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Treating Bulimia Nervosa and binge eating with DBT

What is Bulimia?

Bulimia Nervosa is a serious eating disorder that can have a very profound impact on quality of life, and mental and physical health. 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 Nervosa 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.

People with binge eating problems  may binge on pizza

Bulimia may be linked to problems in emotion regulation


Bulimia Nervosa is often associated with difficulties in regulating emotions, which can be called emotion dysregulation. A person who experiences problems regulating emotions has strong emotional responses to both external events, like having a disagreement with a friend, and internal events, like an upsetting memory or image flashing into mind. Once such an individual has become emotionally upset she or he tends to stay upset for longer than other people might in a similar situation, and have greater difficulty regulating or controlling the emotions and related behaviours so that he or she can emotionally settle down again. These emotional difficulties often result in unstable behaviour across many aspects of a person’s life, including her or his 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 often find ways to help manage their intense emotions, such as using alcohol and drugs, engaging in self-harming behaviour, and bulimic behaviours such as binge eating and purging. Thus we often find that a person diagnosed with Bulimia Nervosa also misuses drugs and alcohol, and perhaps experiences self-harming urges as well. All these behaviours seem to help regulate strong emotions and provide a kind of temporary emotional relief. 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.


Dialectical Behaviour Therapy can help

Dialectical Behaviour Therapy (DBT) was developed in the early nineties by Dr. Marsha Linehan to help people who struggle with emotion regulation, and more recently it has become a useful and evidenced-based treatment for Bulimia Nervosa and binge eating. In DBT clients are taught a variety of skills aimed at assisting them in managing their emotions, thoughts and behaviours, and tolerating distress without doing things like drug use and binge eating that are likely to make the situation worse.

A core component in using DBT to treat Bulimia is the behavioural chain analysis. In this process, an episode of binge eating or self-induced vomiting, for example, 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 concern (in this case the binge eating or vomiting) are uncovered. These links will be a series of thoughts, feelings, behaviours and events that led from the precipitating event and eventuated in the problem behaviour (binge or vomiting episode). 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 problem behaviour of which the person was previously unaware.

Next, 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.

DBT provides a set of extremely useful life skills. Skilled coping and skilled behaviour increases confidence and self-esteem across a wide range of life situations. Using DBT approaches to treat Bulimia Nervosa and binge eating can bring a person an increased sense of control over her or his  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 problem.

If you experience problems with binge eating or think you may have Bulimia, please consider making an appointment with me, so that we can explore your difficulties and decide whether Dialectical Behaviour Therapy is an appropriate treatment for you. I also invite you to review other articles on this website linked to Eating Disorders Brisbane and Dialectical Behaviour Therapy DBT  to obtain more information about both eating disorders and DBT.

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