In the use of cognitive-behavioral treatment for these disorders, the reinforcement of healthy eating and weight, with both positive and negative reinforcers is important. At times, these may be combined with an SSRI medication. Self monitoring and food intake records are valuable tools. Food diaries include recording the circumstances, thoughts, and feelings accompanying eating. Bulemics can record how many times they binge, induce vomiting, use diuretics, take diet pills, and exercise.
Education regarding the consequences of binging, purging, and starving is important.
Initially, with Bulimia, someone else takes the control. As awareness develops, they begin to take control. They learn ways of soothing themselves in order to deal with their negative feelings, instead of using food to numb these feelings. It is also important to help the patient to recognize distorted thoughts and understand the relationship between dysfunctional thoughts and maladaptive feelings and behaviors. About the presenter Dr. Ebrahimi is an instructor at Harvard University and has a private practice in Cambridge.