BULIMIA - BREAKING THE PATTERN

The first steps

The following suggestions may help a bulimic to make a start in finding the right way forward. Such a person has probably been feeling totally out of control around food, trapped in a cycle of bingeing, vomiting, taking laxatives, using diuretics, or starving. It is essential to re-learn a reasonable pattern of eating and living, just as one might have to learn to walk again following an accident.

Recognise that binge eating is a way of coping with anything stressful (e.g. emotional upset, pressure, boredom, fear of failure, uncertainty, PMT, or feeling that life is a mess).

After initially eating sensibly, it becomes impossible to stop. Possibly food is seen as something fast and comforting, but then feelings of guilt and panic set in and the bulimic eats anything that is available until the need is felt to vomit, purge, or starve, in order to get rid of the food eaten. The urge to eat is natural and normal. Food provides the body with the "fuel" it needs. Begin to learn how it feels to be hungry, and to be satisfied by food.

Check with your doctor - be totally honest and share your plans. Many doctors will respect the fact that you are trying to help yourself and will advise you.

Remember that depriving yourself of food tends to make you binge. Recognise that starving yourself all day, or following diets, has not worked. Write out a plan for meals each day to cut down the worry about what to have. Plan to eat little and often at first. Allow yourself breakfast, a mid-morning snack, lunch, a mid-afternoon snack, an evening meal, and something at bedtime. It is better to eat regularly than to depend on distorted body signals. If this seems too much to even contemplate, then do it gradually (eg plan breakfast every day for a week, breakfast and lunch every day for the second week etc.).

Make sure to eat these meals even if you binge and vomit at other times. Choose foods that you enjoy, are comforting, and satisfying to taste and chew. Try to choose a variety each day from the following groups:

• bread, cereals, rice, and pasta
• fruit and vegetables, including potatoes
• meat, fish, eggs, pulses, nuts
• milk, cheese, yoghurt

Do not omit bread, potatoes, and other carbohydrates, and if possible include them at each meal.

Make meal times a pleasant occasion. "Eating on the run" builds up guilt, as you lose track of what has been eaten. Try to eat at the same time each day, if possible with others. Always sit down to eat from a plate. Practise taking small bites; chew slowly, and allow yourself to enjoy the taste and texture of food. Relax afterwards; it takes time for the satisfied message to get through to the brain.

Enlist your family's help, especially if you have to shop and cook for them. Be totally honest about your difficulties with food. They will probably be relieved to learn what is going wrong. Explain to them that until you feel more relaxed around food they can help you spend less time thinking about it by taking over at least some of the planning, shopping, cooking, packing lunches, clearing away, and.washing up. Accept that at first you may be angry because they are interrupting a possible binge.

Be patient while your body re-adjusts and settles down. You will experience temporary feelings of bloatedness and stomach discomfort, you may also gain a little weight. But do not panic, give yourself time. The body is a very efficient machine, and will repay your kindness to it. Eating regular meals will not make you blow up like a balloon. Wearing looser clothes will help you worry less.

Survival strategies

If you feel a binge coming on, then employ delaying tactics. For example, telephone someone, put on some music and dance to it, knit, go for a walk - anything that might put off the binge, even for a time. If all else fails and a binge happens, get it over as quickly as possible. If you have vomited, eat something nourishing to prevent the cycle continuing. Mentally draw a line and start again. Try to identify what triggered the binge and work out ways of coping and reducing your guilt feelings.

Never deprive yourself. Give yourself permission to have something instead of going without - a magazine, coffee, scone, ice lolly, or new tee shirt, are better and cheaper than a binge. If your rules are too rigid then they will crack and so will you. Eventually you will be able to allow yourself a treat of something to eat or drink without the fear that it will lead to a binge.

Talk to people. If it is difficult, practise what you are going to say. Be frank about yourself, do not be put off if you meet people who do not want to talk or who cannot cope with problems, there are plenty of people who can. Most people respect and warm to honesty and will share of themselves in return, helping you to realise that everyone-gets fed-up, uncertain, lonely, bored, or frightened. No-one is completely happy or able to cope all the time. You can learn valuable ways of coping from them, and they from you. Practise asking for help when you need it.

Allow yourself to experience uncomfortable feelings so that they become less frightening. Recognise that you are avoiding them by bingeing. Ask yourself why feelings are difficult to experience - are you refusing to recognise them or are they unacceptable? How can they be tolerated more constructively? Try writing down thoughts and feelings, your situation, or your life story. Share them with a friend or counsellor; it may help to discover where your hurt and angry feelings come from and to get things in perspective. Allow yourself to cry. Find ways of comforting yourself other than food.

Read as much as possible about life, its problems, and how to deal with them. No book or article provides all the answers, but each gives some new insight or idea to help you build a new positive pattern for living.

Discover new interests and activities. This may be difficult at first, especially if you feel worthless or disgusted with yourself, but it gets easier the more you try. Local libraries or Citizens Advice Bureaux will know what is going on in your area. Being really needed, perhaps in some kind of voluntary work, will make you feel better about yourself, and a new hobby or interest can be turned to instead of a binge.

Allow yourself to be real. Banish words like "should", "ought", "must", "if only". Allow yourself to make mistakes and not be perfect. People like you as you are, not the "coping wonder" you are trying to be.

Realistic approach

It really is alright to have times in your life when you cannot cope and need to ask for help.

Work at accepting the body you are given. Look at others, their vastly differing shapes and sizes. Even the few with "ideal" shapes are not happy with the way they look. Are you trying to force your body into something it does not want to be? Accept yourself as you are, physically and mentally.

Finally, remember that your problem has taken a long time to build up and will probably take a long time to undo.

It may seem like "two steps forward, one back" all the way. You need patience and perseverance, but each time you do something positive and different, however small, you will be a step further away from the chaos. Feel proud of each achievement, however small. More and more people are becoming aware of eating problems today. You can make a real contribution towards a new understanding.

Find out from the Eating Disorders Association whether there is a local contact near to where you live. Talking and sharing with others who have the same problem makes you less isolated. Meeting people who are also bulimic will perhaps go some way to helping you to feel less ashamed and guilty about your own problem.

Publications

The following books give useful advice and guidance:

• "Coping With Bulimia" by B French, published by Thorsons
• "Bulimia Nervosa And Binge Eating - A Guide To Recovery" by P Cooper, published by Robinson Publisbing
• "Getting Better Bit(E) By Bit(E). A Survival Kit For Sufferers Of Bulimia Nervosa And Binge Eating Disorders" by U Scbmidt and Treasure, published by Lawrence Erlbaum Associates