Working with Sufferers of Bulimia, part II

As mentioned in Working with Sufferers of Bulimia, part I the need for counsellors who work with sufferers of Anorexia, Bulimia, to enhance their understanding of these disorders in order to improve the quality of the therapy they provide is becoming more and more apparent as each new piece of research emerges. Furthermore, “Delineated treatment specifically tailored to the needs of each disorder” (Quinlan, 2013) as required for the treatment of eating disorders may be best accomplished by a full understanding of the differences in characteristics of these disorders.

Though there is no such thing as a typical patient or client, commonalities do emerge between sufferers of bulimia. It is often found that women who are engaged with the binge purge cycle, have been engaged with weight loss or have concerned with their weight and or a fear of being fat since their early teens (Beaumont, George and Smart, 1976). Additionally, further commonalities in personality traits have emerged among bulimic sufferers. Research into the personality traits of bulimic sufferers has show that they will often display more impulsive behaviours than those with Anorexia, (Garfinkel, Moldofsky and Gerner, 1980). These findings are confirmed by research carried out that showed a higher that average impulsivity often expressed by substance abuse (Pyle, Mitchell and Eckert 1981). In marked contrast to this, those sufferers of Anorexia are often “markedly obsessional, socially withdrawn” ( Bruch 1973). The rigid control of the anorexia patient is at variance with the more outgoing and extroverted style of behaviour of the bulimic patients. Bulimic patients however may alter their naturally outgoing social style as the binge purge cycle takes over their time and efforts, and they may become withdrawn and isolated. Add to this the on-going shame associated with bulimia and the sheer volume of time many bulimics give to their binge purge cycles and even though they may actually crave interaction, friendships and social encounters, they may find they withdraw and retreat into the comfort and familiarity of their food obsession rather than actively seek out and engage with others.

Once again given the propensity for sufferers of bulimia to maintain a fairly even weight, then identifying their eating disorder can be very difficult among their friends and family and so this eventual withdrawal can seem all the more difficult to explain and leave residual feelings of hurt or anger by those who cannot understand her behaviour.

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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