Clinician's Guide to Getting Better Bit(e) by Bit(e)

A Survival Kit for Sufferers of Bulimia Nervosa and Binge Eating Disorders

Janet Treasure, Ulrike Schmidt

• Publisher: Routledge
• Year: 2013
• Print ISBN: 9781138872042
• eBook ISBN: 9781135816117
• Topic: Psicologia
• Subtopic: Storia e teoria della psicologia

The publication four years ago of Getting Better Bit(e) by Bit(e), written by two eating disorder specialists at London's world-famous Maudsley Hospital, was a milestone in the treatment of bulimia.

For the first time a self-help book was shown, by rigorous clinical trials, to cure a significant fraction of women suffering from bulimia, and to reduce the therapist contact time needed by others. Getting Better Bit(e) by Bit(e) offered an efficient way of treating bulimic patients, which would be valued by any resource-conscious health service.

The authors of Getting Better Bit(e) by Bit(e) have now written this Clinician's Guide, to help health care professionals maximize the benefit that patients obtain from the self-help book. Based on the authors' wide-ranging experience of treating eating disorder patients, it provides a step-by-step account of how the chapters in Getting Better Bit(e) by Bit(e) can be used to ameliorate various aspects of bulimics' difficulties, with examples drawn from real patients' case histories. Particular emphasis is given to the problem of motivating patients who are reluctant to change their behaviour, using Miller and Rollnick's motivational interviewing approach.

The Clinician's Guide to Getting Better Bit(e) by Bit(e) will be invaluable for all those treating sufferers of bulimia.

CHAPTER ONE
The Way Forward

DO I SUFFER FROM BULIMIA?

There is a bewildering number of labels that acknowledge that a person has a problem with overeating and is distressed about it. You may have come across some of them: compulsive overeating, bulimia nervosa, bulimia, binge eating disorder, or bulimarexia. These labels overlap and have an awful lot in common with each other. Problems with overeating can occur in people of any body weight (skinny, average, and overweight). This book has been written for people who fall into any of these categories. If you are unsure whether any of this fits you, fill in and score the test in Table 1.1.

If your severity index score is 5 points or above, it is very likely that you have a significant eating disorder at present.

If your symptom score is 15 points or above, you have a lot of the thoughts and attitudes that go with an eating disorder and are clearly distressed by it.

HOW TO USE THIS BOOK

Like many people, you may have the habit of starting books at the end or in the middle, perhaps flicking through the pages and beginning with a chapter with a particularly catching title. In principle there is nothing to stop you doing that with this book, but there are a few things that you need to know before you make a start: Chapters 1 to 6 are the core

TABLE 1.1
Bulimic Investigatory Test, Edinburgh

Questions	Scores
1. Do you have a regular daily eating pattern? Yes = 0, No = 1	___
2. Are you a strict dieter? Yes = 1, No = 0	___
3. Do you feel a failure if you break your diet once? Yes = 1, No = 0	___
4. Do you count the calories of everything you eat, even when not on a diet? Yes = 1, No = 0	___
5. Do you ever fast for a whole day? Yes = 1, No = 0	___
6. If yes, how often is this? Have once = 1; now and then = 2; once a week = 3; 2–3 times a week = 4; every second day = 5	___
7. Do you do any of the following to help you lose weight? (a) Take diet pills; (b) Take diuretics (water tablets); (c) Take laxatives; (d) Make yourself vomit. Never = 0; occasionally = 2; once a week = 3; 2–3 times a week = 4; daily = 5; 2–3 times a day = 6; 5+ times a day = 7. Answer questions 7 (a)–(d) separately, then add them all up.	___
8. Does you pattern of eating severely disrupt your life? Yes = 1, No = 0	___
9. Would you say that food dominated your life? Yes = 1, No = 0	___
10. Do you ever eat and eat until you are stopped by physical discomfort? Yes = 1, No = 0	___
11. Are there times when all you think about is food? Yes = 1, No = 0	___
12. Do you eat sensibly in front of others and make up in private? Yes = 1, No = 0	___
13. Can you always stop eating when you want to? Yes = 0, No = 1	___
14. Do you experience overpowering urges to eat and eat and eat? Yes = 1, No = 0	___
15. When you are feeling anxious do you tend to eat a lot? Yes = 1, No = 0	___
16. Does the thought of becoming fat terrify you? Yes = 1, No = 0	___
17. Do you ever eat large amounts of food rapidly (not a meal)? Yes = 1, No = 0	___
18. Are you ashamed of your eating habits? Yes = 1, No = 0	___
19. Do you worry that you have no control over how much you eat? Yes = 1, No = 0	___
20. Do you turn to food for comfort? Yes = 1, No = 0	___
21. Are you able to leave food on the plate at the end of a meal? Yes = 0, No = 1	___
22. Do you deceive other people about how much you eat? Yes = 1, No = 0	___
23. Does how hungry you feel determine how much you eat? Yes = 0, No = 1	___
24. Do you ever binge on large amounts of food? Yes = 1, No = 0	___
25. If yes, do such binges leave you feeling miserable? Yes = 1, No = 0	___
26. If you do binge, is this only when you are alone? Yes = 1, No = 0	___
27. If you do binge, how often is this? Hardly ever = 1; once a month = 2; once a week = 3; 2–3 times a week = 4; daily = 5; 2–3 times a day = 6	___
28. Would you go to great lengths to satisfy an urge to binge? Yes = 1, No = 0	___
29. If you overeat do you feel very guilty? Yes = 1, No = 0	___
30. Do you ever eat in secret? Yes = 1, No = 0	___
31. Are your eating habits what you would consider to be normal? Yes = 0, No = 1	___
32. Would you consider yourself to be a compulsive eater? Yes = 1, No = 0	___
33. Does your weight fluctuate by more than 5 pounds in a week? Yes = 1, No = 0	___
Adding up and analysing the scores
Total for questions 6, 7 and 27. This will give you a severity index.	___
Total for all other questions. This will give you a symptom score.	___

