Download PDF
PSYCH up2date 2018; 12(05): 415-431
DOI: 10.1055/a-0498-3661
Essstörungen, somatische Belastungsstörungen, Schlafstörungen und sexuelle Funktionsstörungen

Bulimia nervosa

Jennifer Svaldi
,
Brunna Tuschen-Caffier
› Further Information
Also available at
   Permissions and Reprints All articles of this category

Mit einer Lebenszeitprävalenz von 1 – 2% ist die Bulimia nervosa keine sehr häufig auftretende psychische Störung. Sie ist jedoch mit gravierenden psychischen und körperlichen Begleiterscheinungen verbunden und nimmt unbehandelt oftmals einen chronischen Verlauf. Die kognitive Verhaltenstherapie ist die wirksamste Behandlungsmethode. Zentrale Therapiebausteine sind dabei die Normalisierung des Essverhaltens und der Körperbildstörung sowie die Reduktion dysfunktionaler Stressreaktionen.
Kernaussagen

Der Erkrankungsbeginn der BN ist in der späten Adoleszenz. Die Erkrankung wird häufig lange verheimlicht und nimmt oftmals unbehandelt einen chronischen Verlauf. Komorbide psychische und Persönlichkeitsstörungen sind häufig. Kennzeichnend für BN-Patientinnen ist eine ambivalente Therapiemotivation, die einerseits vom hohen Wunsch nach einer Genesung, andererseits von einer geringen Toleranz gegenüber Änderungen im Essverhalten und Gewicht geprägt ist. Daher ist die Förderung der Therapiemotivation durch entsprechende Techniken der Gesprächsführung sehr wichtig. Behandlungsmethode der Wahl ist die kognitive Verhaltenstherapie. Da eine rasche Reduktion des gezügelten Essverhaltens sowie der Häufigkeit unangemessener kompensatorischer Maßnahmen Prädiktoren für einen günstigen Therapieverlauf sind, sollten Interventionen, die auf eine Normalisierung des Essverhaltens abzielen, frühzeitig in der Therapie implementiert werden.

Schlüsselwörter

Essstörungen - Diagnostik - kognitive Verhaltenstherapie - Körperwahrnehmung


Publication History

Publication Date:
11 September 2018 (online)

Georg Thieme Verlag KG
Stuttgart · New York

 

