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Objective: The present review addresses the outcome of bulimia nervosa, effect variables, and prognostic factors. Method: A total of 79 study series covering 5,653 patients suffering from bulimia nervosa were analyzed with regard to recovery, improvement, chronicity, crossover to another eating disorder, mortality, and comorbid psychiatric disorders at outcome. Forty-nine studies dealt with prognosis only. Final analyses on prognostic factors were based on 4,639 patients. Results: Joint analyses of data were hampered by a lack of standardized outcome criteria. There were large variations in the outcome parameters across studies. Based on 27 studies with three outcome criteria (recovery, improvement, chronicity), close to 45% of the patients on average showed full recovery of bulimia nervosa, whereas 27% on average improved considerably and nearly 23% on average had a chronic protracted course. Crossover to another eating disorder at the follow-up evaluation in 23 studies amounted to a mean of 22.5%. The crude mortality rate was 0.32%, and other psychiatric disorders at outcome were very common. Among various variables of effect, duration of follow-up had the largest effect size. The data suggest a curvilinear course, with highest recovery rates between 4 and 9 years of follow-up evaluation and reverse peaks for both improvement and chronicity, including rates of crossover to another eating disorder, before 4 years and after 10 years of follow-up evaluation. For most prognostic factors, there was only conflicting evidence. Conclusions: One-quarter of a century of specific research in bulimia nervosa shows that the disorder still has an unsatisfactory outcome in many patients. More refined interventions may contribute to more favorable outcomes in the future.
http://ajp.psychiatryonline.org/cgi/content/short/appi.ajp.2009.09040582v1?rss=1
Each star a rung,night comes down the spiralstaircase of the evening.
The breeze passes by so very close
as if someone just happened to speak of love.
In the courtyard,the trees are absorbed
refugees embroidering maps of return on the sky.
On the roof,the moon – lovingly, generously -is turning the stars into a dust of sheen.
From every corner, dark-green shadows,in ripples, come towards me.
At any moment they may break over me,
like the waves of pain each time I remember this separation from my lover.
This thought keeps consoling me:
though tyrants may command that lamps be smashed
in rooms where lovers are destined to meet,
they cannot snuff out the moon,
so today,nor tomorrow, no tyranny will succeed,
no poison of torture make me bitter,
if just one evening in prison
can be so strangely sweet,
if just one moment anywhere on this earth.
-Faiz Ahmed Faiz
We know you always deal with your illness with such courage,
but we still wanted to send you a few hugs,
along with rays of sunshine, big smiles,
and a whole roomful of good thoughts!
So think of these words as a beautiful sunset all your own
and the sound of the ocean gently washing the shore…
Let our thoughts wrap you up in warmth and peace
and sit at your side.
So as you imagine yourself in the midst of these things,
remember how many people care about you and are
wishing you comfort and Love.
-Mary Miro
*Lots&Lots of LOVE to You Today and Everyday! — Mom*Dad*Sis*
When you begin to touch your heart or let your heart be touched, you begin to discover that it’s bottomless, that it doesn’t have any resolution, that this heart is huge, vast, and limitless. You begin to discover how much warmth and gentleness is there, as well as how much space.
-Pema Chodron
* A Very Blessed and Happy Mother’s Day! *
In every walk with Nature one receives far more than he seeks.
-John Muir
As many of you may already be aware of, on February 25, 2009 the Eating Disorders Coalition along with the FREED Foundation and others advocating the FREED Act – The Federal Response to Eliminate Eating Disorders – H.R. 1193, successfully were able to get the bill to the House floor.
The next important step towards getting the bill passed will be taking place on April 1-2, 2009 when EDC holds their annual Lobby Day gathering.
If you are not able to attend this event and/or additionally would like to add your voice towards enacting this important and comprehensive legislation for eating disorders that promotes research, treatment, education and prevention programs please write to your state representatives urging them to learn more and help support the passing of the FREED Act.
Below is a sample letter that can be modified and added with your personal message:
Your Name
Street Address
City
March –, 2009
The Honorable First Name Last Name
United States House of Representatives
Washington, DC 20515
Dear Congressman(woman) –,
As a member of the Eating Disorders Coalition and someone who has personally suffered the impact of living with an eating disorder, I am writing you today to ask your support for the Federal Response to Eliminate Eating
Disorders Act (H.R. 1193).
This is the first comprehensive eating
disorders bill in the history of Congress. By focusing on research, education, prevention and treatment this bill is a beacon of hope for the millions of people currently suffering from an eating disorder.
It is estimated that 9 million Americans suffer from anorexia, bulimia, binge eating and other eating disorders. Eating disorders are associated with a host of medical complications including cardiac arrhythmia, cognitive impairment, osteoporosis, infertility, heart failure and most seriously death. In fact, anorexia nervosa has the highest death rate of all mental disorders, upwards of 20%.
