OBJECTIVE: Over the last few years there has been growing concern about bulimia nervosa in Korea, but there was only a few clinical study, especially about outcome and predictors. CBT combined with pharmacotherapy has been recognized as the most effective short-term treatment modality, but there was nonresponders. The purpose of this paper is to examine the factors that influence treatment response and outcome in patients with bulimia nervosa. The identification of prognostic factors in bulimia nervosa will help clinicians to deliver the most appropriate type of initial treatment to patients. METHOD: The subjects were 62 patients from the outpatients of Mind & Mind psychiatric clinic, who had been previously evaluated by EDI-2 and MMPI. The sociodemographic data, disease progress, past history, family history, BMI, EDI-2 and MMPI were variables assessed. All patients received a 12-week course of CBT combined with pharmacotherapy (fluoxetine 20-60mg/d). Responders and non-responders group ware compared with each variables. Responders were defined as patients who had maximum symptom frequencies of three or less during the last 4 weeks of treatment. RESULT: Among 62 patients, responders were 32 and non-responders were 30. There was no difference in sociodemographic variables such as age, education level, job, marriage. As a result of comparing the two groups, non-responders were differentiated by their higher frequency of binge eating vomiting, history of suicide attempt, family history of psychiatric illness and use of laxatives or diuretics. And among the subscale of EDI-2, there were significant high scores in bulimia, ineffectiveness, interoceptive awareness. CONCLUSION: The findings suggest that frequency of binge eating, vomiting, history of suicide attempt, family history of psychiatric illness, and use of laxatives or diuretics could be prognostic factors in patients with bulimia nervosa.
Bulimia Nervosa* ; Bulimia* ; Diuretics ; Drug Therapy ; Education ; Humans ; Korea ; Laxatives ; Marriage ; MMPI ; Outpatients ; Suicide ; Vomiting

Many therapeutic approaches for treafment of binge eating problem including cognitive-behavioral therapy, behavior therapy, focal psychotherapy. psychoanalysis, nutritional counseling, family intervention, psychoeducation, and medication have value. Nevertheless, current research suggest that the most important approant approach to date is a specific form of cognilive-behavioral therapy designed ariginally for patients with bulimia nervosa and recently adapfed for those with binge eating disorder and anorexia nervosa. But it is also important to stress that cognitive-behavioral therapy is not panacea, some patients fail to benefit and others made only limited gains. So there is a need for clinician not only to carefully assess the patient status before freatment start but also to become familiar with and be able to introduce other therapeutic approach.
Anorexia Nervosa ; Behavior Therapy ; Binge-Eating Disorder ; Bulimia Nervosa ; Bulimia* ; Counseling ; Humans ; Psychoanalysis ; Psychotherapy

PURPOSE: The purpose of this study was to develop the day hospital program for Korean eating disorders patients and to examine the effect of the day hospital program on improving frequency of binging and purging, eating disorders symptoms, self-esteem, and depression. METHOD: The subjects were 24 binge eaters visited at eating disorders clinic "M". They participated in a modified day hospital program based on the Toronto Day Hospital Program. All subjects completed the Eating Disorders Inventory(EDI)-2, Rosenberg Self-Eesteem Scale, Beck Depression Inventory(BDI) at pre and post intervention, and recorded daily food records. RESULT: In paired t-test analysis, frequency of binging and purging, self-esteem, depression, and 11 sub-scales of EDI-2(drive for thinness, bulimia, body dissatisfaction, ineffectiveness, interoceptive awareness, perfectionism, interpersonal distrust, maturity fear, asceticism, impulse regulation, social insecurity) were significantly improved after treatment. CONCLUSION: The results of this study suggest that the day hospital program for Korean eating disorders patients may be an effective initial approach to overcoming various eating disorders symptoms. Further studies should investigate longer term outcome data using a larger sample.
Adult ; Bulimia/therapy ; *Day Care ; Eating Disorders/*therapy ; Female ; Humans

Bulimia nervosa is a disorder that is defined as binge eating combined with inappropriate ways of stopping weight gain. It is significantly more common in females than in males. Males in bulimia account for 10-15% of all bulimic patients. There are many methods of treatment, including drug therapy, or psychotherapy. Among them cognitive behavior therapy is reported to be the most effective method of improving the binge eating behavior and the cognitive distortion about body weight and body image. In this case, a male bulimic patient, who was hospitalized in the closed ward involuntarily, was treated with modified Fairburn's cognitive behavior therapy model. After 6 weeks of treatment, binge eating and self-induced vomiting behaviors were controlled and weight gain was nearly successful.
Body Image ; Body Weight ; Bulimia Nervosa* ; Bulimia* ; Cognitive Therapy* ; Drug Therapy ; Female ; Humans ; Male* ; Psychotherapy ; Vomiting ; Weight Gain

