In addition to vomiting, clinicians and researchers have outlined several means by which women with bulimia nervosa purge, including fasting, exercise, laxatives, emetics, diuretics, thyroid hormone, fluoxetine, sorbitol, enemas, heroin, and tobacco (Bulik, 1992; Mitchell, Hatsukami, Eckert, & Pyle, 1985; Pyle, Mitchell, & Eckert, 1981). The following report presents an additional method of purging, namely with excessive dietary fibre, which was particularly reinforcing as it satisfied the need to binge and purge simultaneously.

Ms. A was a 27-year-old single white female who presented for outpatient treatment with a 1-year history of “out of control” binge-eating. She reported no prior history of any eating or weight disturbance. At the beginning of treatment she was 172.7 cm and weighed 64.5 kg (BMI = 21.6). She reported her desired weight to be 59 kg. The onset of her eating disorder was 1 year prior to treatment after moving, taking a new job, and beginning a relationship with a man whose diet consisted mainly of junk food.

During the first few months of the relationship, she gained (4–4.5 kg) and became quite concerned. She was distraught at not fitting into her clothes and disliked her body at that weight. She began a very restrictive diet, losing 6 kg in 2 weeks. Following that 2-week period, she “lost control” and began to binge-eat. This pattern of alternating binge and fast periods and 5 kg weight fluctuations continued for 1 year. With every subsequent binge period, she reported feeling more out of control.