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Bulimia Impacts the Entire Family

By: Kristin Pitman, MA, LPC, Primary Therapist and Kristina E. De Los Santos, Ed.M both from The Renfrew Center of Northern New Jersey.

mother-425804_640Bulimia nervosa, commonly referred to as bulimia, is characterized by episodes of binge eating, in which a person consumes unusually large amounts of food in a short period of time, and then engages in the use of inappropriate compensatory behaviors such as:

  • Self-induced vomiting
  • Laxative use
  • Excessive exercise (Le Grange et al., 2003; Le Grange & Schmidt, 2005)

Along with common medical complications such as dental and esophageal problems, kidney damage, chemical imbalance, and an overall loss of energy and vitality; those suffering with bulimia oftentimes feel a loss of control in other areas of their lives.

Tension, Guilt, and Other Family Emotions

While bulimia has devastating effects on an individual’s mental and physical health, it also affects the entire family. When a loved one is struggling tension is often created within the family unit.

Guilt, as well as feelings of helplessness, can be experienced by family members who feel responsible that the loved one is struggling and unable to stop the individual from engaging in harmful behaviors related to bulimia. Additionally, family members may experience feelings of anger and frustration with the disease, the individual, and oneself.

It is important to keep in mind that these feelings and emotions are normal and the way you handle them is very important. Below you will find some warning signs that your loved one may be struggling with bulimia, how to communicate with them, tips to pass onto them and treatment options.

Warning Signs

Here are several warning signs that may indicate your loved one is struggling with bulimia:

  • Engages in binge eating and cannot voluntarily stop
  • Reacts to emotional stress by overeating
  • Feels guilty or ashamed about eating
  • Is obsessively concerned about weight, body image and shape
  • Uses the bathroom frequently after meals
  • Feels out of control
  • Experiences frequent fluctuations in weight
  • Has menstrual irregularities
  • Has swollen glands
  • Exhibits impulsive behavior, moodiness and depression

Communicating

If you suspect your loved one is struggling with bulimia it is important to communicate your concerns in a manner that is loving, non-confrontational and focuses on behaviors that are concerning to you. Some tips for engaging in this communication include:

  • Focusing on feelings and relationships as opposed to weight and food
  • Avoid commenting on how the individual looks
  • Avoid power struggles about eating and placing shame, blame, or guilt on the person regarding their actions or attitudes
  • Do not use accusatory “you” statements, instead, use “I” statements
  • Avoid giving simple solutions

Furthermore:

  • Be patient and non-judgmental
  • Examine your own attitudes about food, weight, body image and body size
  • Normalize feelings including mixed feelings for the individual
  • Plan meals beforehand
  • Set caring, consistent, and firm limits
  • Give support and praise when possible

Things to avoid doing or saying:

  • Do not engage in disagreements at mealtime
  • Avoid making threats or using scare tactics
  • Avoid making critical comments including any comments about food or body
  • Don’t label food as “good” or “bad”
  • Don’t try to be their therapist
  • Don’t put a timeline on recovery
  • Finally, remember it’s not your fault; eating disorders do not discriminate and many factors contribute to their development (National Eating Disorder Information Center, 2014; National Eating Disorders Association, 2008)

Tips for Individuals Struggling

The first step for the individual struggling with bulimia is to acknowledge they’re struggling and ask for help. The next step is to learn to develop and utilize healthy attitudes about food and one’s body.

Here are several coping skills that can be useful for managing symptom use:

  • Use distractions such as mindful activities, hobbies or pleasurable interests to help occupy one’s attention (Vivyan, 2009).
  • Keep a food diary for documenting daily food intake and create a menu plan with a health professional (Vivyan, 2009).
  • In order to alleviate some anxiety around mealtimes, eat with trusted family members or friends rather than isolating (Vivyan, 2009).

Treatment

While a common misconception is that individuals with bulimia cannot get better, thus hindering some from seeking treatment (U.S. DHHS, 2009), there is a vast amount of research out there demonstrating the effectiveness of various treatment approaches.

Treatment not only focuses on the bulimia itself, but can also be beneficial in treating secondary behavioral, cognitive, and physical disorders which have been correlated with bulimia; these secondary diagnoses may include

  • Depressive and anxiety disorders
  • Suicide attempts
  • Substance abuse
  • Trauma
  • Other related health disorders (Williams, Watts, & Wade, 2012)

There are a number of researched treatment approaches that are found to be useful such as cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), interpersonal therapy (IPT), systems-based, or family approaches, symbolic-based approaches, psychodynamic psychotherapy, and nutritional counseling (APA Presidential Task Force, 2006; Le Grange& Schmidt, 2005; Mitchell, Agras, & Wonderlich, 2007; Safer, Telch, & Agras, 2001; Whittal, Agras, & Gould, 1999).

