People with this disorder engage in frequent episodes of binge eating, during which a large amount of food is eaten, with an associated feeling of being out of control of the eating; that is, it would be difficult to stop, or control what or how much is eaten.
In order to compensate for this large amount of food, sufferers may induce vomiting, restrict subsequent food intake, exercise excessively or misuse laxatives and diuretics.
Typically people with Bulimia feel guilty, shameful or distressed about their eating habits, and have intense negative thoughts and feelings about their body and appearance, with their sense of self-worth tightly linked to their weight and shape, and their ability to control them.
Bulimia and Emotion Dysregulation
Bulimia is also associated with difficulties in regulating emotions, which can be called emotion dysregulation. A person who experiences this has strong emotional responses to both external events, like having a disagreement with a friend, and internal events, like having an upsetting memory or image flashing into mind.
Once this person has become emotionally upset she or he tends to stay upset for longer than other people might in a similar situation, and has greater difficulty regulating or controlling the emotions and related behaviours so that he or she can settle down again. These emotional struggles often result in unstable behaviour in several domains of life, including in relationships with others. The human emotion regulation system is very complex, and a dysfunction in any part of this system can provide the biological basis for emotional vulnerability and subsequent emotion dysregulation.
People who struggle with emotion dysregulation have often found ways to help manage their emotions, such as using alcohol and drugs, self-harming, and bulimic behaviours such as binge eating and purging. Thus, a person diagnosed with Bulimia will often also use drugs and alcohol, and perhaps experience self-harming urges as well. These behaviours seem to help regulate strong emotions and provide a kind of emotional relief at the time.
The problem, however, is that these kinds of strategies often have negative, undesired consequences in the longer term, such as problems in social and work lives, self-esteem, and mental and physical health.
DBT Treatment for Bulimia
Dialectical Behaviour Therapy (DBT) was developed by Dr. Marsha Linehan to help people with emotion dysregulation, and it has become a useful and evidenced-based treatment for Bulimia.
In DBT people are taught a variety of skills to assist them in managing their emotions, thoughts and behaviours, tolerating distress and interacting effectively with others.
A core component in using DBT as a treatment for Bulimia is the behavioural chain analysis.
In this process, an episode of binge eating is studied in great detail. The problem behaviour is described, including the thoughts, feelings and physical sensations that occurred at the time. The precipitating event is also described in detail, along with factors that made the person particularly vulnerable at that time: why did this happen today rather than yesterday, for example.
Next, all the links in the chain from the precipitating event to the behaviour of interest are uncovered. These links will be a series of thoughts, feelings and behaviours that led from the precipitating event and eventuated in the problem behaviour (binge, episode of drug use etc.) occurring. Short and long term consequences are then identified. This part of the process provides an enormous amount of relevant information and often highlights features of the process of which the person was previously unaware.
At this point, a solution analysis is performed. At each link of the chain, DBT skills are identified that could have been used to help in averting the problem behaviour, and thus providing a different outcome for the person. A prevention strategy is also identified to allow for a different response to the precipitating event if it were to occur again. In this way, a person can develop a plan of action that is very specifically targeted to their particular problem behaviours and the ways in which those behaviours come about.
Skills for Life
DBT provides a set of extremely useful life skills. Skilled coping and behaviour increases confidence and self-esteem across a wide range of life domains. Using DBT approaches as a treatment for Bulimia can bring a person an increased sense of control over their eating patterns, and if combined with cognitive and behavioural strategies to address issues such as irregular eating and dietary restriction, and over-valuation of weight and shape, can provide important treatment for this distressing disorder.
If you experience problems with binge eating and other bulimic behaviours, please consider making an appointment with me, so that we can explore your difficulties and decide whether DBT is an appropriate treatment for you.
Author: Bridget Hogg, B.Sc. (Hons), M. Sc. (Clinical Psychology)
Bridget Hogg is a Brisbane Clinical Psychologist drawing primarily on DBT, Acceptance and Commitment Therapy and Mindfulness training as part of the treatment for bulimia.
It is an act of courage and self-care to seek therapeutic help for ongoing psychological difficulties, and Bridget respects and admires all clients who take the first step in that process by making their first appointment. She is passionate about helping people improve the quality of their lives, particularly those for whom life feels at times extremely difficult and painful.
To arrange a session with Brisbane Clinical Psychologist Bridget Hogg, you can freecall 1800 877 924 or book online now!