Running Head INDIVIDUAL PROGRAMMATIC ASSESSMENT1INDIVIDUAL PR.docx

Running Head: INDIVIDUAL PROGRAMMATIC
ASSESSMENT 1
INDIVIDUAL PROGRAMMATIC ASSESSMENT 11
Individual Programmatic Assessment
Mary Oliver
PSYCH / 630
Mr. Adam Castleberry
January 12, 1015
Individual Programmatic Assessment:
Bulimia Nervosa
Psychological disorders occur frequently. A common
psychological disorder selected for the purpose of this paper is
bulimia nervosa. Bulimia nervosa has several therapeutic
interventions that can help when treating the disorder.
Therapeutic interventions can be helpful, but have different

measures of effectiveness. The measures of effectiveness
consist of validity, efficacy, symptom, behavior management,
and recidivism. These measures should be identified, prior to
deciding which therapeutic interventions can be most helpful to
the individuals diagnosed with the psychological disorder. Many
common symptoms are associated with bulimia nervosa. Rates
of symptom reduction or management have been reported with
the three treatments. Furthermore, the neurophysiological
underpinnings of diseases and disorders have to be identified,
along with the contemporary attitudes towards the three
treatments chosen.
Psychological Disorder: Bulimia Nervosa
Bulimia nervosa is known as an eating disorder. This disorder
typically affects females and is most often done by binge-and-
purge eating patterns. This eating disorder brings about the
effects of bingeing and purging, and using laxative. People,
suffering from bulimia nervosa, frequently eat a lot of food at
one time. A short period after eating the food, the person, then,
attempts to remove the food from his or her system by vomiting,
through medication that creates bowl movements, or by working
out. Excess working out has been known to lead one to throw
up. People diagnosed with bulimia nervosa, often lack self-
esteem. Many are self-conscious about their body image and
preoccupied by food. Majority of individuals, suffering from
bulimia nervosa, have normal weight or believe that they have
weight problems. Bulimia is associated with other illnesses, as
well. For example, some suffer from depression. Bulimia
nervosa shares many characteristics of anorexia nervosa.
Anorexia nervosa is a psychological eating disorder that
impacts many people, as well. However, instead of purging or
bingeing, people with anorexia nervosa, simply, do not eat.
People, diagnosed with bulimia nervosa, have a difficult time
maintaining a set weight like other individuals. Furthermore,
more critically, they are able to hide the fact that they have
bulimia nervosa. If bulimia nervosa goes untreated, it can create
critical issues, along with a nutritional downfall. “Bulimia

nervosa can be extremely harmful to the body. The recurrent
binge-and-purge cycles can damage the entire digestive system
and purging behaviors can lead to electrolyte and chemical
imbalances in the body that affect the heart and other major
organ functions” (NEDA, 2012).
The cause of bulimia nervosa has not been, accurately,
identified. Researchers have discovered that genes and
psychological factors may be the main reasons why individuals
are guided down the path of being diagnosed with bulimia
nervosa. Genes can contribute to the diagnosis of bulimia
nervosa because genes can cause people to have a higher or
lower risk of being diagnosed with bulimia, according to their
brothers and sisters or parents. Bulimia nervosa is, often,
created by stress. Stress can come from outside or inside
factors. For example, stress can be contributed by their parents
or families because of pressure. The pressure can be based on
one’s under-achievements or, simply, expectations on the behalf
of the parents or siblings on the individual. This pressure can
create stress, which causes a change in an individual’s self-
esteem and behavior. The individual may gain an inability to
control behavior or try to push themselves above and beyond to
try to minimize the stress from the outside sources. Stress can
cause people to gain negative emotions like anger,
disappointment, or sadness. Bulimia can also be caused by peer
pressure or abuse. Peer pressure, frequently, occurs by friends.
The abuse can be sexual, verbal, or non-verbal. All types of
abuse can make individuals believe that they are not worthy
enough or can create depression, due to their psychological
changes from abuse.
Three Therapeutic Interventions
Bulimia nervosa has many therapeutic interventions. Three
examples of therapeutic interventions that can treat bulimia
nervosa include selective serotonin reuptake inhibitors (SSRIs),
cognitive behavioral therapy, and yoga. SSRIs have been shown
to treat eating disorders. Antidepressants may be used to treat
bulimia nervosa as well. For example, Fluoxetine can be used to