Since Russell described bulimia nervosa as an independent and distinctive eating problem, it has been regarded as one of the rapidly increasing problems during the past two decades in Western society. However, in the past few years, the number of reports concerning eating disorders have increased in developing countries including Korea with the rapid introduction of the Western culture accompanied by economic development. Most individuals suffering from bulimia nervosa can be treated as outpatients. Patients with uncomplicated bulimia nervosa rarely require hospitalization and may achieve clinical improvement with nutritional management or counseling, individual or group cognitive-behavioral therapy(CBT), behavioral techniques, and interpersonally oriented or psychodynamically oriented psychotherapies. However, in clinical practice, CBT with nutritional counseling or inter-personal psychotherapy is a usual method chosen for the treatment of such patients in combination with pharmacotherapy. This review aimed at giving a compact and systemized account of the clinical guidelines that we consider essential in the management of patients with bulimia nervosa. The author also introduced treatment experience with bulimic patients at Seoul Paik Hospital.
Bulimia Nervosa* ; Bulimia* ; Counseling ; Developing Countries ; Drug Therapy ; Eating ; Feeding and Eating Disorders ; Economic Development ; Hospitalization ; Humans ; Korea ; Outpatients ; Psychotherapy ; Seoul

PURPOSE: The purpose of this study was to investigate the mediating effect of adult attachment in the relationship between eating psychopathology and depression among patients with eating disorders. METHODS: Patients (N=146) who visited a clinic for eating disorders participated in the study. Data were collected from December 2017 to February 2018 using the Eating Disorder Inventory (EDI-2), Revised Adult Attachment Scale (RAAS), and Beck Depression Inventory (BDI-II). RESULTS: The subjects showed high scores on eating psychopathology (drive for thinness 15.02±5.11, bulimia 11.77±5.27, and body dissatisfaction 14.16±7.82), adult attachment (attachment avoidance 37.31±6.18 and attachment anxiety 16.63±5.38), and depression (24.26±10.81), and 65.1% of the participants showed above a moderate level of depression. There were significant correlations among eating psychopathology, adult attachment, and depression. We also found that adult attachment fully mediated the association between eating psychopathology and depression. CONCLUSION: Future interventions for patients with eating disorders who have experienced insecure attachment with their primary caregiver should focus on forming a therapeutic relationship with the therapist. In addition, family therapy might contribute to lowering attachment insecurities and depression by recovering the attachment between the patients and their parents.
Adult ; Anxiety ; Bulimia ; Caregivers ; Depression ; Eating ; Family Therapy ; Humans ; Negotiating ; Parents ; Psychopathology ; Thinness

Mindfulness training is growing in popularity as an adjunctive intervention in disordered eating and weight loss. Lifestyle modification, pharmacologic treatment, and surgical intervention have been widely used for weight reduction in obese persons, but these modifications are sometimes insufficient. In particular, stress-induced eating and binge-eating disorder have been frequently associated with increased risk of regaining weight. Initial research suggests that mindfulness training may be an effective intervention for binge eating. In this article, we reviewed 19 studies that investigated mindfulness training as an intervention for weight change and/or emotional eating. Results suggest that mindfulness training effectively decreases emotional eating in persons with good adherence to the training; evidence for its effect on weight reduction, however, is mixed. Further large-scale studies are warranted to explore the effectiveness of mindfulness training on long-term weight loss and emotional eating in persons with obesity.
Binge-Eating Disorder ; Bulimia ; Cognitive Therapy ; Eating ; Humans ; Life Style ; Mindfulness ; Obesity ; Overweight ; Weight Loss ; Weight Reduction Programs

