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FACULTY OF LEADERSHIP AND MANAGEMENT



COUNSELING PROGRAM

ABNORMAL PSYCHOLOGY

ABA 3273



REPORT ON EATING DISORDER FILM:
SHARING THE SECRET



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Prepared for,
DR. NURHAFIZAH BINTI MOHD SUKOR



Prepared by,
NOOR ARIFAH BINTI BUJANG 1110530
SITI SYAHIRAH BINTI AHMAD 1110534
NURUL SYUHAIDA BINTI AMAN 1110535
NURUL IZZATIE BINTI IDRIS 1110538


KAB (TAB1)




Semester II 2013/2014

TABLE OF CONTENT

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No Content Page
1 Introduction 1
2 Synopsis of the Film 2
3 Background Information 4
4 Presenting Problems
a. Causes
b. Symptoms

6
8
5 Diagnosis 10
6 Treatment and Management for Bulimia Nervosa
a. Medical Intervention
b. Psychological Intervention

13
14
7 Conclusion 19
8 References 21








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1. INTRODUCTION
There are four types of eating disorder. Since eating disorder can be dangerous yet can
jeopardize someones life, it shouldnt be taken lightly. Everyone should be aware of all symptoms
of eating disorder and take serious effort to not involve on it. Those four types of eating disorder
are Anorexia nervosa, Bulimia nervosa, Obesity and Binge eating. First is a Anorexia nervous
disorder in which the person eats nothing beyond minimal amounts of food, so body weight
sometimes drop dangerously (Barlow & Durand, 2012). Meaning here, for those who are having
anorexia, they didnt eat and eat only a little just to make sure they are alive.
Second is Bulimia nervosa, which can be defined as out- of control eating episodes, or
binges then followed by self-induced vomiting, excessive use of laxatives or other attempt of purge
of food. Usually they will try to vomit or throw up right after they eat before the food is able to
digest in the digestive system. But according to the book Understanding Eating Disorder:
Anorexia Nervosa, Bulimia Nervosa and Obesity by Mott L. A and Lumsden D. B, bulimia can be
referred as regular episodes of eating very large quantities of food that are generally highly caloric
and easily ingested, followed by vomiting, fasting, vigorous exercise, or using laxatives or diuretic
in an attempt to get rid of the food.
Third, eating disorder also includes binge eating as people will binge repeatedly and find
it distressing, but do not attempt to purge the food. They will regret what they have eaten, but have
no effort to get rid of it. Binge eating often involves consuming a lot junk foods which are
unhealthy to the body system.
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Last but not least obesity also can be included in eating disorder. As cited by Rossen L.
M. And Rossen E. A. (2012), the World Health Organization (WHO, 2010) said that obesity can
be defined as abnormal or excessive fat accumulations that present risk in half.
2. SYNOPSIS OF THE FILM
As the world becomes more complicated day by day, human being become weirder and
sometimes we can call it insane as human dont appreciate what really they have in life. Following
that, there are many psychological disorders discovered over decades yet, the population increase
each time. So, among all those disorders, one of it is eating disorder in which always occurs in
female. Because of this awareness, further research need to be discussed.
So, following the seriousness of recent disorders, we have chosen the movie Sharing the
Secret played by Alison Lohman, Mare Winningham and more as a review. This movie is very
good because it shows many symptoms and the conflict of being Bulimia Nervosa in youth life.
All the symptoms and behaviors are fitted to the disorder and we can learn about eating disorder
just by watching it.
The movie is about a teenager named Beth Moss, who obsesses about her appearance and
her body shape has turned into Bulimia Nervosa after she hides all the symptoms all by herself.
The story began when she and her father having a meal at a restaurant and she only stares at her
plate and her eyes was wide awake when a fat lady and a thin lady passed by and after that Beth
had gone to the toilet.
Beth usually doesnt eat in front of people, although she will stay at the table. Instead, she
will play with the foods and continue talking so that no one will realize that she didnt take her
meal. Later, there are many symptoms that she heard from others and continue her life until one
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day she did some mistake in her ballet class and her teacher asked if she is okay to which she
21replied dont say anything to her mom.
As the symptoms become greater to the point that she passed out at school and couldnt
hide it anymore, she was consulting to her school counselor, but she insists on denying it and after
some forces, she revealed it to her counselor and of course her mother is very upset about her being
purged all this while. Beth said to her mom that she has stopped induced vomiting and live a
normal life but the truth is not.
Next, her mother asked Beth to seek for treatment or therapy but she refused. This is where
conflict arises between mother and daughter as they become hostile and emotional towards each
other. Mom is very disappointed and try to help but daughter is strongly disagree, saying it is her
life not anyone else. As for Dr. Moss, the most painful thing was when she throws out all
substances used for purging, Beth comes toward the toilet, open the seat, self induced and looked
at the mirror like nothing happened. Shocking by Beths action, Dr. Moss couldnt help but shed
into tears. Then, her daughter said her hairs are falling out, heart beats faster and asking for help.
Without wasting any time, Dr. Moss asks for help and go to hospital and Beth was treated
there. Staying in hospital, Beth didnt want to see her father because she didnt want him to see
her being treated like that and continue having a treatment for her eating problem. At the end of
the story, although Beth didnt fully recovered from her problem, but there are positive changes in
her body and she like what she is right now.