reduce the bingeing effect that comes with bulimia nervosa.
Fluoxetine is a SSRI, known as Prozac. It is the only anti-
depressant to gain approval from FDA. Other examples of
SSRIs that can be used to treat bulimia nervosa are sertraline
and luvox. SSRIs have been good in helping to treat bulimia
nervosa. The main weakness of SSRIs is that it can lack
efficacy. The major side effects of SSRIs for bulimia are the
suicidal thoughts that can come with it, especially for the
younger individuals. Studies have noted that SSRIs can produce
suicidal thoughts for teenagers and children, especially. The
amount of SSRIs taken must be observed, just like every other
drug. Individuals, taking SSRIs, should be observed to make
sure that they are not put in a critical mindset. In many cases,
SSRIs do not hold an advantage in minimizing bingeing and
purging from bulimia nervosa more than the cognitive
behavioral therapy (UMM, 2014).
Another therapeutic intervention for treatment of bulimia
nervosa is cognitive behavioral therapy (CBT). Cognitive
behavioral therapy has been identified as the most effective type
of psychotherapy for adults with bulimia nervosa (Treating
Bulimia Nervosa, 2006). Cognitive behavioral therapy aims to
relieve bad thoughts or self-esteem that people create about one
self. It can help individuals to decrease or remove stress and try
to get back on a healthy, positive lifestyle. According to NAMI
(2012), cognitive behavioral therapy is a type of treatment that
centers on the relationships between thoughts, feelings, and
behaviors. By identifying patterns of thinking that can cause
self-destruction, destructive behavior, and the perspectives that
can create these ideas, individuals suffering from mental illness
can change their trends in thinking to help them cope (NAMI,
2012). Cognitive behavioral therapy starts with several sessions
that expand for five months or beyond. After undergoing 10
sessions of cognitive behavioral therapy and there are not
changes in the symptoms of bulimia nervosa, it is recommended
that the individuals start taking medication (Treating Bulimia
Nervosa, 2006). Cognitive behavioral therapy is valid and

accurate. It is able to minimize the symptoms that are linked to
bulimia nervosa within three stages, in the majority of
circumstances. The three stages of cognitive behavioral therapy
focus on maintenance, implementation of alternatives, and
changing the negative trends even after maintenance. The first
stage brings forth new strategies to get rid of binge eating. New
eating strategies are introduced. The second stage offers other
alternatives to eating, as well; continuing on to establishing
healthier nutritional habits then, dieting is removed. Throughout
cognitive behavioral therapy, the focus is on discovering the
mind process of the person to try to determine why there is an
issue with eating. The final stage identifies the trends of eating,
after maintenance (Fairburn et al., 1993).
The last therapeutic intervention, selected, that can be used
to treat bulimia nervosa is yoga or meditation. Yoga or
meditation is on the list of alternatives methods for treating
bulimia nervosa. According to UMM (2014),
Stress reduction technique as well as mind-body, such as yoga
and meditation, often helps one begin to be more aware of one’s
body and have a more positive body image. The results of a one
6-week clinical trial proved that guided imagery allow people
with bulimia to reduce bingeing and vomiting, while allowing
one to feel more comfortable with oneself, and feel better about
their bodies and eating.
Yoga is a spiritual process that involves breath control,
meditation, and shifts in body posture. Meditation is the process
of using images or collecting one’s thoughts or identifying
behavior to establish good peace of mind. Meditation can be
used to treat bulimia nervosa by decreasing the amount of
symptoms of the disorder. Meditation helps people to realize
their weaknesses and try to overcome them, psychologically
more than physically. For bulimia nervosa, meditation can be
used to manage one’s food tolerance and calm their negative
perspectives and behavior. Meditation allows people to focus on
their thoughts and try to change them to be guided into a more
positive path of life. Meditation has been shown to help self-

