{"id":16301,"date":"2019-10-01T00:00:52","date_gmt":"2019-10-01T06:00:52","guid":{"rendered":"https:\/\/www.unk.com\/blog\/?p=16301"},"modified":"2020-03-10T05:19:27","modified_gmt":"2020-03-10T11:19:27","slug":"6-steps-to-treat-bulimia","status":"publish","type":"post","link":"https:\/\/www.unk.com\/blog\/6-steps-to-treat-bulimia\/","title":{"rendered":"6 Steps to Treat Bulimia"},"content":{"rendered":"

“Some nights I’m alone, so I binge. I don’t answer my phone. You wouldn’t believe how fast<\/em> I can eat. Almost too quick to taste it. I gorge myself until I feel I might literally bust. But I know it doesn’t matter, because I can get rid of it anyway.” So said Sharon. And yet she knew it did<\/em> matter.<\/p>\n

And, if you’ll forgive the expression, she was sick of it. Purging herself with laxatives, or more commonly though her long-practised expertise in purposeful vomiting, was robbing her of health and self-respect. She was tired of deceiving her friends and family. Fed up with it all.<\/p>\n

Bulimia nervosa is perhaps the most common eating disorder.1<\/sup> Some clients may tell you they used<\/em> to be anorexic but now they are bulimic (or vice versa), but while some people conflate the two disorders, they are<\/em> different conditions.<\/p>\n

Bulimia vs anorexia<\/h3>\n

While both bulimic and anorexic clients often have extreme body distortion, the way they react to this is different. Anorexia nervosa sufferers starve themselves continually, whereas bulimics eat excessively in a short timeframe but then seek to purge the calories they’ve consumed, either through purposeful vomiting or the use of laxatives – or both.<\/p>\n

Both anorexic and bulimic clients may exercise excessively, and a subset of bulimics, known as non-purging bulimics, simply fast or exercise frantically after overindulging in a bid to make up for the huge amount of calories they consumed.2<\/sup> But usually (not always<\/em>),the bulimic client purges after gorging.<\/p>\n

Research suggests a strong association between anorexia and Asperger’s syndrome<\/a>.3,4<\/sup> When you think about it, it’s not entirely surprising. Repetitive behaviors and thoughts, rigid rituals and routines, and perfectionism<\/a> (or, as Dr Iain McGilchrist<\/a> suggests, a right-brain hemispheric deficit)5<\/sup> characterize both anorexia and autism. However, this association isn’t observed – or at least not as strongly – with bulimia.<\/p>\n

Unlike many anorexic clients, whose condition becomes obvious due to an increasingly emaciated appearance, bulimia sufferers often keep their behaviour and feelings secret, and their weight and appearance may even appear quite stable.<\/p>\n

One and the same client may go through alternating periods of anorexia and bulimia, and of course anorexics may engage in purging, but in this piece I’m going to exclusively focus on strategies for the bulimic client. Eating disorders have been traditionally seen as predominantly a female disorder, but evidence suggests that men are suffering more now too.6<\/sup><\/p>\n

Eating disorders don’t exist in isolation. The emotional problems your bulimic client suffers may be a cause or an effect of bulimia. Or, in a kind of vicious cycle, it may be both.<\/p>\n

Why do people become bulimic?<\/h3>\n

We sometimes see comorbidity between eating disorders such as bulimia and suicidal ideation and self-harm.7<\/sup> (Of course, we can see bulimia itself as a form of self-harm.) Low self-esteem<\/a> , social phobia<\/a>, fear of abandonment<\/a>, or an inferiority complex<\/a> may all drive and maintain, and sometimes result from, bulimia. Feeling in the grip of any emotional condition can damage our sense of independence and fracture our self-esteem.<\/p>\n

And, like many emotional and behavioural problems, bulimia may stem from an unconscious attempt to solve<\/em> problems in your client’s life – so we need to learn about the client, not just their condition or label.<\/p>\n

If life generally feels out of control, then bulimic or anorexic behaviours may seem<\/em> to promise some succour for your client, at least initially. If I<\/em> decide what and when I eat, and even what I choose to digest, that might seem to give me at least some<\/em> sense of control. Indeed, many binges are planned rather than spontaneous.<\/p>\n

