“We need to understand what a woman is saying when she uses her body to express difficult emotional issues. We need to understand why it is safer to say “I need to go on a diet” than “I feel hurt or upset or in conflict” Susie Orbach.

Bulimia was the first eating disorder to be characterised by recurrent binge eating. The Bulimic eats abnormally large amounts of food and then experiences a loss of control.. The person suffering from Bulimia engages in extreme weight-control behaviours to counteract the large intake of food. Some of these behaviours may include self-induced vomiting and/or laxative or diuretic use (purging) or severe dietary restriction and/or intense exercise.

A second syndrome of recurrent binge eating, namely” binge eating disorder” differs from Bulimia in that sufferers do not regularly engage in extreme weight control behaviours. Bulimia nervosa occurs in around 1% of young western women. Intensive psychological treatments have been developed for people with Bulimia.  A manualised form of CBT for bulimia nervosa (CBT-BN) has been developed by Fairburn and colleagues (1989) In this therapy, a range of cognitive behavioural procedures are used in a specific sequence of tasks and experiments. Treatment is out-patient based and involves 15-20 sessions over about five months. There has been positive evidence from controlled studies that CBTBN is an effective approach in the treatment of bulimia nervosa, although it has also been found that for some people it is too intensive, while for others it is not sufficient.

A graduated intervention approach to the treatment of those with bulimia nervosa and binge eating disorder, has received empirical support from research by leading investigators in eating disorders. In this approach, the patients are offered psychoeducation or self-help therapies and then re-evaluated for further treatment as appropriate. Self-help therapy is based around a manual that includes educative material and a version of the CBT-BN manual.

Other psychotherapies have been less frequently evaluated in the treatment of bulimia nervosa. However, there has been recent interest in interpersonal psychotherapy (IPT) and dialectical behaviour therapy (DBT) as alternatives to CBT.

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