Clinical Psychology Bulimia Nervosa

Clinical Psychology / Bulimia Nervosa

The beginnings of clinical psychology date back to the year 1492, and it has changed from the mere treatment of mental illness to an entire field of research and experimentation, which has helped those individuals who have been affected by any form of mental disorders, like for example, the eating disorders like bulimia nervosa and anorexia nervosa prevalent among adolescent and twenty-year-old women all over the world, to overcome their habits so that they may lead better and more productive lives. Some of the more important names in the history of clinical psychology, who can be referred to as the founding fathers of the field, are Lightner Witmer and Wilhelm Wundt. It was their theories and methods that has paved the way for the clinical psychologists of today, who are today being trained to encompass more issues like the entire range of health care, for the individual who comes to them for the treatment of his disorders. The future of clinical psychology may be that it will come under the wide umbrella of health care for the individual, and come out its narrow confines of offering treatment for mental disorders only.

I. History of Clinical Psychology

It must be noted that the actual beginnings of clinical psychology as such can be attributed to Luis Vives, who lived during the years from 1492 to 1540. He can be called the precursor of modern psychology, but the official date of the foundation of clinical psychology may be the year 1879, when Wilhelm Wundt founded his clinical laboratory in the University of Leipzig. (Brief Institutional History of Clinical and Health Psychology)

I.A. Current definition of clinical psychology

Today, Clinical Psychology can be defined as the application of psychology to mental illnesses or abnormal behavior or behavioral problems in the human being's mind. It can also be defined as being the branch of psychology that has as its focus and emphasis the treatment of mental disorders of any kind, and of abnormal mentation and abnormal behavior. The actual term 'Clinical Psychology' was introduced by Lightner Witmer, the American psychologist, in a paper submitted in the year 1907. (Definitions of Clinical psychology on the Web)

However, there has been widespread criticism of the definition of clinical psychology today, and the reasons quoted for this is that the definition is much too broad and all encompassing to include many non-pathological behaviors and disorders within the scope of the definition. As a result of this, there have been quite a few alternative definitions for clinical psychology, and one of the better known definitions is that proposed by Wakefield, in the year 1992, when he termed mental disorder as being 'harmful dysfunction'. Bergner, in 1997, happened to endorse and to agree with a definition that had been proposed earlier by Ossorio, in the year 1985, wherein he had stated that psychopathology can be best defined as a 'significant restriction' on the very abilities and faculties of an individual, whereby he cannot engage in any form of deliberate actions; rather, he is not in control of his actions, and as a result, he cannot take part in all the prevalent social practices of the time with any amount of success. (Stricker; Widiger; Weiner, 2002)

In other words, it can be sated that clinical psychology is a broad field of research within the field of psychology, which applies the various psychological principles available, to the assessment or evaluation, the prevention or the preclusion, the amelioration and, finally, the rehabilitation and healing of the individual who has been undergoing psychological distress or trauma of any kind, so that the enhancement and the betterment of both his mental as well as physical well being is achieved at the end. (Definition of Clinical Psychology)

1. Original definition of clinical psychology

However, the original definition of clinical psychology may not have actually included all these terms within its scope of the definition; the field in itself developed in ways that the founder of clinical psychology Lightner Witmer may not have anticipated in the year 1896, when he opened the very first psychology clinic, and also founded the very first scholarly academic journal that was related to psychology, which was named 'The Psychological Clinic', and which was responsible for the training of quite a few of the very first generation of clinical psychologists of the world. One of the first cases of the world, as is popularly known today, is that of Charles Gilman, who was a school going child; with certain spelling difficulties. (Routh, 1996)

After treatment for visual difficulties, Witner was convinced that the field of psychology would indeed help such cases where any form of psychological treatment would be able to help the individual with great success. Therefore, it must be noted that Witner had as his primary emphasis the academic treatment of the so called 'retarded children', where retarded meant those delinquent children who were 'retarded' in their normal mental development, for any reasons whatsoever. This type of emphasis on children's academic problems has led to the development of school psychology at that time, and this was a major developmental stepping stone for the definition of clinical psychology in older times. (Routh, 1996)

I.B. Beginning of Clinical Psychology

The beginnings of clinical psychology can be again attributed to Lightner Witner. As mentioned earlier. It was in his first publication in a magazine called 'The Psychological Clinic'; entitled 'Clinical Psychology' that Witner explained the clinical method that he had been using in the treatment of his subjects, in what has been known to the world as the very beginnings of clinical psychology. This method was to perform small experiments on his subjects, or 'cases' as he referred to them, so that the attending psychologist could well understand the basic nature of the patient's difficulties. As time went on, Witner began to understand more in his chosen field, and this was when he started to conduct educational experiments, wherein he stated that the best approach was to 'teach to weaknesses. Even though today both Witner's Clinic and also his Journal do not exist any more, his conception of what clinical psychology actually is, and its beginnings, must of course, be attributed to this great man. (Lightner Witner and the Beginning of Clinical Psychology)