Your bulimic client may have personality issues such as maladaptive perfectionism, which may need to be treated alongside the bulimia. Some clients find a kind of numbing or escape from problems or difficult feelings while they binge. Endorphins may be released during the pain of purging. We always need to look at why<\/em> people do what they do. What are the pulls of the pattern?<\/p>\n

Sharon was prone to the kind of all-or-nothing thinking that tracks alongside perfectionism. But, thanks to the bulimia, she had other problems too.<\/p>\n

An unhappy body<\/h3>\n

The first time Sharon visited me her voice was hoarse, her throat dry and sore. “I had a terrible binge at the weekend,” she told me in a cracked and pained whisper. “It hurts to talk.”<\/p>\n

Ask your client about any physical effects from the bulimia. These may include tooth decay (from the rush of acidic stomach contents against the teeth), swollen salivary glands, and intestinal disorders, among other serious consequences.8<\/sup><\/p>\n

Bulimia is a physical health issue as well as a mental health one.<\/p>\n

So what are some of the must-dos when treating bulimia?<\/p>\n

Step one: Discover what’s driving the bulimia<\/h3>\n

Is it body image? A sense of wanting to be ‘pure’ or ‘worthy’, or to numb difficult feelings? Was the bulimia ‘caught’ from someone else as a kind of learned behaviour that has become a habit, as often happens with smoking<\/a>? Your bulimic client may not be able to give you all the answers if you ask about these things directly, but by asking generally<\/em> about their life you should be able to glean much vital therapeutic information<\/a>.<\/p>\n

Is the bulimia a symptom of unresolved trauma? If so, you will need to take steps to deal with your client’s trauma<\/a> as comfortably as possible. Finding out when it began and the circumstances around that time can give you a sense of why<\/em> it started.<\/p>\n

What are your client’s bulimia triggers? Loneliness? Boredom? Anxiety? Frustration? Sharon told me she would make up her mind to binge when she felt alone, “like a failure”.<\/p>\n

By asking your client about their life generally, you will get a sense of to what extent they are meeting their primal emotional needs<\/a>. This is information we need from all our clients, of course. Once we find out which universal needs are lacking, we can begin to work with our client to help them meet those needs as wholesomely as possible and thereby, to some extent, negate the ‘need’ for the bulimia.<\/p>\n

If your client’s bulimia is really intractable, it may be that it is held in place by what’s known as ‘molar memory’, a kind of two-rooted memory containing both positive and negative aspects. I won’t go into that here, but check out this link<\/a> from the Human Givens Institute to learn more about this fascinating kind of memory.<\/p>\n

You can look at more ways to discover what has caused or is causing the problem here<\/a>. On top of this, you can find out something else really useful.<\/p>\n\n

Step two: Why didn’t<\/em> it happen?<\/h3>\n

Exception questions<\/a> are a goldmine of potential therapeutic information.<\/p>\n

“When did you feel like you were about to binge but you just didn’t?” I asked Sharon. At first she could think of no such exception, but after a while she offered:<\/p>\n

“Well, sometimes I feel like I’m going to, but something else happens. Like this one time, a friend called and for some reason I picked up and we had a really great chat and afterwards the urge to binge just wasn’t there!”<\/p>\n

Wow. That tells us something really important about what need the bingeing may be trying to fulfil.<\/p>\n

“Another time I felt like I was – and I know this sounds weird – outside<\/em> of the bulimia, and it was trying to get me to binge again and I didnt want to. I just started doing something else and it went away.”<\/p>\n

Ask exemption questions to find out what kinds of circumstances help your client step aside form the bulimia, then form strategies out of those exceptions.<\/p>\n

And talking of stepping aside…<\/p>\n

Step three: Remove the bulimia from your client’s core identity<\/h3>\n

So often we talk about ‘bulimics’ or ‘depressives’, or even ‘smokers’ versus ‘non-smokers’, as if people are defined by these monikers. And yet part of therapy may involve removing a toxic label<\/a> from a person’s sense of who they are.<\/p>\n

It may be crass and clich\u00e9d to say “you are not your bulimia”, but we can be more subtle than that and help our clients:<\/p>\n