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One of the things that we know about bulimia nervosa is that when people overly restrict or you know, stop eating a lot or go for, you know, a day and a half and really restrict their calories, that oftentimes that that kind of leads into that kind of binge eating cycle. And we know that that's the case. The other thing that we're aware of is that a lot of individuals who struggle with eating difficulties like this also report a lot of difficulties they have like with managing stress or managing relationships or have a difficult time knowing what they're feeling or managing feelings. Is that something that you've experienced? Okay. Yeah. All right. Well, that's okay. Because in many respects, I think both things go on for individuals that struggle with eating difficulties like that. And so we know that there's a lot of dieting and restriction that goes on but we also know that there are other things that are happening in terms of managing feelings, managing stress, etc. So one of the things that I like to focus on in terms of working with clients and working with individuals like yourself is I take an approach it's called interpersonal psychotherapy and, and what that means, in essence is that I like to approach the eating problem by looking at kind of the kind of social in kind of more interpersonal context, because there's a lot of things that are probably going on, or may have gone on in your life that have been kind of associated with times and you've been more likely to use food or to restrict your calorie intake. And so what I'd like to do is really talk with you over the next, you know, few sessions about, you know, periods of time in your life currently and in the past where you've had, you know, overeating episodes and when you've restricted your calories, when you've You know, lost weight, or when you, you know binge and things like that and really start looking at, you know, patterns perhaps in your relationships and then what we'll do is kind of sum that up at the end of the time that we're together and see if we can kind of come up with a little bit of a game plan and some goals to help you reduce your binge eating. So how's that sound? Okay. And there's really good evidence for the things you know, the things that we're going to be doing, in fact, the more that we work on some of these issues, you'll you'll know pretty quickly that you're gonna start feeling a lot better and, and it'll have a, you know, pretty positive impact on your eating. Okay, great. So this is what I'd like to do is first of all, first of all, let's start with I want you to give me a recent episode, where like just recently within the last couple days where you've had one of those episodes that you talked about where you felt like a lot that you lost control, and that you ended up vomiting or you know, and and it will and kind of get an idea about that. And then what I'd like to do is and we'll go kind of back in time, and then I want you to tell me the first time that you had an episode like that. So and then then what we'll do then over the next couple of sessions is then we'll, we'll start from when it started and kind of like work our way up to the present. And I'll just ask you a lot of questions and we'll, you know, kind of go from there. Right? So why don't you tell me the Tell me like a recent episode, that where you felt like that you'd lost control. You're eating | 1irq
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me like just this Saturday night, I guess. I went out with my friends. And it was fun. It was a good night at first and whatnot. And we then went to a party. I guess guess what kind of sparked it would be I saw the sky that I kind of liked for a little while and I mean, I just wasn't I was a little nervous about kind of what I was wearing and it just didn't feel that good to see him. So I kind of left pretty early on and went home or back to my apartment. And yeah, I mean, kind of what typically happens is the kitchen grabbing different foods bag of chips. I think my roommate had left out like a sleeve of cookies or something and, and I just ate on the couch. Yeah. Finished most of it and yeah. | 0id
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Okay. Did you been restricting your your food? You know, for the prior to that or you've been dieting prior to that? | 1irq
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I mean, I guess like, dieting isn't what you would consider it as I try to eat more healthy typically. And yeah, I mean, I've been like dealing with different assignments and stress around that. So Yeah, it's kind of fluctuated time. Okay. Okay. | 0id
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I'm meant to tell you to I like to take a lot of notes at least initially so I have a good sense of what's going on. So what else was going on? Okay, so it sounds like Saturday night out with friends. See person that you like that you've just say you dated some? | 1irq
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I really like we've kind of been like okay interested. Interesting. Yeah. | 0id
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Okay. All right. I'm sorry. Okay, so you're kind of interested. Yeah. And then you sounds like what you were, then you began to feel more concerned about how you were how you looked at how your outfit felt. Yeah. | 1irq
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I mean, I didn't plan on seeing him right now. Yeah, yeah, it just, it was Yeah, the right outfit to see. | 0id
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Okay. And so that then, then what's then what happened then is that you go back to the apartment foods there. And then you kind of sat down on the couch and you felt like that you'd lost control. | 1irq
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Yeah. And then I guess after that, like before bed I made sure. Okay. Go into the bathroom. Okay. | 0id
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Okay. It's just kind of a typical scenario. | 11orq
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Yeah. I mean, yeah, eating before. Okay. | 10od
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Okay. And then um, so you went home to the apartment. | 1irq