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3. BACKGROUND INFORMATION
Beth Moss is beautiful daughter of a child psychologist, Dr. Moss who always takes care
of her daughter. They love each other and share everything except one thing that Beth always
wanted to hide it of. Living together with her mother and as a single child of the family, Beth
sometimes slept over at her fathers home because her parents were divorced and her father had
remarried and have a baby. Beth look normal and going through a happy life though her parents is
not living together yet they dont argue and hostile towards one another
From a professional life, as an 8
th
grade student of high school, she is going through a good
condition where she excels in academic and scores in every subject. At one point, she once was
mistakenly being cheated on her homework saying that she plagiarized the work and been
suspended from coming to school for a period of time and she didnt tell her mother about that.
Aside from academic, Beth also excels and very good in ballet and become one of best
ballerina in her class. Even her ballet teacher praised her for her good job. Because of this too,
Beth need to concern more about her body and monitor her eating so that it cannot ruin her body
proportion.
Adding to it, that is the right start of her health status become chronic as Beth is obsess to
maintain her body and start binging and at the same time been purging to induced vomit. She rarely
eats or drinks and if she started to eat, she will binge and later forced herself to throw up.
In terms of social life, Beth dont really have many friends because everyone seemed to
dont like her because of her good achievement and her best friend is Edward who likes to go to
her home when she was being suspended from school. Other than Edward, Beth also had seen
being with two girls during a party and teach them on how to purge at the bathroom.
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Looking at Beth, she always wanted to achieve as best as she can to the point that she will
jeopardy her own life. She who live more than she can expect wanting to achieve at least one
aspect in her life which is dancing and perfect body. Her life becomes completely difficult because
of her own desire. Moreover, she try hard to impress her mother because she got all the praises
form her and her father too said that she is gorgeous and wish hat she can stop grow up and stay
like she used to be making her even more confuse.
In terms of goal, the most obvious goal Beth desperately want to acquire is to have a perfect
body and beautiful as she can. As a teenager who is going through puberty, Beth seems to struggle
to be beautiful and she would do anything just to achieve her goal. Being ambitious is something
can be proud of but it can be dangerous if it takes too serious.
As she is extremely cautious about her body, she will control her eating meal and been
binging and purging at the same time. With her high goal, it is a must to not take any food and stay
slim. Unfortunately, she become bulimic and having a problem once they news leaked and make
everyone knows it. Here comes the weakness as Beth denies her problem. Beth didnt want other
people to know her secret and keep it just to herself. Even her mom couldnt do anything although
she was forced to go to the therapy but Beth keep insisting that she is okay and bulimic is her
problem not her mom.