esteem, confidence, and can minimize one’s bingeing cycles.
The bad thing about meditation is that the changes are not often
long-term. Mediation can bring about improvement in a short
time. It is hard to keep people from bingeing or vomiting long-
term. It is not a very accurate or effective strategy for bulimia
nervosa.
Common Symptoms and Rates of Symptom Reduction
Most symptoms of bulimia are reported to be the eating of a
large portion of food in a small period of time, purging through
vomiting, exercising, vomiting, misuse of medication or
supplements, inability to control how much is eating, binge or
purge cycles that happen a lot, fear of weight gain, and being
ashamed of eating so much (WebMD, 2014). There are many
other symptoms that come with bulimia nervosa, as well.
Examples include mouth sores, lack of energy, depression, and
drug abuse. The risk of receiving recovery for bulimia nervosa
is better when bulimia nervosa is targeted earlier for the
individual. Rates of symptom reduction have to be identified for
the alternative treatments. SSRIs or antidepressant medication
has been shown to be very beneficial, when combined with
cognitive behavioral therapy (Wilson, 1997). By itself, SSRIs
are capable of minimizing the rates of binge-eating, along with
purging. However, it has not shown to be very effective at
making depression better or remission. Non-placebo SSRIs had
over 60% of an impact in reducing the binge-eating processes,
taking 8 weeks of treatment (Hay, 2011). Over 40% of
individuals, diagnosed with bulimia nervosa, experienced
cancellation after a short amount of time of taking the
medication or undergoing psychotherapy treatment. Cognitive
behavioral therapy has shown to have long-lasting impacts on
patients of bulimia nervosa. Individuals, suffering from bulimia
nervosa, were shown to be able to maintain results for 6 to 12
months, once treatment is over. Moreover, there has been a long
effect that had a mean of about 5.8 years (Fairburn et al., 1995).
Cognitive behavioral therapy is known to have the best results
out of all of the alternative, therapeutic interventions. There has

also been research on the combining of cognitive behavioral
therapy with SSRIs. This strategy has been shown to be
effective in helping people with bulimia nervosa, reducing the
main features of bulimia.
Neurophysiological Underpinnings / Contemporary Attitudes
about Treatments
Neurophysiology consists of physiology and neuroscience.
It studies the functioning of the nervous system. Diseases and
illnesses can be hard to find treatment for. A neurophysiological
study takes time to examine it is, often, associated with a
variety of studies. Examples include imaging and blood tests.
Overall, neurophysiology is used to diagnose diseases and
disorders of the nervous system. Areas of the nervous system it
helps to diagnose for this is central and peripheral. For
example, Bulimia nervosa is one of the most known chronic
psychiatric disease affecting in particular female adolescents.
Within the acute phase of starvation a number of hormonal,
neuropsychological and cerebral morphological changes occur
(Buhren, Holtkamp, Herpertz-Dahlmann, & Konrad, 2008).
Neurophysiology would help to identify these changes and
identify the issues of the brain.
SSRIs have created arguments for many researchers or
individuals. Several individuals are not for antidepressant
medication, believing that the side effects majorly hinder the
success of the medications. A lot of people stop taking anti-
depressants, due to the side effects. Many feel they are unsafe.
Research has shown that cognitive behavioral therapy is the
most effective, when treating symptoms. The contemporary
attitude towards cognitive behavioral therapy is that it should
be used first, before turning to any other treatments. Yoga or
meditation is recommended, due to the fact that it does not have
a lot of critical side effects, such as when being compared to
SSRIs.
Conclusion
Bulimia nervosa is a psychological disorder that causes people
to binge and purge. It can alter one’s nutritional stance and can

also hurt them psychologically, while physically. Bulimia has
no full identification for its cause. There are a variety of factors
that may have caused individuals to go into becoming bulimic.
Three therapeutic interventions that can treat bulimia nervosa
are SSRIs, cognitive behavioral therapy, and yoga or
meditation. Out of all the interventions, cognitive behavioral
therapy is the most effective alternative. SSRIs are medications
that can reduce symptoms of bulimia nervosa. Yoga or
meditation brings peace and helps individuals to manage their
psychological issues. Common symptoms of bulimia are eating
a large amount of food over a small period, bingeing, vomiting,
medication or supplement misusage, inability to control how
much is ate, fear of weight gain, and problems with self-esteem
or imagery. Research shows that bulimia nervosa can be better
treated with cognitive behavioral therapy or a combine of
cognitive behavioral therapy with SSRIs. Neurophysiology’s
motive is to identify the nervous system and the changes that
occur within. Contemporary attitudes support cognitive
behavioral therapy over SSRIs. However, researchers also
believe that meditation can be a nice type of treatment for
bulimia nervosa. Many people fear SSRIs, due to its side
effects.