  • Literatur

  • 1 American Psychiatric Association (APA). Hrsg. Diagnostic and Statistical Manual of mental Disorders. 5th ed. DSM 5. Washington, DC: APA; 2013
    Google Scholar
  • 2 Dilling H, Mombour W, Schmidt MH. Internationale Klassifikation psychischer Störungen: ICD-10 Kapitel V (F) Klinisch-diagnostische Leitlinien. 9. Auflage. Göttingen: Huber; 2013
    Google Scholar
  • 3 WHO. ICD-11 Beta Draft. 6B81 Bulimia nervosa. Genf: WHO; 2018
    Google Scholar
  • 4 Swanson SA, Crow SJ, Le Grange D. et al. Prevalence and correlates of eating disorders in adolescents results from the National Comorbidity Survey Replication Adolescent Supplement. Arch Gen Psychiatry 2011; 68: 714-723
    Google Scholar
  • 5 Hudson JI, Hiripi E, Pope jr. HG. et al. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 2007; 61: 348-358
    Google Scholar
  • 6 Sansone RA, Levitt JL, Sansone LA. The prevalence of personality disorders among those with eating disorders. Eat Disord 2005; 13: 7-21
    Google Scholar
  • 7 Magallon-Neri E, Gonzalez E, Canalda G. et al. Prevalence and severity of categorical and dimensional personality disorders in adolescents with eating disorders (S. 176). Eur Eat Disord Rev 2014; 22: 176-184 Erratum: 306 Erratum: 306
    Google Scholar
  • 8 Trace SE, Thornton LM, Root TL. et al. Effects of reducing the frequency and duration criteria for binge eating on lifetime prevalence of bulimia nervosa and binge eating disorder: Implications for DSM-5. Int J Eating Disord 2012; 45: 531-536
    Google Scholar
  • 9 Stice E, Marti CN, Rohde P. Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. J Abnorm Psychol 2013; 122: 445-457
    Google Scholar
  • 10 Stice E, Marti CN, Shaw H. et al. An 8-year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents. J Abnorm Psychol 2009; 118: 587-597
    Google Scholar
  • 11 Smolak L, Murnen SK, Ruble AE. Female athletes and eating problems: A meta-analysis. Int J Eating Disord 2000; 27: 371-380
    Google Scholar
  • 12 Treasure JL, Wack ER, Roberts ME. Models as a high-risk group: the health implications of a size zero culture. Br J Psychiatry 2008; 192: 243-244
    Google Scholar
  • 13 Arcelus J, Witcomb GL, Mitchell A. Prevalence of eating disorders amongst dancers: A systemic review and meta-analysis. Eur Eat Disord Rev 2014; 22: 92-101
    Google Scholar
  • 14 Zancu SA, Enea V. Eating disorders among fashion models: a systematic review of the literature. Eat Weight Disord 2017; 22: 395-405
    Google Scholar
  • 15 Nagl M, Jacobi C, Paul M. et al. Prevalence, incidence, and natural course of anorexia and bulimia nervosa among adolescents and young adults. Eur Child Adolesc Psychiatry 2016; 25: 903-918
    Google Scholar
  • 16 Grilo CM, Pagano ME, Skodol AE. et al. Natural course of bulimia nervosa and of eating disorder not otherwise specified: 5-year prospective study of remissions, relapses, and the effects of personality disorder psychopathology. J Clin Psychiatry 2007; 68: 738-746
    Google Scholar
  • 17 Fairburn CG, Stice E, Cooper Z. et al. Understanding persistence in bulimia nervosa: a 5-year naturalistic study. J Consult Clin Psychol 2003; 71: 103-109
    Google Scholar
  • 18 Wonderlich SA, Peterson CB, Crosby RD. et al. A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa. Psychol Med 2014; 44: 543-553
    Google Scholar
  • 19 Fichter M, Quadflieg N. Twelve-year course and outcome of bulimia nervosa. Psychol Med 2004; 34: 1395-1406
    Google Scholar
  • 20 Arcelus J, Mitchell AJ, Wales J. et al. Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry 2011; 68: 724-731
    Google Scholar
  • 21 Preti A, Rocchi MBL, Sisti D. et al. A comprehensive meta-analysis of the risk of suicide in eating disorders. Acta Psychiatr Scand 2011; 124: 6-17
    Google Scholar
  • 22 Bulik CM, Sullivan PF, Carter FA. et al. Predictors of rapid and sustained response to cognitive-behavioral therapy for bulimia nervosa. Int J Eating Disord 1999; 26: 137-144
    Google Scholar