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4. PRESENTING PROBLEMS
In this movie there are severe causes and symptom that client (Beth) presents through physical,
emotional, thought, feeling and perception.
a. CAUSES
i. Family conflict
Beth has a family conflict where she has a parent whose divorce and her father is who is remarried
and has a young son. Meanwhile, her mother is a child psychologist who treats children suffering
from emotional difficulties is does not have a new partner but works long hours as a child
psychologist. In this movie show how Beth is adapting and trying to accept parent situation when
her parent is living separately and her parents seem to have worked hard to avoid any openly
expressed negative emotions about their separation, although animosity simmers just below the
surface. This, in turn, has left Beth trying hard to please them both with her compliant behavior
and high academic achievements and she also pretends that shes okay or happy about her situation
now.
ii. Binging
Beth also has a conflict with own self when she is suffering from Binging. Binging is a pattern of
eating involving distress. Bingeing means when someone has a binging she/he tempt to eat a lot
and more like Beth in this movie is she raid the fridge and go out and buy lots of fattening foods
that she is normally avoided and then eat it all, quickly in secret like in her room . She takes a
packet of biscuits, several boxes of chocolates in just a couple of hours. She also takes her mothers
food to satisfy the urge to binge before making herself vomit before she tempt to sleep, but in front
of her parents or friend she doesnt eat anything or eat a lot she just play around her plate . Even
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though she is suffers from binge eating, but she also holds a principle about sugar is my enemy.
When Beth aware that she eat a lot or eat anything she will purge back by inducing vomiting and
this continuous without she aware that she is suffering from bulimic.
iii. Depression
Most of us have eaten for comfort when we have been upset, or even just bored. People with
bulimia are often depressed, and it may be that binges start off as a way of coping with feelings of
unhappiness. Unfortunately, vomiting and using laxatives can leave you feeling just as bad. Like
in this movie Beth actually fell depress when her parent gets divorced and live separately and in
deep she pretend to be happy and okay in front of her parent.
iv. Social pressure
Social surroundings powerfully influence others behavior. Societies which dont value thinness
have fewer eating disorders. Thin is beautiful in Western culture. Television, newspapers and
magazines show pictures of idealized, artificially slim people. So, at some time or another, most
of people try to diet. So, in this movie also show Beth may influence by the magazine at the shop
and at advertisement board, which show a model with ideal body like thin and slim. So, she tries
to be like a model in a magazine and in advertisement board. Other than that pressure from a friend
at school Beth in this movie is a student is young and attractive, she struggles to fit in with her
peers, who are all preoccupied to some extent with their body appearance and the world of dating.
In this movie, Beth also teaches one friend how to purge by inducing vomiting to maintain their
weight to look thin and skinny, but other there are other friend who are tring to aware Beth that
she is skinny enough.

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v. Ballerina
Places where thinness is valued, such as ballet schools have more eating disorders. Beth is a bright
and able student who has a passion for ballet so she tempts to care much on her body to become
thin and slim. She loves ballet class and ballet teacher who is nice with her and always praised the
talent that she have in front of Beth mother. From this she wants to have maintain and perfect body
to become a ballerina and pay a more care about her appearance to maintain her weight to get the
perfect body.
vi. Emotional Distress
We all react differently when bad things happen, or when our lives change like in the movie when
life Beth change after her parent get divorce her emotional become unstable and she is facing
difficult life where is her parent is breaken and this case is disturbing her emotional.

b. SYMTOMPS
i. Bleeding gum
In this movie there is severe symptom are showing by Beth include bleeding gum. Beth gum is
bleeding suddenly because she loses the enamel on her teeth (it is dissolved by the stomach acid
in vomit), but she keeps this symptom secret from acknowledge by her parent and just her friend
know about her.
ii. Pale, headache and collapse
When someone is doing vomit and purge it can make the body become weak and tired all day.
Such as in this movie Beth look pale and she is tired of ballet class while doing ballet, she miss a
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step and almost fall, then her teacher notice that, but she tell her teacher to not tell her mother about
what happen to her in ballet class. Other than that, it also happens when she in her class at school
she having a headache and cant solve the problem question giving by her teacher after class she
go to the toilet and then suddenly she get a collapse
iii. Scar knuckle
After her father finds out about her collapse at school her father bring her to see a physician who
diagnoses her as anemic. When the doctor asks if she has been eating, she says that she usually
eats properly, but has not lately because she was sick. She then hides her scarred knuckles. She
gets the scar from doing vomiting.
iv. Salivary gland enlargement
Beth has a salivary gland enlargement every time when she vomits and purging. In movie the
symptom is showing after her doing vomit and purging. It also make her look like a puffy face
because of the salivary glands in her cheeks swell up.
v. Hair falling out and heart beating rapidly
When Beth mother finds out about Beth condition they have a big conflict between them because
Beth mother felt very fail as a psychologist because she cant notice symptom in her daughter and
then Beth breaks down in tears, telling her mother that her hair is falling out and that her heart is
beating rapidly.


