What Causes the Urge to Binge and Purge?

By November 26, 2012

For many years I have struggled with disordered eating. I’ve never sought treatment, so I’ve never been formally diagnosed. However, for over a year now, what went from consistent over-exercising and severe restricting to bulimia – the purging type. I binge and purge almost every single day, sometimes several times per day. No matter how hard I try to convince myself that I will stop this behavior, I’m at it again, and again beating myself up about it. I do not want to continue this. I am exhausted, very exhausted. Here are my questions: 1. What causes this urge to binge? Weekends not so long ago were my worst time. My two days of rest were spent in a constant b/p cycle until I went to sleep. Work days were always better because my job leaves very little time for eating, leaving only the nights to battle. Over the past month I’ve gotten a “grip” on the weekends. I keep myself busy, and work out moderately (30-45 min. tops). Now I’m trying to conquer the nights. I leave work all wound up and fatigued at the same time. The whole commute home I’m obsessing about to binge or not to binge. It feels like an uncontrollable urge and a frantic mental state until I act on the behavior. Once finished – everything goes back to normal, other than the guilt and the endless promise of not to do it again. I really want to know how can I change the thought? I’ve always heard if you can change the thought, you can change the behavior. I try to change the thought, but it just keeps coming back. Is there anyway to just stop? I am not a fan of medications, but sometimes feel as if though it could be a chemical imbalance. The urge to engage in the behavior just seems so powerful. Are there any studies that show correlation between chemical imbalances and bulimia? Is their any hope for recovery without medication if so? 2. I have avoided my friends and most of my family for months now. I do not answer the phone, and do not respond to E-mails. Outside of this disease, my personal is chaotic and my job is stressful. If I’m not at work, taking care of family, or practicing bulimia I’m am tired. Too tired mentally and physically to talk to anyone, let alone about anything serious. I miss my friends, but I’m not lonely. I do not want to lose them, I greatly value their friendship, and love them dearly. However, I feel ashamed that I have been so rude. I want to let them know that I’m not avoiding them because I’m upset with them. I do not want to let them know about the bulimia. How do I begin to explain this to them? – anonymous

Dear anonymous:

I really admire you coming forward and disclosing your battle with bulimia. It does feel very shameful and as a result makes it really tough to ask for help. You are very insightful – obviously a very smart person. If you could control this on your own, you would’ve found a way.

I truly believe that you cannot recover without some help. I have never met anyone who could do it all on their own. Now, whether or not treatment involves the use of medication, that’s for you to decide with a professional. The first step is to find a good therapist in your area who treats eating disorders and start seeing them for counseling. It is possible to recover without the use of meds. But you really must see a counselor. See “Finding Treatment” for more guidance.

The bulimia is not simply about “changing your thoughts.” That’s only one theory, but there is so much more to it. Eating disorders are very complicated, and difficult to understand. Many factors contribute to the binge/purge cycle. For example, some believe genetics play a part (obsessive/compulsive tendencies), and there are also links to social pressures, family stressors, relational stressors, anxiety. There is “evidence” that brain chemicals such as dopamine, nor-epinephrine, and serotonin play a part also, which is probably why studies have shown that in bulimia medications are often successful at reducing the amount of bingeing. It is not a cure by any means, but it can help to decrease the amount of bingeing and purging and can help in the process of counseling. It is important to note, however, that all research I have seen concludes that when meds are used for treating bulimia they must be used in conjunction with therapy.

One thing that popped out to me is the part you wrote about driving home from work and obsessing about the binge. Can you take a few minutes before you start your car, and eat a nutrition bar of some sort (something you can eat without guilt)? If you can sit and eat, say a “bar” or something with sustenance and about 200-250 calories, it might help you to diminish that ravenous hunger that you experience. Just sit and listen to the radio and try to relax a little before your drive home. Sounds simple, but it works for some people.

If or when you’re ready to talk to some of your close friends, just be honest with them. You don’t have to go into any details, unless you want to. Just be honest and talk about the fact that you have really been struggling physically and mentally, and it has pretty much consumed you. And tell them how much you do love them and value their friendship. Some are going to be an added source of support, some will not. Some will be understanding, and others not. That’s just human nature. All you can do is take care of you.

Good luck and take care of “you.”

Nicole Bourquin, MS