Cognitive therapy applied with dynamic psychotherapy is useful to identify the source of turbulence in the inner life of the bulimic – to uncover the personal and social difficulties which are hidden, and to explore the poor body image which lies at the root of the problem.
This is best done by asking people to keep a diary of their eating and their feelings. This helps them become self-aware – and understanding that eating doesn’t “just happen” but it arises within a context of situations, moods, feelings, and inner conversations with oneself, which can lead to destructive actions.
A trained therapist will have the tools to address these difficulties. These tools might include, where necessary, relaxation therapy, the teaching of problem solving skills, encouraging lifestyle change, and expressive therapies (such as art therapy or psychodrama) – as well as normal counselling skills.
Bulimia is commonly found among people with low self-esteem – which shows itself in perfectionist attitudes (a fear of inadequacy) and a high need to gain the approval of others. Bulimic people will typically define themselves as kind, lacking in confidence and unassertive.