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5. DIAGNOSIS
The DSM-IV recognizes three eating disorders. The eating disorders are characterized by severe
disturbances in eating behavior. The condition of eating disorder describes by abnormal eating
habits that will be involve either insufficient or excessive food intake by the individual. It is related
to the individuals physical and mental health. There are two specific diagnoses which are anorexia
Nervosa and Bulimia Nervosa and eating disorder not otherwise specified which includes binge
eating disorder. As noted, binge eating is required for the diagnosis of bulimia disorder. Based on
the movie, it shows a symptom of bulimia disorder. The DSM-IV criteria (APA, 1994) agree about
the importance of
Compensatory behavior, but distinguishes between the purest type of bulimia nervosa. Actually,
Bulimia Nervosa is characterized by repeated episodes of binge eating. Then, it's followed by
inappropriate compensatory behavior such as self-induced vomiting, misuse of laxative, diuretic
or excessive exercise. There is some controversy concerning whether those who binge eat, but do
not purge should be included within this diagnostic category.
There are three features have to become for people to be said to have bulimia nervosa.
Firstly, the person has frequent binges. A binge is defined as eating, in a discrete period of time an
amount of food that is definitely larger than most individuals would eat under similar
circumstances. Then, the person who is involved in binge eating must have a sense of loss of
control at the time to eat. Secondly, the person who has the bulimia disorder must regularly use
one of a variety of extreme measures for controlling their body shape or weight. This measure
includes intense dieting, fasting, thyroxine, amphetamine or other medication, may occur.
Individuals with bulimia nervosa may fast for a day or more or exercise excessively in an attempt
to compensate for being eaten. As a third for the feature of bulimia disorder is the person must be
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excessively concerned about their body shape or weight or both. At the same time, there should be
an intense fear of fatness or weight gain and control shape and weight that characterize bulimia
nervosa.
Furthermore, in bulimia nervosa however, dietary restriction cannot be maintained and is
broken by episodes of reactive binge eating, which result from a combination of physiological and
psychological factors. Compensatory behaviours follow in order to counteract the effect of binge
eating on weight. The person, therefore, maintains a weight, usually within the normal range
despite overeating but commonly progresses into a vicious cycle of attempted compensatory
purging frequently on a daily basis. The behaviours dominate daily life, the person becomes
preoccupied with thoughts of food and life may be re-organised around shopping, eating and
purging behaviour. Initially, those with bulimia nervosa are generally secretive about their bulimic
episodes, though some may leave obvious signs of their disorder such as empty food packaging
and occasionally bags of vomit for other family members to discover.
Actually, bulimic episodes are frequently planned, with food purchased or prepared in
order to be consumed without interruption. Individuals who has involve with bulimia nervosa are
typically feel ashamed of their eating problems and attempt to conceal their symptoms. The
individual may also avoid situations in which they are likely to be exposed to food or will find it
difficult to control their eating, such as when eating out with others. This avoidance behavior tends
to add to any social and relationship difficulties that may be present in their daily life. In addition,
mood disturbance is extremely common in bulimia nervosa and symptoms of anxiety and tension
are frequently experienced. Then, self-denigratory thoughts may develop out of disgust at
overeating or purging whilst low self-esteem and physical self-loathing may in some be rooted in
the past experience of physical or sexual abuse. After that, self-harm, commonly by scratching or
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cutting, is common. A significant proportion of those who are involved with bulimia nervosa have
a history of disturbed interpersonal relationships with poor impulse control. Sometimes, there are
some people will abuse alcohol and drugs that make them involve with the episodes of disorder.
Based on the movie, it is shown which Beth are always not eat even she has already in
dining table with her family for lunch or dinner. But, she decides to eat alone in her room every
night because she have kept a stock of food like chocolate, sweets, candy and fast food under her
bed. So, she will eat without knowing by her mother, Dr Nina Moss. Based on the Islamic
perspective, Muslim is encouraged to eat together anytime and anywhere. Because, eating with
others bring about harmony and understanding among people, especially in a family member. It
is caused people are usually can feel more relaxed when they eating together. This is called the
Sunnah of the Prophet Muhammad. The Prophet has said, when eating in company, ones mind is
less absorbed in their daily activities and it will become free of worries or anxiety. The Prophet
also brought the attention of Muslim about the importance of eating together. However, eating
together between male and female at parties or banquets is not intermixing. So, eat together and
not separately for the blessing is associated with the company, by Ibn Majah.





