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New Content Added: To update the content we have added Bowen Family Theory and Eating Disorders information found at the end of the Table of Contents.
4 Reasons Bulimics Binge
Reason #1 - Avoiding Failure
The client that fails at a task may remark that he or she failed because of the binge the night before rather than admitting that they were not prepared. Clients who use binging to avoid failure ultimately are trying to find a scapegoat in an attempt to defend themselves against a blow to their self-esteem. They blame the disorder instead of facing their shortcomings.
Linda, age 20, would binge the night before a final exam. She stated, "I would become so worked up, I would consume the entire contents of my mini-fridge! This could include a whole jar of peanut butter, all my milk and cereal, half a bag of chips, and three bowls of ramen noodles! The next day I would feel so sick that if I did poorly on the test, I would chalk it up to being sick. My mom once asked me why I had failed this test. I told her I hadn’t been feeling well and the professor wouldn’t let me take it another time. In reality, I hadn’t even asked my professor for an extension. I lied outright to my mother so I could feel better about myself."
Think of your Linda who is binging. Is he or she lying to him or herself and others in order to cover up faults?
Reason #2 - Handling Stress
This client will use the thought to cope, like a worry stone, repetitively creating and calling up images of binging and overeating. Like an obsessive compulsive client, the binging client uses his or her obsession to calm an otherwise anxious mind and to completely dissociate from the world around him or her.
Gina, age 23, used her bulimia as a stress reducer. She stated, "I attended a party that included some well-known people. As usual, I felt tongue-tied, dumb, and inconsequential! As usual, I smiled sweetly and engaged in chitchat. All the time, though, I was secretly planning a midnight binge when I returned home! I started this binging in order to alleviate the anxieties I had about undertaking new things and to provide myself with an excuse to take a rest from everything once in a while!"
I stated to Gina, "But you don’t have to put your health in danger in order to have an excuse to relax. Everyone deserves a break. It’s what we do with that break that tells us something about ourselves. Instead of binging, I want you to think about another relaxing activity that does not involve food. One that you will enjoy and will also serve your need to ‘get away’ every once in a while."
The next week, Gina stated, "I thought about what you said, you know, about relaxation activities. So I made myself a little vacation in my bathroom. I put a waterproof stereo on the counter, I bought some aromatherapy candles, and a ton of books. When I’m feeling overwhelmed, I retreat to my vacation in the bathtub. I still have the urge to binge, of course. But this has given me an alternative to think about." Think of your Gina. What other ways could he or she get away from societal pressures?
Reason #3 - Postponing Sexual Relations, 2 Ways
Terry, age 22, would binge after having sex with her former boyfriend. She stated, "He was a horrible lover! He didn’t care about my needs at all! To tell you the truth, most of the time he coerced me into sex! It wasn’t rape because he didn’t lay a hand on me, but I didn’t really consent either. Afterwards, I would eat an entire package of Oreo cookies. I would say to myself, ‘I love you, even if he doesn’t! Go ahead and eat if it makes you feel loved!’ I just wanted some kind of happy feeling after sex, even if I couldn’t get it from him."
We will discuss the technique "Exploding with Exaggeration" which I used to treat clients like Terry, on track 2. Think of your Terry. What issues regarding sex could he or she be hiding through his or her binging and purging?
Reason #4 - Eliciting Attention
Obviously, this is the ultimate way of avoiding responsibility for the behavior. Instead of accepting the feelings of guilt and disappointment after a binge resulting from their own behavior, some clients will try and transfer guilt. Not only do these clients harbor grudges, but they also differ from other clients in that they do not acknowledge their own role in the binging and purging.
Stephanie, age 16, used her disorder as a means to gain sympathy from the girls at school. Instead of trying to find a steady support system of one or two friends, Stephanie would tell an entire group of girls, sometimes numbering up to 11 students.
She stated, "They like me when I’m bulimic. They think I’m sick and they invite me to sit at their table. Whenever I feel like I’m ignored, I would tell them I threw up again that day! They would feel guilty and sometimes I played on that guilt. I would tell them that they didn’t invite me to the party they had had that weekend and so I felt bad about myself and binged and purged. They feel better by treating me like a baby and I’m now part of a group!"
Because she used her bulimia as a tool to gain a reputation, Stephanie would become more hesitant towards treatment. She did not want to give up her only means of gaining social acceptance. Think of your Stephanie. Does he or she use his or her bulimia to make friends or enact revenge?
On this track, we discussed four motives clients have for binging. These four binging motives included: avoiding failure; handling stress; postponing sexual relations; and eliciting attention
On the next track, we will examine three manifestations of depression in binging and purging clients. These three manifestations of depression include: guilt; worthlessness; and social withdrawal.
Bulimia Nervosa in Adolescents: Prevalence and Treatment Challenges
- Hail, L. and Le Grange, D. (2018). Bulimia Nervosa in Adolescents: Prevalence and Treatment Challenges. Adolescent Health, Medicine, and Therapeutics, 9. p. 11-16.
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