Epidemiological studies on bulimia and eating disorders in Europe and the United States show a disconcerting picture. Their incidence is worrying: in industrialized countries 10 out of 100 girls between the ages of 14 and 25 suffer from some form of eating disorder). But also the age of onset, increasingly precocious.
The eating disorders have a profound impact not only on those affected, but also on the people who live with someone who has this problem. So above all family members, in whom conflicting feelings, tension and frustration are inevitable.
Many difficulties are also due to the dissemination of a lot of inadequate or even wrong information. These generate confusion and false beliefs and make it even more difficult to deal with such situations in the most appropriate way.
The alleged causes of bulimia
This is certainly also due to the fact that we do not yet have precise knowledge on the causes of eating disorders . Research has shown that the development of bulimia and eating disorders in general is due to a complex combination of genetic and environmental risk factors.
Unfortunately, however, certain theories that emphasize the primary role of family relationships in the onset of these disorders (which led to the coining of derogatory terms such as “anorexogenic mother”) are still in circulation and die hard. Yet these have been recognized as overly simplistic and erroneous.
The theoretical models that have identified family styles as the cause of the disorders lead to misconceptions and contribute to the development of feelings of guilt and reactions in family members that can actually contribute to aggravate or maintain the disorder. Today we know that the family does not “cause” the eating disorder . However, family emotional modalities can influence its progress and therefore play a role in maintaining or aggravating the disorder or, on the contrary, favoring its improvement. In particular, critical comments and hostility appear to have a negative impact on treatment.
Correct information on the causes of bulimia and eating disorders
The word “bulimia” comes from the Greek and literally means “ox hunger”. The bulimia nervosa typically begins with a strict diet restriction of which is interrupted after a certain period by binges. In most cases, bulimic episodes are followed by compensatory behaviors such as self-induced vomiting, inappropriate use of laxatives and / or diuretics, fasting or excessive exercise to prevent excessive weight gain.
The first fundamental thing to keep in mind is that the bulimic person’s disorder is not the consequence of a personal choice, nor is it due to a lack of will. It is the result of a complex interaction of factors.
In fact, current research is in agreement in considering the genesis of eating disorders according to multifactorial models that refer to a bio-psycho-social perspective. The cause of these disorders is not unique, but a concomitance of factors that can interact with each other in various ways and that can favor their appearance and maintenance must be considered.
Predisposing factors
According to Garner (1993), predisposing factors can be defined as all the possible causes that can predispose and facilitate the onset of the problem. Among these we have genetic factors, factors related to the mechanism of hunger and satiety, sociocultural factors (in an environment where beauty and personal worth are associated with thinness), individual factors ( low self-esteem , feelings of helplessness, extreme sensitivity to criticism, conflict between autonomy and dependence, perfectionism and the search for control ) and factors related to emotional experience in family relationships.
Precipitating factors
Among the precipitating factors, dissatisfaction with one’s own body and the choice of restrictive behavior as a dysfunctional solution to improve self-esteem and self-control play a central role . Puberty, life changes, negative criticism of one’s physical appearance, bereavement, traumatic experiences and the choice to undertake a strict diet are therefore all factors that can lead to the real onset of bulimia.
Maintenance factors
Among the factors that instead contribute to maintaining the symptomatology we have the symptoms of fasting , the reinforcement reactions of others with respect to the physical form obtained with the restriction (as it is adequate to the standards proposed by society), critical comments with respect to the problematic behavior of the person bulimic.
How to deal with bulimia sufferers
Encourage the person to seek professional help only to make an assessment and not to initiate treatment
It must be borne in mind that the bulimic person in most cases has a profound ambivalence regarding starting a cure. This is the first aspect to work on when starting a treatment. Some patients do not view eating disorders as a problem, others have an extreme fear of becoming fat, others are generally afraid of change and have a hard time letting go of their control system.
In addition, bulimic people can have a deep sense of shame about their behavior and react very badly to attempts of assistance and help from family members and loved ones in general, not accepting in a positive way the efforts made by others to help them.
Help yourself and the sick person see beyond weight and food issues
The bulimic person needs to understand, not to be blamed. The symptom is in fact the way that the person has found to cope with an internal problem or conflict, a pseudo-solution (dysfunctional) and must be helped to understand and find more functional ways.
Avoid negative critical comments
Often such comments are the result of incorrect information about the disorder. Keep in mind that behaviors such as binging or excessive exercise are not the result of personal choices, much less a sign of weakness or poor discipline. Instead, they are an expression of the disorder itself.
It may be useful to maintain the same attitude that would occur spontaneously if the family member suffered from a somatic disease that prevents him from performing adequate behaviors.
Also avoid comments on body weight and shape, better focus on the negative effects of bulimia on positive and healthy life dimensions such as friendships, school or sports.
Avoid judgments, threats, hostile reactions and aggression
Even these reactions are often due to a wrong interpretation of the symptoms of the bulimic person but they only intensify the negative emotions. They generate guilt and shame in the sick person, who often accentuates the use of dysfunctional behaviors precisely to manage these emotional expressions.
Anyone who wants to help a bulimic person must have patience, healing takes time. The bulimic person also needs to feel not judged but supported, also through listening and empathic attitudes.
Don’t ignore the problem
Sometimes ignoring the problem is a way to avoid conflict and try to create a peaceful environment. However, this behavior can be interpreted as a lack of affection and interest, further worsening self-esteem and helping to maintain the problem.
Don’t treat the bulimic person in a condescending way
You can be open and honest about your concerns and be specific and concrete about problem behaviors. However, it is not useful to force the person with respect to his way of eating, better delegate these aspects to the specialist
Provide informative material and encourage evaluation by an appropriately trained specialist according to proven approaches
The treatment of eating disorders has made many advances and many more needs to be made. Regarding bulimia, however, there are approaches whose effectiveness has been widely documented by rigorous studies.
The National Institute for Clinical Excellence (NICE) in the UK has developed guidelines based on scientific evidence. Cognitive Behavioral Therapy (CBT-BN, conceived by Fairburn in the 1980s at the University of Oxford) is recommended as the first choice intervention for adults with bulimia nervosa . This recommendation is based on the empirical support of more than 20 controlled clinical trials which have demonstrated not only its efficacy, but also its superiority over other psychotherapeutic or pharmacological interventions.
The most effective psychotherapy
Recently a form of “enhanced” CBT-BN called CBT-E (Cognitive Behavior Therapy-Enhanced) has been developed, derived from the transdiagnostic theory and designed to cure all eating disorders. The specific diagnosis is therefore not relevant to the treatment, the content of which is adapted to the maintenance mechanisms of the individual patient.
Initially designed for the treatment of adult patients in outpatient treatment, it was then adapted for more intensive levels of care and for adolescent patients. In fact, the treatment model is developed by successive steps adapted both to the patient’s needs and to the resources available in the community and in the territory.
The DSM -5 (APA 2013) has included traumatic life events within the environmental risk factors for the onset of eating disorders.
In light of this, it is necessary to identify suitable therapeutic methods for the resolution of symptoms but also that can directly intervene on traumatic memories. In this way the person reorganizes his own functioning system by finding more adaptive modes than those of the symptom. The EMDR psychotherapy allows intervention directly on these experiences and is recognized by numerous controlled studies as an effective intervention in disorders related to stress (Chemtob et al, 2000).