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your junior year. So my third year | 0id
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in school, and what are you working on? | 1irq
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at English isn't major? | 4crq
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Yeah. Because I was thinking about the time of the year, so Coming up or any projects coming up, so, anything big on the horizon for you? | 6cd
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I mean, like midterm, | 0id
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okay. Okay. Okay. | 7ack
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Ah, yes, studying for one of my midterms and like on Thursday night, my test was on Friday, and my roommate kind of has had her boyfriend over a lot. And it's pretty annoying because like she knew I had a test to study for and, like, I like being home to study. I don't want to, I don't want to be in the library. Like, I want to be in my room and my bed and they're constantly in the living room on the couch. And yeah, they're pretty loud. So it's kind of frustrating and yeah, it's pretty stressful. Okay, | 0id
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sounds like it. Um, what's your roommates name? | 1irq
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Kathy | 0id
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Kathy. Okay. Okay. So then Kathy has a roommate over quite often this last week she was they were there quite a bit boyfriend, her boyfriend. Okay. And then you're trying to study and did you talk with them about that in terms of the noise or that bothering you? | 1irq
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I mean, she knew I had a midterm coming up. Okay. Okay. | 0id
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Sounds like you feel like that you've tried to let her know in various ways that you know, you've got something coming up and that you'd like to study and when it's quiet and you'd like to be able to focus but that the sounds like that. They're kind of constant commotion is really distressing to you, right? If you talk with her, like one to one about How that bothers you or that that's a real problem for you. Okay, she know what's hard about doing that, in terms of talking with her. | 1irq
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I mean, we're kind of like newer roommates, each other we were introduced. So we haven't known each other. | 0id
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Okay. All right, that makes sense. Okay. | 4crq
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I mean, he's ever alive. | 6cd
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Okay. Okay. Okay. All right. Okay, that's helpful. | 7ack
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Yes, middle school, so or eighth grade, probably 12 or 13? | 6cd
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Middle School, 12 or 13 years old. Um, good. So we'll start from there. Tell me about your. Tell me about your parents. | 1irq
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So my mom, Lisa, she, my dad is Steve. They actually got divorced when I was 10. Okay, so she then remarried soon after. Okay. | 0id
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Okay, so your mom and dad divorced when you were 10. Okay, and so, alright, so let me Okay, that's helpful. And then you say your mom got remarried. | 1irq
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Two years after that. Okay. Okay. | 0id
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You haven't any siblings? | 1irq
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I do now from this from her second marriage. | 0id
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Okay. All right. And is that a boy or a little sister? What's her name? Brooke. Okay, so mom remarried. What's your stepdad same? Bruce. Bruce. Okay. Okay. All right. So, Mom and Bruce. They have a little girl and her name is Brooke. Okay, how old is Brooke. Okay, six. Oh, she's six. Okay. Okay. All right. Okay. | 1irq
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I mean, like after, or what led up to that | 0id
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kind of do you have a sense about what led up to the divorce or what was going on? | 1irq
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I guess they were fighting a lot. Yeah, probably that those are probably my most memorable memories. Yeah, that's a fighting and dad, just they weren't around each other as much anymore. And mom was kind of out of the house more. | 0id
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Okay. Then Then. So then they divorced when you were 10. And so then how soon after, did your mom marry a Bruce? | 1irq
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just under two years | 0id
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under two years. Okay. How was that for you to have her remarry so quickly? | 1irq
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I mean, they really like it. Yeah. Okay. | 0id
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During the, during that period of time, because I know you talked about middle school, but during the period of time when they were having difficulties with their marriage. What was your, you know, your eating like? or How are you managing that during that time in terms of your feelings about the night? Ah. | 1irq
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I mean, I guess I don't really recognize too many issues right then necessarily. | 0id
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Were you talking to anybody or you know, anybody? reasonable. Did anybody else know what was going on? Or? | 1irq
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I mean, I was like, pretty close with my grandma, my dad's mom. Okay. | 0id
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And she was aware of what was happening. | 4crq
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Yeah, she was. Yeah. So she was definitely there. Okay, I'm closer with my dad. I'd say. | 6cd
