Bulimia encompasses a wide range of behaviors. Some women may binge on buying clothes and then purge by returning them the next day.
Bulimia often develops as teenagers begin the transition out of adolescence. By focusing on calories, food, weight, and eating, the teenager is able to distract herself from the normal anxieties of growing up and the conflicts around becoming an adult. The very act of bingeing and purging dulls and anesthetizes difficult inner feelings. The ritual of planning the binge and purge, overeating and vomiting, cleaning up afterward, hiding the evidence, and beginning the cycle again consumes a large amount of time and energy, serving as a detour from the demands of real life. The bulimic’s eating cycle starts with ransacking the food: ravage®, regret®, regurgitate®, repent®, restrict®, repeat.
Depression, alcohol, substance abuse, anxiety and panic disorders are prevalent among bulimics and possibly their close family members as well. This supports the belief that strong family genetic and biochemical causes contribute to all these disorders.
Bulimics are aware of being in trouble, but because of shame, guilt, and fear they often do not reach out for help. The thin bulimic sees her slenderness as counterfeit because she has achieved it by “cheating,” and so she is terrified to be found out. She feels like a fraud by trying to maintain her weight through vomiting.
Bulimia is a form of coping, a creative solution to deal with difficult feelings. Vomiting is a violent act that releases tension, purifies the self, and blunts the pain. Because the bulimic gets rid of her feelings through action, it is difficult yet crucial to help her tolerate and be with her emotions, rather than doing something about them.
Since bulimics have not found a satisfying, verbal way to express themselves, they discharge their feelings through their bodies instead.
Simone described how when she was a little girl she was prohibited from expressing any resentment to her mother. Instead, when she was frustrated, she would bang her head against the wall. Her mother would lash out and sarcastically demand, “Bang your head harder!” And Simone would obey and do her mother’s bidding and bang her head harder. This was the beginning of a lifelong tendency to purge feelings destructively through her body and her bulimia.
The Treatment of Bulimia
From Demons to Daylight
Because I believe all eating disorders are emotional communications from our inner selves, I try to help each person translate into “feeling language” what her eating disorder is trying to express. I will ask a patient, “If your fat could talk, what would it say?” or “If your vomit could talk, what would it say and to whom?” “What is your theory about why you have this eating disorder?” Or I will ask, “When we help your eating problem get better, what is the very next issue that will come up for you?” With these questions, we try to form a partnership to discover the creative meaning of the eating problem.
The goal for eating disorder sufferers is to reclaim their self-expression that they have detoured from through their destructive behavior—to use their mouths for speaking their inner truth and not for bingeing and purging.
An effective therapy involves understanding how the person learned that her needs were unacceptable and how she resorted to bulimia as her substitute for vital nourishment and nurturance. Behavioral and cognitive techniques to help her strategize alternatives to the binge/purge cycle are crucial. Often medication for depression and anxiety is beneficial.
And hopefully, eventually, the person, who once upon a time was derailed and muted by bulimia, will emerge with a full-bodied, expressive self, a self of vibrant dimension, filled with vitality and passion.
By Mary Anne Cohen, Director of The New York Center for Eating Disorders in Brooklyn.