ReferencesBuhren, K., Holtkamp, K., Herpertz-Dahlmann, B., &
Konrad, K. (2008). Neuropsychological Performance in
Anorexia and Bulimia Nervosa, 36(6): 377-386.Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/19034853
Hay, P. (2011). Bulimia Nervosa.
Retrieved from http://bestpractice.bmj.com/best-
practice/evidence/intervention/1009/0/sr-1009-i10.html
Fairburn, C., Marcus, M., & Wilson, G. (1993). Cognitive-
behavioral therapy for binge eating
and bulimia nervosa: a comprehensive treatment manual. In
Binge Eating: Nature, Assessment, and Treatment. New York:
The Guillford Press.
NAMI. (2012). Cognitive Behavioral Therapy (CBT?).
Retrieved from
http://www.nami.org/Template.cfm?Section=About_Treatments
_and_Supports&template=/ContentManagement/ContentDisplay.
cfm&ContentID=7952
NEDA. (2012). Bulimia Nervosa. Retrieved from
http://www.nationaleatingdisorders.org/bulimia-nervosa
Treating Bulimia Nervosa. (2006). Harvard Health Publications:
The Harvard Mental
Health Letter. Retrieved from
http://search.proquest.com/docview/1351062634?accountid=458
UMM. (2014). Bulimia Nervosa.
Retrieved from
http://www.umm.edu/altmed/articles/bulimia-nervosa-
000020.htm
WebMD. (2014). Bulimia Nervosa – Symptoms.
Retrieved on from http://www.webmd.com/mental-
health/bulimia-nervosa/bulimia-nervosa-symptoms
Wilson, G.T. (1997). Cognitive behavioral treatment of bulimia
nervosa. The Clinical
Psychologist, 50(2), 10-12.

University of Phoenix Material
Neurotransmitter Chart
Select four neurotransmitters. Complete a table for each
neurotransmitter.
Neurotransmitter 1
State if this neurotransmitter is inhibitory or excitatory:
Serotonin
Serotonin is inhibitory neurotransmitter.
What is this neurotransmitter's role on behavior?
Serotonin has an influence on almost all human behaviors,
emotions, appetite, automatic, motor, and cognitive. Serotonin
controls sleep, moods, appetite, and regulates body temperature.
It also regulates the rate hormones are released. Serotonin
modulates the tone of nervous system activity (Frazer &
Hensler, 1999).
References
Frazer, A. & Hensler, J. (1999). Serotonin Involvement in
Physiological Function and Behavior. Bookshelf. Retrieved
from http://www.ncbi.nlm.nih.gov/books/NBK27940/
Pharmacological agent prescribed to increasethe
neurotransmitter:
List three possible side effects linked to this agent:
Prozac is an antidepressant of the selective serotonin reuptake
inhibitors (SSRI) that is selective serotonin reuptake inhibitor

class (Dore, 2014).Prozac increases the level of usable
serotonin in the brain. High levels of serotonin are associated
with good moods, as serotonin plays a large part in mood
regulation. If serotonin levels are too low, moods can suffer
(Dore, 2014).
References
Dore, D. PharmD (2014). Prozac (Fluoxetine). Everyday Health.
Retrieved from http://www.everydayhealth.com/drugs/prozac
1) nausea, vomiting, and diarrhea
2) stiff rigid muscles
3) Headache, and trouble concentrating.
Example of a neurological disorder, disease, or condition where
this agent occurs
List possible risks associated with not taking this agent for the
disorder, disease, or condition:
Prozac is used to treat depression, or major depressive disorder.
Risks associated with not taking medication for depression are:
suicide, addiction, self-injury, risk taking behaviors, poor
academic performance, health problems, and relationship
problems (Hollerstein, 2014).

Hollerstein, D. J. MD ( 2014). Heal Your Brain. Depression,
and Anxiety Disorders Damage Your Brain, Especially When
Untreated. Psychology Today. Retrieved from
http://www.psychologytoday.com/blog/heal-your-
brain/201107/depression-and-anxiety-disorders-damage-your-
brain-especially-when-untre
Pharmacological agent prescribed todecreasethe
neurotransmitter:
Redux (Leonard, 2014)
1) depression
2) insomnia
3) somnolence (state of feeling drowsy) (Leonard, 2014)
this agent occurs
Redux (Dexfenfluramine) is serotonin reuptake inhibitor, used
as an anti-obesity drug, used to promote weight loss and the
management of obesity (Leonard, 2014).
References
Leonard, L. PhD (2014). Reducing Aggression and Violence
The Serotonin Connection. Life Enhancement. Retrieved from
http://www.life-enhancement.com/magazine/article/208-
reducing-aggression-and-violence-the-serotonin-connection
Possible risks associated with not taking the agent are:

obesity, high blood pressure, high cholesterol, heart disease,
and diabetes (Weight Loss and Prevention Plans, 2014).
References
Weight Loss Prevention Plans (2014). WebMD. Retrieved from
http://www.webmd.com/diet/tc/obesity-health-risks-of-obesity
Neurotransmitter 2
Ephinephrine
Epinephrine is an Excitatory
Epinephrine is adrenaline, this neurotransmitter drives off the
autonomic nervous system giving the fight or flight response,
when something dangerous happens or a stressful situation it is
immediately released into the bloodstream and the body is
prepped with oxygen and glucose to the brain and muscles.
neurotransmitter:
An EpiPen is a pharmacological agent that is prescribed and
given to individuals who severely allergic to particular items in
the world. When the body goes into a severe stressful situation
the EpiPen is injected into the high thigh area which is released
into the blood stream increasing the adrenaline putting the body
at ease saving the life of someone.

1) Anxiety
2) Palpitations/tremors
3) dizzness
this agent occurs
Epinephrine auto injector or EpiPen is used to treat anaphylaxis
Life threatening reaction such as death// rapidly decline//closing
of airways//swelling or inflammation//nervous system
weakening// Severe GI Symptoms
neurotransmitter:
Benzodiazepines (Valium)
http://www.heartspring.net/brain_improving_happy_balance.ht
ml
1. Reduces stress
2. Anxiety Levels are lowered
3. Impairs patient awareness/drowsy

this agent occurs: Claustrophobic
Claustrophobic
Woods,M. (2014). NYU Langone Medical Center. Retrieved on
Dec. 14, 2014. From
http://www.med.nyu.edu/content?ChunkIID=100695
1) Agitation/anxiety
2)fatigue/lack of focus
4) No excitement about life
Neurotransmitter 3 Dopamine
Dopamine
Both-inhibitory and excitatory (Carlson, 2013)
“Dopamine is one of the more interesting neurotransmitters
because it has been implicated in several important functions,
including movement, attention, learning, and the reinforcing
effects of drugs that people tend to abuse” (Carlson, 2013, p.
114).
neurotransmitter:
L-DOPA
1) Nausea

2) vomiting
3) Low blood pressure
(WebMD, 2014)
this agent occurs
Parkinson’s Disease
Tremors
Rigidity of the limbs
Poor balance
(Carlson, 2014)
neurotransmitter:
Chlorpromazine
1) drowsiness
2) blank facial expression
3) shuffling walk
(MedlinePlus, 2014)
this agent occurs
Schizophrenia
Hallucinations
Delusions

Disruptions in normal, logical thought process
(MedlinePlus, 2014)
Neurotransmitter 4
Acetylcholine (ACh)
Excitatory
In the central nervous system Acetylcholine plays a part in
attention and arousal. In the peripheral nervous system
Acetylcholine helps to activate muscles. (Carlson, 2013)
neurotransmitter:
Neostigmine, Botulinum Toxin
1) Headache
2) Blurred Vision
3) Slowing of heart rate
this agent occurs
Myasthenia Gravis
Increased weakness
Muscles become less responsive

neurotransmitter:
Atropine, Curare
1) Blurred Vision
2) Tachycardia
3) Rash
this agent occurs
Parkinson’s Disease
Increased rigidity
Increased tremors
Progression of the disease (Science Daily, 2000)
References

Carlson, N.R. (2013). Physiology of Behavior (11th ed) Upper
Saddle River, NJ. Pearson Education
Medline Plus, (2014). Chlorpromazine. Retrieved from
http://www.nlm.nih.gov
Mayo Clinic (2011). Seratonin syndrome. Retrieved from:
http://www.mayoclinic.org/diseases-conditions/serotonin-
syndrome/basics/definition/con-20028946
Nordqvist, C. (2011). What is serotonin? What does serotonin
do? Retrieved from:
http://www.medicalnewstoday.com/articles/232248.php#neurotr
ansmitter
Science Daily. (July 28, 2000). Ecstasy use depletes brain’s
serotonin levels. Retrieved from:
http://www.sciencedaily.com/releases/2000/07/000727081324.ht
m
WebMD. (2014). Drug & Medication Search. Retrieved from
http://www.webmd.com/drugs/drug-8323-
desipramine+oral.aspx?drugid=8323&drugname=desipramine+o
ral&source=2
WebMD, (2014). Parkinson’s disease Health Center. Retrieved
from http://www.webmd.com
Team B,
You all did a good job on this assignment. You addressed all
key elements and your responses were very thorough. Your
reference list looks good. 10 / 10 points

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