Healthcare Training Institute - Quality Education since 1979
Psychologist, Social Worker, Counselor, & MFT!!

Section 1
Track #1 - Binging Motives

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Welcome to the Home Study Course sponsored by the Healthcare Training Institute, homestudycredit.com.  This course is entitled, Eating Disorders Vol 2:   Techniques for Treating Binging & Purging Clients

Our primary intent for this home study course is to provide quality education to foster your professional growth.  The Institute has provided quality education since 1979.
 
We appreciate that you have chosen us as a vehicle for you to earn your Continuing Education Credit.

The purpose of the course is to assist you in increasing your knowledge regarding how to treat patients, clients, etc. dealing with binging and purging.  As each case study is given, if the concepts seem to be applicable to your situation, I encourage you to turn your CD player off and make a few notes regarding the application of the principle to your setting.  However, these notes are for your purposes only and are not to be sent to the Institute.  Also each track is very content dense.  So feel free to replay the track to review the content either for your own purposes, or if you feel appropriate play the track in an individual or group session for client education.  Also permission is granted to reproduce this CD.  We encourage you to duplicate and give copies of this CD to colleagues, clients, etc. as you deem appropriate. We feel the information on our CD's is valuable.  Thus, we have an interest in distributing CD's in as many ways as possible, to benefit the greatest number of people, who have a need and are receptive to this practical information.

The questions in your Answer Booklet are sequential and deal with the section of content that preceded it.  For this reason, to facilitate the answering of each question, you might read the question from the Answer Booklet prior to listening to that CD track.  By knowing what the question is ahead of time, you will then know the content to listen for that contains the answer.  So just a hint, after you write down the answer to a question in your Answer Booklet, read on to the next question in order to give you a “heads up” to listen for the content that contains the answer to the next question.

Merely write the correct letter on the corresponding blank line in your answer booklet. Each answer is only used once. Keep in mind there is nothing tricky or hard about these questions.  They are merely intended to verify the playing of this CD.

For the purpose of brevity, most generally, I will use the term “therapists” or “mental health professional.”  However, don’t let these terms deter you from applying the concepts to your situations.  When you hear the word “therapists,” if your job title is social worker, psychologist, marriage and family therapist, mental health counselor, professional counselor, resident director, program assistant, etc. merely substitute the appropriate term that is the most meaningful to you. In short, don’t let my use of the term “therapists” cognitively set you off track from hearing the content because your job title is school counselor, for example.  I will also use the term “client” for the purposes of brevity.  However, if you deal with patients, residents, students, consumers, etc., transpose “client” for the term that is the most meaningful to you in your work setting. 

On this CD set we will discuss such topics as: binging motives; manifestations of depression; self-image distortion; binge triggers; interpersonal relationships; anxiety; anger; boredom and loneliness; restoring confidence; binging levels; redefining hunger; binge regression; the compulsive dieter; and releasing diets.

So  let’s get started

As you are aware, many eating disordered clients become trapped in the binging and purging cycle.  During a binge, the client may consume nearly twice his or her daily required intake of calories.  Subsequent to one of these overeating sessions, the client will purge him or herself of the fattening foods.  In his book, “Bulimia Nervosa and Binge-Eating:  A Guide to Recovery”, Peter Cooper described the binging purging cycle as “the powerful and intractable urges to overeat followed by attempts to avoid the ‘fattening’ effects of food by inducing vomiting, abusing purgatives, or both.” 

Most people associate the binge-purge cycle with the eating disorder bulimia nervosa, but in fact, clients who may not fall under the same criteria for bulimia may binge as well.  Instead of using laxatives or purgatives, however, the client may not take such extreme measures to purge.  Instead of fasting, they may go on a more restricted diet or not even technically purge at all.  However, the feelings of guilt and shame are the same.  The first half of this course will deal with bulimic clients, while the second half will address a more general population of bingers and purgers.

On the rest of this track, we will examine four motives clients have for binging.  These four binging motives include: avoiding failure; handling stress; postponing sexual relations; and eliciting attention. 

#1 Avoiding Failure
The first motive for binging is avoiding failure.  In these instances, clients tend to be under an additional stressor.  He or she may be anxious about this stressor and may binge instead of taking action.  The client may postpone taking responsibility by first binging and then tackling the assignment is causing his or her anxiety.  The client that fails at a task may remark that he or she failed because of the binge the night before rather than admitting that they were not prepared.  Clients who use binging to avoid failure ultimately are trying to find a scapegoat in an attempt to defend themselves against a blow to the irself-esteem.  They blame the disorder instead of facing their shortcomings.

Linda, age 20, would binge the night before a final exam.  She stated, “I would become so worked up, I would consume the entire contents of my mini-fridge!  This could include a whole jar of peanut butter, all my milk and cereal, half a bag of chips, and three bowls of ramen noodles!  The next day I would feel so sick that if I did poorly on the test, I would chalk it up to being sick.  My mom once asked me why I had failed this test.  I told her I hadn’t been feeling well and the professor wouldn’t let me take it another time.  In reality, I hadn’t even asked my professor for an extension.  I lied outright to my mother so I could feel better about myself.”  Think of your Linda who is binging.  Is he or she lying to him or herself and others in order to cover up faults?