6. TREATMENT AND MANAGEMENT OF BULIMIA NERVOSA
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In the movie Sharing the Secret Beth has been diagnosed with Bulimia Nervosa. In the movie,
it can be see that Beth has undergone several types of treatment. For the first time, her mother sent
her to a therapist. Beth claims that she already recover, however her mother then knows her lies.
After that, we can see that she has been hospitalized and undergone treatment.
a. MEDICAL INTERVENTION
As the first step for evidence-based self-help program, a patient that has been diagnosed with
Bulimia Nervosa can be prescribed with anti-depressant under the doctors advice. This drug
therapy used for Bulimia is typically a selective serotonin-reuptake inhibitor
(SSRI) antidepressant. One of the popular and frequent anti-depressant used is called as Prozac.
The use of Prozac has been approved by The Food and Drug Administration (FDA) in 1996. The
effectiveness of Prozac is usually measured by reductions in the frequency of binge-eating, as well
as by the percentage of patient who stop binge-eating and purging altogether (Barlow & Durand,
2009).
Antidepressant medications are used to treat a variety of conditions, including depression and other
mental/mood disorders. These medications can help prevent suicidal thoughts or attempts and
provide other important benefits. Indeed, Prozac is more effective than placebo in the short term,
and may enhance the psychological treatment somewhat, recent research indicate that
antidepressant drug alone do not have long-lasting effects on bulimia nervosa. Besides that, using
antidepressant drugs also might have side effects. Studies have shown that a small number of
people (especially people younger than 25) who take antidepressants for any condition may
experience worsening depression, other mental or mood symptoms, or suicidal thoughts/attempts.
Nausea, drowsiness, dizziness, anxiety, trouble sleeping, loss of appetite, tiredness, sweating, or
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yawning also might occur. Therefore, it is very important to talk with the doctor about the risks
and benefits of antidepressant medication (especially for people younger than 25), even if
treatment is not for a mental/mood condition.
Sometimes, rarely, when the patient has a severe Bulimia Nervosa episode, he or she will need
hospitalization. The hospitalization process happen when the patient has binge-purge cycles that
led to anorexia nervosa. Besides that, when the patient seems a need for drugs because of the
withdrawal from purging, he also need to be hospitalized. The other reason for hospitalization is
because of the present of major depression. Hospitalization provides the patient with protection
and treatment where the doctor will begin returning the patient to the normal eating behavior that
is called as refeeding (Sonenklar, 2011). However, hospitalization may carry an extra risk for
suicide and staff should always keep an open mind throughout the entire stay of patients (Swain,
2006).
b. PSYCHOLOGICAL INTERVENTION
Some doctors recommend a stepped approach for patients with bulimia, which follow specific
stages depending on the severity and response to initial treatments: There are several empirically
supported psychosocial treatments for bulimia nervosa.
i. Evidence-Based Self-Help Program
As a possible first step, patient with bulimia nervosa could follow an evidence-based self-help
programme. Here, therapist could providing direct encouragement and support to the patient.
Besides that, support groups also may be helpful for patients who have mild conditions with no
health consequences. The other treatment in this step is by giving anti-depressant drug toward the
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patient. This evidence-based self-help program may be sufficient treatment for a limited subset of
patients. Sometimes, patients might need more effective psychotherapy.
ii. Cognitive-Behavioral Therapy for Bulimia Nervosa (CBT-BN)
Cognitive-behavioral therapy, or CBT, is the leading evidence-based treatment for adults with
eating disorders especially for bulimia nervosa and is also adapted for use with younger patients.
This treatment is based on a cognitive view of the processes maintaining the disorder (Fairburn,
1997). It is based on the theory that a persons thoughts, emotions, and behaviors are
interconnected and can be restructured to support new, healthier thoughts and actions. Cognitive
behavior therapy provides the foundation for individual and group therapies throughout all levels
of care at the Center for Eating Disorders. By using Cognitive Behavior Therapy for Bulimia
Nervosa, therapist might take 4 to 5 months, around 16 to 20 sessions to treat the bulimia patient.
Cognitive behavioural therapy is a structured treatment that focuses on the present and the future.
According to the cognitive behavioural theory of the maintenance of bulimia nervosa, the patients
over evaluation of eating, shape, weight and their control is the central cognitive disturbance and
is of primary importance in maintaining the disorder (Fairburn, 2005). This cognitive-behavioral
model emphasizes the important role that both thoughts (cognitive) and actions (behavioral) can
play in maintaining an eating disorder. The maintaining factor include cognitive factor and
behavioral factor.
Cognitive factors that always roaming around the patient are over-evaluation of weight and shape,
negative body image, core beliefs about self-worth, negative self-evaluation, and perfectionism.
