Dialectical Behavior Therapy for Binge Eating and Bulimia Read Online Free PDF Page A

personality disorder and 1.8% for avoidant personality disorder (Samuels et al., 2002).
    As to eating-disorder-specifc psychopathology, people with BN, compared with non-eating-disordered controls, report signifcantly higher levels of concerns

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    regarding body shape, body weight, eating (e.g., preoccupation with food and calo— ries), and dietary restriction (Cooper, Cooper, & Fairburn, 1989).
    Social Impairment and BN
    BN affects social adjustment. For instance, individuals with BN, compared with non-eating-disordered controls, depict more overall social impairment, specifcally in the areas of work, leisure, and family relationships (Herzog, Keller, Lavori, & Ott, 1987). Women whose BN is active, compared with women whose BN is in remission and with non-eating-disordered controls, report signifcantly less emotional support (Rorty, Yager, Buckwalter, & Rossotto, 1999). And both those with active or remitted BN, compared with non-eating-disordered controls, expressed signifcant dissatisfaction with the quality of emotional support provided by rela— tives (Rorty et al., 1999). The social impairment experienced by patients with BN appears to be enduring. Ten years after being diagnosed with BN, women contin— ued to experience diffculties in their interpersonal relationships (Keel, Mitchell, Miller, Davis, & Crow, 2000).
    Studies of quality of life in BN show that individuals with a history of BN versus those without such a history report more diffculties, particularly with emotional functioning (Doll, Petersen, & Stewart-Brown, 2005). Compared with a group of individuals with mood disorders, eating-disordered patients, including patients with BN, reported having a worsened quality of life (de la Rie, Noorden— bos, & van Furth, 2005). These differences in quality of life seem long-standing, with former eating-disordered patients having a poorer quality of life than a control reference group (de la Rie et al., 2005).
    Physiological Consequences of BN
    BN is associated with serious physiological consequences, especially among those who regularly vomit or engage in laxative abuse. Though mortality due to BN is low, it is not insignifcant. Crude mortality rates due to all causes range from 0.3% to 2% (Fichter, Quadfieg, & Hedlund, 2008; Keel & Mitchell, 1997). Potentially life-threatening complications include low potassium (hypokalemia), esophageal ruptures, cathartic colon, impaired kidney function, cardiac arrythmias, and cardiac arrest (Kaplan & Garfnkel, 1993; Sansone & Sansone, 1994).
    In one study of 275 women with BN, the most common complaints were weak— ness (84%), bloating (75%), cheek puffness (50%), dental symptoms (36%), and fnger calluses (27%; Mitchell, Hatsukami, Eckert, & Pyle, 1985). Even when not directly life threatening, bulimic behaviors profoundly affect the body in terms of oral complications, gastrointestinal symptoms, renal and electrolyte abnormalities, cardiovascular symptoms, and negative consequences to the endocrine system (see, e.g., reviews by Mehler, Crews, & Weiner, 2004; Mitchell & Crow, 2006). Ero— sion of teeth enamel, for example, is usually seen within 6 months of self-induced vomiting and is always evident in those suffering for 5 or more years (Althshuler, Dechow, Waller, & Hardy, 1990). Parotid gland enlargement is estimated to affect between 10 and 50% patients with BN (Mehler et al., 2004). Hypokalemia occurs in approximately 14% of bulimic patients. This serious electrolyte disturbance

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    DIALECTICAL BEHAVIOR THERAPY FOR BINGE EATING AND BULIMIA
    may potentially lead to other complications, such as cardiac arrythmias and the degeneration of cardiac muscle (Casiero & Frishman, 2006). In terms of endocrine system involvement, although evidence for a causal relationship between bulimia and diabetes is mixed, it is clear that the presence of an eating disorder in addition to diabetes is linked to a worsened diabetic course—including the