Expert: Joanne - 3/15/2008

Question
My girlfriend suffers from bulemia. She knows she has a problem, but can't afford a therapist, refuses to do group therapy, and admits she can't do it alone even with me helping. She binges and the purges and than lies to me about it even though i find the packages of cookies and chocolate hidden everywhere. I don't know what to do, it's almost like she doesn't want help, and I'm a personal trainer so the whole diet aspect is extremely important to me, so her lying to me about it frustrates me. And she seems to not want to get help, so i'm seeking it for her!

Answer
B

Unfortunately you can not get the help for her!  She needs to want to do this for herself.  She needs to want to do this for herself as well, it is not enough to want to do it for you, family or friends.  She needs to realise that for her own health, happiness, and even life, she needs to do this and do it soon.  She knows she has a problem - that is great, but now she needs to own that problem and want to change her ways.

There is a 'model of behavioural change' that is used by people in the health care profession

Pre-contemplation -> Contemplation -> Preparation -> Action -> Maintenance -> Relapse/Termination ->Pre-contemplation -> Contemplation, etc

Your girlfriend realises she has a problem so would most likely be in the contemplation stage.  She needs to be in the preparation stage before she will be able to start to recover.  She needs to be ready, willing and planning what action to take, and by sounds of it, she is not doing that!  It looks like she is looking for excuses possibly - I can understand that finance may be a problem, however it may be worth talking to her Doctor to find out what is in her area and within her financial limits.  I'm not sure where you are from, and if you are from the US rather than the UK, I know you don't have the same health system as we do in the UK, but can't imagine that there will be nothing out there for those that aren't wealthy!  Unfortunately, it may just take a bit more searching for it!  Group therapy can be intimidating, but it can also be even more helpful in some cases than individual therapy.  It can be reassuring to know that people are having similar experiences to your own and be able to relate and advise you.  Many therapists may not have experience with eating disorders, so although may be able to help you get to the root of the problem, may not be able to advise you what to do about the eating disorder itself.

What is her relationship with her family like?  Is there any chance of any sort of support (emotional, practical or financial) from them?  Although you have to be careful about how you go about confronting someone with an eating disorder, it doesn't mean that you shouldn't confront them!  Tell her how this makes you feel.  Speak about it from your own view point, but avoid sounding accusatory, such as starting sentences with 'I feel, or I think...' rather than 'you make me feel, you are...'.  This sounds like a strange thing to ask, but it just helps to know that you aren't accusing her of anything, helping her to realise that the way you feel or what you think isn't directly because of her, but because of the illness.  It is easy for someone with an eating disorder to turn things round in their head.  'You are really upsetting me/worrying me' turns into 'I'm a horrible person, I'm making my b/f so worried' the guilt and feeling horrible and worthless then feeds into the eating disorder.  "I'm concerned because..." just seems slightly better, and is less likely to be turned around as much.  Let her know that you do not appreciate being lied to, and that you are there to help and support her without judgement, providing she is honest with you.

Let her know that you can only help her as long as she is going to help herself, as until she starts to recover, you will never have a full and trusting relationship.

Joanne