Imam Ghazali on said, If the first inward thought is not warded off, it will generate a desire, then
the desire will generate a wish, and the wish will generate an intention, and the intention will
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generate the action, and the action will result in ruin and divine wrath. So evil must be cut off at
its root, which is when it is simply a thought that crosses the mind, from which all the other things
follow on. Here, Imam Ghazali obviously said that the first inwards bad thought will generate to
a bigger problem and might ruin ourselves.
The other factors is behavioural factors. In this factor, they are weight-control behaviors including
dietary restraint, restriction, binge-eating, purging behaviors, self-harm, body checking and body
avoidance. As we know, a man was not created to develop unhealthy obsessions with food, weight
and body but to do something better and has a great end. Imam Ghazali has said Know, O
beloved, that man was not created in jest or at random, but marvellously made and for some great
end. Although he is not form everlasting, yet he lives for ever; and though his body is mean and
earthly, yet his spirit is lofty and divine.
Individuals with eating disorders often hold a negative or distorted view of themselves and their
bodies. These highly critical thoughts can result in feelings of shame, anxiety or disgust that often
trigger weight control behaviors and fuel a cycle of negative self-evaluation. Guided by therapist
Cognitive-behavioral therapy aims to maintaining mechanisms through the use of a specific
sequence of behavioral and cognitive procedures.
Cognitive-Behavior Treatment
In cognitive behavioral therapy, there are three stages of treatment for therapist to follow.
a) Stage one
Stage one is about the presentation of the cognitive-behavioral view of the maintenance of
bulimia nervosa. This stage focuses on three major aims. The first aim or objectives is to
engage the patient by explaining and individualizing the rationale underpinning the treatment
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and in particular, the need not only tackle binge eating but also to address dietary restraint and
over evaluation of eating, shape and weight (Fairburn, 2005). Therapist should rationalized the
patient on his or her eating style. For Muslim, therapist might told the patient on how the
Prophet Muhammad (pbuh) has strictly forbidden overeating in the following hadith:
overeating is the source of all diseases, (narrated by Al-Sayuthy cited in Abdillah, 1996).
The next aim in this stage is to educate patients about the disorder and to correct any
misconception about dieting and weight control. Here, therapist should provide education
about body-weight regulation and fluctuations, the physical complications and ineffectiveness
of self-induced vomiting and laxative misuse as a means of weight control, and the adverse
effects of dieting. Prophet Muhammad (pbuh) once advised people not to be extreme in the act
of eating and said No person can fill a dish that is worse than his stomach. It is advice for
the bulimia because most of them tend to do binge-eating. Allah the Almighty also stated in
al-Quran Eat and drink, but be not excessive. Indeed, He likes not those who commit excess
(Quran 7:31). In addition, in Surah Allah said: "Eat from the good things with which We have
provided you and do not transgress [or oppress others] therein, lest My anger should descend
upon you. And he upon whom My anger descends has certainly fallen." (Quran 20:81). As a
human kind, we should not do or eat something that will ruin our body.
The third and last aim in this stage is to help patients start to regain control over eating.
Here, therapist might introduce a pattern of regular eating like a normal people do. A Muslim
therapist could suggest to the patient to eat sunnah food. Prophet Muhammad (pbuh)
said: There is blessing in three things: in the early morning meal, in bread and in soup. It
is mean that, therapist could teach patients to take three meal per day; breakfast, lunch and
dinner. Patient could start with the small amount first. Besides that, patients also should be
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advised to take sunnah food like barleys, dates, honey, milk, meat, olive oil and so on. Rasullah
(pbuh) once said There is a tree among the trees which is similar to a Muslim (in goodness),
and that is the date palm tree. [Al-Bukhari]. Besides that, The Prophet (puh) is also reported
to have said: Allah the Almighty sent down four blessings from the sky: fire, water, iron and
salt." [Ibn Maajah].
b) Stage Two
In this stage, therapist should continue to emphasis on regular eating but in addition with
the combination of cognitive and behaviour. Here, the cognitive restructuring applied to
concerns about food, eating, shape and weight, and, where relevant, other general cognitive
distortions (e.g. perfectionism, negative self-evaluation). The Muslim also should be
remind that there is no one that is perfect and they should keep being thankful to Allah by
saying Alhamdulillah. Besides that, the Muslim patients also could be ask to always
remembering Allah SWT by keep dhikr all the time. Allah has said in Surah Az-Zukhruf,
verse 36-37: And whoever is blinded from remembrance of the Most Merciful - We
appoint for him a devil, and he is to him a companion. And indeed, the devils avert them
from the way [of guidance] while they think that they are [rightly] guided.

