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Breaking the Binge-Purge Cycle of Bulimia

Bulimia has been recognized as a major health problem for a long time, particularly among women. This eating disorder is characterized by recurrent episodes of binge eating and purging. The typical bulimic will binge on large quantities of food in a short period of time. After feeling a sensation of fullness or discomfort, the person will then engage in a purging behavior such as vomiting, using laxatives or over-exercising. Fasting and severe diet restrictions are other drastic methods used to control weight. Bulimia is found more often in women in their late teens or early 20s, although it can be manifested in adolescent girls and boys. This disorder can be difficult to detect, as there is no dramatic reduction in weight loss, and the binge and purge cycle is often performed in isolation and secrecy.

Bulimic women find that vomiting their food is a good way to enjoy the taste of rich and forbidden pleasures, while at the same time hope to maintain or lose weight. They are often oblivious to the physical complications that include abnormal electrolyte balance, fatigue, sore muscles, faintness, chills, and cold sweats. The binge-purge cycle of bulimia can cause a great deal of irritation to the gastro- intestinal tract. Swelling of the salivary glands, extensive wear of dental enamel, sore throats, mouth lesions, and constipation or diarrhea are common problems that bulimics may face.

Physiologically, it has been discovered that bulimics suffer from lower levels of serotonin, a specific brain neurotransmitter. This is why recent medical authorities have prescribed drugs like Prozac and whole spectrum light therapy to bulimics in order to increase the amount of serotonin in their brain. These treatments have proven to be somewhat successful, as bulimia is more than a biochemical imbalance.

The socio-psychological roots

In general, the more traditional a woman's family is, the greater her risk for bulimia. Often, the mother of a bulimic girl works at home, while the father is an independent, powerful, successful and emotionally distant man.

By equating her mother's traditional role or passive nature, she may perceive her mother's emotional vulnerability as a failure to succeed in the modern world. As a result, the importance of the father figure becomes overly dominant, and internalized. Thus the bulimic patient adopts a strong male personality and becomes outwardly friendly, competent, successful and very much in control. She may develop the profile of a superwoman, one who is both high achieving and a great caregiver. However, behind that mask of success lie the repressed emotional needs: anger, hurt, loneliness, and sadness.

The healing path...

The road to recovery is complex for the bulimic. Acknowledgement of one's binging and purging behavior as a dysfunctional method of weight control is the first step. Then, in order to break the addictive binge-purge cycle, bulimics have to attend to their bodies as well as their minds.

A woman suffering from an eating disorder has a very distorted concept of what constitutes a healthy and normal body. Her own body image tends to be grossly overestimated. Her recovery requires that she change the way she views her body. Reality therapy, body awareness exercises, art therapy and other body-centred techniques are used to reshape the deformed body image.

A woman with bulimia sees the world in a very biased way. In her eyes, the world is untrustworthy, unloving, disapproving and highly critical. Of course, what she fails to realize is that her external world is a mere reflection of her troubled inner world. This explains why she fails to trust herself, is not able to give herself love, constantly puts herself down, and is highly perfectionist. The process of healing thus requires her to build a new frame of reference based on rational and realistic data. Cognitive restructuring is one technique that is used to refute negative, irrational thoughts and replace them with accurate statements based on reality.

The bulimic woman is a victim of childhood incest, molestation, sexual assault or has experienced a severe trauma. The shame over this abuse may produce intense feelings of guilt, anger, and hurt. As a result of the abuse and the inability to cope effectively with these very intense emotions, the bulimic turns to rites of self-purification. She avoids food, vomits whatever she eats and over exercises.

Identifying the psychological conflicts that lead to bulimia is thus an important step to take. The use of powerful techniques such as imagery, role-play and art therapy are helpful to uncover and work through the painful repressed issues.

For the family and friends of a bulimic woman, the desire to provide any assistance can be of genuine interest, but it may be viewed as an unwanted intrusion of privacy by the bulimic. Support must then be direct, but without attempting to further lower the self-esteem of the individual. For example, it is vital that the bulimic individual learn to take responsibility for her own food intake.

Specific behavioral techniques can be employed to aid the woman in altering her eating habits and in helping the family serve as a positive source of support.

Treatment needs to provide sufficient support and structure to allow the individual to successfully stop binge-eating and purging. Care should be taken when selecting a health care provider who is experienced in successfully treating bulimia. Once the appropriate treatment and the motivation to overcome the eating disorder is present, recovery can occur.

© Stephane Bensoussan, M.A., Holistic Psychologist

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