Adapted from M. Henderson & C.P.L. Freeman (1987). British Journal of Psychiatry, 150, 18–24. Reproduced with permission.

chapters that will teach you all the steps you need for cracking unhealthy eating habits. It is sensible to read chapters 1 to 6 together, but you can do this in whatever order you like. With the help of these chapters you will be able to decide whether you are correct in making the decision that you want to get over your bulimia and are ready to do so.

If in addition to a problem with your eating habits you are also overweight, you should include chapter 7 in your initial reading.

Chapters 8 to 14 focus on the links between your eating disorder and the rest of your life. You can read them at a leisurely pace over the next few weeks, in whatever order you like. The aim of these additional chapters is to help you spot problems in different areas of your life, to get you to make some connections with factors that may have contributed to the origins of your eating problem or are obstacles for overcoming it.

If you are currently drinking heavily or are regularly taking drugs, you should look at chapter 12 early on. Drug and alcohol problems make your eating difficulty much more difficult to control and should therefore be tackled early on. Chapter 12 will help you (a) to assess how serious your alcohol/drug problem is, and (b) to decide what to do about it.

FIRST STEPS

Are You Ready to Undertake the Journey?

Before starting, it is important to dip into the core chapters (2–6) of the book to obtain basic background information.

Read chapters 2, 3, 4, 5, & 6 Now. Don’t attempt to follow any of the instructions given there, skip over these. Re-read each chapter until you are sure that you have been able to take the information on board. Are you ready to undertake the journey?

• Now, when you have a quiet hour, work on writing your bulimia balance sheet.

First, take a large sheet of paper and divide it length-wise into two main columns. At the top of one column write, “Reasons for giving up bulimia”, and on the other write, “Reasons for staying bulimic”. You may have important reasons to fear change from familiar behaviour, and yet part of you is desperate to shake yourself out of the vicious circle that is keeping your bulimia nervosa going. It is impossible to keep all these thoughts and ideas together in your head at one time as our memory has its limits, and so there is a tendency to swing from one side of an argument to the other. Writing a balance sheet will help you to deal with all of your thoughts systematically. Plan to work on this project during a week—keep going back to it each day.

In order to focus your thoughts, make four divisions across the sheet and at the start of each row, write:

1. Practical gains and losses for SELF
2. Practical gains and losses for OTHERS
3. Emotional gains and losses for SELF (self-approval or self-disapproval)
4. Emotion...

Table of contents

• Cover
• Half Title
• Full Title
• Copyright
• Acknowledgements
• Contents
• Clinician's Guide to Getting Better Bit(e) by Bit(e)
• Appendix: Workbook—Motivational Enhancement Therapy
• Getting Better Bit(e) by Bit(e) A Survival Kit for Sufferers of Bulimia Nervosa and Binge Eating Disorders
• Introduction
• 1. The Way Forward
• 2. Tools for the Journey
• 3. Dieting: A Health Warning
• 4. Bingeing, Nibbling, and Compulsive Overeating: The Black Hole of the Never-satisfied Stomach
• 5. Vomiting, Laxatives, and Diuretics: Have Your Cake and Eat it—Or Not?
• 6. Learning to Feel Good about Your Body
• 7. Jack Spratt's Wife: Being Fatter May be Better
• 8. Relapse: Walking In Circles—Or Not?
• 9. The Wounds of Childhood
• 10. Food for Thought
• 11. Finding Your Voice
• 12. The Seduction of Self-destruction
• 13. The Web of Life: Parents, Partners Children, and Friends
• 14. Working to Live, Living to Work
• 15. Is this the End of the JourneyȔOr Not?
• Appendix
• Some Useful Addresses