1. Scientific-Practitioner Model

The Scientist-Practitioner Model' is also popularly known as the Boulder Model of clinical psychology, and this is the model that has been widely acknowledged as one of the first models for training in clinical psychology. The scientist-practitioner model for graduate education in psychology was in actuality the end result of more than seventy three educators and others discussing a practical and the best sort of educational program meant for doctoral psychology programs, in a Conference held in order to discuss the explosive growth of clinical psychology during the years after the Second World War. The several professionals who were in the field at that time stated that they felt that the existing traditional graduate training programs for doctoral psychology programs were in fact quite insufficient and under developed, and that both clinicians as well as the faculty were being under trained. (Hodgson; Johnson; Ketring; Wampler; Lamson, 2005)

Therefore, when the Boulder Model was created, it was with the intention of teaching both clinical as well as research skills to the students and practitioners of clinical psychology. It was stated at the time that the scientist-practitioner model was in fact the 'mid-point in a continuum' that placed the emphasis on either research or on practice, wherein the very key to this model would be integration of both. As a matter of fact, it was an article in a journal of the American Psychological Association, Committee on Training in clinical Psychology of 1947 that provided the basic starting pint for this model of training, and accordingly, it was believed that there must be an integration of research, theory, and practice, throughout the candidate's research period. (Hodgson; Johnson; Ketring; Wampler; Lamson, 2005)

2. Reflective Practitioner Model

On the other hand, the 'Practitioner Scholar Model' of clinical psychology training believes in laying emphasis on the provision of the various skills that are necessary for the student so that the student may be able to think and analyze issues critically and would also be able to evaluate the findings of the research-based knowledge with their own acquired experience in the field. In other words, the interns are expected, throughout the year of their study, to both develop, as well as to use their thinking and analytical skills, and also their prior knowledge of scientific literature and so on in order to evaluate all their research findings as being a basis for their clinical interventions. The methods that are followed to encourage students to base their study on the practitioner scholar method are through case assignments, individual and also group supervisions, training seminars, mentoring and monitoring methods, in service training procedures, and so on and so forth. (Practitioner-Scholar Model: The Counseling Centre for Human Development, practitioner-scholar Model)

The widespread belief is that this model of training would encourage the scholar or the student to develop his own 'reflective' skills, so that he may be able to better follow the processes for being a practitioner of clinical psychology. In the opinion of Hoshmand and Polinghorne in the year 1992, professional education must always be based on the development of a reflective judgment on the part of the student, who would then be able to effectively control the various existing biases that generally hamper or hinder their full comprehension of the issue, and also lessen their effectiveness as a clinical practitioner when the time came for them to begin their practice as a clinical psychologist. (Practitioner-Scholar Model: The Counseling Centre for Human Development, practitioner-scholar Model)

3. Influence of psychoanalysis

Psychoanalysis can be defined as the virtual family of psychological theories and methods that fall within the field of psychotherapy that has as its basic aim the clarification and the elucidation of the various connections between the unconscious components of an individual's mental processes in a systematic manner by tracing out the several different associations that the patient may have in the back of his mind. In classical psychoanalysis, for example, the basic subject matter that is used for the purpose of such analyses is the unconscious pattern of the life of the individual, which may become revealed to the patient as well as to the analyst, in what is also known as 'free associations'. When the analyst knows this, then he can start to help the patient, and therefore liberate him from the various unconscious barriers that he may have erected within himself for his own protection. These barriers are often referred to as 'transference' and 'resistance', that is, he is taken through paths of relatedness which are now no longer applicable to him or serviceable to him in any way. Basically, psychoanalysis seeks to restore to the patient his self-esteem and self-confidence so that he may be able to overcome the various rational and irrational fears in his sub-consciousness and become a better individual for it. (Psychoanalysis: Wikipedia)

There is a lot of confusion in people's minds about what psychology and psychiatry are, exactly. It must be made clear that a psychiatrist is an individual who has attended medical school and is a physician who has received specialized training in the field of psychiatry, and also in psychoanalysis, while a psychologist is an individual who holds a Doctoral Degree from a University, and who is in clinical practice, and who has done extensive research in his field. As a matter of fact, it is this research that differentiates the psychologist from others in the field, and when an individual desires to become a psychoanalyst, then he must study and train under a recognized psychoanalytic institute, where he will analyze the various intricacies and subconscious wants and desires of his patients in order to gain a better understanding about them. (Psychology and Psychiatry: A Guide to psychology and its practice)

