At the heart of the struggle with Bulimia Nervosa is an extreme focus and worry about weight and body shape, with a person’s sense of self and judgements of self-worth dependant on achieving a particular body shape and weight ideals. Thoughts often involve themes of low self-esteem; being dissatisfied with body image and need for perfection.
A person with bulimia can experience cognitive distortions very intensely and frequently:
The Cycle of Bulimia
Behaviour becomes very reactive to thoughts about the body and aimed at avoiding any weight gain to an extreme degree. This often involves developing very rigid rules regarding diet and engaging in extreme dieting behaviour (Fairburn and Cooper, 2004). The rules are so rigid and difficult to follow that when they are naturally broken, the person can become very self-critical, let go of all control around eating and binge for a period. The binge eating involves eating in a discrete period of time an amount of food that is obviously larger than most would eat in similar contexts and period of time. In an attempt to compensate for the binge eating, the person gets caught up in compensatory behaviours such as vigorous exercising, induced vomiting or misuse of purgatives or diuretics.
The struggle continues with the fixation on body shape and weight, low self-esteem and extreme dieting behaviour. The compensatory behaviours of induced vomiting or misuse of purgatives or diuretics can maintain binge eating when the person believes these are an effective strategy for reducing the body’s absorption of the calories. The Bulimic may get caught up in a cycle of believing they can binge on ‘banned’ foods without this impacting their weight ideal. Further, the extreme weight loss dieting can have a physiological impact of inadequate nutrition and trigger a starvation reaction. This is experienced as an extreme urge to eat and seems uncontrollable leading to a binge and the cycle of compensatory behaviours to follow. The binge eating and compensatory behaviours are often associated with feelings of guilt, shame and disgust.
Prevalence of Bulimia
It is estimated that 4% of the Australian population have an eating disorder and of these, 12% have bulimia nervosa (Butterfly Foundation, 2012). Unfortunately, it is common for people with bulimia to keep their disorder secret struggling with shame, guilt and disgust associated with the episodes of out of control eating and compensatory behaviours. It is estimated that the true prevalence of bulimia is 1 in 5 females (NEDC 2012). The prevalence of eating disorders is increasing among boys and men (NEDC 2012).
Risk factors for Bulimia
The following outlines some of the factors that may increase a person’s likelihood of developing bulimia:
Possible Consequences of Bulimia on Health and Wellbeing
Bulimia is a serious disorder. A person struggling with bulimia can suffer inflammation and rupture of the oesophagus and stomach as a result of frequent vomiting; chronic sore throat, reflux and indigestion; dental enamel erosion; stomach ulcers; problems with bowel movements as a result of misuse of laxatives (chronic constipation or diarrhoea); osteoporosis; irregular or loss of menstrual cycle; increased risk of fertility issues and slow or irregular heart beat which can increase the chance for heart failure (NEDC, 2019). There may also be a negative impact on social engagement, relationships and work. For these reasons it is important to seek help as soon as a problem is identified.
Psychological Treatment of Bulimia
Psychological treatment of Bulimia involves addressing both cognitive and behavioural aspects of the disorder and aims to restore appropriate eating behaviour (Fairburn and Cooper, 2004). It also involves addressing other issues in the person’s life depending on the individual treatment goals and presenting concerns such as problems in relationships, sense of purpose or meaning in life, employment/career and health issues.
The journey of treatment for Bulimia may involve the following and is individually tailored to the particular needs of the individual:
These inform broader therapy goals and provide motivation for behaviour change.
If you think you may be struggling with bulimia seek help! This is a serious problem left untreated and you can recover with willingness to make changes for your longer-term health and wellbeing. Discussing your concerns with your GP and a psychologist are great options to begin. The involvement of other professionals may be relevant such as a dietician to guide an eating plan.
At CBT Professionals we have a number of clinical psychologists experienced in working with eating disorders. If you wish to consult with our service, please download our Referral Information sheet here and take this with you to your consultation with your GP.
CBT Professionals – Feel good, Live well
Disclaimer: Content on this website is provided for education and information purposes only and is not intended to replace advise from your doctor or registered health professional. Readers are urged to consult their registered practitioner for diagnosis and treatment for their medical concerns.
Butterfly Foundation. (2012). Paying the Price: the economic and social impact of eating disorders in Australia. Melbourne, Butterfly Foundation.
Fairburn, C.G. and Cooper, P.J. (2004). Eating disorders. In Cognitive Behaviour Therapy for Psychiatric Problems: A Practical Guide, (ed. K. Hawton, P. M. Salkovskis, J. Kirk, and D. M. Clark). Pp. 277–314). Oxford University Press, Oxford.
The National Eating Disorders Collaboration (2012). An integrated response to complexity – National eating disorders framework 2012. Sydney, NEDC.
NEDC. Bulimia nervosa. 2019. https://www.nedc.com.au. [accessed 28/2/2019].