by Dr. Joseph  A. Precker

Last time, in response to many questions, an out line of bulimia was presented.

In brief, bulimics are overly concerned about weight (even though they have what others consider to be good figures), tend to be perfectionistic; have high (often unrealistically high) expectations of them­selves; basically feel unloved or unlovable (“until I become thin enough, achieve enough”); need to be “in control” (but keep being thrown off-balance be­cause they feel they cannot even control themselves to keep on a diet; to stop bingeing, to avoid vomiting and/or purging); they tend to be rigid in their think­ing, and see things in black or white; have difficulty in intimate relationships (particularly with men) usu­ally have distorted ideas about their own bodies, and, bottom line: don’t like themselves (most particularly, their bodies, but this is often a mask for a deeper self-deprecatory view of themselves.)

How can one break through all of this, particu­larly since most bulimics, (in spite of the capability of putting on “a good and bold front,”) are very often depressed?

Let’s look at the depression, first. There are professionals who believe the depression is the result of a near-starvation diet. Over the years, systematic study of people on near-starvation diets (either as a result of historic events such as wars, famines, natu­ral or “unnatural” disasters, as well as people who have volunteered for long-range “laboratory studies”) demonstrate that near-starvation over a fairly long period of time leads to symptoms such as irritability, poor concentration, anxiety, apathy, fatigue, rapid (often seemingly unpredictable) mood changes—and depression.

The depression may be accompanied by hypochondriasis (that constant search for something “physical” do explain their poor morale!), hysteria, persistent tiredness and social isolation—which usu­ally leads to even greater depression since we human beings are essentially social animals. The chang­ing moods and depression often leads to impulsive behavior, as in those too-frequent binges, and to manipulation—or attempts at manipulation—of people and/or events meaningful in their lives. Aggression may also be evidenced, although fre­quently masked by “nice” behavior, and “good in­tentions” . . .

Low self-esteem and dependency also frequently are manifested, even though many sufferers of bulimia may appear somewhat ” tomboyish” and, on the surface, independent.

My own personal view is that the underlying depression characteristic of the bulimic is less a re­sult of near-starvation (although that certainly plays a part), but rather more likely to lead toward bulimia, because the person (most usually a woman) dislikes her body, their self-perceived lack of achievement (although, objectively, and in the view of others, they are, if anything, over-achievers), and their “failure” to achieve perfection. When self-esteem is low, it may seem almost impossible to function effectively in life, in love, in career, in self-regard…

What can be done? There are at least five levels of approach which are desirable, simultaneously, if possible:

1) Medical review and care, to reduce and to eliminate possible effects of bulimia, such as electro­lyte imbalance, hormonal dysfunctions, amenorrhea and so forth.

2) Establishment of an effective eating regime. Yes, EATING, not dieting! Proper intake of nutri­tious foods, at regular intervals (in some cases, per­haps five small meals a day!). Ideally, a good dieti­cian will assist in this process.

3) Revision of the ideas about what a “beautiful body” is like. Some people may never be as thin as those beautiful models on runways and posters and on TV— and yet, may be considered very attractive by many. It seems as if the Good Lord created some­body to appreciate every body type. In museums around the world, I’ve observed men pausing longer to look at voluptuous Rubens nudes than at anything else.

4) Social support, by such groups as Weight Watchers, Bulimics Anonymous (not in Tokyo, yet) or group psychotherapy. Someone to call whenever the binge-bug bites, can be very helpful.

5) Individual psychotherapy with a well-quali­fied, mature psychotherapist, experienced in dealing with bulimics, to help these people regain appropri­ate self-esteem and meaningful “control” over self…

At a later day, more about weight, eating, beauty and effective performance. . .