I am a night binger. I eat normally but then towards bedtime I am ravenous. I don’t keep sweets in the house. Yet, around midnight, I go downstairs to the local deli and buy junk food. Bread, ice cream, stuff like that. Then I throw up afterwards. Disgusting. For a while I thought it was a clever way to not get fat. I reasoned, “Ballet dancers do it” so it can’t be so bad. But after my sister got engaged, it did get bad. That was a year ago. So I now know I have a problem. However, it’s extremely embarrassing. I don’t want anyone to know. How can I help myself?

Dr. J replies:

You’ve already taken an important step by acknowledging that you do have a problem and that you do need help.

An eating disorder means precisely that… a disordered relationship to food, whether or not your weight is technically normal for your height and body frame. While bulimia is embarrassing for you, it is also a significant symptom. Your motivation for throwing up exists in a “psychological” blind spot, which is another way of saying it is “unconscious.” Without outside help, you probably cannot change this behavior.

Binge eating frequently leads to throwing up. The cycle of being empty and then full, or full and then empty is your body’s way of dealing with intense forbidden feelings. Binge eating not just fills your stomach. It is a desperate effort to fill a sense of inner emptiness and address emotional hungers you may not be aware of. It is followed by the act of purging — a way to symbolically eject unwelcome or even unbearable feelings.

The uses and misuses of food as a way to deal with psychological pain often go back to childhood. But a “triggering event,” such as your sister’s engagement, provides some clues as to what feeling states and issues are involved.

Ask yourself, “what are some of the things that might account for your sense of being empty?” Early childhood traumas sometimes interfere with the consolidation of a sense of self. Or the self you are aware of does not feel vital and present. Perhaps you are depressed?

And ask, “what feelings might you symbolically be evicting?” I wonder if the engagement means to you that your sister will have a full bed while you have an empty one. So perhaps there is some envy of her situation or a resurfacing of competitive feelings? Or you may fear she will have no room in her life for you, that you are being replaced? Your empty
feelings surface at bedtime, linking it with feelings about loneliness, sexuality, and conflictual feelings about relationships.

Clearly, these are all speculations, but I hope you will consider psychotherapy. Medication alone, or nutritional counseling alone is rarely sufficient. In the safety of a professional relationship, you will come to explore these different possibilities. That understanding may allow you to stop binging and purging.