IMAGE: Sergio Marín Gómez
Text: Alejandra Misiolek Marín
Bulimia is an eating disorder (ED) characterized by a lack of balance and difficulties in emotional management.
Bulimia is an eating disorder (ED), but above all it is a difficulty in controlling emotions on the part of the person* who suffers from it. The pattern of bulimia is binge-eating and purging to compensate for overeating. Like anorexia and other eating disorders, from the psychological point of view, we understand bulimia as an attempt to use the body to control emotions. In the case of bulimia, it is above all the excessive fear of losing control and a certain impulsive tendency. Bulimia is often a natural development of anorexia. Several authors confirm that up to 40-50% of anorexics also have bulimia.
How can we understand the patterns of bulimia?
Let’s start with the etiology. Bulimic people have very frequently suffered from childhood trauma such as abuse, parental neglect or emotional abandonment. Empirical research confirms separation difficulties in bulimic patients and concludes that binge eating is a defense (or reaction) against the fear of abandonment.
How can we understand that neglect or abandonment are a cause of bulimia? Let´s have a look at different phases:
- An emotional abandonment or parental neglect in childhood is interpreted by the child as a confirmation of their lack of value: if they don’t listen to me, they don’t love me because there is something wrong with me. This creates in me a conviction that I am not valid.
- This conviction contributes to the image of myself that I am creating and causes my self-esteem to be low.
- In addition, these traumatic childhood situations generate very strong emotions that are not being seen by anyone, neither registered nor collected or understood and they generate unbearable emotional states that I cannot control.
- When I reach adolescence, many things happen that generate strong emotions. Adolescence is a complicated stage because we are exposed to the validation of others. Due to my lack of self-confidence, I depend a lot on this external validation to build my identity. It is very easy to hurt me because I interpret many things as abandonment or neglect because I look at the world through the filter of my past experiences (I have been abandoned before and this rejection has hurt me, so I have to protect myself from it and I have an increased sensitivity to detect possible rejections).
- I look for ways to feel validated and one of them is through my body. The excessive preoccupation with the physique in our society does not help many young women to have a healthy relationship with their body. In addition, having been treated as an object, that is, without being considered a person, we learn not to respect our body and use it as a tool to please.
- I try to restrict my food to be thin. But at the same time, I feel deprived of something and the feeling of deprivation is a trigger for many strong emotions that I do not know how to control. On the one hand I am very physically hungry because I am not eating enough, and on the other I am very emotionally hungry for love and validation. To these feelings of deprivation, I respond impulsively with overeating. In addition, I beat myself up for not having been strong and for not having endured “on a diet” and this lack of self-control reaffirms that I have no value. It’s a blow to my self-esteem.
- I develop a lot of hatred towards myself and towards what I have eaten, and I feel desperate to throw up to feel good again. It comes to my mind to purge as if nothing had happened and emotionally it seems that I am fine again.
- There is something addictive to this mechanism – I seem to have been winning. But I’m really cheating on myself. From the outside it seems that everything is perfect but inside I feel more and more useless and I feel that I have no control.
- Every time I eat, I am afraid that I will lose control again and I feel like my stomach is a bottomless sac. I am afraid that I will gain weight so I can no longer stop repeating purgative behaviors. And sure enough, I have lost control. My fear is reaffirmed. Even more I depend on the possibility of vomiting. Something that started as a solution to a problem has become my problem. Every time I feel more lost, more ashamed and less valid. And to control these emotions of being worthless, I depend even more on my body to give me value and my fear of gaining weight is increasing.
This pattern is not the only one, bulimia is a very complex disorder and it also has its different phases. However, it explains certain vicious circles that cause these self-destructive behaviours to be maintained.
To help a person with bulimia we have to help them understand themselves and not start by telling them that they have to change their behavior. Why not? Because if we tell them that they have to do it because it is self-destructive, we reaffirm that the problem is them and we do not help them regain their self-esteem. In addition, you have to provide them with the tools to manage their emotions differently. A very important point in bulimia is the lack of balance between extremes and impulsive behaviors. The bulimic person is not able to see anything between the black and white – they see themselves as good or bad, eat all or nothing, overeat, or purge. Finding balance and being able to trust themselves and their body again to regulate their “insatiable” hunger in another way is a very important therapeutic task.
The therapy for bulimia that we offer in the ART Clinic focuses on helping people who suffer from it learn to control their emotions in another way, to treat themselves differently and with self-consideration, on helping them to improve their self-esteem and learning to relate in a different, more rewarding way with others.
In the ART Clinic we work with Mentalization Based Therapy (MBT) to treat bulimia. Scientific studies show its effectiveness in eating disorders.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Patton, C. J. (1992). Fear of abandonment and binge eating: A subliminal psychodynamic activation investigation. Journal of Nervous and Mental Disease.
Robinson, P., Skårderud, F., & Sommerfeldt, B. (2018). Hunger: Mentalization-based treatments for eating disorders. Springer.