Bulimia Nervosa

Bulimia nervosa is characterized by dangerous episodes of binge eating and recurrent compensatory behavior, such as self-induced vomiting, abuse of laxatives, diuretics, and diet pills in order to “undo” or compensate for the effects of the binge episode. Binge episodes can occur up to several times per day. Those who suffer are overwhelmed by the feeling of needing to rid themselves of the food and calories consumed. Because most people who suffer from bulimia nervosa are able to maintain a normal body weight, the illness may go unnoticed. As is true of those who suffer from other forms of disordered eating, Bulimia nervosa often occurs together with other psychiatric disorders, such as obsessive compulsive disorder, bipolar disorder, depression, self-harm, and substance dependence.

Signs and Symptoms include the following:

  • Constant concerns about food, weight, and body image
  • Overwhelming feelings of helplessness, embarrassment, guilt, and shame during a binge episode
  • Regularly consuming unusually large amounts of food, usually secretly, until left feeling uncomfortably and painfully full
  • Over exercising, also called compulsive exercise
  • Going to the bathroom during or immediately after meals
  • Body weight that fluctuates up and down
  • Irregular menstruation or loss of menses, called Amenorrhea
  • Abdominal pain
  • Discoloration and/or staining of the teeth
  • Bad breath
  • Sore throat or mouth sores

Medical Complications

Bulimia nervosa is a potentially life-threatening illness. Recurrent binge eating and purge cycles cause damage to the entire digestive system leading to reflux, gastritis, tears of the esophagus, malabsorption, slowed gastric emptying, and severe constipation. Purging causes electrolyte imbalance and dehydration, both of which can cause cardiac complications and sometimes, sudden death. Loss of potassium may cause heart failure as well. Electrolyte depletion can disrupt heart function and lead to kidney failure, both of which are potentially fatal. In extreme cases, frequent, large binge episodes can lead to gastric rupture. Purging by diuretics, laxatives or vomiting can lead to electrolyte imbalances and dehydration. Chronic irregular bowel movements and constipation may occur as a result of laxative abuse. Frequent vomiting can lead to dental cavities, erosion of tooth enamel, tooth decay, and gum disease. Other frequent medical complications include esophagus irritation, irregular heartbeat, and swelling of the mouth and jaw. All patients with bulimia nervosa should be screened for medical and dental complications.

Treatment

The goal of treatment is to ultimately end the cycles of binging and purging. Individuals who suffer from Bulimia nervosa may be unable to recognize that he or he she is ill and needs treatment. Thus, it is crucial to become familiar with the signs and symptoms of this disorder. Initial treatment depends on the severity of the Bulimia nervosa and the duration of time the individual has struggled with binge eating and vomiting. If the cycles of binging and purging have been ongoing for quite some time, hospitalization may be required to restore electrolytes and potassium levels. Resolving emotional issues, changing unhealthy thoughts and patterns, and undergoing nutritional counseling are also important elements of treatment. Cognitive-behavioral therapy (CBT) has the strongest scientific support of its long-term effectiveness. In CBT, the patient begins by monitoring nutritional intake and thoughts and feelings about eating. A nutritionally-balanced meal plan consisting of three meals and two to three planned snacks a day is implemented. The individual learns effective strategies to cope with anxiety about eating and the urges to binge and purge. Finally, inaccurate and harmful beliefs about eating, weight, appearance, and personal qualities are identified and modified to encourage a healthy appreciation of oneself. Recovery from bulimia nervosa is possible with the right treatment team and outside support.

Dialectical Behavior Therapy Treatment: What is Dialectical Behavior Therapy, or DBT?

DBT is an effective treatment combining behavioral, cognitive, and supportive therapies. While DBT was originally developed to treat Borderline Personality Disorder, self-injury, and suicidal thoughts/behaviors, it has since been proven effective for a number of additional disorders, such as binge eating disorder, bulimia nervosa, substance abuse disorders, and post-traumatic stress disorder. DBT’s balance of acceptance, validation, and warmth with change-oriented approaches creates a supportive atmosphere for growth.

One of the main reasons people engage in desperate behaviors is to feel better or survive an overwhelming situation. Individuals with eating disorders often struggle with other self-destructive behaviors, such as self-injury and substance abuse, in addition to their eating disorder behaviors. These behaviors can become one’s primary means of coping with life because they have not learned effective alternatives that actually work. While these desperate behaviors may provide short-term relief, the long term costs to personal health, self-esteem, identity, mood, relationships, life accomplishments, and spiritual growth are far too great. It is impossible to fully experience and enjoy life while these behaviors are present. In DBT, a variety of skills are taught and practiced in each of the categories below, allowing you the freedom to break the cycle of self-destructive coping.

Mindfulness- Being present and learning to control your mind so it doesn’t control you

Emotion Regulation- Emotional acceptance, decreasing emotional vulnerabilities, and regulating emotions effectively

Distress Tolerance- Surviving crisis situations without making them worse

Interpersonal Effectiveness- Handling conflict, asking for what you need effectively, and setting limits with others

Who can benefit from DBT for Eating Disorders?

If you have an eating disorder and struggle with any of the following, one of our DBT options may be right for you.

  • Difficulty managing emotions
  • Hiding your emotions from others
  • Feeling numb or empty much of the time
  • Binge eating / Feeling out of control when eating
  • Purging (self-induced vomiting, laxative abuse, etc.)
  • Restriction of food intake
  • Recurrent self-injury or suicidal thoughts and/or actions
  • Substance abuse or other addictive/impulsive behaviors
  • Difficulties with relationships and trusting others

DBT for Eating Disorders (DBT-ED)

DBT-ED is designed for those struggling with binge eating, purging, food restriction, and potentially other self-destructive behaviors that stem from emotion regulation difficulties.

DBT-ED includes:

Weekly individual sessions with a DBT specialist focused on support, motivation for treatment, reviewing target behaviors, and problem solving.

Weekly skills training group to learn and practice MINDFULNESS, EMOTION REGULATION, DISTRESS TOLERANCE, and INTERPERSONAL EFFECTIVENESS skills.

Coaching, as needed, involve contact with your individual therapist between sessions to strengthen and generalize the skills you have learned into your real life… where it matters most!