Eating Disorders: Bulimia
Help Yourself is created by Counseling Services, Kansas State University
© 1989, 1997
"Whenever I feel lonely, unsure of myself, or angry, I end up eating. It's like I have no control. I put food inside me as quickly as I can and then when I can't eat another thing I make myself sick. Then I hate myself."
Bulimia refers both to uncontrolled eating and to related thoughts, feelings, behaviors,and ways of seeing yourself.
The problem with bulimia, you find yourself eating large amounts of food in an uncontrolled way, then heading for the bathroom to throw it all up. You also may be using laxatives, vigorous exercise, and fasting to try and control your weight. Eating binges may be pleasurable, but self-criticism and even self-loathing, guilt, fear, loneliness, and low self-confidence often follow. You will probably feel as if your life is dominated by thoughts of food.
The problem usually begins quite innocently. You may start with a diet to lose weight and to feel better about yourself. But diets are hard to stick to and you may overeat because you feel hungry or because you are feeling anxious, depressed, angry, frustrated, or just lonely. For a short while, food is a comfort. Then that full feeling makes you feel guilty and a failure. At first purging (inducing vomiting) seems an ideal answer-it's as if you can eat without facing the consequences of weight gain. But it just exaggerates the bad feelings you started with, and it leaves you worried about being discovered and fearful of what others will think. This pattern of feeling bad, eating, purging, and feeling bad again becomes a vicious cycle that can eventually control your life and leave you feeling hopeless and helpless to change.
There are things you can do to help yourself!
Here are a series of exercises to help you understand and take control of your eating behavior. It will take about three hours--not much time when compared with the years it has taken to build patterns of bulimia. Identify an hour at three different times for working through these processes. Be patient and understanding with yourself.
IDENTIFY THE CUE
Keep a "binge diary." In it, record the following observations for each binge:
- Date and time
- What you were doing (behavior cues) before you began.
- What you were thinking before you began.
- What you were feeling before and during the binge.
- What hunger cues you noticed.
- What you ate.
Be sure that you actually write this down (don't just do this from memory).
Do this each day. After a week, look back and see what patterns are emerging. See if you can begin to identify cues--behaviors, thoughts, feelings, or hunger, --that contribute to your binge.
THE KEY: WORKING "WITH THE CUE"
Behavioral cues--Are there any behaviors or situations that keep occurring before a binge? Possibilities include being alone, being around others who are tense or angry, being around others who have problems with food and/or weight.
List in your diary any behaviors you see occurring--actually list them on a sheet of paper. Then set aside some time to devise ways you can minimize these recurring behaviors. Be creative. Maybe get a close friend to help.
Get another sheet of paper. On it develop a list of activities that get your mind off thoughts of eating. Examples: going for a walk, running, biking, telephoning or visiting a friend, taking a bath, learning and using deep relaxation, studying with someone who will make you study and not let you eat. What works best for you is that which removes you from the temptation to eat. Keep that list in a visible spot.
Also, change something about your appearance by doing something other than losing weight. Get a new hairstyle, some new make-up, new clothes, a new combination of clothes, or change your accessories.
Persons with bulimia are usually harder on themselves than on others. They overload themselves with "I should. . ." such as: "I should get good grades." "I should study all the time." "I should be able to do without candy." "I should always be good, kind, and selfless." "I should always be responsible." Such messages leave them feeling empty and burdened by a lot of negative feelings (e.g., not being good enough, inadequate, useless) that spark binges.
Get a sheet of paper and make a list of the should messages that you give yourself most often. For each should, list its affects on your behavior. Some examples are: Believing that you "should study all the time" leaves you tired and stressed and reduces your ability to do well. Believing that you "should always be kind and responsible" leaves you feeling guilty and likely to withdraw from others. Believing that you "should be perfect" leaves you feeling inadequate and imperfect and heading for a binge.
Then, take some time to make each should statement into a statement of your rights. You have a right to choose when to study and when to have fun. You have a right to put yourself first sometimes. You have a right to not be perfect--in fact, there is no such thing as a "perfect person."
Put the revised version of your most frequent "shoulds" on a bright 3" x 5" card and carry it with you. When you become aware of thinking of an old "I should," look at the restatement of your rights and mentally substitute it in place of the old, self-defeating should. Keep at it. You will have to do it many times (we all do when changing our attitudes), but you can make the change!
Another aspect is that "perfect self" you think you should be able to become. Right now, write down all those qualities of that "perfect self." Wow! That probably is more than anyone short of an angel could become. On the same sheet of paper, list the advantages of trying to live up to this ideal. Then list the disadvantages of trying to live up to it.
If you feel that the price of trying to be perfect is too high, make another list, a more realistic list of the qualities you would like to have.
Now consider how many of those excuses (thinking cues) you use to justify or excuse why you cannot stop binging and purging. You know, the ones like: "If I gain one pound, I'll end up gaining 30 pounds." "It's been an awful day. I'll cheer myself up with a snack." "I was good all day, so now I'll just have a small snack" "I can't lose weight any other way."