4. Life Span Approach

The theory of life span development and its effect on clinical psychology cannot be ignored, and as in a life span of an average human being, the development of a human being from infancy to adolescence to early adulthood, and then to the inevitable ageing process is analyzed and researched, and this is the life span approach to psychoanalysis as well. (Child Clinical) According to the School of Psychological Sciences, the University of Indianapolis, which believes in following the scientist-practitioner method of training for its students of clinical psychology, the students are encouraged to create and to develop solid core knowledge of assessment, evaluation, intervention, and research skills, with a structured method of classes. This is what the study of clinical psychology generally focuses on, and the qualified student may adopt any one of the several different approaches that he has learnt, and apply them as he sees fit, in his treatment and cure of his patient. (Psy. D Program in Clinical Psychology)

C. Contributors to Clinical Psychology

Lightner Witmer and Wilhelm Wundt

Two of the more important contributors in the field of clinical psychology are Lightner Witmer and Wilhelm Wundt. Witmer as mentioned earlier was one of the most famous of the early clinical psychologists of his time, and he was also the inventor of the term 'clinical psychology'. He was also the founder of the very first psychological clinic in the year 1896. It was in the year 1908 that Witmer happened to publish his first journal of the 'Psychological Clinic', in which his article named 'Clinical Psychology' explained his work in the field for the past ten years, and also detailed the need for this new term 'clinical psychology' at that time. (History of psychology at Penn)

William James and Wilhelm Wundt are generally known as the Fathers of psychology' of their time, and also the founders of the first great schools of psychology in their time. Wilhelm Wundt was born in 1832, and it was in 1867 that he started a course that he called 'physiological psychology', according to which the primary focus would be laid on the border area between physiology and psychology, that is, on the various senses, and their reactions. In fact, his basic lecture notes would later on become his major work and his contribution to the field of psychology, which were entitled "The Principles of physiological Psychology." The method that was created by Wundt was this: an experimental introspection whereby the researcher was supposed to carefully observe any simple event, an event whose quality and intensity and duration could be effectively and accurately measured, and then record his responses to that event and also to variations to that event. (Wilhelm Wundt and William James)

Wilhelm Wundt also established the very first laboratory in the world that would be dedicated to experimental psychology, and this would prove to be a great development in the field of clinical psychology in later years, and as a matter of fact, all the subsequent psychological laboratories where philosophers and psychology students would be able to get together and share their views and opinions were modeled on this initial laboratory created by Wilhelm Wundt. (Wilhelm Wundt, German philosopher and psychologist)

D. Bulimia Nervosa

There are two types of people who have been afflicted with the disorder named 'bulimia nervosa', and while one is the 'purging' type, the other is the 'non-purging type'. Any individual with bulimia nervosa engages in the following cyclical actions, whereas on one hand he indulges in discrete periods where he will over eat considerably, on the other hand he will compensate for his previous over indulgence by several attempts to lose the weight that he may have supposedly gained during his bouts of over eating. One typical episode of over eating in an individual with bulimia nervosa would mean that he would consume an amount of food that one would normally consider to be excessive. (Bulimia Nervosa: International Eating Disorder Referral)

The basic factor in a bulimic's mind is the lack of control that he generally has over his own eating, and while on one side he may indulge in excessive or binge eating, he would invariably make attempts to compensate for this by self-induced vomiting, or by a misuse of laxatives, or by caloric restrictions achieved through dieting, or by using enemas, diuretics, and exercising excessively and so on. The bulimic may base his self-evaluation on his own perception of his body or image, and he would be an individual who is at all times excessively or obsessively concerned about his shape or his size and weight. (Bulimia Nervosa: International Eating Disorder Referral)

1. Definition of Bulimia Nervosa

Bulimia Nervosa can therefore be defined as an 'eating disorder' wherein the affected individual more often than not indulges in consuming great amounts of food in one sitting, also called binging, and then compensates for his actions by vomiting or purging, both self-induced. As a matter of fact the vomiting is generally triggered by a fear of weight gain, and the individual may exhibit a stomach pain, and also suffer from a great amount of guilt due to over eating. In most of the cases of bulimia nervosa, the individual either misuses laxatives, or diuretics, or enemas, or some other forms of medicines that would cause him to eliminate the food that he would have consumed in the earlier bout of over eating. Self condemnation and feelings of depression and of guilt are all hallmarks of bulimia nervosa. As far as the diagnosis of the disorder is concerned, the individual must indulge in such episodes of over eating and then fasting for three moths in a row, and at least two times a week. (Definitions of bulimia nervosa on the Web)