#2 Handling Stress
The second motive for binging is handling stress.  The act of binging or even the mere thought of binging can serve as a means of escape from a stressful situation, and most especially those related to social events.  The binging and purging client’s pattern of obsessive thinking allows him or her to separate from the person or people he or she is with at the moment.  This client will use the thought to cope, like a worry stone, repetitively creating and calling up images of binging and overeating.  Like an obsessive compulsive client, the binging client uses his or her obsession to calm an otherwise anxious mind and to completely dissociate from the world around him or her. 

Gina, age 23, used her bulimia as a stress reducer.  She stated, “I attended a party that included some well-known people.  As usual, I felt tongue-tied, dumb, and inconsequential!  As usual, I smiled sweetly and engaged in chitchat.  All the time, though, I was secretly planning a midnight binge when I returned home!  I started this binging in order to alleviate the anxieties I had about undertaking new things and to provide myself with an excuse to take a rest from everything once in a while!”  I stated to Gina, “But you don’t have to put your health in danger in order to have an excuse to relax.  Everyone deserves a break.  It’s what we do with that break that tells us something about ourselves.  Instead of binging, I want you to think about another relaxing activity that does not involve food.  One that you will enjoy and will also serve your need to ‘get away’ every once in a while.”  The next week, Gina stated, “I thought about what you said, you know, about relaxation activities.  So I made myself a little vacation in my bathroom.  I put a waterproof stereo on the counter, I bought some aromatherapy candles, and a ton of books.  When I’m feeling overwhelmed, I retreat to my vacation in the bathtub.  I still have the urge to binge, of course.  But this has given me an alternative to think about.”  Think of your Gina.  What other ways could he or she get away from societal pressures?

#3 Postponing Sexual Relations
The third motive for binging is postponing sexual relations.  A binging client may use their binging in regards to sex in a number of ways.  First, clients may tell their partners that they are too “stuffed to have sex” in order to avoid being both physically and emotionally vulnerable.  Like the client who wishes to avoid failure, clients who use their binging to avoid sex may have issues with the emotional weight involved.  Second, the client may use binging to compensate for a disappointing sexual encounter.  This can result from rejection or simply dissatisfaction in performance or enthusiasm. 

Terry, age 22, would binge after having sex with her former boyfriend.  She stated, “He was a horrible lover!  He didn’t care about my needs at all!  To tell you the truth, most of the time he coerced me into sex!  It wasn’t rape because he didn’t lay a hand on me, but I didn’t really consent either.  Afterwards, I would eat an entire package of Oreo cookies.  I would say to myself, ‘I love you, even if he doesn’t!  Go ahead and eat if it makes you feel loved!’  I just wanted some kind of happy feeling after sex, even if I couldn’t get it from him.”  We will discuss the technique “Exploding with Exaggeration” which I used to treat clients like Terry, on track 2.  Think of your Terry.  What issues regarding sex could he or she be hiding through his or her binging and purging? 

#4 Eliciting Attention
In addition to avoiding failure, handling stress, and postponing sexual relations, the fourth motive for binging is eliciting attention.  This type of client uses the disorder in an attempt to become noticed and an object of sympathy in his or her social network.  In another way, it may also be a form of revenge against those the client perceives to be the cause of the disorder.  Obviously, this is the ultimate way of avoiding responsibility for the behavior.  Instead of accepting the feelings of guilt and disappointment after a binge resulting from their own behavior, some clients will try and transfer guilt.  Not only do these clients harbor grudges, but they also differ from other clients in that they do not acknowledge their own role in the binging and purging.

Stephanie, age 16, used her disorder as a means to gain sympathy from the girls at school.  Instead of trying to find a steady support system of one or two friends, Stephanie would tell an entire group of girls, sometimes numbering up to 11 students.  She stated, “They like me when I’m bulimic.  They think I’m sick and they invite me to sit at their table.  Whenever I feel like I’m ignored, I would tell them I threw up again that day!  They would feel guilty and sometimes I played on that guilt.  I would tell them that they didn’t invite me to the party they had had that weekend and so I felt bad about myself and binged and purged.  They feel better by treating me like a baby and I’m now part of a group!”  Because she used her bulimia as a tool to gain a reputation, Stephanie would become more hesitant towards treatment.  She did not want to give up her only means of gaining social acceptance.  Think of your Stephanie.  Does he or she use his or her bulimia to make friends or enact revenge?

On this track, we discussed four motives clients have for binging.  These four binging motives included: avoiding failure; handling stress; postponing sexual relations; and eliciting attention

On the next track, we will examine three manifestations of depression in binging and purging clients.  These three manifestations of depression include:  guilt; worthlessness; and social withdrawal.

QUESTION 1
What are four motives clients have for binging? To select and enter your answer go to Answer Booklet.