Re-examine those "beliefs" with your rational mind. Then try to replace these negative statements with positive ones. Some examples: "This is crazy all-or-nothing thinking." "A snack now would just make me feel worse." "There's no such thing as a small snack when my stomach is empty." "Next time I won't starve myself. That's not being healthy." "Binging and purging is no way to lose weight. The only way is to eat sensibly."
Or perhaps you use "all-or-nothing" thinking (e.g., you tell yourself that just one slip will destroy all your efforts to change). Perhaps you see eating in extremes -- dieting or binging. That's very common for persons with bulimia and very destructive. What might be some alternative "in-betweens?" "One sweet does not blow a diet." "I can eat one cookie without eating a whole box." When you catch yourself slipping into "all-or-nothing" thinking, practice substituting more realistic "in-betweens."
These are the most difficult cues for most bulimics -- to identify the variety of positive and negative feelings and to recognize that they are legitimate feelings for bulimics and for all human beings. Recognizing the role that these feelings play in the bulimic syndrome is absolutely crucial. This is difficult and often requires professional help -- and that's a legitimate need. Determine which particular feeling or feelings are associated with your binging. There is very often a relationship between binging and non-assertiveness or unexpressed anger. Instead of being assertive and expressing anger appropriately, people with bulimia often "swallow" their anger and bottle it up inside. Later they get rid of the bottled up feelings by binging and "throwing up."
One cause of anger is not saying "no" when you want to say "no." Here are some reasons why you might have difficulty saying "no" or expressing anger: you don't want to hurt others' feelings (or lose their friendship?): you don't want to seem selfish; you want approval or acceptance; you want to be seen as capable and competent.
Some ways of saying "no" are: be direct and to the point and do not be swayed by guilt, pleading, threats, or other forms of manipulation. Others usually can sense a weak "no" and they will try and sway you--so be firm and strong. You may need to use the "broken record" technique, which is just saying "no" over and over, calmly, without being distracted by side issues. Also, you should consider reading about or participating in an assertiveness training program on your campus or in your community.
Are there any other feelings that seem to be associated with your binging? Loneliness? Inadequacy? Insecurity? What are better ways of dealing with those feelings other than eating? The best and most effective way is to reach out to a friend. Once you let others close, then you no longer feel so alone, inadequate, or useless. Start by joining activities that involve other people, perhaps a sport, a hobby, or an interest group. Do not isolate yourself.
Many bulimics get help with feelings of hunger by learning more about basic nutrition. Often the best way to do this is to identify with a group of persons with eating disorders. The dietitian in Lafene Health Center works almost exclusively with groups and individuals with eating disorders.
Here are a few ideas to help you get started:
- The amount of calories you can eat and still maintain your weight is your current weight times 12.
- Your hunger is increased when you eat or drink food containing sugar substitutes (such as diet pop).
- The long-term effects (usually two to four hours) of processed sugar and caffeine are feeling blue and depressed (conditions in which you are more likely to binge).
- Chances are that you are setting yourself up for a binge by eating the wrong kinds of food at the wrong time of day. Bulimics often skip meals so when they do eat they are starving and end up eating more than they would have had they had their three meals. Try not to skip meals. Also, the easiest foods to binge on are soft, high-calorie foods like cereal, ice cream, or candy. Avoid these at all costs at times when you are feeling down or tempted to overeat.
- Participating in individual or group programs for persons with bulimia can help you find other ways of "nurturing' and "feeding" yourself without the wrong use of food.
Some helpful suggestions:
Seek the input of a dietitian. AT KSU, the dietitian in Lafene Student Health Center, room 257, spends nearly all of her time working with persons with eating disorders. If you live in a residence hall on campus, you can also speak with a dietitian there.
Consider seeing your physician. Whether it is your family physician or a physician at your University's Health Center, a physician can help you assess the physical damage done by bulimic behavior and can help you in your steps towards a more healthy life.
Seek a support group for contact. Support group members share strategies and help encourage each other as they learn to overcome their eating disorders. These groups might be organized and run by other persons with bulimia or by a professional person trained in helping persons with eating disorders.
Consider other group work. Counseling or therapy groups work more intensely in helping participants understand their eating disorders and the thoughts, feelings, and behaviors that lead to such disorders, and may help you learn ways to be more effective and comfortable.
Individual counseling also tends to focus on both the source of your eating disorders and more effective strategies for living.
Some sources of help:
The Counseling Services, 232 English/Counseling Services Building, offers group and individual counseling services for currently registered KSU students with eating disorders.
Pawnee Mental Health Services, 2001 Claflin Road (at corner of Claflin and Sunset Roads), Manhattan, also offers individual and group services. (785) 587-4300
Check with your local Community Mental Health Services: Here is a listing of these offices in Kansas.
Check your local telephone "yellow pages" for listings of other options ; you may find further assistance under categories such as: "Mental Health--Centers, Counselors", "Psychologists", "Marriage & Family Counselors", "Counseling", among others.