What Is Cognitive Behavioral Therapy (CBT) for Bulimia?

Medically Reviewed by Melinda Ratini, DO, MS on September 08, 2021

Bulimia is a severe and potentially life-threatening eating disorder. It can often fly under the radar for years as individuals can maintain an average or above-average weight while still having bulimia. Many people who seek treatment for bulimia are between the ages of thirty and fifty when the habit is already deeply rooted.

However, no matter what age you are, there are always treatment options available. The most effective known method of treatment is called Cognitive Behavioral Therapy or CBT. Read on to learn more about bulimia treatment through CBT.

What Is Bulimia?

Bulimia or bulimia nervosa is an eating disorder where you have episodes of uncontrolled eating or bingeing. After bingeing, you then purge either by using laxatives or by throwing up. Binge eating is defined as eating larger and out-of-control amounts of food than you would typically in a very short amount of time.

The two types of bulimia are:

  • Purging bulimia. This type of bulimia involves vomiting by choice, laxatives, diuretics, enemas, or other medications.
  • Non purging bulimia. If someone has this type of bulimia, they engage in behavior like fasting or too much exercise instead of purging. 

Regardless of the type of bulimia, it can be an extremely disruptive and consuming disorder. It can also be life-threatening and present some serious physical consequences, some of which are:

  • Stomach rupture
  • Heart problems 
  • Dental problems
  • Inflamed esophagus
  • Swollen glands near cheeks
  • Irregular menstrual cycles
  • Kidney problems
  • Lessened sex drive
  • Addiction and compulsive behaviors
  • Mental health issues 
  • Suicidal thoughts or behaviors

Due to bulimia’s far-reaching and grave consequences, it is important that you get help if you believe that you or a loved one is following these patterns.

What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy is a type of psychological treatment used for various mental health issues and addictions. The effectiveness of cognitive behavioral therapy has been widely studied, experienced, and documented. It has even been proven to be as or more effective than other types of therapies and medications.

CBT is ultimately based on several core principles. These include:

  • Psychological issues stem from unhelpful thoughts.
  • Unhelpful learned behavioral patterns cause psychological problems.
  • People who have psychological problems can get better by learning to cope with their problems and developing better strategies for dealing with them. 

Typically, CBT involves first learning to recognize these patterns, understanding the problems, and then working with your therapist to repattern your thoughts and feelings around them. While certain things do need to be told about a patient’s past, typically, you will focus on your present with your therapist to learn how to move forward into the future in a more healthy way.

How Is Cognitive Behavioral Therapy Used to Treat Bulimia?

To start with, CBT treatment for bulimia will be focused on disrupting the cycle of eating, binging, and then purging. Then therapy shifts to challenge the ideas and beliefs that underpin the eating disorder.

Usually, CBT is set on a schedule of nineteen sessions over eighteen weeks. At the end of each session, your therapist usually assigns homework. The homework is usually a mix of self-awareness exercises and tests to try between therapy sessions.

Usually, patients also are asked to keep a journal of how they think and feel. This journaling helps you understand that your eating disorder takes place in the much broader context of your mental state. For example, you may see trends in what triggers engaging in bulimia. As a result, you can start to become aware of your behavioral patterns.

Becoming aware of the mechanisms that allow an eating disorder to continue can give you freedom. You can learn to recognize, name, and then interrupt your patterns. Some of these patterns or cognitive distortions are:

  • All-or-nothing thinking
  • Thinking that you can read other people’s minds
  • Emotional rather than rational thinking
  • Personalization

These various cognitive distortions are difficult to dismantle. It can take quite a while to get rid of them. As a result, patients are often asked to collect a lot of data to support and deny their beliefs. That way, when you recognize your thoughts and feelings as a part of your eating disorder, you are armed with effective arguments against it and can work towards better and healthier habits instead.

Show Sources

American Psychological Association: “What is Cognitive Behavioral Therapy?”

Johns Hopkins Medicine: “Bulimia Nervosa.”

Inquiries Journal: “Treating Bulimia Nervosa with Cognitive-Behavioral Therapy and Interpersonal Psychotherapy.”

Visions Journal: “The Cognitive-Behavioral Approach to Treating Individuals with Eating Disorders.”

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