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Bulimia Nervosa

Counselling in Perth

 

 Bulimia Nervosa (bulimia) is a disorder involving over-eating and requires the following criteria in order to be diagnosed1: 

A

Recurrent episodes of binge eating. An episode of binge eating is characterised by both:

 

1

Eating in a discrete period of time (e.g. within any 2 hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.

 

2

A sense of lack of control over eating during the episodes (e.g. a feeling that one cannot stop eating or control what or how much one is eating.

B

Recurrent inappropriate compensatory behaviours to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.

C

The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for 3 months.

D

Self-evaluation is unduly influenced by body shape and weight.

E

The disturbance does not occur exclusively during episodes of anorexia nervosa.

Statistics estimate that in 2012 approximately 4% of the Australian population had an eating disorder (ED), 12% of which had bulimia2.  Bulimia often starts out as a desire to lose weight and the compensatory behaviours work very well in the beginning, which reinforces its effectiveness, encouraging the behaviour to continue.  However, over time, the compensatory behaviours stop being so effective and the disorder becomes more problematic.

 

Physical and Medical Co-Morbidities

There are significant  medical problems associated with bulimia that include:

  • Imbalances in electrolytes such as potassium, sodium, and chloride, caused by the dehydration resulting from purging behaviour (vomiting, laxatives),
  • Vomiting can cause gastric rupturing,
  • Inflammation of the throat/oesophagus,
  • Stomach ulcers,
  • Leaky bowel,
  • Release of stomach acids during vomiting may cause tooth decay and staining,
  • Chronic irregular bowel movements caused by inappropriate laxative use,
  • Heart failure and death.

Psychosocial Co-Morbidities

Psychosocial problems that accompany bulimia include:

  • depression,
  • anxiety,
  • suicidal thoughts and behaviour, and self-harm,
  • guilt, self-loathing, self-disgust, shame,
  • mood swings,
  • alcohol,
  • social withdrawal and isolation,
  • school, study and employment problems.

 

How can a psychologist or counsellor help with bulimia?

A psychologist can provide counselling to deal directly with the emotional and behavioural aspects of the bulimia, as well as other co-morbid issues such as depression and anxiety often associated with the ED.  The most common forms of psychological therapy for bulimia is Cognitive Behaviour Therapy (CBT) and Dialectical Behaviour Therapy (DBT).

Cognitive Behavioural Therapy

CBT specifically for Eating Disorders (CBT-E) has been shown to be an effective treatment when emotional dysregulation is the precursor to the ED.  This type of therapy addresses thoughts (cognitions), feelings, and behaviours directly, with treatment focussing on:

  • Normalising eating – set up a regular eating routine
  • Reducing or eliminating compensatory behaviours
  • Reducing or eliminating binge eating behaviour
  • Reducing or eliminating any avoidance of specific foods or strict dieting
  • Reducing eating due to mood or event triggers
  • Exploring core beliefs about body image and the self
  • Exploring fears relating to weight (loss) and body shape
  • Exploring self-esteem
  • Increasing a sense of self-control
  • Increasing self-awareness of normal, healthy appetite cues

 

Dialectical Behaviour Therapy (DBT)

DBT for binge eating teaches skills for emotional regulation and distress tolerance – alternatives to binge eating and purging.

 

If you think you have Bulimia, or even issues with disordered eating (emotional or comfort eating, obesity etc.) and you are seeking the services of a psychologist or counsellor in Perth to assist you, please contact me directly on 0406 033 644 or This email address is being protected from spambots. You need JavaScript enabled to view it.

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References

  1. American Psychiatric Association. (2013).Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  2. Butterfly Foundation. (2012). Paying the price: the economic and social impact of eating disorders in Australia. Melbourne: Butterfly Foundation.