c) Stage Three
Stage Three is the final stage in cognitive-behavior therapy treatment. In this stage,
therapist should ensure that progress is maintained in the future that the risk of relapse is
minimized. Here, therapist could providing education about realistic expectations, devising a
short-term plan for the months following treatment and devising a long-term plan to minimize
relapse in the future. Patient also should be remind to keep praying to Allah and always
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remember Him. Imam Ghazali said: There has to be a balance in everything, except dhikr of
Allah which needs to be constant/often. Besides that, patients also should be maintained to
always have positive thinking and understand the concept of redha and tawakkal.
iii. Interpersonal Psychotherapy for Bulimia Nervosa
Interpersonal psychotherapy is one the therapy that can be used to treat the bulimia nervosa patient
that could not responded to Cognitive-Behaviour Therapy. This therapy also will give the same
result like the CBT treatment. However, it will take more time about 8 to 12 months to achieve the
result.
After all the treatment has been done, therapist should remind and aware on the relapse case.
Bulimia Nervosa patients tend to have relapse case. In other to prevent that, support from family
and friend will be need.








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7. CONCLUSION
As a conclusion, eating can be categorized as a type of disorder. The experiences of emotional
depression, binging, family conflict, social pleasure and depression can lead to eating disorder.
Besides, it also can make the people who are involve in disorder will death. Experiencing of
overeating, over exercise and night eating is normal as a part of daily life. By learning, eating
disorder topic, it can help us determine and maintaining our body health. Besides, we can provide
the best way how to care the physical sides. At the same time, it also can prevent us from any harm
and dangerous disease because of eating disorder, it can contribute to many disorders that leads to
destruction of one self. Anxiety is a key base feature for many aspects of the eating disorder. This
is more to global patterns of personality disorder characteristics and its more typical of eating
disorder. The techniques of Cognitive Behavior Theory and interpersonal proses will be used to
people who in eating disorder. At the same time, join therapy with the therapist is also the best
way to recover from eating disorder. We as a human and especially as a Muslim should know how
to analyzed the symptom of eating disorder through physical and mental. If someone feels
depressed, quickly find a way to overcome to solve the problem. So, a normal feeling of emotional
depress can be cured as we find the effects of it towards our body. As Allahs servant, live the life
to the fullest, which feels of happiness and joy.




24

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