Experiential aspects of bulimia nervosa. Implications for cognitive behavioral therapy.
Starvation, solitude after meals, and family fights are the three most common spark plugs for a bulimic episode.
01Research in Context
What this study did
The author asked 30 women with bulimia to fill out a survey. They wrote down what happened right before each binge and vomit.
The survey listed 18 possible triggers like hunger, being alone, or fights. The women checked which ones came first.
What they found
The top three triggers were starving all day, being alone after eating, and arguing with mom or a partner.
Mood swung from tense and angry before the binge to calm during it, then to shame after vomiting.
How this fits with other research
Wanchisen et al. (1989) showed CBT cuts bulimia signs both in and out of hospital. Manabe (1990) tells you which cues to target in that CBT.
Douma et al. (2006) later proved slowing each bite to a 10-second pace wipes out the vomit urge. That lab test grew from the same eating cue Manabe (1990) found.
Ganz et al. (2004) reviewed pica studies and also stress the need to spot personal triggers first. Same rule: assess before you treat.
Why it matters
You now have a quick checklist to use in session. Ask your client: “Did you skip meals today? Were you alone after eating? Did you clash with mom?” If any box is ticked, teach them to notice that cue early and use a coping skill right then. This turns the 1990 survey data into real-time relapse prevention.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Hand your client a simple card with the three top triggers; have them circle any that happened before their last binge and role-play one coping skill for that cue.
02At a glance
03Original abstract
Fifty female bulimic patients were asked to complete a questionnaire describing their experience during a binge-vomit episode. Findings indicated that starvation was a common precipitant of bingeing, as were situations such as being alone and eating something, and dysphoric feelings such as anxiety and frustration. Significant others, particularly the mother and the boyfriend or husband, might also precipitate a binge. Although many feelings increased or decreased in a linear fashion as the episode progressed, others such as depression and relief waxed and waned at different points in the episode. Implications of these findings for cognitive behavior therapy were discussed.
Behavior modification, 1990 · doi:10.1177/01454455900141004