, N. (2006). Processes for Systemic Cognitive-Behavioural Therapy with Children, Young People and Families. BehaviouralandCognitivePsychotherapy,34, 179-189. https://doi.org/10.1017/s135246580500264x
[10]
Dummett, N. (2010). Cognitive-Behavioural Therapy with Children, Young People and Families: From Individual to Systemic Therapy. AdvancesinPsychiatricTreatment,16, 23-36. https://doi.org/10.1192/apt.bp.107.004259
[11]
Gspandl, S., Peirson, R. P., Nahhas, R. W., Skale, T. G., & Lehrer, D. S. (2018). Comparing Global Assessment of Functioning (GAF) and World Health Organization Disability Assessment Schedule (WHODAS) 2.0 in Schizophrenia. PsychiatryResearch,259, 251-253. https://doi.org/10.1016/j.psychres.2017.10.033
[12]
Hail, L., & Le Grange, D. (2018). Bulimia Nervosa in Adolescents: Prevalence and Treatment Challenges. AdolescentHealth,MedicineandTherapeutics,9, 11-16. https://doi.org/10.2147/ahmt.s135326
[13]
Harrington, B. C., Jimerson, M., Haxton, C., & Jimerson, D. C. (2015). Initial Evaluation, Diagnosis, and Treatment of Anorexia Nervosa and Bulimia Nervosa. American Family Physician, 91, 46-52.
[14]
Katakis, C. (2002). Family Oriented Group Therapy with Individuals: An Integrative Model of Systemic Psychotherapy. Working Paper 2002/4. Laboratory for the Study of Human Relations Working Paper Series.
[15]
Levy, K. N. (2013). Introduction: Attachment Theory and Psychotherapy. JournalofClinicalPsychology,69, 1133-1135. https://doi.org/10.1002/jclp.22040
[16]
Levy, K. N., Kivity, Y., Johnson, B. N., & Gooch, C. V. (2018). Adult Attachment as a Predictor and Moderator of Psychotherapy Outcome: A Meta‐Analysis. JournalofClinicalPsychology,74, 1996-2013. https://doi.org/10.1002/jclp.22685
[17]
Marmarosh, C. L., & Sproul, A. (2021). Group Cohesion: Empirical Evidence from Group Psychotherapy for Those Studying Other Areas of Group Work. In ThePsychologyofGroups:TheIntersectionofSocialPsychologyandPsychotherapyResearch (pp. 169-189). American Psychological Association. https://doi.org/10.1037/0000201-010
[18]
Martins, D., Leslie, M., Rodan, S., Zelaya, F., Treasure, J., & Paloyelis, Y. (2020). Investigating Resting Brain Perfusion Abnormalities and Disease Target-Engagement by Intranasal Oxytocin in Women with Bulimia Nervosa and Binge-Eating Disorder and Healthy Controls. TranslationalPsychiatry,10, Article No. 180. https://doi.org/10.1038/s41398-020-00871-w
[19]
Mathisen, T. F., Rosenvinge, J. H., Pettersen, G., Friborg, O., Vrabel, K., Bratland-Sanda, S. et al. (2017). The Ped-T Trial Protocol: The Effect of Physical Exercise and Dietary Therapy Compared with Cognitive Behavior Therapy in Treatment of Bulimia Nervosa and Binge Eating Disorder. BMCPsychiatry,17, Article No. 180. https://doi.org/10.1186/s12888-017-1312-4
[20]
Mond, J. M. (2013). Classification of Bulimic-Type Eating Disorders: From DSM-IV to DSM-5. JournalofEatingDisorders,1, Article No. 33. https://doi.org/10.1186/2050-2974-1-33
[21]
Nitsch, A., Dlugosz, H., Gibson, D., & Mehler, P. S. (2021). Medical Complications of Bulimia Nervosa. ClevelandClinicJournalofMedicine,88, 333-343. https://doi.org/10.3949/ccjm.88a.20168
[22]
Rachman, S. J. (1978). An Anatomy of Obsessions. BehaviouralAnalysisandModification,2, 253-278.
[23]
Seligman, M. E. P. (1998). The President’s Address. AmericanPsychologist, 54, 559-562.
[24]
Seligman, M. E. P. (2019). Positive Psychology: A Personal History. AnnualReviewofClinicalPsychology,15, 1-23. https://doi.org/10.1146/annurev-clinpsy-050718-095653
[25]
Stein, D. J., Phillips, K. A., Bolton, D., Fulford, K. W. M., Sadler, J. Z., & Kendler, K. S. (2010). What Is a Mental/Psychiatric Disorder? From DSM-IV to DSM-V. PsychologicalMedicine,40, 1759-1765. https://doi.org/10.1017/s0033291709992261
[26]
Udo, T., & Grilo, C. M. (2018). Prevalence and Correlates of DSM-5-Defined Eating Disorders in a Nationally Representative Sample of U.S. Adults. BiologicalPsychiatry,84, 345-354. https://doi.org/10.1016/j.biopsych.2018.03.014
[27]
Williams, C. J. (2001). OvercomingDepression:AFiveAreasApproach. Arnold.
[28]
Yalom, I., & Leszcz, M. (2020). The Theory and Practice of Group Psychotherapy. Basic Books.