Anorexia nervosa, bulimia and other related eating disorders are a heterogenous group of psychiatric disorders whose prevalence rates reach 0.5-1.0% for anorexia nervosa and 1.0-3.0% for bulinmia nervosa. Anorexia nervosa is characterized by a refusal to maintain a minimally normal body weight and bulimia is characterized by repeated episodes of binge eating, misuse of laxatives. diuretics or other medications ; fasting and excessive exercise. A disturbance in perception of body shape and weight is an essential feature of both disorders. Patients with eating disorders may have numerous medical, hypothalamic endocrine, metabolic and nutritional abnormalities. There have been several conceptual models to explain the etiology of eating disorders These are socio-cultural, family pathological, individual psychodynamic, developmental psychobiologiccl, primary hypothalamic dysfunctional, cognitive-behavioral and affective disorder theories. Among these thoeries, this paper attempts to review the biological theory and pharmacotherapy in eating disorders. Specifically, this review deals with physiology of eating behavior, neurotransmitter regulation of appetite and eating bvehavior, disturbances in brcin neurotransmitter system, neuroendocrine findings in anorexia nervosa and bulimia nervosa. and finally pharmacotherapy. Based on this review, future directions for research are also sutggested.
Anorexia Nervosa ; Appetite ; Biology* ; Bulimia ; Bulimia Nervosa ; Disulfiram ; Diuretics ; Drug Therapy* ; Feeding and Eating Disorders* ; Eating* ; Fasting ; Feeding Behavior ; Humans ; Ideal Body Weight ; Laxatives ; Mood Disorders ; Neurosecretory Systems ; Neurotransmitter Agents ; Physiology ; Prevalence

This study was conducted to investigate the effect of a 3 week low calorie diet (LCD) and a 9 week of behavior modification (BM) program on the weight loss, mineral and vitamin status in 22 obese women. The subject were healthy, obese (PIBW > 120%) women aged 20 - 50 Yr and not taking any medications known to influence body composition, mineral or vitamin metabolism During the LCD program, subjects were provided commercial liquid formulas with 125 kcal per pack and were instructed to have a formula for replacement of one meal and at least one regular meal per day within the range of daily 800 - 1200 kcal intake. During the BM program the subjects weekly attended the group nutrition counseling session to encourage themselves to modify their eating behavior and spontaneously restrict their energy intakes. The BM program focused on stimulus control, control of portion sizes and modification of binge eating and other adverse habits. The initial mean energy intake of subjects was 2016.9 +/- 129.8 kcal (100.8% of RDA) and dropped to 1276.5 +/- 435.7 kcal at the end of a 3 week of LCD program and elevated to 1762 +/- 329.3 kcal at the end of a 9 week of BM program. Carbohydrate, protein and fat intakes were significantly decreased at the end of the LCD but carbohydrate was the only macro nutrient that showed significant decrease (p < 0.05) at the end of the BM program compared to baseline. Calcium and iron intakes decreased significantly (p < 0.01, respectively) with no significant changes in other micronutrients at the end of the LCD. The mean weight of the subjects decreased from 73.8 +/- 8.0 kg to 69.2 +/- 7.7 kg with LCD and ended up with 67.7 +/- 7.1 kg after 9 weeks of BM. The 3 weeks of LCD reduced most of the anthropometric indices such as BMI, PIBW, fat weight, wast-to-hip ratio and subscapular and suprailiac skinfold thickness. The 9 weeks of behavior modification showed slight change or maintenance of each anthropometric measurements. Weight loss and decreased WHR with the diet program induced significantly decreased systolic blood pressure. SGOT, SGPT and serum insulin levels with improved serum lipid profiles. Biochemical parameters related to iron status such as hemoglobin, hematocrit were significantly decreased (p < 0.01) at the end of the LCD. But their mean values were within normal range. The mean serum 25 (OH) vitamin D3 level significantly increased after whole diet program. Serum folate level significantly decreased after 12 weeks of diet program. In conclusion 3 weeks of LCD brought 4.6 kg reduction in body weight without risk of iron, zinc or vitamin D deficiency and 9 weeks of the BM was effective to maintain nutritional status with slightly more weight reduction (1.5 kg). However calcium intake and serum folate should be monitored during the LCD and BM because of increased risk of deficiencies..
Alanine Transaminase ; Aspartate Aminotransferases ; Behavior Therapy* ; Blood Pressure ; Body Composition ; Body Weight ; Bulimia ; Calcium ; Caloric Restriction* ; Cholecalciferol ; Counseling ; Diet ; Energy Intake ; Feeding Behavior ; Female ; Folic Acid ; Hematocrit ; Humans ; Insulin ; Iron ; Meals ; Metabolism ; Micronutrients ; Nutritional Status* ; Portion Size ; Reference Values ; Skinfold Thickness ; Vitamin D Deficiency ; Vitamins ; Weight Loss ; Zinc