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In the last section, we discussed three concepts related to self-image distortion in clients with bulimia. These three concepts related to self-image distortion in clients with bulimia included: weight-obsessive thoughts; overestimating size; and unrealistic standards.
In this section, we will examine three binge trigger categories. These three binge trigger categories include: food and eating; body weight and shape; and negative emotions.
3 Binge Trigger Categories
♦ Category #1 - Food and Eating
The first trigger category is food and eating. For instance, breaking a sole dietary rule that the client has outlined for him or herself. By giving in just a fraction to the strict rules they have set out for themselves, the behavior of the client with bulimia becomes uncontrollable. This inability to "play by the rules" can result in acute guilt and depression after a severe binge. Even thinking about eating can incite a binge.
Likewise, feeling full after eating, or the satisfaction of having had a full meal, can trigger on onset of binging. Also, having fattening foods readily available can also trigger a binge. The client, extremely hungry at this point, craves calories, and the fattening foods provide a large source of these calories.
Stacey, age 19, began binging only occasionally. Every week or so, she would have a binging and purging episode. As the disorder progressed, Stacey noticed her episodes becoming more and more frequent. After a year, Stacey had developed a sort of pseudo-schedule.
Stacey stated, "The urge to binge usually begins around midday on a ‘normal’ day—that is a day on which I am trying not to eat. During the afternoon thoughts of food become more and more of a preoccupation; and eventually at around 4:00 pm my power of concentration will be sufficiently non-existent for thoughts about food to be totally overwhelming! So I leave my work and go to the store!"
Stacey’s triggers had become so regular that she could pinpoint them to a time of day. Think of your Stacey. What are his or her common triggers?
♦ Category #2 - Body Weight and Shape
The second trigger category is body weight and shape. Clients whose weight or shape trigger binging may be pushed into a binging episode by discovering weight to be higher than expected or discovering clothes to be too tight or too small. When a client with bulimia starts to "feel fat", he or she may experience feelings of hopelessness, despair, and disgust. They see their future as bleak and unsatisfying. These emotions will trigger a sudden eating frenzy. Although this logic may sound backwards, the client with bulimia is seeking comfort which he or she may find in binging. Even merely brooding about body shape or weight may be enough to trigger an episode.
Shawna, age 21, obsessed about her fluctuating weight. During a binging session, Shawna could consume over 3,000 calories. She stated, "If I discover my weight has gone up, or I find that my clothes are too tight, or I look in the mirror and see that I am too fat, immediately I want to eat! I know this is silly when I really want so desperately to be thin, but I just feel as if I can’t cope anymore and I might as well just give up and eat myself to death! Of course, I feel even worse after the binge!"
Clients like Shawna not only experience distress about their fluctuating weight resulting from binging, but also experience body image distortion. Although the client with bulimia may be within a normal BMI, he or she may perceive a completely different self-image than others. While Shawna weighed 110, she still believed herself to be overweight and terribly fat. Think of your Shawna. How does his or her body image affect his or her binging?
♦ Category #3 - Negative Emotions
In addition to food and eating and body shape and weight, the third binge trigger category is negative emotions. These emotions can range from depressive states to lonely or isolated, to anxiety or irritability. Just as clients use binging to relieve stress, so too do they use binging to escape from these negative emotions. Paradoxically, the more the client binges, the more he or she experiences negative emotions. Only for a few minutes during the binge are the emotions numbed. Yet subsequent to the overeating, the client with bulimia may feel guilty, drained, or depressed and the cycle begins again.
Julia, age 24, was an emotional eater and purger. She stated, "Binges start when I’m tired or depressed, or just upset. I become tense and panicky and feel very empty! I try to block out the urge to eat but it just grows stronger and stronger! The only way I know to release these feelings is to binge. And binge-eating does numb the upset feelings. It blots out whatever it was that was upsetting me. The trouble is that it is replaced with feeling stuffed and guilty and drained!" Think of your Julia. What are his or her emotional triggers?
♦ Cognitive Behavioral Therapy Technique: Trigger Talk
To help clients like Stacey, Shawna, and Julia, I suggest they try the "Trigger Talk" CBT exercise. I ask them to practice coaching themselves through their worst triggers. For example, Shawna’s trigger was anxiety about her weight and body shape. I asked her to think of phrases and words that could help her make it through an anticipated binging episode without overeating. Shawna’s monologue proceeded as follows:
"So, here we go again. I’m feeling fat, but I’m not really fat. Mom says I look just like Ingrid Bergman in ‘Casablanca.’ Ingrid Bergman is beautiful and so am I. I am not just beautiful because of my weight, either. I’m beautiful inside and out."
Think of your clients with bulimia. Could they benefit from "Trigger Talk"?
In this section, we discussed three binge trigger categories. These three binge trigger categories included: food and eating; body weight and shape; and negative emotions.
In the next section, we will examine three concepts of interpersonal relationships with regards to the binging and purging client. These three concepts of interpersonal relationships include: early childhood development; as a means to please; and secrecy.
Binge Eating Disorder
- Office on Women's Health. (2016). Binge Eating Disorder. U.S. Department of Health and Human Services.
Peer-Reviewed Journal Article References:
Luo, X., Nuttall, A. K., Locke, K. D., & Hopwood, C. J. (2018). Dynamic longitudinal relations between binge eating symptoms and severity and style of interpersonal problems. Journal of Abnormal Psychology, 127(1), 30–42.
Racine, S. E., VanHuysse, J. L., Keel, P. K., Burt, S. A., Neale, M. C., Boker, S., & Klump, K. L. (2017). Eating disorder-specific risk factors moderate the relationship between negative urgency and binge eating: A behavioral genetic investigation.Journal of Abnormal Psychology, 126(5), 481–494.
Schaefer, L. M., Smith, K. E., Anderson, L. M., Cao, L., Crosby, R. D., Engel, S. G., Crow, S. J., Peterson, C. B., & Wonderlich, S. A. (2020). The role of affect in the maintenance of binge-eating disorder: Evidence from an ecological momentary assessment study. Journal of Abnormal Psychology, 129(4), 387–396.
Stice, E., Gau, J. M., Rohde, P., & Shaw, H. (2017). Risk factors that predict future onset of each DSM–5 eating disorder: Predictive specificity in high-risk adolescent females.Journal of Abnormal Psychology, 126(1), 38–51.
Stice, E., Presnell, K., & Spangler, D. (2002). Risk factors for binge eating onset in adolescent girls: A 2-year prospective investigation.Health Psychology, 21(2), 131–138.
Tanofsky-Kraff, M., Schvey, N. A., & Grilo, C. M. (2020). A developmental framework of binge-eating disorder based on pediatric loss of control eating. American Psychologist, 75(2), 189–203
QUESTION 4 What are three binge trigger categories?
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