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Bulimia Nervosa and Impulsiveness

Most of the patients I have treated for Bulimia Nervosa over the years have experienced symptoms typical of impulse disorders. An impulse disorder is simply the inability to resist the impulse to steal (kleptomania), gamble, use drugs, lie about activities, and etc. What is so impressive about these symptoms is that they are associated with people who otherwise are intelligent, high achieving and have good judgment. In none of the many people I have seen with Bulimia Nervosa have anyone believed that there was anything wrong or immoral about their behavior. I should quickly note that not all people with Bulimia engage in these activities. However, it has been my experience that many do engage in at least one of them. In addition, the activity of theft was always petty and totally unrelated to economic need. Whether theft or otherwise, the patients all had ways of justifying what they did. These justifications were unshakeable.

It is unclear why this happens with people who have bulimia except that it must be part of some form of difficulty controlling impulses. For example, those with bulimia cannot resist the urge to binge when they feel overwhelmed by that impulse. In the same way, they experience a similar purge after the binge is over. Similarly, they feel they may feel an impulse to steal a small item when in a store, a wish to sneak into another movie in a multiplex after having paid for the first movie or use marijuana, alcohol or another drug to feel better.

In all cases, there is a need to be secretive and never admit what they have done. In the context of psychotherapy, people have admitted to these activities. In the case of bingeing and purging there are overwhelming feelings of shame that motivate extreme secrecy. Shame does not seem to be the motivating factor behind the other impulsive activities.

It is important to point out that purging affects the same parts of the brain that are affected by drug abuse. In actuality, purging becomes addictive just the same as drugs of abuse. It may seem counter intuitive to those who do not purge to know that there are intense feelings of pleasure and relief experienced by the bulimic after the purge. In the same way there are intense feelings of pleasure experienced by the drug abuser. It is the memory traces set down on the neurons in the pleasure parts of the brain that make it so difficult for the bulimic and drug abuser to stop the activity.

One advantage the bulimic has over those addicted to drugs is that the feelings very quickly turn from pleasure to intense self hate and deep depression after the binge purge cycle ends. That self hatred and depression become good motivating factors for many people with bulimia to seek help and learn how to end the cycle.

It could just be that the binge purge process, along with minor theft and alcohol or drug abuse are all attempts to self treat depression. Paradoxically, these very activities, especially the binge purge cycle, reinforce self hate and depression.

Finally, it has also been my experience that all of these impulsive activities end when patients gain control over the way they eat and, thereby, end the purging. The better able a person is to fight the impulse to purge, the less frequently will they engage in the purge. Gradually, the need to purge decreases bringing with it increased self esteem and decreased depression. The help and support of a therapist and nutritionist, both trained in eating disorders, is an excellent way to bring this condition under control and, with it, all the other impulsive activities.

    Reader Comments
    Discuss this issue below or in our forums.

    Recovered from bulimia but still engaging in impulsive behavior - - Jan 13th 2015

    I no longer purge or binge but i still am cheating on my boyfriend and my depression has gotten much much worse. Why hasnt my self esteem and impulsive behaviors improved? 

    my story - - Mar 30th 2011

    During my sophomore year of high school my dad admitted to me that he had a gambling addiction and stole $1000 dollars from my savings. Along with that my parents talking about divorce made me feel as tho i had no control over my life. Before this event id had a long history of hating my body and the way i looked and bulmia just seemed like the answer to all my problems. Soon making myself throw up was the only way i could relieve my stress. After i was done i knew what i was doing was wrong, but I didnt know if i could find something to replace how it made me feel. Soon a friend found out what i was doing and i was forced to tell my parents what i was doing. A week later i started counseling and it helped sort out why i did the things i did. Its been four months since ive given into temptation and im extremely happy the cycle of my bad habbits stopped. However the urge to go back to my habbits still exist and im trying to find ways to get ride of my stress in other ways. For any one who is struggling with this i know its become a big part of your life but your not truley living your life till u are free from this. It will be hard but in the end u will love yourself more and begin to feel relief you dont have to hide this big secret. Talk to friends, family, or a counselor or someone u trust and u know can get u through it. If anyone would like to talk with me further id love to talk u can send me an email at acavy94@yahoo.com, no judgement or shame ive been where you are.

    i have been fighting bullimia for 40 years - andy - Mar 21st 2011

    I used to be nearly 20 stone when i was 16 years old, i started then becuase i didnt like myself.i have been      12 1/2 ever since.

    i am now 54 and a meal to me is about 50 calories. in the evening i have a masive meal. and get rid. and then control my wieght with a couple of cans of lagar, i am now finding it hard to maintian body wieght now i am older and have soght advise from my GP because  i am close to the next level of starvation , i know that nothing is going to work

    i need help - gfhghlhjhljh - Oct 7th 2010

    I need help, i am bulimic and i need help to stop, does anyone that has been bulimic have any advice? im obsessed with my work outs already so its not that im to lazy to do the work. i just feel like food is an addiction i used to be over weight but i no longer am. ive been bulimic for about 2 years. and if i dont stop soon im afraid i wont be able to.

    understanding the impulse - River - Sep 22nd 2010

    I have been a struggeling bulimic for about 7 years now. I never knew the control it actually had over me until about five years gos, and I never wanted to stop it until these last 3 years. At first I felt so in control of doing it, I was losing mmy weight and eating more then ever. Some say you cant have the cake and eat it to, but for me this was exactly what I could do and I felt like it gave me power.