Bulimia is often termed as a 'social epidemic', which is at present approaching epidemic proportions, not only in the U.S.A. But in most other parts of the world as well. The American Psychiatric Association has brought out both practice guidelines as well as manuals that show that this very common eating disorder has been diagnosed across a mainly female population with about 1 to 10% middle and upper class females in the adolescent and college going age groups. On an average, it stated that about 1 out of every 200 teenage girls must suffer form some sort of eating disorder or the other, and this may be either bingeing, or starvation. (Beach, 1996)

a. Diagnostic Criteria

One of the more important diagnostic criterions for bulimia nervosa is the presence of recurrent episodes or incidences of binge eating in the individual. Another important criterion is the presence of 'extremely compensatory behavior' in order to supposedly maintain and control the shape and the weight of the individual. The third diagnostic criterion is that the person would base his sense of self-worth and self-confidence on his own weight and body shape and on nothing else. According to a study that was conducted by Fairbum et al., in the year 1996, the prevalence rate of bulimia nervosa was generally between 1 and 2%, but the problem with this figure is that most number of bulimia nervosa cases go either unreported or undiagnosed. (The prevalence of anorexia nervosa, bulimia nervosa, and binge eating disorder)

The characteristics for bulimia nervosa are that it is a disorder that it may more often than not have prevalence over the entire lifetime, of about 1.1%, in women aged from 16 to 65. however, this dose not mean that men do not suffer from eating disorders, and a study revealed that although the rates of bulimics and those suffering from anorexia nervosa among men were significantly lower than that of women, men too do suffer form eating disorders, at a rate of about 0.1% and 0.5% on an average. However, most cases of eating disorders among men may often go unreported or undetected, and this means that there may be more men suffering form this disorder. (The prevalence of anorexia nervosa, bulimia nervosa, and binge eating disorder)

Most men and women who suffer form bulimia nervosa are people who often feel overwhelmed in the efforts made to cope with their various emotions, and they feel that they must blame themselves for something that realistically may not be their fault at all, and this disorder may often stem from a need for self punishment. They may either over eat or purge in order to get rid of or cope with emotions such as anger or stress or anxiety or depression, and the best method with which they feel they can do it is through overeating and then punishment through purging or vomiting. (Bulimia Nervosa: www.something-fishy.org/)

b. Treatment Methods

It is often stated that all bad habits take root in an individual, and the longer one indulges in them, the more difficult it becomes to get rid of them, and this can be applicable in the case of bulimics as well. Therefore, this means that the recognition and the addressing of the problem as soon as it becomes evident is extremely important, so that the habit can be changes sooner rather than later. As bulimia in fact involves both the mind and the body, a team of professionals must get involved in the treatment of the bulimic, including medical and mental doctors, health professionals, and dieticians. The basic goal of the treatment method must involve a basic psycho education about the medical impact and implications of this eating disorder, and then the self-identification of the so called 'triggers' that are the precursors of either bingeing or purging behavior, and then the interruption of the 'rituals' of the bulimic episodes. (Bulimia: signs, symptoms, effects, and treatments)

The next step would be to challenge the weight and the body image beliefs that the individual holds about himself, and then moving on towards the development of self-esteem and self-confidence of the patient, where he would soon be able to see himself for what he actually is, rather than identify himself on the basis of his body and shape alone. A successful treatment plan would provide a basic support system for the bulimic and thereby put an end to the isolation and aloneness that is often felt by the bulimia nervosa patient. Some of the more common treatment programs for the bulimic are the 'Overeaters Anonymous', the '12 step Program', the self-help groups that are run by the Eating Disorders Association'. (Bulimia: signs, symptoms, effects, and treatments)

c. Theorists involved

There are several theories about the real causes of this eating disorder, and while some theorists state that these are people who are trying to redeem their self-esteem by purging and bingeing, there are others who feel that the extremely distorted body image that is popular across the entire Western culture may be an important reason. (Eating Disorders Overview) Some theorists on the other hand lay stress on 'guided imagery' with which bulimics can regularly comfort themselves, by providing an external source of soothing, and at the same time, providing them with an enhanced self soothing method. Winnicott, one of the proponents of the guided imagery method, described the 'good enough mothering' methods, and the 'holding environment' which laid stress on the bonding between the mother and the child. If this experience were to be internalized, he explained, and then the bulimic would find himself soothed internally. (Esplen; Garfinkel, 1998)