Reworking the Myth of Personal Incompetence: Group Psychotherapy for Bulimia Nervosa

by JUDITH ASNER, MSW, BCD

Psychiatric Annals 20:7/July 1990

Group psychotherapy offers a unique format in which some of the more intractable features of bulimia nervosa are amenable to change.

The 1964 edition of "The Abnormal Personality" has little mention of eating disorders as we know them today. Anorexia nervosa and bulimia nervosa are subsumed under gastrointestinal disturbances, with the author stating:

Digestive and eliminative processes are subject to many kinds of disorder. There are disorders of appetite and eating: at one extreme stands bulimia, marked by inordinate appetite and excessive eating; at the other extreme, anorexia nervosa, a loss of appetite so exaggerated that it sometimes threatens life.

In a mere two decades, with the cultural sway toward slimness, eating disorders have become a major health problem. Eating disorders have become so prevalent that they are included in the DSM-III-R as discrete clinical phenomena.

Bulimia nervosa is a compulsive eating syndrome characterized by uncontrolled binges followed by self-induced vomiting, laxatives, or diuretic abuse. Ambivalence, dysphoria, and self-deprecating thoughts accompanied by an over-concern with slimness are yet other features of this disease. The vast majority of those afflicted with this disorder are young women between the ages of 14 and 42, with the majority falling in the adolescent and young adult age ranges. Currently, 8% of all females and 1% of males are diagnosed as bulimic, according to DSM-III-R criteria.² The prevalence of the disorder under-scores the need to examine treatment successes critically and to continue to develop viable methods that combine the best of group, individual, and pharmacotherapy strategies. Although comparative studies have vet to demonstrate the superior efficacy of group psychotherapy, a considerable body of literature suggests many of the symptoms of the bulimic patient may be reduced through this modality.³

Group psychotherapy offers a unique format in which some of the more intractable features of bulimia nervosa are amenable to change. In particular, intense feelings of alienation and shame are reduced by sharing the secret of the binge-purge cycle. Perfectionism, unrealistic expectations, and negative beliefs about the body and the self may be challenged by other group members. Identification of feelings may take place in an atmosphere conducive to interpersonal learning.^3-18 Moreover, in a medium in which trust develops, the myth of personal incompetence-the belief that an individual has no value apart from her slimness-can be challenged.

Because the group symbolically represents the nuclear family, childhood traumas can be reworked and resolved in the group setting. As such, group psychotherapy offers a viable modality for patient recovery.

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