chapter  11
14 Pages

MANAGING PURGING

Introduction Purging, especially self-induced vomiting, is a difficult behavior to extinguish. Patients usually agree when we say that purging is the eating-disorder (ED) behavior that is most addicting. We respectfully acknowledge that purging may seem like a logical solution to a number of problems. Besides an ersatz weight-management tool, purging provides short-term relief of anxiety, resulting in relaxation, exhilaration, and even a sense of “purity.” To be effective with patients who purge, we find that we must be sympathetic, tolerant, and understanding of each patient’s difficulties, particularly his or her embarrassment about purging. We keep in mind that correcting purging behaviors takes much effort on the patient’s part and constant encouragement and help with problem-solving on our part. In this chapter, we define and describe purging behaviors (see Chapter 1: Clinical Features of Eating Disorders, pp. 3-31) and then devote the rest of the chapter to describing approaches we use to help patients become free of the compulsion to purge.