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Okay, even at that time, and sounds like that. You're pretty close to you're pretty close to your dad's mom. | 1irq
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Yeah. She's not around anymore. But yeah. | 0id
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Oh, I'm sorry about that. When did she pass away High School. Okay, so alright, so make a note of that okay all right so yeah definitely make sure that we talk a little bit about that okay so at 10 mom and dad divorce less than two years your Mamrie Mary's Mary's Bruce so then what happened what happened to you after the divorce Did you were you with your dad with with you | 1irq
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know with my mom more we moved to a different area okay not too far from my dad I saw him like a decent amount but definitely was with my mom more | 0id
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okay so then you alright so then Bruce your mom and Bruce in the you because I know you're seeing more time with her moved to what like a different different town different | 1irq
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I just like a town over okay, but change schools and whatnot. | 0id
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Okay. All right. So prior to moving to a new school, were you in a public school or private school | 1irq
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isn't a public school, then switch to a private | 0id
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switch or private school? Okay. Okay. All right. Okay. How was that transition for you going from public school to private school? | 1irq
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I mean, I wasn't excited about it. It was kind of like a more uppity area. Yeah, I mean, like, it was kind of hard, because they're like, like in a private school, these people have kind of been together for a little while. And because there's less people there, they kind of moreso all know each other and have their groups and whatnot. | 0id
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Okay. And so then that would have been in around the time when you were 1213 when you made that move. Okay, so then, sounds like to that that was the time when you first were aware of struggling with your eating. | 1irq
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Yeah, I think I like started. Mate, and I felt like more pressure from my mom. She was very vocal. towards me about my eating and my looks and whatnot. | 0id
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Oh, that you felt when you say pressure from her In what way? Were she pressuring you? | 1irq
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I mean, like she wanted me to look good. | 0id
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Okay. Like what say that you would fit in more or okay. Okay, okay doing | 5yq
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hair. Yeah. Okay. | 7ack
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And it sounds like what you were saying was that we'll ask you how you felt. And you said you You said you weren't excited. You weren't excited. Like I wasn't excited, but so doesn't mean so did that mean that you weren't sounds like if you weren't happy? | 4crq
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happy let them know that I didn't like the school. | 6cd
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Okay. And then what when you would do that what would be the risk | 1irq
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I just like, oh, you should feel lucky. Like it's good school. Okay. | 0id
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Okay. Well, so many ways, like, one might be putting words your mouth, but what like, kind of get over it or like deal with it or, okay. So and so then you were feeling pressure from her sounds like also to that you weren't really feeling like that they were really that maybe there wasn't as much concern about your feelings about where you were. Was there anything specifically that your mom would say to you about that in terms of like, kind of the Get over it? You know that? | 1irq
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I mean, you mean in terms of the schooler? My body? | 0id
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No, you're in terms of the school. | 1irq
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I mean, like get over it, like, it will get better with time. Like you just have to put yourself out there to meet people. | 0id
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Okay. All right. So, that kind of pressure. Yeah. And then you said that you didn't really like Bruce, what kind of person was a man? What was making you not like him so well? | 1irq
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I mean, he's just kind of like a sketchy guy. Okay. | 0id
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Oh, so that maybe that there was something going on between Bruce and your mom prior to the divorce? Yeah. Sorry to hear that must have been really hard. Yeah. And were you keeping in touch with your dad during that time? Yeah. Okay. Like, were you? I mean, how what was the arrangement where you're spending time with him sometimes and spending time with your mom? | 1irq
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Yeah. So I said my mom during the week and I got to my dad like every other week. Okay. | 0id
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Okay. So then, given the fact that in case you weren't happy in school, you said that it was more kind of an uppity school, private school. Kids Was it a mixed school or was it like an all girls school? Yeah, mix school and that kind of clicky sounds like and then your mom really sounds like she really was pressuring you really wanted to try to pressure you so that you fit in a little bit better. So when in this process Did you find yourself like like turning to food or being excessively concerned about your weight or starting to diet binge things like | 1irq