Additionally, Multi-Family Group (MFG) which focuses on helping family members learn by identifying with other families and increasing parental involvement has been shown to result in significant positive changes and recovery rates (Scholz & Asen, 2001). The effectiveness of these treatment methods indicates that the involvement of a support system is beneficial for the individual.

Additional Resources

child-17387_640Education on the topic is one of the most essential tips for both individuals struggling and their families. There are a vast number of resources that individuals and their loved one have access to, especially through various organizations that focus on eating disorders.

Some of these resources include the National Eating Disorders Association (NEDA), Academy for Eating Disorders (AED), National Institute of Mental Health (NIMH), National Association of Anorexia Nervosa and Associated Disorders (ANAD), and The Renfrew Center Foundation. Many of these organizations have helplines that individuals or families could call as well as online screening tools.

Conclusion

As a family member or a friend, do not underestimate how important your role is in your loved one’s recovery, the more information you have the better you will be prepared to deal with the task of helping your loved one throughout the recovery process.

If you or someone you love is struggling with bulimia speak with your primary care physician or a treatment facility, such as The Renfrew Center, which specializes in this type of care.


 
Biography for Kristin Pitman:

Kristin Pitman, MA, LPC works at The Renfrew Center of Northern New Jersey where she is the primary therapist for individuals with eating disorders and comorbid anxiety, depression, and substance-related issues. She previously worked at St. Joseph’s Hospital in the screening center and psychiatric emergency services departments where she worked with diverse populations of clients to provide effective crisis intervention services including evaluation and referral services.

Kristin has her Master’s in clinical/counseling psychology from William Paterson University and will complete her Psy.D. in Clinical Psychology from Chestnut Hill College this winter. For the past year, Kristin was an intern at Rider University Counseling Center where she worked with students who presented with diverse mental health issues.

In addition, she has worked as an adjunct professor at Bergen Community College teaching courses in general psychology and developmental psychology, as well as at Montclair State University teaching courses in child advocacy.


 
Biography for Kristina E. De Los Santos:

Kristina De Los Santos is currently a graduate student at Monmouth University working towards a Master’s of Science degree in Mental Health Counseling. She has been interning at The Renfrew Center of Northern New Jersey since May. Kristina also works at Carrier Clinic, a mental and behavioral health treatment center which specializes in psychiatric and addiction services for adolescents and adults.

She obtained her Bachelor’s degree in Psychology from Montclair State University in 2011 and her Master’s of Education in Counseling Psychology from Rutgers University in 2013. Kristina plans to pursue her licensure as a Licensed Professional Counselor and a doctoral degree in Clinical Psychology upon completing her studies at Monmouth University.


 
References:

APA Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in
psychology. American Psychologist, 61, 271-285.

Le Grange, D., Lock, J., & Dymek, M. (2003). Family-Based Therapy for Adolescents with
Bulimia Nervosa. American Journal of Psychotherapy, 57 (2), 237-251.

Le Grange, D. & Schmidt, U, (2005). The treatment of adolescents with bulimia nervosa.
Journal of Mental Health, 14 (6), 587-597.

Mitchell, J., Agras, S., Wonderlich, S. (2007). Treatment of Bulimia Nervosa: Where are We and
Where Are We Going? International Journal of Eating Disorders, 40 (2), 95-101.

National Eating Disorder Association. (2008a). What Should I Say? Retrieved from
http://www.nationaleatingdisorders.org/what-should-i-say

National Eating Disorder Association. (2008b). NEDA Toolkit for Parents: How to be Supportive. Retrieved from http://www.nationaleatingdisorders.org/sites/default/files/Toolkits/ParentToolkit.pdf

National Eating Disorder Information Center. (2014). Help for Friends and Family. Retrieved
from http://www.nedic.ca/give-get-help/help-friends-family

Office on Women’s Health, U.S. Department of Health and Human Services [OWH, U.S. DHHS] (2009). Bulimia nervosa fact sheet. Retrieved from http://www.womenshealth.gov/publications/our-publications/fact-sheet/bulimia- nervosa.html#moreInfo

Safer, D., Telch, C., & Agras, WS. (2001). Dialectical Behavior Therapy for Bulimia Nervosa.
American Journal of Psychiatry, 158 (4), 632-634.

Scholz, M., & Asen, E. (2001). Multiple Family Therapy with Eating Disordered Adolescents:
Concepts and Preliminary Results. European Eating Disorders Review, 9 (1), 33-42.

Whittal, ML., Agras, WS., Gould, RA. (1999). Bulimia Nervosa: A meta-analysis of
psychosocial and pharmacological treatments. Behavior Therapy, 30, 117-135.

Williams, S. E., Watts, T. K., & Wade, T. D. (2012). A review of the definitions of outcome used in the treatment of bulimia nervosa. Clinical Psychology review, 32(4), 292-300.
Vivyan, C. (2009). Bulimia and binge eating self-help. Retrieved from http://www.get.gg/bulimia.htm

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