Michelle Barratt Psychology - Brisbane Clinical Psychologists
The core problem for people suffering from the eating disorder Bulimia Nervosa is an overvaluation of weight and shape and their control, such that self-evaluation is heavily or completely based on these features. The disorder involves extreme weight control behaviours, such as dietary restriction, excessive exercise, vomiting and/or laxative misuse, and is associated with recurrent binge eating in which an objectively large amount of food is eaten accompanied by a sense of loss of control.
Recent research by the Victorian Government found the incidence of bulimia nervosa in the Australian population to be about 5%, and two recent studies estimate that only about 10% of bulimia cases are identified. Research shows that bulimia sufferers typically hide the disorder for 8 to 10 years before seeking treatment, which of course has significant impacts on physical and psychological health. Depression and anxiety are also common in bulimia sufferers. On the positive side, well-researched effective treatments are available, and studies show that 70% of bulimia sufferers who seek treatment report significant improvement in their symptoms.
Although binge eating can occur in all kinds of eating disorders, it is a prominent feature of bulimia. Binges can be objective, in which the amount of food consumed is clearly excessive to normal expectations given the circumstances, or the binges can be subjective, in which the amount of food consumed feels excessive to the sufferer only. Bingeing is often followed by purging behaviour which can take the form of self-induced vomiting and /or laxative misuse.
A large portion of binges are the result of undereating, such as dietary restriction and attempts to delay eating. A basic survival instinct is operating in this situation, creating a strong physiological urge to eat. The treatment strategy here is regular eating. According to the regular eating protocol, clients are asked to eat three planned meals and two or three planned snacks each day, leaving no more than three or four hours between any meal or snack. Eating in this way minimises hunger and usually produces a significant and gratifying reduction in episodes of binge eating.
Residual binges may remain despite adherence to the regular eating protocol, and these are usually the result of one of three factors – breaking a dietary rule, being disinhibited by alcohol, marijuana etc, and experiencing a distressing or unwanted mood or event (often referred to as “emotional eating”).
The consequence of breaking a dietary rule is often very familiar to people with bulimia. The sequence runs as follows, using the example of chocolate. A young woman has a dietary rule about never eating chocolate, and attempts to strictly adhere to this rule. One afternoon she nibbles a square of chocolate from the fridge. Her response to this is what we can call “catastrophic”, in that she feels now that she has totally messed up the day and ruined all her prior attempts at dietary control. This catastrophic reaction leads the abandonment of any and all attempts to control dietary intake, which of course leads to a binge in which the young woman eats the entire bar of chocolate. This is followed by regret, often referred to by sufferers as “guilt”. The rule is thus reinforced, along the lines of “if only I had stuck to my rule, this would never have happened”. The rule therefore becomes the “good guy”, and the young woman blames herself for lack of strength and self-control.
In fact the reverse is true - the rule is the driver for this entire cycle of events, and the woman is merely responding to a strong physiological urge to eat when hungry. In treatment, dietary rules are addressed and people encouraged to instead adopt dietary guidelines, which by their very nature cannot be “broken”.
“Emotional eating” is also often a focus of treatment. Clients are assisted in identifying events or mood states that trigger binge eating and/or purging and, in conjunction with their psychologist, learn alternate ways to deal with distressing and difficult emotions.
If you are concerned that you or someone close to you has a problem with binge eating please consider making an appointment with our specialised clinical psychologist.
Author: Michelle Barratt - Clinical Psychologist, and Clinical Director of Michelle Barratt Psychology, a Brisbane based Clinical Psychology Practice - Promoting the Therapeutic Care and Therapy for those struggling with an eating disorder.
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