Psychotherapy in bulimia nervosa

Patients are helped to improve their low self esteem. This may be particularly difficult as they may present a self- assured facade. Their low self esteem may be linked to problems with their interpersonal relationships, which may be helped with counselling and self help groups.

The therapist puts forward the following propositions:

• binge eating relieves distress in the short term but makes things worse in the long term
• that the patient fears losing control
• that vomiting is an attempt by the patient to regain control of their food intake

With a shared understanding the therapist and patient can work together towards:

• identifying immediate causes of binge behaviour with a diet diary which details the context of any binges
• solving problems and developing coping strategies to avoid stressful situations
• identifying and solving relationship problems which may provide background levels of stress