Interpersonal Psychotherapy for Bulimia

Interpersonal psychotherapy (IPT) is a form of therapy originally developed to address the symptoms of the mood disorder called major depression. Practitioners of this therapy view interpersonal difficulties as one of the primary sources of mental health issues, and work with patients to improve four areas of interpersonal function. Current evidence supports the use of IPT as a psychotherapeutic treatment for people affected by the eating disorder bulimia nervosa.  Individuals who receive this therapy commonly experience long-term benefits equal to those associated with other highly regarded options for bulimia treatment.

Interpersonal Psychotherapy Basics

Essentially everyone experiences interpersonal conflict at various points during his or her daily life. Some people withstand these types of conflicts while remaining psychologically stable and healthy. However, others do not tolerate these situations very well, and as a result they develop stress reactions that can trigger mental and/or physical unpleasantness. Interpersonal psychotherapists regard these adverse mental and physical reactions to social conflicts as potential triggering events for the onset of mental health issues. Certain factors can increase the likelihood that any given individual will develop psychological problems as a consequence of stressful social interactions. They include inherited emotional tendencies, the formation of dysfunctional social/emotional ties to others and the influence of early life experience on the development of specific personality traits. The founders of interpersonal psychotherapy originally designed the therapy in the 1970s in response to a perceived lack of scientifically reputable psychotherapeutic treatments for people affected by major depression. Since that time, use of the therapy has spread to the treatment of a variety of mental disorders. The typical IPT treatment takes place over six to 20 weeks in an outpatient setting. Each week, the therapist conducting the treatment will focus on any one of four possible areas of interpersonal conflict: overt disagreements with other people, issues related to loss and grief, problems related to cultivating and keeping intimate relationships or friendships, and problems related to the need to take on different social roles. Techniques used to address these areas of interpersonal conflict include role-playing, analysis of specific incidents and assessments of a patient’s general communication style.

Bulimia Basics

Bulimia nervosa is one of three eating disorders fully recognized by the American Psychiatric Association. People with the disorder eat excessive amounts of food during temporary episodes called binges, then find some way to eliminate the calories of the foods they consume in order to avoid gaining weight. Some individuals have a subtype of bulimia called purging bulimia, which centers on intentional vomiting or the abuse of laxatives, enemas or diuretics for the purpose of calorie elimination. Other individuals have a subtype of the disorder called nonpurging bulimia, which centers on the use of calorie-eliminating techniques such as excessive exercise participation, temporary suspension of food consumption (i.e., fasting), or heavy restriction of food intake.

Use in Bulimia Treatment

At the beginning of IPT treatment for bulimia, a therapist will point out the connection between interpersonal conflict and the origins of bulimic behaviors. However, the Society of Clinical Psychology reports, once this connection is made, the therapist will typically not directly address or discuss bulimia during most of the treatment that follows. Instead, he or she will focus on the specifics of the patient’s interpersonal problems. During the first phase of treatment, the therapist spends time identifying the specific interpersonal issues present in any given individual. During the second phase of treatment, the therapist allows the patient to guide the search for appropriate solutions to the identified issues. During the third phase of treatment, the therapist helps his or her patient learn how to solidify the gains made during IPT and prevent a recurrence of bulimic behaviors. Most people receive interpersonal psychotherapy for bulimia in one-on-one sessions with their therapists; however, group approaches have also produced positive results for some individuals. Apart from interpersonal psychotherapy, the most well-known psychotherapeutic treatment for bulimia and other eating disorders is a group of techniques collectively referred to as cognitive behavioral therapy, or CBT. In fact, CBT is widely regarded as the gold standard of eating disorders-related psychotherapy. Interpersonal psychotherapy works more slowly than cognitive behavioral therapy, and immediately after treatment ends, bulimia-affected individuals who participate in CBT commonly experience greater levels of improvement than bulimia-affected individuals who participate in IPT. However, after roughly one year, the two psychotherapies produce more or less identical benefits, and interpersonal psychotherapy has proven usefulness as a long-term bulimia treatment.  

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