  • 23 Agras WS, Crow SJ, Halmi KA. et al. Outcome predictors for the cognitive behavior treatment of bulimia nervosa: Data from a multisite study. Am J Psychiatry 2000; 157: 1302-1308
    Google Scholar
  • 24 Fairburn CG, Agras WS, Walsh BT. et al. Prediction of outcome in bulimia nervosa by early change in treatment. Am J Psychiatry 2004; 161: 2322-2324
    Google Scholar
  • 25 Olmsted MP, Kaplan AS, Rockert W. et al. Rapid responders to intensive treatment of bulimia nervosa. Int J Eating Disord 1996; 19: 279-285
    Google Scholar
  • 26 Wilson GT, Fairburn CC, Agras WS. et al. Cognitive-behavioral therapy for bulimia nervosa: time course and mechanisms of change. J Consult Clin Psychol 2002; 70: 267-274
    Google Scholar
  • 27 Thompson-Brenner H, Shingleton RM, Sauer-Zavala S. et al. Multiple measures of rapid response as predictors of remission in cognitive behavior therapy for bulimia nervosa. Behav Res Ther 2015; 64: 9-14
    Google Scholar
  • 28 Svaldi J, Tuschen-Caffier B. Bulimia nervosa (Fortschritte der Psychotherapie). Göttingen: Hogrefe; n Druck
    Google Scholar
  • 29 Baker JH, Janson L, Trace SE. et al. Genetic Risk Factors for Eating Disorders. In: Smolak L, Levine MP. Hrsg. The Wiley Handbook of Eating Disorders. West Sussex, UK: John Wiley & Sons; 2015: 367-378
    Google Scholar
  • 30 Stice E. Interactive and mediational etiologic models of eating disorder onset: Evidence from prospective studies. Ann Rev Clin Psychol 2016; 12: 359-381
    Google Scholar
  • 31 Hilbert A, Pike KM, Goldschmidt AB. et al. Risk factors across the eating disorders. Psychiatry Res 2014; 220: 500-506
    Google Scholar
  • 32 Rodgers RF, Chabrol H. Parental attitudes, body image disturbance and disordered eating amongst adolescents and young adults: A review. Eur Eat Disord Rev 2009; 17: 137-151
    Google Scholar
  • 33 Stice E, Agras WS, Hammer LD. Risk factors for the emergence of childhood eating disturbances: A five-year prospective study. Int J Eating Disord 1999; 25: 375-387
    Google Scholar
  • 34 Caslini M, Bartoli F, Crocamo C. et al. Disentangling the association between child abuse and eating disorders: A systematic review and meta-analysis. Psychosom Med 2016; 78: 79-90
    Google Scholar
  • 35 Johnson JG, Cohen P, Kasen S. et al. Childhood adversities associated with risk for eating disorders or weight problems during adolescence or early adulthood. Am J Psychiatry 2002; 159: 394-400
    Google Scholar
  • 36 Sanci L, Coffey C, Epi GD. et al. Childhood sexual abuse and eating disorders in females. Arch Pediatr Adolesc Med 2008; 162: 261-267
    Google Scholar
  • 37 Chen LP, Murad MH, Paras ML. et al. Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clin Proc 2010; 85: 618-629
    Google Scholar
  • 38 Farstad SM, McGeown LM, von Ranson KM. Eating disorders and personality, 2004–2016: A systematic review and meta-analysis. Clin Psychol Rev 2016; 46: 91-105
    Google Scholar
  • 39 Wu MD, Hartmann M, Skunde M. et al. Inhibitory control in bulimic-type eating disorders: A systematic review and meta-analysis. PLoS One 2013; DOI: 10.1371/journal.pone.0083412.
    Google Scholar
  • 40 Culbert KM, Racine SE, Klump KL. Research review: What we have learned about the causes of eating disorders – a synthesis of sociocultural, psychological, and biological research. J Child Psychol Psychiatry 2015; 56: 1141-1164
    Google Scholar
  • 41 Lilenfeld LRR, Stein D, Bulik CM. et al. Personality traits among currently eating disordered, recovered and never ill first-degree female relatives of bulimic and control women. Psychol Med 2000; 30: 1399-1410
    Google Scholar
  • 42 Cagar-Nazai HP, Corfield F, Cardi V. et al. A systematic review and meta-analysis of ʼSystems for Social Processesʼ in eating disorders. Neurosci Biobehav Rev 2014; 42: 55-92
    Google Scholar
  • 43 Horesh N, Apter A, Ishai J. et al. Abnormal psychosocial situations and eating disorders in adolescence. J Am Acad Child Adolesc Psychiatry 1996; 35: 921-927
    Google Scholar
  • 44 Rojo L, Conesa L, Bermudez O. et al. Influence of stress in the onset of eating disorders: data from a two-stage epidemiologic controlled study. Psychosom Med 2006; 68: 628-635