Research shows that eating disorders can be successfully overcome with early detection and adequate and appropriate treatment. Unfortunately eating disorders are often undiagnosed by health professionals and/or access to treatment is limited. Less than half of all people with eating disorders receive the treatment needed.
The Federal Response to Eliminate Eating Disorders (the FREED Act) can change these state of affairs. H.R. 1193 will save lives by providing more funds for research so that we can better understand, prevent and treat eating disorders, grant programs that provide training for health professionals, and steps toward better access to treatment coverage.
We urge you to sign on as a cosponsor of the FREED Act. I look forward to
hearing from you. Thank you again for your consideration.
Warm regards,
*You can make a difference! Merci!*
When caring for an adolescent suffering with an eating disorder for any length of time, you soon realize how invaluable earlier diagnosis and treatment become in making purposeful and healthy strides forward, as well as any necessary changes and re-strategizing needed to better support a loved ones recovery process.
And while there is a better knowledge base available regarding eating disorders today, studies and research of “what works” and “what doesn’t” in the real day to day of those living with this illness, and how to better train, educate and provide for those treatment services are still slowly surfacing.
Dr James Lock, whom many a parent are familiar with from his work and book: Help Your Teenager Beat an Eating Disorder is spearheading one of the Largest-Ever Bulimia Study involving adolescents suffering from bulimia through Stanford University:
…psychiatrists at the Stanford University School of Medicine and the University of Chicago are seeking volunteers for the largest-ever randomized controlled trial of bulimia treatments for adolescents.
Only two small randomized trials have previously been done in this age group. “We desperately need more information,” said James Lock, MD, PhD, professor of psychiatry and behavioral sciences at Stanford and the study’s senior investigator. Lock is also director of psychiatric services at the Comprehensive Eating Disorders Program at Lucile Packard Children’s Hospital.
Prior bulimia-treatment trials focused on adult patients, Lock said, which is why the National Institute of Mental Health awarded his team a five-year, $2 million grant to compare bulimia treatments for young people. Full-blown bulimia affects 1 to 2 percent of adolescents, and another 2 to 3 percent display significant bulimic behaviors, Lock noted. Female patients outnumber males by five to one, he said.
The team will study three treatments that may help adolescent bulimics. Study subjects will be randomly assigned to receive 20 outpatient consultations using cognitive behavioral therapy, family therapy or individual psychotherapy. Cognitive behavioral therapy is widely recognized as the preferred bulimia treatment for adults, whereas family therapy is used in teens with anorexia nervosa. Individual psychotherapy has succeeded as an alternate treatment for bulimic adults and adolescents.
Interested individuals should contact research assistant Brittany Alvy at (650) 723-9182.
The pathology Lock hopes to heal stems from poor body image and an unhealthy focus on rigid dieting. Strict dieting sets up patients for lapses of control—binge-eating episodes. After binge eating on thousands of calories, patients purge with vomiting, laxatives or excessive exercise. They then feel guilty over their loss of control, fueling further negative thoughts and deepening the downward spiral.
Cognitive behavioral therapy works on changing patients’ behaviors and thinking patterns related to food and to body image. The therapist aims to help the patient stop thoughts that overemphasize the importance of weight and shape and end severe, destructive dieting. Family therapy focuses solely on eating behaviors.
The patient’s parents are involved in every therapy session, and the underlying goal is to change the home environment so that it reinforces healthy eating and discourages dieting. “In this treatment, we see parents as a resource to facilitate behavioral change,” Lock said. Individualized psychotherapy, rather than targeting eating, examines underlying life problems that contribute to negative self-image.
“We hope early intervention will become a chronic, long-lasting strategy,” Lock said. Instead of treating bulimia in adulthood, “after the horse is out of the barn,” early treatment has a better shot at causing a lasting cure, he added.
About Stanford University Medical Center Stanford University Medical Center integrates research, medical education and patient care at its three institutions — Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children’s Hospital at Stanford. For more information, please visit the Web site of the medical center’s Office of Communication & Public Affairs at http://mednews.stanford.edu/.
About Lucile Packard Children’s Hospital Ranked as one of the best pediatric hospitals in the nation by U.S.News & World Report and Child magazine, Lucile Packard Children’s Hospital at Stanford is a 272-bed hospital devoted to the care of children and expectant mothers. Providing pediatric and obstetric medical and surgical services and associated with the Stanford University School of Medicine, Packard Children’s offers patients locally, regionally and nationally the full range of health care programs and services — from preventive and routine care to the diagnosis and treatment of serious illness and injury. For more information, visit http://www.lpch.org/.
So many celebrations lately- my blog-baby has turned “1″!
Happy Blog Anniversary to You….
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