The Dialectical Behavior Therapy Skills Workbook for Bulimia teaches readers a healthier coping mechanism for dealing with their feelings called dialectical behavior therapy (DBT). Using skills drawn from this proven approach, along with motivational interviewing, readers learn to regulate their emotions in effective ways that are healthy for mind and body. Worksheets and exercises throughout the book help readers put new skills like commitment, mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness into practice. This book also helps readers identify and address mental health conditions, such as anxiety and depression, that are often comorbid with bulimia.

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Introduction

If you are reading this, you may suspect that you (or someone you care about) might have an eating disorder. Think about how the following questions may apply:

If most of these questions fit you and your experience, you may have bulimia. The good news here is that help is available. It is now known that self-help by itself, or with some assistance, can aid you in overcoming an eating disorder. This book contains the essential information and skills to help you break the cycle of bulimia.
Western society is preoccupied with appearance, and thin is in. Added to this message we constantly hear about the fight against obesity, conveying the message that fat is unacceptable and if you are obese you should fight your body. As a consequence, many women (and increasingly men) in our society have issues with body image and food. At what point are concerns about weight and appearance normal, and when do they become a problem? At what point are people’s efforts to control or improve their weight or appearance healthy, and when do those efforts become abnormal? We can all recognize extreme behavior. We identify an eating problem in a person who binges and purges numerous times a day or in one who consumes nothing but lettuce and water. The use of diuretics, laxatives, excessive exercise, or self-induced vomiting to purge food is an easily recognizable symptom of an eating problem. Likewise, we know that there is an eating disorder in people who are so obese that they can’t participate in regular activities and yet continue to consume huge amounts of food. But eating disorders to this degree are the exception, not the norm.
Are Your Eating Habits a Concern?
Because many people have some symptoms of an eating disorder, the question arises: at what point do these symptoms become problematic? The first question to consider is how well you are able to function on a daily basis. For example, are you preoccupied with thoughts of food? Do you often find yourself thinking things like "When will I eat again?"; "What should I eat?"; "Why did I eat that? Why did I eat so much food?"; "How can I keep myself from eating when I am so hungry?"; "How many calories have I eaten today?"; "Was the food at the restaurant prepared with oil, butter, cream, or sugar?"; or "Where can I go to get diet foods?" Do you have constant concerns about body image, constantly fielding thoughts like "I am so fat!"; "I am terrified of being fat"; "How can I lose weight?"; "If I ate that, how much do I have to exercise to burn the calories?"; or "What exercise should I do to get my stomach flat?" Do these concerns make it difficult for you to concentrate and focus on daily activities? Do these concerns make enjoyment difficult? If thoughts of food and body image consume your mind, time, and energy, then you likely have a problem with eating.
Sometimes people don’t recognize these symptoms in themselves, but comments from friends and loved ones may call attention to an unrecognized eating problem. For example, do others tell you that you are getting too thin? Do you think that others try to get you to eat more food or to eat more often? Do others comment on how slowly you eat? Do others talk about your great self-control around food? It may be easier for a friend or family member to see these as symptoms of an eating disorder than for you to see the problem. In many ways, these behaviors may work for you. If you are reading this and have concerns about your eating, these worries should be taken seriously. Here are some possible warning signs of developing bulimia nervosa:
As you read this, you may recognize that you’re developing some early sign of bulimia nervosa. If that is the case, you should know that the sooner you recognize the problem, the sooner you can get help. The longer eating disorders go untreated, the more resistant they become to treatment.
Help Is Available
If some or many of these signs and symptoms apply to you, the ideas, skills, and exercises in this workbook can be of great help. We have brought together several different approaches to helping people with eating disorders. Each of these approaches has been shown through research to benefit people with bulimia. The first approach addresses motivation, because changing any behavior can be difficult, and changing behaviors related to eating is no different. You may have noticed that some days you feel more strongly that things need to change than other days. You may see how you handle food and your appearance as a problem sometimes, but not at other times. You may be very fed up with your behaviors related to eating or have doubts about your ability to change. As a client once described in an e-mail, "I used [problem eating] behaviors last night, and they spilled onto today. I know I am done with it today, because I want the cycle to end right now and for it not to claim another day. But I’m scared that I don’t have what it takes to do it." Feelings of helplessness and confusion around eating disorders are all too common, and that’s why we stress motivational therapies in our program and in this book. These techniques will help you build and keep up your desire to change.
But motivation is only one part of change. We recognize that many people need to build a variety of skills in order to change successfully. For example, you may feel very motivated to stop yourself when you are in the middle of a binge, but you may not know how. Or you may find yourself overwhelmed with feeling guilty or sad. These feelings may come along with strong urges to use your eating-disordered behaviors (bingeing, purging, fasting, exercising too much, taking laxatives, and so on). These behaviors typically help to calm or repress these painful feelings. But because of the long-term problems that arise from the use of these disordered behaviors, you will likely eventually want to deal with these feelings in healthier ways. This is where skills and strategies from dialectical behavior therapy (DBT) can give you the tools and strength you need. DBT is a treatment that has been developed to help people who have strong emotions and behaviors that feel out of their control.
The rest of this workbook will take you through a step-by-step approach to understanding and changing the thoughts, feelings, and behaviors you have about food and your appearance that are making you miserable. Each chapter provides new ways of thinking about what is going on for you and exercises that you can use every day to help make your life better.The Dialectical Behavior Therapy Workbook for Bulimiacan be useful for people as a stand-alone way of helping themselves, but you can also use it as an additional aid if you are already in therapy for bulimia. If you’re using this book on your own, remember that some eating problems can be very serious and require the help of an experienced therapist or even an entire program devoted to eating disorders. While we have relied on tested approaches for helping you, we ask that you remain open to seeking out additional help if it seems that your problems are too much for you to handle on your own.
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