SELF-HELP PROGRAM FOR RECOVERY
by Frank D. Young Ph.D., C. Psych.
Bulimia Nervosa is an
emotional and behavioral disorder that involves fasting and other distorted
eating patterns, purging through excessive exercise and/or self-induced vomiting,
rigid and rulebound thinking patterns, and other emotional disturbances.
This self-help program is designed
for those who have sincerely decided that they want to end their bulimic
practices and habits and make a commitment toward sustained recovery. It will
not work unless you are committed to its principles. You can prepare for it by
carefully examining all the positives that bulimia has allowed you in your life
(escape from boredom, numbing the pain of disappointment, eating your anger,
etc.). Resolve that you will face these
emotions and find other ways of dealing with them.
Come to the point in your
life where you are sick and tired of being sick and tired. Decide that you will
do whatever it takes to get better, that other than the life of your child or
the loss of your livelihood you will put this recovery as your main focus in
the next 3 months. If you have made this step, you are motivationally ready to
begin the program.
- Set a
start date and begin to assemble the necessary materials and arrangements to support success.
a support team or network.
Generate a list of 12-20 people and their phone numbers and contact
information. Ask each person for their support in your recovery from
bulimia. Find out at what times of day or under what circumstances they
will be unavailable to help (e.g. after 10 p.m., at work, etc.). Tell them
you will be calling them to calm yourself down when you are in danger of
being overwhelmed with the impulse to binge and purge (BP) in the next few
months. You maybe will only need 5-15 minutes of their time, but ask them
to return your call as soon as possible after you have left them a
voicemail message. Check out your system by doing a “dry run” or “fire
drill” as if you did need help, to test the availability and response
times of your friends and family on your support team. This step is very
important, so don’t skip it. You need to be able to have confidence that
you can ask for help when you need it, and that help will mostly be
nutritious foods that are easy to prepare. You will be following Canada’s
Food Guide approximately. You will be eating 3 meals and 1-2 snacks per
day. On almost every eating occasion you will be eating some kind of
animal protein (chicken, beef, pork, fish, eggs) preferably starting from
your first bite. This practice will stabilize your blood sugar level and
minimize the production of insulin, thereby stabilizing body weight and improving
the feeling of satiety. The best practice is to go to the deli department
at the grocery store and have them finely slice ham or turkey or some
other luncheon meat. Every morning, the first thing you will do is pop 2
slices of this meat in your mouth while you are deciding what else to eat
for breakfast. This will begin to set the protein platform that is so
crucial to recovery. Another necessary fast food is frozen vegetables,
because the can easily be microwaved and ready to eat within 2 minutes. This
can be used as a substitute for binge foods if eaten about 20 minutes
before a key binge time. Anything that takes time and work to prepare
could undermine your resolve when you are tired or short of time. Keep it
simple and fast. Soups, especially vegetable soups and stews, are also
fast and helpful. Breads for sandwiches and cereals for breakfast or
snacks are handy. The dairy group is handled with cheese, milk, and
yogurt. Finally, fruit and salad veggies are important. To summarize,
virtually all eating occasions should have a representative of the 4 food
groups: Animal protein, bread or cereal, fruit or veggies, and cheese or
milk. If you are dedicatedly vegetarian, or you object to any part of this
regime, stop now! This program is not for you. Without full and balanced
eating, especially during the first 10 hours awake each day, you will not
succeed. Skipping meals and snacks is a guaranteed way to generate the
rebound eating that will sabotage your recovery.
slowly and mindfully to allow the satiety mechanism to operate properly. As you may recall, your body and brain need 20
minutes to trigger the signal that you have eaten enough. Ignore
distractions. Do not multitask. Focus on the act of eating. In the first
month of the program, you need to eat regularly as if you were taking
medication, whether you are hungry or not. Later, after your digestive
system has been retrained, you may opt for eating on demand, but have no
period of fasting go longer than 4 hours. Paradoxically, regular eating is
your best insurance against BP relapse.
- If the
impulse to purge with vomiting or laxative abuse is overwhelming, arrange
to have supervised eating in your first week of recovery. You recovery buddies remain with you until the
impulse to purge the food has passed (usually within an hour of eating).
Trips to the washroom are accompanied by your support person to prevent
you from vomiting. In opposite-sex pairings, the bathroom door is kept
open, or some other arrangement is made. Remember, this response
suppression is for your own good. It is easy to sabotage this part of the
program. If you cannot tolerate this temporary and somewhat embarrassing
invasion of privacy, perhaps this program is not for you.
eating requires a moderation strategy, vomiting can be stopped entirely. Purging by vomiting or laxatives send the body
into a state of nutritional emergency, adding more emotional upset that
increases the likelihood of further episodes of bingeing-purging (BP).
