top of page

What is Bulimia? Causes, Theories, and Treatments

Writer's picture: dr.ssa Elizabeth Mooredr.ssa Elizabeth Moore

Un'immagine astratta che rappresenta il colore blu versato in un liquido, simboleggiando la complessità e la profondità emotiva associata alla bulimia e ai disturbi alimentari


Bulimia is a serious eating disorder that involves a cycle of binge eating and extreme compensatory behaviors to prevent weight gain. During a binge, a person may consume a significantly larger amount of food than most people would in a similar period of time. Afterwards, the person experiences guilt, shame, and fear of gaining weight, which leads to compensatory behaviors to eliminate excess calories.

Psychological Theories and Main Authors


Hilde Bruch's Theory

Hilde Bruch, a pioneer in the study of eating disorders, proposed a significant theory about bulimia. According to Bruch, bulimia nervosa is closely linked to identity and personal autonomy issues. Bruch believed that people with bulimia often lack a clear perception of their own body and internal needs, such as hunger and satiety. This perceptual deficit, combined with low self-esteem and a sense of loss of control, leads to binge episodes followed by compensatory behaviors, such as self-induced vomiting. Her theory emphasizes the importance of helping patients develop greater self-awareness and an understanding of their bodily sensations, as well as working on improving autonomy and personal identity. Bruch also highlighted the negative influence of social and family expectations in the development of eating disorders.


Cognitive-Behavioral Theory

Christopher Fairburn, a pioneer in bulimia research, developed a cognitive-behavioral model that highlights how distorted thoughts about weight and body shape can contribute to maintaining the disorder. According to Fairburn, patients with bulimia develop a rigid and perfectionistic thought pattern that leads them to evaluate themselves primarily based on weight and physical appearance.


Self-Esteem and Self-Efficacy Theory

Albert Bandura, with his self-efficacy theory, and Nathaniel Branden, with his self-esteem theory, contributed to the understanding of bulimia by emphasizing the role of low self-esteem and the perception of personal inefficacy in maintaining the disorder. People with bulimia often have fragile self-esteem and use weight control as a way to feel competent and valid.


Predisposing Personality Theory

Research conducted with the EDI (Eating Disorder Inventory – 3), a tool for evaluating eating disorder symptoms that investigates personality traits, shows that personality traits such as feelings of inefficacy (or low self-esteem), perfectionism, reduced interoceptive awareness (or insensitivity to internal signals like hunger and satiety), and interpersonal discomfort are often found in individuals with eating disorders rather than in the general population.


Integrated Biopsychosocial Model

The biopsychosocial model suggests that there is an interaction between the organism, its past behavior, and its environment (biological, psychological, and environmental variables). This model, developed by Schlundt and Johnson in 1990, was considered for about twenty years to be the most important in explaining the development of eating disorders. Eating disorders would thus be determined by multiple causes that interact and integrate in ways that are not yet fully understood.


Psychological Therapies to Address Bulimia

Cognitive-Behavioral Therapy (CBT)

CBT is considered one of the preferred treatments for bulimia. This therapeutic approach aims to modify dysfunctional thoughts and behaviors associated with the disorder. Techniques used in CBT include:

  • Food Monitoring: Keeping a food diary to record meals, binge episodes, and compensatory behaviors.

  • Identification and Modification of Distorted Thoughts: Recognizing and replacing negative and irrational thoughts about weight, body shape, and food.

  • Exposure and Response Prevention: Gradually exposing patients to feared foods without resorting to compensatory behaviors.

  • Meal Planning: Establishing a regular and balanced eating routine to prevent hunger and binge episodes.


Interpersonal Therapy (IPT)

IPT focuses on improving interpersonal relationships and resolving communication and conflict issues that may contribute to bulimia. This approach helps patients develop more effective social skills and improve social support.


Dialectical Behavior Therapy (DBT)

DBT, developed by Marsha Linehan, combines elements of CBT with mindfulness techniques and emotional regulation. This approach is particularly useful for patients with bulimia who also exhibit self-harm behaviors or suicidal ideation.


EMDR (Eye Movement Desensitization and Reprocessing)

EMDR is used to address past traumas that may contribute to the eating disorder. Through eye movements or other bilateral stimuli, patients can reprocess traumatic memories in a more adaptive way.


Acceptance and Commitment Therapy (ACT)

ACT was developed by Steven C. Hayes in 1982 and is an evidence-based behavioral therapy that focuses on acceptance, mindfulness, and value-based actions to help individuals accept the difficulties that arise in life. One of ACT’s core concepts is that emotional intolerance is the primary source of psychological suffering, opposing the Western myth of “healthy normality,” which defines happiness as the absence of pain. ACT embraces the idea that normality includes the presence of suffering as a common experience.


Group Therapy

Group therapy offers a supportive environment where patients can share their experiences and learn from others. This approach can improve the sense of belonging and reduce feelings of isolation.


Techniques to Stop Nervous Hunger

Nervous hunger is a common symptom of bulimia, characterized by a compulsive desire to eat in response to negative emotions such as stress, anxiety, or sadness. Some practical techniques to manage nervous hunger include:

  • Emotional Awareness Exercises and Meditation Techniques: Practicing mindfulness to recognize and accept emotions without turning to food.

  • Physical Activity: Using exercise as an outlet for stress and negative emotions.

  • Relaxation Techniques: Learning relaxation techniques such as deep breathing or progressive muscle relaxation.

  • Distraction: Engaging in enjoyable or productive activities to take attention away from the desire to eat.


Conclusion

Bulimia nervosa is a complex disorder that deeply affects both the mind and the body, and addressing it is never easy. For those suffering from it, each day can be a struggle, but with the right support, a difference can be made. Understanding the psychological roots of bulimia and accessing appropriate therapeutic options enables better management of the disorder. With a combination of practical techniques and targeted support, it is possible to improve quality of life and regain a healthier relationship with oneself and food.



 Written by

Dr Elizabeth Moore, Psychologist

(consultation only in Italian)

 

For clarifications regarding the article or to book an appointment in person or online, please visit the Contacts section or:




Consultations are available in Italian only

 

Bibliography

  • Riccardo Dalle Grave, Terapia Cognitivo Comportamentale dei Disturbi dell'Alimentazione, 2013, Positive Press.

  • Paolo Cotrufo, Disturbi del Comportamento Alimentare: Diagnosi e Trattamento, 2012, Il Pensiero Scientifico.

  • Lucio Rinaldi, Bulimia e Anoressia: Un Approccio Integrato, 2005, Franco Angeli.


External resources

If you wish to explore the topic of psychological manipulation further and find relevant articles and studies, consider these important academic and institutional resourc


  1. National Eating Disorders Association (NEDA)Link: NEDA


  2. American Psychiatric Association (APA)Link: APA


  3. Istituto Superiore di Sanità (ISS)Link: ISS


  4. National Health Service (NHS)Link: NHS


  5. Mental Health FoundationULink: Mental Health Foundation


  6. Bulimia.comLink: Bulimia.com


  7. World Health Organization (WHO)Link: WHO


  8. Eating Recovery CenterQLink: Eating Recovery Center


  9. European Eating Disorders ReviewLink: European Eating Disorders Review

La Manipolazione
bottom of page