Bulimia Treatment
Eating disorders are on the rise, according to statistics from eating disorder charities, GPs, and hospital admissions. One eating disorder charity says that calls to their helpline were likely to reach 17,000 in the financial year ending March 2018 – up from 7,000 the year before.
Eating disorders, often classified as “food addictions”, carry the highest morbidity rate of all psychiatric conditions. Recent research from the NHS information centre showed that up to 6.4% of adults in the UK displayed signs of an eating disorder (Adult Psychiatric Morbidity Study, 2007). The research shows that 25% of those showing signs of an eating disorder are male.
The latest version of the DSM (Diagnostic Statistical Manual of Mental Disorders), cites the main eating disorders as anorexia, bulimia, and binge eating disorder (BED). It estimates that of all patients with eating disorders, 10% are anorexic, 40% are bulimic and the rest fall into the “Eating Disorder not otherwise specified” category.
Bulimia is perhaps the least understood of all the eating disorders. It was not widely known in medical circles until the British Psychiatrist, Gerald Russell classified it in 1979. Bulimia Nervosa is a psychological and severe life-threatening eating disorder characterized by the ingestion of an abnormally large amount of food in a short time period – often referred to as a “binge” – followed by extreme purging, to avoid gaining weight.
Purging can include forced vomiting, excessive use of laxatives or diuretics and prolonged periods of extreme exercise. The binge/purge cycle may be repeated several times a day leading to physical symptoms such as:
- Weight Fluctuation
- Electrolyte imbalances which can result in cardiac arrhythmia, cardiac arrest and sudden death
- Broken blood vessels within the eyes
- Enlarged glands in the neck and jawline
- Oral trauma such as lacerations in the lining of the mouth and throat from severe vomiting
- Inflammation of the oesophagus
- Infertility
Given the extreme symptoms, and now the number of both male and female sufferers, little is known about the causes and treatment for bulimia. The illness itself is shrouded with such a high degree of secrecy and shame, that it is often hard for sufferers to come forward for treatment in the first place.
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What causes bulimia?
There is no single cause for bulimia. Genetic and biological factors are thought to play a part, but most experts believe that childhood trauma or neglect play a large part in the development of bulimia. Cultural pressures on women and increasingly men, to have the “perfect” body, are also thought to play a part, with certain professions or lifestyles prizing aesthetics more highly.
As with other eating disorders, research suggests that children raised in a family system with criticism, high expectations and a culture of achievement or perfectionism, will be more likely to develop an eating disorder. Victims of physical or sexual abuse are also highly represented in eating disorder statistics.
More recently, clinicians and psychologists have charted the rise of social media, with its emphasis on digitally altered perfect looks, and sometimes unattainable standards, as being a major factor in the spike in eating disorders.
Treating Bulimia
Sadly, treatment for eating disorders in the UK is becoming harder to gain access to. NHS community out-patient services are rare, and many sufferers have to wait until they are ill enough for a hospital admission before they are treated.
Treating a complex condition such as bulimia nervosa requires expert services, but it is perfectly possible to recover. The best recovery rates are usually achieved with a mixture of psychotherapy, cognitive behavioural therapy and sometimes group support. In addition, some sufferers may benefit from certain SSRI (“selective serotonin reuptake inhibitors”) antidepressants, which are thought to lessen the urge to binge/purge and to reduce anxiety.
Cognitive Behavioral Therapy (“CBT”) is a useful therapy for eating disorders. CBT is based on the principle that emotions, thoughts and behaviours are interconnected. Therefore by identifying and challenging distorted thought patterns, particularly around food and body image, then new thoughts and behaviours can emerge.
Psychotherapy is particularly useful for bulimia nervosa. Psychotherapy is sometimes called “talking therapy” and its aim is to help individuals gain a better understanding of what may be underneath maladaptive behaviours, such as binge eating. Psychotherapy helps individuals understand how some of their thoughts and feelings were formed. A psychotherapist will usually be interested in a person’s childhood experience of safety, love, relationship and ultimately self-esteem.
Most bulimia sufferers have a distorted sense of self, suffer from feelings of low self-worth, self-hatred and struggle to tolerate and regulate difficult emotions. A specialist eating disorder psychotherapist will work with a client to improve their poor sense of self, to understand why they think and feel as they do, and to better tolerate difficult feeling states.
Recovery from bulimia can take some time. An experienced psychotherapist will work with a client in the early phase of their recovery, where the client is attempting to gain some remission from binge eating and purging. Many eating disorder recovery professionals recommend that eating disorder suffers abstain from sugar and alcohol as they try to stabilize their eating patterns, thus helping to minimize the physiological cravings for sugary or carbohydrate-laden food.
A psychotherapist will help a client begin to notice the difficult feeling states which begin to emerge and help each sufferer understand and better tolerate this, without resorting to binge eating or purging behaviour. This can be a challenging first phase of recovery. It is vitally important that suffers find a therapist whom they trust and has to experience in working with eating disorders
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