Nutritional counseling as an adjunct to psychotherapy in bulimia treatment

Tratamento nutricional da bulimia nervosa

A bulimia nervosa é um transtorno alimentar caracterizado por compulsões alimentares e métodos compen-satórios recorrentes. Os pacientes apresentam ingestão alimentar inadequada e comportamentos alimentares disfuncionais. O adequado tratamento do transtorno requer uma equipe multiprofissional e terapia nutricional especializada. Compreender as características desse transtorno, os padrões de consumo e o comportamento alimentar, bem como atentar para as atitudes alimentares dos pacientes, é fundamental para o planejamento e para a adequada condução da abordagem nutricional. A terapia nutricional para esse transtorno é diferenciada, exigindo do nutricionista maiores habilidades de aconselhamento nutricional. Educação nutricional e acon-selhamento nutricional, com ênfase na abordagem de atitudes alimentares e insatisfação corporal, são o foco da terapia nutricional. Para o atendimento eficaz desses pacientes e o sucesso no tratamento nutricional, é importante que o profissional se mantenha atualizado sobre nutrição e transtornos alimentares e procure especialização e experiência nessa área do conhecimento.

Cognitive-behavioral therapy and nutritional counseling in the treatment of bulimia nervosa and binge eating

The goals of manual-based cognitive-behavioral therapy (CBT) and nutritional counseling for eating disorders are similar, namely, eliminating dysfunctional patterns of eating. Modifying these behaviors requires specific therapeutic expertise in the principles and procedures of behavior change that is not typically part of the training of nutritionists and dieticians or mental health professionals without specific expertise. We discuss ways in which principles of behavior change can be applied to eating disorders by non-CBT experts. Specific nutritional rehabilitation programs have the potential to augment CBT in addressing the array of appetitive abnormalities present in eating disorder patients. The dysfunctional appetitive, hedonic, and metabolic characteristics of patients with bulimia nervosa (BN) and binge eating disorder are reviewed. These abnormalities constitute potential target areas that might be more fully addressed by nutritional interventions designed to restore normal appetitive function.

How to help the athlete with bulimia: practical tips and a case study

Surveys suggest that 8 to 41% of athletes may struggle with binge/purge and bulimic eating behaviors. Many of these athletes with bulimia struggle alone, receiving no professional help for recovery. This article offers effective counseling strategies for nutrition professionals who want to help bulimic athletes. Through a case study of a triathlete who binges, and then purges through compulsive exercise, a nutrition care plan is discussed that addresses the food and weight concerns commonly expressed by athletes with bulimia. The priorities of the care plan are to reduce preoccupation with weight, establish a pattern of regular eating, and address the underlying causes of the binges. The case demonstrates that nutrition counseling is only one part of the treatment program, and emphasizes the importance of developing a team of health professionals to assist athletes with bulimia.

Bulimia. A review of nutritional and health behaviors

Nurses working with adolescents need an understanding of the clinical syndrome of bulimia in order to identify individuals at risk for this disorder and implement preventive and therapeutic interventions. The epidemiology, early precipitants, physiology, and biochemistry of bulimia nervosa are reviewed. From this integrated framework, implications for treatment are explored with an emphasis on holistic nursing care including health education.

The treatment of bulimia nervosa

We review treatment approaches to bulimia nervosa, with particular emphasis on methodology and research design. The following treatments are considered: behaviour therapy, cognitive behaviour therapy, pharmacological treatment, group therapy, psychoanalytic psychotherapy, self-help and support groups, hypnosis and miscellaneous (family therapy and nutritional approaches). Several directions for future research and methodological recommendations are suggested.

Bulimia: the emergence of a syndrome

The literature on bulimia, which has regarded it as a psychiatric entity or as a form of disordered eating, suggests that this behaviour is now widespread among the obese, among those with anorexia nervosa and those of normal weight. While physiological, psychological and sociocultural explanations and forms of treatment have been proposed, a holistic perspective on the context in which it occurs can distinguish bulimia nervosa and bulimarexia from 'simple' bulimia.

Treatment of bulimia

Bulimia (bulimia nervosa; binge eating) is characterized by episodic eating of large amounts of food, followed by self-induced vomiting or laxative abuse. Psychotherapy has been the mainstay of treatment and often has been unsuccessful. The similarity of bulimia to major depression has led to evaluation of antidepressant drugs for treatment of the disease. Imipramine has proven effective in reducing binging episodes, and further evaluation of antidepressants seems warranted. Phenytoin also has been effective in some cases, suggesting that bulimia may be a neurologic disorder analogous to epilepsy. Optimal treatment may be antidepressants combined with a nutrition/psychotherapy program.