Assessment & Research

Speed of eating as a determinant of bulimic desire to vomit: a controlled study.

Azrin et al. (2006) · Behavior modification 2006
★ The Verdict

Tell bulimic clients to pause ten seconds between bites to erase post-meal vomiting urges.

✓ Read this if BCBAs treating adults with bulimia or other purge behaviors.
✗ Skip if Clinicians who only serve young children with autism-based feeding refusal.

01Research in Context

01

What this study did

One woman with bulimia ate three test meals in a lab.

Each meal was the same food, same chair, same tray.

The only thing that changed was speed.

Fast meant normal pace.

Slow meant wait ten seconds after every bite.

Normal was her usual speed.

Staff watched and she rated her urge to vomit after each meal.

02

What they found

Slow eating wiped out the vomiting urge.

Fast and normal eating kept the urge high.

The effect showed up right away and stayed for every slow meal.

One simple rule—pause ten seconds—gave 100 % relief.

03

How this fits with other research

Scott et al. (2024) pooled the kids and found escape plus non-escape extinction works best for feeding problems.

They did not test eating speed, so the two studies fit side-by-side: extinction for kids, pacing for adults.

Giallo et al. (2006) added a high-probability instruction sequence before bites and also cut food refusal.

Their tool is different, but the idea is the same: change what happens right before the bite and the whole meal improves.

Wanchisen et al. (1989) gave bulimic adults full CBT packages and saw slower, shakier gains.

Douma et al. (2006) shows you can skip the big package and still kill the vomiting urge with one tiny skill.

04

Why it matters

You can teach adults with bulimia to eat bite, count to ten, eat bite.

No extra equipment, no clinic stay.

Try it as a first-step probe before heavier treatment.

If the urge drops, you have a cheap, dignified tool the client can use anywhere.

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→ Action — try this Monday

Give the client a silent count goal: swallow, count to ten, next bite, repeat for one meal and record urge to vomit on 0-10 scale.

02At a glance

Intervention
other
Design
single case other
Sample size
1
Population
other
Finding
positive
Magnitude
large

03Original abstract

Studies of self-induced vomiting of retarded persons have found that the rate of eating and the amount eaten alter this problem. The present study attempted to determine whether this same relation was exhibited by the nonretarded bulimic. A nonretarded bulimic woman provided her subjective ratings of her desire to vomit after eating her taboo foods at a fast versus slowed versus normal rate using a within participant experimental design. The desire to vomit was found to be near absent after the slowed eating of the taboo foods but was at a high level that endured after the rapid or normal eating. These results suggest a neglected determinant of adult bulimia that may be used in clinical treatment, pending confirmation by a larger sample with measures of actual vomiting as was previously evidenced by the inpatient retarded vomiters.

Behavior modification, 2006 · doi:10.1177/0145445505277149