In my work as a psychologist specializing in the treatment of bulimia nervosa, I have worked with many who struggle with binging and purging behaviors, in my private practice in Los Angeles and in eating-disorder residential facilities. By the time my clients seek out therapy, they are excited to put an end to their disordered eating behaviors. They know about the negative physiological and psychological impact of their eating disorder and they are motivated to work toward recovery. However, many of them soon realize that without having a solid plan or strategy to change their behaviors and identifying what factors contribute to them, they will keep returning to their destructive behaviors.
The shame associated with eating disorder behaviors is such that many of my clients want to leave them in past and focus on other issues in their lives. They hope that their binging and purging was just a phase and they can stop behaving in that way by themselves, relying on their will power alone. When I met Angela (not her real name) a few years ago, she had this outlook.
Angela was a 27-year-old, successful attorney who began therapy because of recent problems she had been having with her boyfriend. Although she briefly mentioned during her first visit to my Torrance office that she had chosen me because of my specialization in eating disorders, she insisted that her binging and purging had only become an issue since fights with her boyfriend had become more frequent. She added that now that their relationship had improved, she was confident that she would be able to stop the cycle of binging and purging. She did not want us to take the time to examine these behaviors in our session.
To her surprise, she found herself stuck in a cycle of binging and purging for months after we started our work. She arrived at our sessions week after week feeling defeated and defective, since she wasn’t able to stop. She was taken aback by her lack of success in changing her eating disorder behaviors until we began in our sessions to explore the cycle and its role in her life in more detail. After she really focused on understanding and strategizing around her binging and purging, she was quickly able to stop the behaviors.
It is easy to blame your lack of success in changing eating disorder behaviors on your “weak willpower”; however, I can assure you that a big part of success in the treatment of eating disorders is the identification and implementation of effective strategies.
Below you will find steps you can take that will help you understand and end your binging and purging behaviors:
Map Three Recent Episodes of Binging and Purging
Toxic shame may prevent you from examining the binging and purging cycle in depth. You might feel paralyzed by the negative emotions associated with each episode, which might lead you to avoid thinking about those episodes. The first step to changing your behavior is to examine this cycle with curiosity. One of my supervisors always used to say, “examine your behaviors like an anthropologist studying a behavior of a tribe.” The goal is to understand the behavior without attaching a meaning to it. Ask the following questions to study the binge and purge cycle in more detail:
- Where was I when I first noticed the urge to binge and purge?
- What was I feeling at the moment?
- Who was I with?
- What were some of the factors that made me vulnerable to those feelings (e.g., sickness, hunger, use of alcohol or drugs, lack of sleep)?
- What actions did I take to delay or prevent the binge–purge cycle?
- What I was feeling during and after each binge–purge cycles?
Answering the above questions may have helped you clarify what factors in your internal and external environment trigger the binging and purging cycle. Triggers are emotions, feelings, or situations that send you to bulimic behaviors. If you have identified those elements that can cause the behavior you are trying to avoid, it is important to come up with detailed plans on how you will address them in future.
When it comes to triggers in the external environment, such as places and people, the best approach would be to avoid them at all costs, at least during early recovery. To deal with emotional triggers, many people find it helpful to identify and practice coping mechanisms to reduce the intensity of those emotions. For example, if anxiety is a trigger for you, make a conscious effort to practice breathing exercises on daily basis to reduce your baseline anxiety. If you are experiencing acute trauma and grief, it is highly recommended that you seek out professional support to effectively address these feelings. Do not try to avoid or block them.
Accept That You Have Urges
Next time you are feeling triggered, do not panic. Although triggers and urges can appear powerful, this does not mean that you will necessarily act on them. In early recovery, it is normal to experience an urge in response to a trigger. Fighting it and trying to deny it can just make it stronger. In such a situation, tell yourself that there is nothing to be afraid of. These feelings and sensations cannot harm or hurt you. These are just thoughts. Keep repeating that thoughts are like clouds and they will pass. Examine the shape and color of those thoughts in your body the same way you would examine clouds in the sky.
Practice Urge Surfing
Urge surfing is a skill developed by Dr. Marsha Linehan, a psychologist and professor of psychiatry at Washington University, as part of her Dialectical Behavior Therapy. The goal of urge surfing is to train your brain to create a different response to a trigger. If you practice it frequently enough it can change your brain pathways in a way that reduces the intensity of your urges.
You urge surf the same way a surfer rides a wave. The urge to binge and purge is a wave. Stepping back, not reacting, notice how the intensity of the urge evolves and shifts over time. After you have done this several times you may notice the following pattern: just like a wave, in the beginning, when you notice the urge, it tends to rise higher and higher, but after a while, it will start to fall. It will always eventually fall if you give it enough time.
Use Distraction/Self-Soothing Techniques
Another approach that some of my clients find helpful for managing their triggers is to distract themselves and engage in self-soothing behaviors until the urge passes. You may choose to soothe any of your five senses. I highly recommend that you create a list ahead of time so that when you are in a high-risk situation you have several options. Some examples of self-soothing behaviors that my clients have found helpful include paging through an album from a vacation you took, looking at a picture of someone you love, watching one of your favorite movies, listening to your favorite music, taking a bubble bath, cuddling with your dog, or eating or drinking something pleasant.
Using Other Intense Situations
In some rare situations, despite your best efforts, your urges might remain strong, and you might feel powerless and tempted to give in. At such times, some find it helpful to put themselves into a safe but equally intense situations. Examples of such situations include holding an ice cube until it melts in your hand, standing under a very hot shower, or immersing your face in cold water. The key to this technique is to use it very infrequently, so it will remain powerful the next time you are really struggling.
If you have tried all these techniques and still relapsed, don’t get discouraged. These are only a few techniques from among dozens of others that you can use to overcome your binging and purging cycle. The most important element in recovery is accepting that you have a problem and being willing and open to exploring potential solutions.
Dr. Nazanin Moali is a psychologist specializing in providing effective treatment for bulimia nervosa, anorexia nervosa, binge eating disorders, and orthorexia. She completed an APA-accredited postdoctoral residency in treatments of eating disorders prior to starting her private practice in Torrance. Dr. Moali lives with her family in Rancho Palos Verdes.