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Bulimia

Bulimia or Bulimia Nervosa is a voluntary cycle of binge eating followed by purging of that which has been consumed. A binge may involve the ingestion of thousands of calories across many different types of food in one sitting, although in some cases the eating behavior is much less severe or may involve only one type of food.

As a rule, bulimics are chronic and highly restrictive dieters, allowing themselves only certain types of low calorie or low-fat foods. When they violate their own self-imposed dietary constrictions, bulimics almost invariably begin binge eating.

Purging includes vomiting, excessive and inappropriate use of laxatives, and excessive exercise.

The primary motivation behind binge-purging is “having one’s cake and eating it, too” i.e., to be able to consume large amounts of high calorie, diet-forbidden food without paying the consequences by subsequent weight gain. The problem with this method is that purging itself begins to inflame and worsen the disorder by removing the fear of weight gain. For example, Jane Fonda wrote that she was vomiting 17 times or more each day before working to eliminate her willingness to purge her food. When vomiting reduced in frequency, so did the binge eating.

In addition to being severely weight and diet conscious, bulimics tend to be perfectionistic, insecure, worried about how others perceive them (especially their weight), anxious, depressed, and prone to incorrect self-judgments about being fat. They tend to have trauma or abuse in their backgrounds and typically are highly motivated, intelligent individuals with low self-esteem. The great majority are women.

Research on the problem indicates that one of its most important therapy recommendations for bulimics is for them to practice the consumption of a wide range of foods without resorting to purgatives thereafter. Sometimes therapists ask bulimics to bring problem foods to sessions and then ingest them without purging. Using this method, anxiety about weight gain increases dramatically in the therapist’s presence, allowing the therapist to begin giving the bulimic appropriate information about weight gain, the role of dieting in bulimia, proper nutrition, and how to increase self-esteem. Over time, this type of practice reduces the bulimic's fear of food, helps her gain a more realistic perspective about the causes weight gain, and most importantly helps her become more and more resistant to purging as a means of weight control.

A complete treatment approach to bulimia may also include cognitive therapy for depression, assertiveness training, relationship counseling, non-restrictive nutritional counseling, and use of trauma-therapies such as EMDR to address past incidents of sexual or other abuse.