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By Root 967 0

America. Hundreds of thousands of young women have contracted it. More than 5 percent of the young women to whom I teach Abnormal Psychology every fall complain of it. Two percent of adult women may have it in severe form.19 It consists of bouts of binge eating and purging alternating with days of undereating. These young women are universally concerned with their body image. They are usually normal in weight or a bit on the thin side, but they are terrified of becoming fat. So they diet. They exercise. They take laxatives by the cup. Twice a week they find themselves at a buffet or in an ice-cream parlor. They gorge: four hot-fudge sundaes topped off with a banana split. Then they vomit and take more laxatives. This malady is called bulimia nervosa (“bulimia” for short).

Therapists are puzzled by bulimia, its causes and treatment. Debate rages about whether it is an equivalent of depression, or an expression of a thwarted desire for control, or a symbolic rejection of the feminine role. Almost every psychotherapy has been tried. Antidepressants and other drugs have been administered with some effect, but—with one exception, which I’ll discuss shortly—little success has been reported.20

I don’t think that bulimia is mysterious, and I think that it will be curable. I believe that bulimia is caused by dieting. The bulimic goes on a diet, and her body attempts to defend its natural weight. With repeated dieting, this defense becomes more vigorous. Her body is in massive revolt—insistently demanding food, storing fat, craving sweets, and lowering metabolism. Periodically, these biological defenses will overcome her extraordinary willpower (and extraordinary it must be even to approach an “ideal” weight, say, twenty pounds lighter than her natural weight). She will then binge. Horrified by what this will do to her figure, she vomits and takes laxatives to purge calories. Thus bulimia is a natural consequence of self-starvation to lose weight in the midst of abundant food.21

Every bulimic I have met is dieting. Systematic surveys of bulimics show that at least 80 percent are on diets immediately before bulimia starts. The epidemic is sweeping America right now because the thin ideal has become thinner and thinner over time as the average female body has gotten heavier and heavier. The ideal has so far outstripped the capacity to achieve it that the discrepancy between natural weight and “ideal” weight is so great as to produce binge eating on a massive scale. Women whose natural weights are most discrepant from their “ideal” weights will be most vulnerable.

One study observed twenty bulimics who binged an average of three times a week. Ten received a nutritionally adequate treatment diet for eight weeks consisting, unbeknownst to them, of at least 1,400 calories a day. All of them stopped binging. A control group of ten others ate a sham diet that was the equivalent of what they had been eating. They continued to binge, but when they were switched to the nutritionally adequate diet, all of them stopped binging completely. This suggests that dieting is a cause of bulimia and suggests a major strategy for therapy.22

The therapist’s task is to get the patient to stop dieting and become comfortable with her natural weight. He should first convince the patient that her binge eating is caused by her body’s reaction to her diet. Then he must confront her with a question: Which is more important, staying thin or getting rid of bulimia? By stopping the diet, he will tell her, she can get rid of the uncontrollable binge-purge cycle. Her body will now settle at her natural weight, and she need not worry that she will balloon beyond that point. For some patients, therapy will end there because they would rather be bulimic than “loathsomely fat.” For these patients, the central issue—ideal weight versus natural weight—can now at least become the focus of therapy. For others, defying the social and sexual pressure to be thin will be possible, dieting will be abandoned, weight will be gained, and bulimia should end quickly.

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