    Hoever now as my husband and I begin our family I want to get better. I am now on day three of fighting an overwelmin impulse to binge and purge. My thoughts are so obbssesive I feel like the only way I can usually get them to be quiet is to just give in...However I dont want to....I am trying very hard to reinforce how I usually feel after I do it to motivate me not too.

    Fighting the impulse must be like what an alchohlic feels like  when they cant have a drink...I wish it was easier. I wish I had never started to begin with because only now do I realize the control it has over me.

    AGREE - - Jan 31st 2010

    I can completely, 100% relate to the implusiveness that tends to follow bulimia. i have been suffering from an eating disorder for about 6 years. anorexia to bulimia and back and forth. but i can completely agree with implusiveness with mia. i have experienced that myself. i still can get that way sometimes and i don't even know it until i feel awful about myself or i just come back to reality and am like " what the @#$#$?". good article

    bulimic suffer - - Oct 30th 2009

    hey im 16 and im bulimic, i was just saying that no drugs of anything will help what we are going through, oh and im also battling anorexia, yay .. not this is nothing that can be written in simple form, its like being on a elevator amd you just cant get off the floor just gets further and further away, you cant just simpley eat and get over it is my point, but there obviously has to be some way to stop?1!

    Why live a lie? - Allan N. Schwartz, PhD - Apr 30th 2009

    I agree that you have been treated badly by your husband and that you have every reason to feel depressed, anxious, betrayed and angry. However, why give up? You have your children to protect and raise and your own life to live. Instead of huriting yourself, why not divorce and go for all the child support and income that he can afford and more. It always feels better to take action than feel helpless. Also, how about some psychotherapy for you and why not join our online support community?

    Dr. Schwartz

    why I live a lie!!!!!!!!!! - - Apr 30th 2009

    I am 29 years old . I have 2 kids and I thought I had a perfect life finally. But my husband started seeing this woman right before I had our 2 child.  I could not deal.  It hurts so bad because I thought he loved me.  I started to make myself throw up on the regular basic.  I starve myself also.  I can't find out why he wanted to cheat.  It hurts so bad.  I can't stop my eating disorder, cause all my life people have gave up on me.  My mom left me as a baby, My boyfriends in pasted relationships, And I was attacted.  Then the one person I trusted with all my heart burt me to.  I just want to give up and I don't think it matters anymore what happens.  I still live with my husband but he doesn't treat me the same its like I live in a prison.  What do I do?

    relationships suck. why? - to-bulimic - Apr 6th 2009

    this is a quick question to the person who commented, or vented, in early January 2009.  I am curious why you say your relationships suck?

     I was recently in a relationship which lasted about a year with a bulimic woman in her mid 30's.  It was a long distance relationship but we kept in touch everyday and managed to see each other about once a month.  I thought everything was going well and we had talked about long term plans for the relationship, eventually with me moving to her city.  Then suddenly she stopped returning my messages and would not answer the phone when I called, she sent me a letter saying she needs time and space to think and then eventually told me that she met someone else and wanted to see where that new relationship might lead.  Shortly after that letter, I found out that she had a boyfriend immediately before me, then dated me and now quickly on to the 3rd boyfriend.  During our time together she said many encouraging and convincing things to me that made me think there was nothing to worry about so I've had a hard time trying to figure out what happened.  I'm just trying to understand the impulsiveness of her behaviour and if there was anything I could have done to prevent this relationship from ending.  And my question above, why did you say your relationships suck?

    thanks!

    - bulimic - Jan 2nd 2009

    I really think this is true. I hate myself when I binge, much less to say when I purge. It's a feeling that beings and it itches, it hurts, and all you want to do is indulge your mouth. Only to realize that's it's a party with the toilet seat. I know this sounds very graphic. -But it's true. At least this is my experience. I've been a bulimic since 1995. Today the date is January 2nd, 2009. I want to put an end to this cylce. It has erroded my teeth. Today my upper jaw is veneered. The cost was 9K. Pretty sad huh? Not to mention over 15K worth of food that's gone in a "flush".

    I've seen a psychologist who wanted to put me on medication. I've done recreational drugs.... Trust me it is not worth it. Yeah you lose the weight but your heart is at risk and so are your loved ones seeing slowly vanishing away. Then I saw a therapist.... only to realize I was doing most of the talking. Yes I am a smart individual. I am a high-achiever and a perfectionist......This is a new begining and this is first time I've vented online....My relationships suck.... I've become a drunkorexic. Drinking was ok.....eating was not. Although reality is drinking is still taking still involved weight gain. Calories in vs. Calories out.

    I pray this new year puts an end to this feeling.

     

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