Academic journal article Journal of Cognitive Psychotherapy

Triggers of Self-Induced Vomiting in Bulimic Disorders: The Roles of Core Beliefs and Imagery

Academic journal article Journal of Cognitive Psychotherapy

Triggers of Self-Induced Vomiting in Bulimic Disorders: The Roles of Core Beliefs and Imagery

Article excerpt

Recent evidence has suggested a specific role for core beliefs in the triggering of bulimic behaviors. However, less is known about the role of imagery in this link despite its role in other disorders. The present study aimed to investigate the potential roles of core beliefs and imagery in triggering self-induced vomiting. Thirty bulimic women took part in a semistructured interview focusing on their mental processes prior to vomiting and completed a self-report measure of core beliefs. The results showed that prior to vomiting, a clinically significant proportion of bulimic patients reported thoughts relating to defectiveness/shame, failure, and social isolation core beliefs and associated feelings of shame and anxiety. Most patients perceived these feelings as triggers to their vomiting. A large number of bulimic patients also reported experiencing visual images prior to vomiting, and those images tended to be recurrent and linked to adverse life experiences. Overall, the findings suggest that defectiveness/shame, failure, and social isolation core beliefs and recurrent negative images (linked to adverse life experiences) may play important roles in the triggering of self-induced vomiting in bulimic disorders.

Keywords: bulimia; anorexia; vomiting; core beliefs; schemas; imagery

To date, most cognitive theories of bulimia have stressed the role of negative automatic thoughts or dysfunctional assumptions regarding weight, shape, and food. While there is good evidence in support of the roles of these cognitive structures (e.g., Rieger et al., 1998), recent findings suggest that they may not be sufficient to explain cognitive content in bulimic psychopathology. Evidence for this comes from two sources. First, while cognitive-behavioral therapy (CBT) is effective in the treatment of bulimia nervosa, leading to a complete remission of eating disorder symptomatology in approximately 40% to 50% of cases and a reduction of bingeing and purging symptoms in about 80% of cases, there is little conclusive evidence that CBT in its existing form is more effective than other treatments. Results from two controlled trials have shown that interpersonal psychotherapy is about as effective as CBT in the longer term (Agras, Walsh, Fairburn, Wilson, & Kraemer, 2000; Fairburn et al., 1995). Second, there is now considerable evidence showing that negative emotional states can precipitate bulimic behaviors (e.g., Fairburn, Cooper, & Shafran, 2003; Meyer, Waller, & Waters, 1998). Models of bulimia that have incorporated this evidence have suggested that bingeing may serve the function of reducing awareness of negative emotional states (e.g., Cooper, Wells, & Todd, 2004; Lacey, 1986; Waller, Kennerley, & Ohanian, 2007). However, the functions of vomiting are less clearly established.

Theoretical accounts, such as the anxiety reduction model proposed by Rosen and Leitenberg (1985), have suggested that vomiting in bulimics may serve as an "escape" response, reducing the anxiety about body shape and weight, triggered by eating "forbidden foods." To date, most research examining subjective events preceding an episode of self-induced vomiting has focused on cognitions relating to shape and weight. The limited success of current CBT approaches, as well as initial findings indicating a role for alternative preceding experiences such as affective states, suggest that current cognitive-behavioral models of bulimic behaviors do not fully account for bulimic pathology and need to be broadened to integrate these findings. Two promising areas for further exploration include the potential role of core beliefs in triggering self-induced vomiting and the potential relevance of imagery.

The Potential Role of Core Beliefs

Given the failure of current cognitive-behavioral interventions to induce change in a substantial minority of bulimics, it has been suggested that the models on which they are based do not sufficiently account for the roles of past experiences and core beliefs in the development and maintenance of eating psychopathology (Cooper et al. …

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