Bulimia Nervosa and ImpulsivenessMost of the patients I have treated for Bulimia Nervosa over the years have experienced symptoms typical of impulse disorders. An impulse disorder is simply the inability to resist the impulse to steal (kleptomania), gamble, use drugs, lie about activities, and etc. What is so impressive about these symptoms is that they are associated with people who otherwise are intelligent, high achieving and have good judgment. In none of the many people I have seen with Bulimia Nervosa have anyone believed that there was anything wrong or immoral about their behavior. I should quickly note that not all people with Bulimia engage in these activities. However, it has been my experience that many do engage in at least one of them. In addition, the activity of theft was always petty and totally unrelated to economic need. Whether theft or otherwise, the patients all had ways of justifying what they did. These justifications were unshakeable. It is unclear why this happens with people who have bulimia except that it must be part of some form of difficulty controlling impulses. For example, those with bulimia cannot resist the urge to binge when they feel overwhelmed by that impulse. In the same way, they experience a similar purge after the binge is over. Similarly, they feel they may feel an impulse to steal a small item when in a store, a wish to sneak into another movie in a multiplex after having paid for the first movie or use marijuana, alcohol or another drug to feel better. In all cases, there is a need to be secretive and never admit what they have done. In the context of psychotherapy, people have admitted to these activities. In the case of bingeing and purging there are overwhelming feelings of shame that motivate extreme secrecy. Shame does not seem to be the motivating factor behind the other impulsive activities. It is important to point out that purging affects the same parts of the brain that are affected by drug abuse. In actuality, purging becomes addictive just the same as drugs of abuse. It may seem counter intuitive to those who do not purge to know that there are intense feelings of pleasure and relief experienced by the bulimic after the purge. In the same way there are intense feelings of pleasure experienced by the drug abuser. It is the memory traces set down on the neurons in the pleasure parts of the brain that make it so difficult for the bulimic and drug abuser to stop the activity. One advantage the bulimic has over those addicted to drugs is that the feelings very quickly turn from pleasure to intense self hate and deep depression after the binge purge cycle ends. That self hatred and depression become good motivating factors for many people with bulimia to seek help and learn how to end the cycle. It could just be that the binge purge process, along with minor theft and alcohol or drug abuse are all attempts to self treat depression. Paradoxically, these very activities, especially the binge purge cycle, reinforce self hate and depression. Finally, it has also been my experience that all of these impulsive activities end when patients gain control over the way they eat and, thereby, end the purging. The better able a person is to fight the impulse to purge, the less frequently will they engage in the purge. Gradually, the need to purge decreases bringing with it increased self esteem and decreased depression. The help and support of a therapist and nutritionist, both trained in eating disorders, is an excellent way to bring this condition under control and, with it, all the other impulsive activities. bulimic suffer - - Oct 30th 2009
hey im 16 and im bulimic, i was just saying that no drugs of anything will help what we are going through, oh and im also battling anorexia, yay .. not this is nothing that can be written in simple form, its like being on a elevator amd you just cant get off the floor just gets further and further away, you cant just simpley eat and get over it is my point, but there obviously has to be some way to stop?1! Why live a lie? - Allan N. Schwartz, PhD - Apr 30th 2009
I agree that you have been treated badly by your husband and that you have every reason to feel depressed, anxious, betrayed and angry. However, why give up? You have your children to protect and raise and your own life to live. Instead of huriting yourself, why not divorce and go for all the child support and income that he can afford and more. It always feels better to take action than feel helpless. Also, how about some psychotherapy for you and why not join our online support community? Dr. Schwartz why I live a lie!!!!!!!!!! - - Apr 30th 2009
I am 29 years old . I have 2 kids and I thought I had a perfect life finally. But my husband started seeing this woman right before I had our 2 child. I could not deal. It hurts so bad because I thought he loved me. I started to make myself throw up on the regular basic. I starve myself also. I can't find out why he wanted to cheat. It hurts so bad. I can't stop my eating disorder, cause all my life people have gave up on me. My mom left me as a baby, My boyfriends in pasted relationships, And I was attacted. Then the one person I trusted with all my heart burt me to. I just want to give up and I don't think it matters anymore what happens. I still live with my husband but he doesn't treat me the same its like I live in a prison. What do I do? relationships suck. why? - to-bulimic - Apr 6th 2009
this is a quick question to the person who commented, or vented, in early January 2009. I am curious why you say your relationships suck? I was recently in a relationship which lasted about a year with a bulimic woman in her mid 30's. It was a long distance relationship but we kept in touch everyday and managed to see each other about once a month. I thought everything was going well and we had talked about long term plans for the relationship, eventually with me moving to her city. Then suddenly she stopped returning my messages and would not answer the phone when I called, she sent me a letter saying she needs time and space to think and then eventually told me that she met someone else and wanted to see where that new relationship might lead. Shortly after that letter, I found out that she had a boyfriend immediately before me, then dated me and now quickly on to the 3rd boyfriend. During our time together she said many encouraging and convincing things to me that made me think there was nothing to worry about so I've had a hard time trying to figure out what happened. I'm just trying to understand the impulsiveness of her behaviour and if there was anything I could have done to prevent this relationship from ending. And my question above, why did you say your relationships suck? thanks! - bulimic - Jan 2nd 2009
I really think this is true. I hate myself when I binge, much less to say when I purge. It's a feeling that beings and it itches, it hurts, and all you want to do is indulge your mouth. Only to realize that's it's a party with the toilet seat. I know this sounds very graphic. -But it's true. At least this is my experience. I've been a bulimic since 1995. Today the date is January 2nd, 2009. I want to put an end to this cylce. It has erroded my teeth. Today my upper jaw is veneered. The cost was 9K. Pretty sad huh? Not to mention over 15K worth of food that's gone in a "flush". I've seen a psychologist who wanted to put me on medication. I've done recreational drugs.... Trust me it is not worth it. Yeah you lose the weight but your heart is at risk and so are your loved ones seeing slowly vanishing away. Then I saw a therapist.... only to realize I was doing most of the talking. Yes I am a smart individual. I am a high-achiever and a perfectionist......This is a new begining and this is first time I've vented online....My relationships suck.... I've become a drunkorexic. Drinking was ok.....eating was not. Although reality is drinking is still taking still involved weight gain. Calories in vs. Calories out. I pray this new year puts an end to this feeling. | 