    Google Scholar
  • 45 Crowther JH, Kichler JC, Sherwood NE. et al. The role of familial factors in bulimia nervosa. Eat Disord 2002; 10: 141-151
    Google Scholar
  • 46 Haedt-Matt AA, Keel PK. Hunger and binge eating: A meta-analysis of studies using ecological momentary assessment. Int J Eating Disord 2011; 44: 573-578
    Google Scholar
  • 47 Haedt-Matt AA, Keel PK. Revisiting the affect regulation model of binge eating: a meta-analysis of studies using ecological momentary assessment. Psychol Bull 2011; 137: 660-681
    Google Scholar
  • 48 Berg KC, Crosby RD, Cao L. et al. Facets of negative affect prior to and following binge-only, purge-only, and binge/purge events in women with bulimia nervosa. J Abnorm Psychol 2013; 122: 111-118
    Google Scholar
  • 49 Lavender JM, Wonderlich SA, Engel SG. et al. Dimensions of emotion dysregulation in anorexia nervosa and bulimia nervosa: A conceptual review of the empirical literature. Clin Psychol Rev 2015; 40: 111-122
    Google Scholar
  • 50 Nolen-Hoeksema S, Stice E, Wade E. et al. Reciprocal relations between rumination and bulimic, substance abuse, and depressive symptoms in female adolescents. J Abnorm Psychol 2007; 116: 198-207
    Google Scholar
  • 51 Wagner G, Penelo E, Nobis G. et al. Predictors for good therapeutic outcome and drop-out in technology assisted guided self-help in the treatment of bulimia nervosa and bulimia like phenotype. Eur Eat Disord Rev 2015; 23: 163-169
    Google Scholar
  • 52 Keel PK, Dorer DJ, Franko DL. et al. Postremission predictors of relapse in women with eating disorders. Am J Psychiatry 2005; 162: 2263-2268
    Google Scholar
  • 53 Blechert J, Ansorge U, Beckmann S. et al. The undue influence of shape and weight on self-evaluation in anorexia nervosa, bulimia nervosa and restrained eaters: a combined ERP and behavioral study. Psychol Med 2011; 41: 185-194
    Google Scholar
  • 54 Blechert J, Nickert T, Caffier D. et al. Social comparison and its relation to body dissatisfaction in bulimia nervosa: Evidence from eye movements. Psychosom Med 2009; 71: 907-912
    Google Scholar
  • 55 Tuschen-Caffier B, Bender C, Caffier D. et al. Selective visual attention during mirror exposure in anorexia and bulimia nervosa. PLoS One 2015; 10: e0145886
    Google Scholar
  • 56 Brooks S, Prince A, Stahl D. et al. A systematic review and meta-analysis of cognitive bias to food stimuli in people with disordered eating behaviour. Clin Psychol Rev 2011; 31: 37-51
    Google Scholar
  • 57 Staiger P, Dawe S, McCarthy R. Responsivity to food cues in bulimic women and controls. Appetite 2000; 35: 27-33
    Google Scholar
  • 58 Bulik CM, Lawson RH, Carter FA. Salivary reactivity in restrained and unrestrained eaters and women with bulimia nervosa. Appetite 1996; 27: 15-24
    Google Scholar
  • 59 Vogele C, Hilbert A, Tuschen-Caffier B. Dietary restriction, cardiac autonomic regulation and stress reactivity in bulimic women. Physiol Behav 2009; 98: 229-234
    Google Scholar
  • 60 Herpertz S, Herpertz-Dahlmann B, Fichter M. et al., Hrsg. S3-Leitlinie. Diagnostik und Behandlung der Essstörungen. Heidelberg: Springer; 2011
    Google Scholar
  • 61 Hilbert A, Tuschen-Caffier B, Ohms M. Eating Disorder Examination: Deutschsprachige Version des strukturierten Essstörungsinterviews. Eating Disorders Examination: A German version of the Structured Eating Disorder Interviews. Diagnostica 2004; 50: 98-106
    Google Scholar
  • 62 Hilbert A. Eating Disorder Examination für Kinder. Version 3. Tübingen: dgvt-Verlag; 2016
    Google Scholar
  • 63 Fairburn CG, Cooper Z, Shafran R. Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behav Res Ther 2003; 41: 509-528
    Google Scholar
  • 64 Stavemann HH. Sokratische Gesprächsführung in Therapie und Beratung. Weinheim: Beltz; 2002
    Google Scholar
  • 65 Trentowska M, Svaldi J, Blechert J. et al. Does habituation really happen? Investigation of psycho-biological responses to body exposure in bulimia nervosa. Behav Res Ther 2017; 90: 111-122
    Google Scholar