Working with Sufferers of Bulimia; Part I

Counsellors who work with sufferers of Anorexia, Bulimia, and other eating disturbances (Norma Leclair and Belinda Berkowitz, 1983) are acutely aware of the rise in prevalence of sever eating disorders among young women. Of this trifecta, bulimia is silently increasing year on year and is one of the most under reported and un-explored. One of the major concerns with Bulimia is the frequency with which is goes undiagnosed. Given the fact that the sufferers body weight typically will not fluctuate in the same way as other eating disorders, and the shame and secrecy that surrounds the binge purge cycle,( Pyle, Mitchell and Eckert, 1981) as well as the substantial physical and psychiatric illness that goes with repeated binge purge cycles (Mitchell, Hatsukami, Eckert, & Pyle, 1985) up to as many as one third of Bulimia sufferers do not seek treatment, (Fairburn & Cooper, 1982; Yager, Landsverk, & Edelstein, 1987). Add to this a conservative estimated increase in the mortality ratio of up to 30% (Patton, 1988), and we have what makes for very grim reading.

Dietary awareness and Nutritional Counselling (L. K. George Hsu, Barbara Holben, Shirley West, 1990) in conjunction with cognitive behavioural modification has been found to greatly assist in the treatment of Bulimia, however what this article is concerned with are some of the common characteristics among those being treated in private practice for bulimia.

The prevalence of young white middle class women towards bulimia is borne out by Pyle et al (1981) but it is the psychosocial traits that concern me in my practice at Midwest Counselling the most. The awareness of variances between the different forms or eating disorder has given rise to the need for counsellors to enhance their understanding of these disorders in order to improve the quality of the therapy they provide.

For example, it is only in comparison to Anorexic patients that the traits of Bulimic patients are seen to emerge. Whereas with Anorexia it is a morbid fear of being fat, accompanied with a totally distorted view of the body that drives self-starvation, by contract those sufferers of Bulimia are fully aware of the abnormality of the binge purge cycle in which they are caught; and this, along with the fear of lack of control over the binge purge cycle as well as the inherent shame associated with the binge purge cycle feeds negative thought pattern and a depressive mood.

Delineated treatment specifically tailored to the needs of each disorder are the means by which treatment may be most successfully delivered, and as such further research into each is urgently required