**6. References**

80 New Insights into the Prevention and Treatment of Bulimia Nervosa

curbing attempts to lose weight. At assessment, 29 (85%) women reported trying to lose weight in the previous six months whilst in the three month period between assessment and

In this chapter we describe two attempts to identify and assist women with EDs in the community, one a sample of younger women from tertiary education institutions and one a sample of older women attending their family doctors. In the first trial we did not replicate the positive findings of an earlier study which found a brief BN-MHL intervention improved mental health related quality of life when compared to a control condition of information about ED services only. The MHL intervention had little impact on changing attitudes and beliefs about EDs, their identification or their treatment. However, the present studies were possibly underpowered to show differences. The second study was with an enhanced intervention that included provision of an evidence-based self-help book. There may have been a small impact on identification of the ED but overwhelmingly participants still had a comparatively low regard for specialist treatments and rated getting more

information as the most helpful approach for a fictitious person with a bulimic ED.

Given that identifying the main problem for the woman with a bulimic ED in the vignette as low self-esteem it was of interest that the self-esteem self-help book appeared better received and more found it personally helpful than the ED self-help book. Anecdotal comments were that the title of the ED book was disconcerting and some women were puzzled as to why they had received it. Although not overt we suspected that it may have been perceived as stigmatising by some participants. Many community women perceive significant stigma and discrimination for those who have a known ED (Hepworth & Paxton, 2007) and particularly for those with binge eating and (over) weight (Darby et al., manuscript in preparation). We think it is likely that self-help books for binge eating and BN such as that used in the present study are thus best provided in the context of a consultation where their

An additional factor (the 'elephant in the room') is the ambivalence people have towards the ED behaviours. We have found that despite distress from ED symptoms, people with EDs have a favourable regard for ED weight losing strategies (Mond et al., 2010) and are much more likely to seek help to lose weight than to modify disordered eating (Hay et al., 1998; Mond et al., 2007; Evans et al., 2011). This apparent paradox is perhaps understandable in the context of widespread public and community concerns about obesity and negative community attitudes towards weight disorders with widespread cultural positive regard for being thin. If a woman's main concern is to receive help for a perceived or actual overweight problem, then she may be less likely to want to engage in treatments that are not known to reduce weight. In addition, we have found many women and up to a third of general practitioners and other key health professionals consider weight gain to be likely

The question of how best to improve ED-MHL for people with disordered eating, and if an improvement subsequently leads to an increase in accessing evidence-based treatments from appropriately trained professionals thereby reducing community and individual burden from EDs is still unanswered. Large scale universal public health campaigns and /or programs that target health care professionals are alternatives to the targeted programs described here. One focussing on depression and its treatment has likely had an effect in

follow up 21 (91%) reported they had been trying to lose weight.

**4. Conclusions** 

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**7** 

*Brazil* 

**Bulimia Nervosa and Dissatisfaction of** 

Alice Maria de Souza-Kaneshima and Edilson Nobuyoshi Kaneshima

Bulimia nervosa is an eating disorder that affects young people and causes serious damage to life quality and death in extreme cases (Affenito & Kerstetter, 1999; Cordás, 2004; Costa et al., 2008; Gucciardi et al., 2004). Since most people with the disorder have normal weight,

The etiology of bulimia nervosa has yet to be understood. However, low self-esteem, depression, social pressure on keeping oneself slim and a dissatisfaction with the body shape are factors that may be associated with the bulimia nervosa event, especially in the case of adolescents and female young adults (Affenito & Kerstetter, 1999; Alvarez-Rayon et al., 2009; Costa et al., 2008; Crosby et al., 2009; Gucciardi et al., 2004; Jauregui-Lobera et al.,

Excessive concern with weight gaining is not the only criterion for a diagnosis of bulimia nervosa. Nevertheless, adolescents with such concern have a seven-fold chance in

The fact that many young people are not satisfied with their own body shape may be an effect of pre-conceived ideas on idealized body images taken from aesthetic values transmitted by society or by the social media (Andrade & Bosi, 2003; Reato et al., 2000; Reato, 2002). The female adolescent finds herself in conflict between a fantasy-created image and her real body shape. From her perspective, there is a great difference between what is observed and what is desired. This event may lead towards dissatisfaction and low selfesteem which induces the development of eating disorders such as bulimia nervosa

Many authors agree that the most prevalent aspect of female dissatisfaction occurs in issues referring to weight and appearance. Many women, including those with normal weight or even slim ones, have the impression that they are overweight or even obese. This is the reason why their body image distortion mainly affects female adolescent and young adult females (Alvarez-Rayon et al., 2009; Cordas, 2004; Costa et al.*,* 2008; Mond et al., 2004;

Studies related to adolescent's psychological and eating behaviour alterations are important for the determination of factors involved in the development of eating disorders in young populations. The use of self-evaluation scales is an asset in the detection of possible eating

the diagnosis of bulimia nervosa becomes a highly complex issue (Kaufman, 2000).

developing some type of eating disorder (Grillo & Silva, 2004).

(Andrade & Bosi, 2003; Mond et al., 2004; Reato, 2002; Silva et al., 2003).

disorders or of sub-clinic individuals (Kjelsas et al., 2004; Wichstrom, 1995).

**1. Introduction** 

2008; Thompson & Chad, 2000).

Nunes et al., 2001).

**Adolescent's Body Shape** 

*State University of Maringá. Maringá PR,* 