Furthermore, research has shown that, in the long run BP is an ineffective
strategy for weight loss. As soon as you begin to swallow food, empty
calories are begun to be absorbed by the walls of the esophagus even
before the food reaches the stomach! That’s why people can still gain
weight, even if they vomit every single thing they eat.
Disruption part 1: the Replacement Rule. You can quit bulimia for the rest of your life if you follow
this rule exactly: after any instance where you vomit either deliberately
or accidentally you replace the vomited food with the same kind and amount
of that food. For example, if you ate 4 doughnuts, then purged them, you
would immediately have to eat another 4 doughnuts and keep these doughnuts
down. This procedure could repeat any number of times, as long as the
ritual ended with keeping that same amount of food down for digestion to
occur. This pattern disruption is called a spoiling intervention because
it typically defeats the thinking process “I’ll just get rid of this food
and I will be okay.” It also works because it allows for a way of getting
back on track so that an accidental slip will not become a slide. If you
can’t stomach the Replacement Rule and commit to it fully, you may not be
ready for this program.
Disruption part 2: the Purging Uniform. Another intervention that has had outstanding success over the
years is to have the client select her favorite dress, then require that
she can vomit as much as she wants, but only if she is wearing her
favorite dress. This idea requires the client to carry around her favorite
dress in a gym bag wherever she goes as a constant reminder that she is in
a recovery program. The time and effort required to change into the dress
usually outlast the 20 peak minutes of an impulse before it subsides. It
also makes it more difficult to be sneaky and hide the disorder from
discovery from others. Even when done alone at home, it introduces a
symbol of recovery that spoils the indulgent privacy of a very personal
and intimate ritual. It disempowers the bulimia’s control over your life.
of a new future during and beyond recovery. Using the audio tape “Building Self-Esteem: The
Mirror of your Mind” by listening to side B every day, 5 days a week will
keep you focused on a life beyond the grip of your disorder and its body
image disturbances, a life of increasing freedom and emotional and
psychological empowerment. As imagery guides our behavior, you will break
through scripts such as “I’ll never be good enough” “I don’t deserve
success or happiness.” ”I am unworthy” and other negative self-statements
will fade as you go beyond them to envision your future life. In addition,
the A-side of the tape focuses on digesting compliments to integrate them
with your developing self-esteem, parallel to digesting food properly to
nourish your body.
retention. Unless a person is
more than 20% below their Biological Set Point, they typically will gain
no weight in this program of nutritionally balanced eating. I am assuming
that you know how to avoid large amounts of junk food high in saturated
fats (French fries, potato chips, you know what I mean). I am also
assuming that you are following a lifelong commitment to have at least 2
aerobic exercise sessions and at least 1 or 2 other non-aerobic activities
(walking, dancing, etc.) per week. If you haven’t made this commitment to
yourself, now is a good time in your life to build these positive habits
into your lifestyle. Thankfully, ending bulimia will allow for more time
and energy to pursue these changes. Now, there is one caution: many but
not all people who follow this program to end purging will notice more
fluid retention of up to 5 pounds. Although this may be somewhat
uncomfortable in the short run, it will redistribute and rebalance within
3 menstrual cycles as your body learns to adapt to your recovery.
to call your team quickly for emotional support even for the slightest
things that could upset you, like a disappointment, or a fight with you
boyfriend, or some other frustrating event. Get support early. Don’t let bad feelings
fester and grow into an impulse to BP. Never mind that you are leaning on your
friends and family or bothering them. They have volunteered to help, so
you need them right now; make sure you use their help rather than
jeopardize your recovery.
So there you have it! This
program does not cover cognitive distortions such as all-or-nothing,
black-white thinking, overpersonalizing, negative self-talk, perfectionism, and
other personality traits that are often seen underlying eating disorders. If
these persist beyond your initial recovery, you may want to seek the further
assistance of a therapist or counselor. However, this present program will help
alleviate most of the distress that is generated by bulimia itself. This
disorder sometimes invades and entirely disrupts some people; it’s like the
disorder has a life of its own. With this program you have a great chance to
get your life back for yourself.
This program is offered to
you free of charge as part of the grace of the universe. However, please do not
abuse this privilege by taking it for granted. It will only work if you work.
My pleasure in offering it will be fully compensated by the news of your
recovery over this disorder. Your caring community wishes you all the best. Fy.