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dieting, it's definitely I guess, like eighth grade, ninth grade. And that definitely came from like, my mom thinking were telling me that to look a certain way to knit Yeah, and then there were times like, like there was unhealthy food around the hospital debris seats. Mm hmm. And is there an accessible at times like I would eat that I would say for the most part, I would try to like really restrict myself to Okay. | 0id
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Okay. And do you recall the first time that you then vomited or use vomiting as a way to kind of like manage the overeating? | 1irq
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I mean, just like pressures of starting High School, and I'm in a same school, same people and I really wasn't happy, hard to make friends. I don't know When I guess I heard from some of the other girls about, like vomiting as like an option, right, that they've heard some of their friends talk about before. Right? Right. Yeah, so, okay. And like the dieting even though if I was eating healthy, I would still hear from my mom like, oh, like you need to look like this, right? Here's this outfit I want you to wear, but you can't wear it like if your body's like that. | 0id
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So she was really critical of how you looked. Okay, okay, so then what was that? What did that do? Let me take a step back. So it sounds like that. You've always been a little closer to your dad. So then what was the divorce and the move and some of that transition? What effect did that have on your relationship with your mom? | 4crq
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I mean, I don't even really remember like a really good time with my mom. | 6cd
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Okay. Okay. All right. So the two of you don't get along as well. Okay. Did it was it getting? Was it kind of the same during that time? Or was it getting worse? | 1irq
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I mean, I guess I was getting more vocal towards her and speaking my mind more. | 0id
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Okay. All right. And then she was then coming back more harshly and more critically. Okay. All right. Okay. Well, it's not unusual. I mean, a couple things, certainly not unusual for, you know, girls at that age, you know, in terms of like, kind of the social influence or kind of the social contagion of, you know, with eating and diet, you know, binge eating and dieting and vomiting. So it sounds like that, that was kind of, in some respects part of that culture. But it also sounds like that there, you know, in terms of the external pressure that you were getting from your mom to look a particular way. It almost sounded like that, that she was saying that you were like, What? You were too heavy for a particular outfit. And so then, I'm sure that that Do you remember how that was feeling to you at that time when she would say things like that? | 1irq
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Today? Yeah, I felt like nothing I could do. Right. Right. Yeah. | 0id
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All right cut of Trump. Did you talk to anybody about that? Did you talk with your dad about that? Or? | 1irq
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It's like, No, not really. Okay. We have. | 0id
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Okay. So you kept a lot of those feelings to yourself. Okay. All right. Okay, well, that's that's, that's helpful. Let's kind of let's kind of hang on to that, because we've got a couple things because obviously, I think the the divorce the move the transition from middle school to high school. Also sounds though that also during that time that you're obviously you didn't have a very good relationship with Bruce to begin with. And that your relationship with your mom was kind of deteriorating. Yeah. And then I know you said your grandmother passed away when you were in, in high school, but during that time, like, you know, eighth or ninth grade, did you have more contact with her? Were you able to, like | 1irq
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connect with her on that as much as I could? She also I mean, she didn't live in That's where I was living. Like when I would see my dad like occasionally we got, | 0id
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okay, okay. Okay, um, | 7ack
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I mean, like I love, we're really close and I love her. But as well as training so as an only child and then your mom gets remarried and soon after a new baby And others also like, my mom and stepdad, like they both worked a lot. And so there's also like, I was kind of looking after Brooke, got Okay. Okay. | 0id
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Okay, so then, right? So not only did Where's your relationship with your mom kind of deteriorating, then all of a sudden, she's pregnant, she delivers. You have a baby sister. They're working. And now not only are you kind of feeling distressed about your relationship with her, but now you're also feeling the pressure to take care of a baby sister. Okay. Okay, and so, during that time, you're feeling what? | 1irq
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Ah, I just have, you know, a lot of weight on my | 0id
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okay. emotional weight on your shoulders. Yeah. Yeah. Yeah. And then and then what was your eat so then that would have been like, you know, the years like 14 maybe to 16 when you were more active. involved with that. What was your eating? Like during that time? | 1irq
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I mean, I guess kind of similar to, like what I described, kind of now. I mean, I like try to eat like super healthy, right? But then at times, like, especially because there was food available. | 0id
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So were you binge eating more during that time then? | 1irq
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Yeah, and I mean, because I kind of found other ways to make up for the binge eating. | 0id
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