A young woman in her early twenties had been living with controlled bulimia for a number of years. All of a sudden it became out of control and she began bingeing and purging multiple times a day.
She couldn’t understand why she was no longer able to control her eating, and why she was bingeing again. She felt that nothing in her life had changed that would account for her loss of control.
On closer examination, this woman had been through a number of changes in the preceding few months. Her siblings had just moved overseas, and her two best friends had just moved out of town. Furthermore, her flatmate had been spending more and more time out of the flat and with her boyfriend.
Although they may seem unrelated, these are the kind of factors that can exacerbate eating disorders. This woman’s life had changed in ways that she had no control over, and she was socially isolated. Her feelings of loneliness were increasing as were her feelings of desperation and depression. She had no idea what to do.
In therapy we talked about her options, and where she could start. The first thing she needed to do was to go from being passive to active in taking control of her own life. The more passive people are, the more depressed they become; the more active they are, the better they feel about themselves and the world. She made a list of all of the things that she could address in her life that were causing her difficulties – frustrations at work, her social isolation, dating and so on. Next, she needed to find practical solutions to overcome the difficulties on her list. For example, she could try internet dating or speed dating; she could talk to her boss to solve some work problems; and she could make more of an effort to make re-new old friendships that she had let slip. Each of these steps involved her being proactive in her life.
Social isolation is a big issue for eating disorders. Being socially isolated is depressing for most people, and usually exacerbates eating disorders and loss of control. Therefore, addressing social isolation is crucial. This may involve working with the family to help the person build up support networks.
Finally, I encouraged this young woman to use the Bulimia/Compulsive Over Eating worksheet.