WEIGHT LOSS: THE GOALS OF TREATMENT FOR BULIMIA NERVOSA
Treatment of bulimia has a different focus. For one thing, anorexics need to do more of something – eating – while bulimics need to do less of something – bingeing and purging.
Rodney Dangerfield, the comedian, tells about the time he went to his doctor with a sore shoulder. Raising his arm, he said, “It hurts when I go like that.” The doctor replied, “Don’t go like that.”
Unfortunately, breaking the binge-purge cycle is rarely that easy. Instead of just telling the patient, “Don’t go like that,” one must reduce the forces behind the urge to binge and purge. These forces include the physical effects that are caused by an irregular pattern of eating or trying to maintain a weight that is too low.
Another goal of treatment is to change the patient’s characteristic cognitive distortions and disturbed emotional responses. For example, learning how to be more assertive can be a key element in recovery. A binge is frequently triggered by anger that the patient feels powerless to express. One woman told me her boss demanded that she work on a Saturday when she had made other plans. She suppressed her fury, telling herself that “I’m lucky to have this job, no one else would hire such a worthless person.” She worked that Saturday, then went home and pigged out for two hours. After assertiveness training, such patients find it easier to “just say no” without feeling guilt or self-hatred.
Finally, improving family relationships can be very helpful, especially for patients living at home. But because bulimic families can vary widely in their dynamics, therapy must address the particular family pattern involved.
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