Resources for Professionals who Treat Patients with Bulimia

Contributor:  W. Travis Stewart, LPC, NCC writer for Eating Disorder Hope

workplace-480214_640Whether you are a new counselor who is working with bulimia or a seasoned professional, it is important to continue growing and learning.

As a new professional it would be easy to feel overwhelmed and uncertain when first treating someone with bulimia. As a professional who regularly works with the same issues day in and day out, it is easy to become stuck in a rut, or too comfortable with the approach you have been using.  Either way, it is important to continue growing and finding new resources for treating a client struggling with bulimic behaviors. Here are four ideas on how to continuing growing personally and professionally; Expand, Read, Learn and Attend.

Expand your knowledge of treatment modalities for patients with Bulimia

There are a wide range of approaches to treating bulimia and binge/purge behaviors. These include:

  • Cognitive Behavioral Therapy (CBT) – it is widely acknowledged that CBT is one of the treatments of choice for bulimia. It has history and research to support its use and effectiveness in treatment. Because one of the core features of bulimia is the overvaluation of shape and weight (cognitive distortions) it is seen as a logical approach.
  • Dialectical Behavior Therapy (DBT) – Over the past 20 years the practice of using DBT in the treatment of bulimia has grown. This approach sees bingeing and purging as ineffective coping skills to deal with emotional distress and teaches clients new skills to cope and basic mindfulness practices.
  • (ACT) – More treatment centers are incorporating ACT into the recovery process for bulimics. Like DBT, there is a strong incorporation of mindfulness and like CBT, there is a focus on evaluating thoughts and feelings. Sam Lample, LPC, in Phoenix, Arizona, uses ACT therapy frequently in treating bulimia, “The mindfulness focus of ACT allows the individual to look at and urge rather than looking through an urge which increases the chances they can avoid an unwanted behavior.”
  • Narrative Therapy – This approach, developed by Australian Michael White, externalizes the eating disorder behavior and helps clients develop resistance to the associated thoughts and urges. The book Biting the Hand that Starves You; Inspiring Resistance to Anorexia/Bulimia is an excellent resource in helping both professionals and clients to better understand the eating disorder thought process.
  • Family Based Therapy (FBT) – This approach was developed at the Maudsley hospital in London in the mid-80’s. It is now being called Family Based Therapy (which is different that Family Systems therapy). The emphasis is on the family providing the support and structure for refeeding the child. It has been shown to be most effective for adolescents within 3 years of the onset of their eating disorder. The eating disorder is seen as a chronic illness and the symptoms are considered mostly outside of the adolescent’s control. This illness needs the attention and care of the parents who unite in establishing a “no eating disorder behavior environment in the home.”
  • Internal Family Systems (IFS) – This approach, rather than considering the eating disorder behavior as an external force, it is considered an expression of one “part” of the person. In this framework people are considered to have various “parts” that constitute a whole person. The goal of therapy is to develop a Self-led life and integrate the various “parts” into a more mature, calm and confident person.

Other Factors to Consider in Treating Bulimia

Doctor and patientIn addition to specific treatment models for bulimia it is helpful to learn about other concepts and approaches to helping change the behavior.

  • The Addiction Model – There are significant similarities between addiction and bulimia. This includes the role of shame, the presence of urges and cravings, and the despair and renewed self-effort following the use of behaviors. It can be very helpful to explore how addiction can explain binging and purging and well as learn from many of the resources developed by Alcoholics Anonymous and other treatments for addiction.
  • Externalizing the Eating Disorder – To externalize the eating disorder means to conceptualize the thoughts and behaviors associated with an eating disorder as “external” to the person. This is done in Narrative and IFS therapy but was popularized by the book Life Without Ed by Jenni Schaefer and Thom Rutledge. These are helpful concepts to consider and many clients and patients have benefited from this approach.
  • Self-Directed Neuroplasticity – This is the idea that the brain has, through experiences and repetition, as well as genetic and family history, developed the compulsive patterns of thinking and acting that result in unhealthy behaviors such as OCD, addictions and bulimia. Developed by Jeffrey Schwartz, MD and, most recently, explained in his book You Are Not Your Brain, this approach details a 4 Step Model for rewiring the brain.

Read Broadly

Patients with BulimiaIn addition to reading about eating disorder and bulimia nervosa specifically I recommend reading in other areas, not only of mental health, but beyond that as well. This can reap new insights, creative solutions and energize you to keep learning. Some of the books I have found enjoyable that also prompted me to think differently about eating disorders include:

  • Drive; the surprising truth about what motivates us by Daniel Pink
  • Mindset; the new psychology of success by Carol Dweck
  • Switch; how to change when change is hard by Chip Heath and Dan Heath
  • Made to Stick; why some ideas survive and other die by Chip Heath and Dan Heath
  • The Organized Mind; thinking straight in the age of information overload by Daniel J. Levitin
  • Enchantment; the art of changing hearts, minds and actions by Guy Kawasaki

Learn Willingly

Keep learning about the subject and related topics. This is easier and cheaper to do than you might think. Many treatment facilities offer continuing education at little or no cost. Not only are these helpful, but most will also serve as Continuing Education Units for your state licensure. Here are some links where you can learn more:

Professional Conferences

About the Author

Travis Stewart earned a Master of Arts in Counseling (2001) and a Master of Arts in Theological Studies (2003), both from Covenant Seminary in St. Louis, MO.  Travis is a Licensed Professional Counselor in the State of Missouri and a writer for Eating Disorder Hope and Addiction Hope.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders.  These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.  We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors.  If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on June 29, 2017. Published on EatingDisorderHope.com