Bulimia Nervosa is a severe eating disorder that affects men and women of all ages and races. Bulimia is characterized by the behaviors of binge eating and purging via vomiting or other compensatory behaviors like over exercising in efforts to avoid weight gain. For those suffering from bulimia, one’s evaluation of self, and how they feel about themselves is also tied to their body and weight. Recovering from bulimia nervosa is difficult and yet it is very possible!

To recover and best understand behaviors present with bulimia, it is helpful to understand the binge purge cycle. There is a common cycle of problematic behaviors that is present with people who struggle with bulimia. An individual gets caught in a cycle of binge eating followed by purging. The cycle looks like this; restrictive eating, such as refusing to eat or honor hunger cues, resulting in an increase in cravings, a desire to eat (and often eat specific foods), as well as an increase in tension and heightened emotions. This increase in cravings and heightened emotions leads to an episode of binge eating, where a person experiences a loss of control and consumes an excessive amount of calories. Post binge, a person will experience discomfort — both physically and emotionally. There is often stomach pain and bloating, as well as emotional discomfort like shame and/or guilt, embarrassment, and disgust. The physical and emotional discomfort is what often leads a person into an episode of purging. Purging becomes the behavior to try to offset the physical discomfort, emotional discomfort and criticism, as well as to “compensate” for the excessive amount of calories consumed. And then the emotions of shame and disappointment often return, leaving a person feeling disappointed and critical of self. This cycle can start to become habitual, as the individual gets stuck in the pattern of behavior, as well as struggle to properly feed themselves, manage and ride out emotions and cope with stressors. The binge and purge behaviors can become the slippery slope for an individual to rely on these behaviors instead of learning to cope with discomfort, feelings and stressors.

So what does one do to get out of this cycle? Here are some helpful tips/ideas to help if you find yourself struggling with binge and purging behaviors.

First, stop restricting!

Yes, I know this is VERY difficult, but it is a must. I always encourage people to get on a schedule with their eating, specifically the rule of three. The rule of three involves 3 meals a day, 3-4 hours a part, and up to 3 snacks. The consistent nourishment to the body is imperative, as well as getting out of a pattern of restriction and deprivation. If you prioritize feeding your body regularly, what it wants, it will learn to trust you again and you will learn to trust it.

Second, it is important to shift our mind and practice having an “all foods fit” mentality.

This means that no food is off limits! When we restrict a certain food or label a food as “bad” and off limits, we then typically binge on those foods when we finally have them, eating them in a way that we then in turn feel “out of control with them”, which then makes you fear them. However, when we normalize them in our diet, recognize that they are not “off limits” and shift into the practice of having them (when of course we are not restricting), we then learn that we can have them, enjoy them, and eat them to a point of satiety or enjoyment. Cultivate a mindset and a practice where you choose what you want to eat, not what you “should” or “ought to eat”.

Third, I’d like to leave you with a skill.

One of my favorite coping responses/skills is a practice called urge surfing. Urge surfing is a mindfulness skill where you learn to be an observer of your experience — where you take notice and recognize when you are experiencing heightened emotion as well as urges to avoid, suppress, and urges to purge or use eating disorder behaviors.

To use this skill, you must simply observe, take notice of your inner experience, any heightened emotions, as well as observe your thoughts. Perhaps you are having the thought of “I have to get rid of this” or you are experiencing the emotion of disgust. Learning to be aware of and acknowledge your experience is necessary. Next, you must learn to observe this urge. This is the most difficult part because the urge will build, it will climb and you may even start to have thoughts of “I can’t do this”, however, what goes up must come down. By riding out this urge, you are building emotional tolerance skills, skills that are needed throughout life, as well as teaching yourself that you do not need to run, avoid or detach from emotions, that by sitting with them and experiencing them, they will rise and fall.

When it comes to the urge of purging due to physical discomfort and thoughts of “I feel gross” or “I need to get rid of this”, riding this urge out and being compassionate to yourself is so important. By choosing to not purge, you are sending a message to yourself that you do deserve food, that you can handle it, and that you can sit with discomfort. If this is getting hard, I always encourage my clients to set a timer for their urge surfing. For example, set a timer for 20 minutes and during that 20 minutes, you commit to not purging. At the beginning of the 20 minutes, you can rate the intensity of your urge to purge on a scale of 1-10. Perhaps it is initially at an 8, and at ten minutes, re rate the urge, and maybe you notice that you have gone from an 8-6. At the end of the 20 minutes, I encourage you to re-rate, and now you may be at a 5. A 5 is much more manageable than an 8, and one can feel encouraged that not only were they able to manage for 20 minutes, but they also witnessed the intensity decline with time. Once the intensity of the urge has come down, it is also helpful to examine what thoughts you may have had that were assumptive, judgmental, and/or contributed to the urge to purge and bring compassion, a nonjudgmental stance to them.

Living with bulimia is hard and you are not meant to do it alone! It is incredibly helpful to increase your support and resources.Support may come from friends, family, support groups, or therapy. Know that there are resources and places for you to start to take steps towards recovery. Be patient with yourself, and I encourage you to pause and remind yourself of the dialectic that you are doing the best you can and you can grow.

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