Not ready to recover from Bulimia? 5 steps to help you move forward

by | Jan 11, 2024 | Bulimia | 0 comments

Home » Bulimia » Not ready to recover from Bulimia? 5 steps to help you move forward

Are you not sure if you’re ready to recover from bulimia? If you’ve never had an eating disorder, it might be hard to understand why someone might not want to recover. The reality is lots of people feel uncertain about making changes to their eating. 

I’ll talk about what psychologists know about being ready to recover from bulimia. After that, we’ll explore five steps you can use to understand your motivation, connect with your values, and move forward with your life.  

You can choose to do all the exercises, or you might pick a couple that you feel most connected to. They build on each other, so if you do complete them all you should find each step adds a new layer of depth. 

Turning point sign. Eating disorder recovery.

Stages of change

Before delving into the five steps, we need to talk about why we don’t always feel like we want to get better. Eating disorder recovery can feel like a rollercoaster. People often tell me that they feel hugely motivated one day, and hopeless the next.

This is a really common experience but can feel overwhelming. The stages of change model helps us to understand what is going on here. 

There are 5 main stages: 

  1. Pre-contemplation: Not yet ready to change, not actively considering getting better. 
  2. Contemplation: Starting to think about recovery but not ready to take practical steps. 
  3. Preparation:  Want to recover and laying the groundwork for change (e.g. researching how to find a good therapist)
  4. Action: Taking steps to change, such as meeting with a therapist of altering eating patterns.  
  5. Maintenance: Sustaining progress and changes made, incorporating strategies such as relapse prevention. Living life in line with values. 
  6. Relapse: Most people will experience setbacks as part of the recovery process. Each setback provides an opportunity to learn and develop.
Cycle of change in eating disorder recovery. Adapted from Prochaska & DiClemente (1983)

The Cycle of Change, adapted from work by Prochaska & DiClemente (1983)

You may transition from one stage to the next, in this order. Or you might skip between steps.

You might find that one day you are fully committed to Action and challenging yourself with fear foods. Maybe you binged later that evening even though you’d been practicing distraction techniques. You might find yourself back in Precontemplation “I’ll never be able to change, there is no point in trying”. 

Understanding these stages means you are less likely to feel out of control. Knowledge is power!

It also means you have information on how to make the next step. In this example, maybe you revisit your letter from your future self (more on this coming up) and jump back into Action by completing a binge analysis. 

Now let’s discuss the steps…

1. What scares you about recovery? 

In order to move forward, it’s important to make explicit your fears about eating disorder recovery. Grab a pen and paper and take some time to jot down the things that scare you about bulimia recovery. Let’s explore some common themes that might stop people from feeling ready to recover from bulimia:

Weight gain 

This is the most common fear I see in eating disorder therapy. Do you worry that recovering from bulimia will cause you to gain weight? Contrary to what many people fear, recovery is more likely to help you stabilise your weight and prevent weight gain. In the next section we will dive into some of the facts about eating disorder recovery and weight gain.  

Not ready to give up trying to lose weight

This point is closely related to the first. Many people I work with struggle with not feeling ready to give up on trying to lose weight. Unless it is medically advisable for you to lose weight, I believe weight loss is not an appropriate goal for eating disorder recovery. Even if it is medically necessary, healing your relationship with food will be essential before you can improve your health by reducing your weight.  

Fear of judgement

Are you scared that your family or friends will judge you for seeking eating disorder treatment? Or even your therapist? Some people worry that they aren’t thin enough for eating disorder therapy. We know that most people with an eating disorder are within a healthy or overweight weight range. You are always deserving of recovery, no matter your size. 

Losing control

Do you worry that allowing yourself to eat more will cause you to spiral out of control? If you normally restrict what you eat in the day you might be scared that you’ll start bingeing in the mornings too. Regular eating will help you stop binge eating.

Fear of facing your emotions

Bingeing often offers a temporary escape from emotions. Similarly, being sick or using laxatives lets people temporarily avoid feelings of guilt or disgust. Recovery involves you getting to know your emotions, accepting them, and reducing the impact they have on you.  

For people that have experienced trauma, bingeing might be a way to push away distressing memories or flashbacks. Therapy can help you feel better for the long term, not just temporarily. 

2. Knowledge is power: Psychoeducation

Now that we have a list of fears, we can start to untangle them. There are a lot of myths about dieting and behaviours related to eating disorders. Psychoeducation, a key tool in therapy, involves therapists sharing key information clients need to know about their mental health difficulty. 

Take a moment to read the information below. Did you discover anything you didn’t know before? What surprised you? How does the new information change your perspective on recovery? 

  • Vomiting is not effective. Research has found that, at most, about 50% of food consumed during a binge is removed through vomiting. For many, it’s even less. So, if you binge on 3000 calories, your body likely retains at least 1500 calories. 
  • Vomiting increases the likelihood of bingeing again. When you eat, your body releases insulin to process the glucose (or sugar). Vomiting disrupts this process, making your body expect more food than remains. This then causes blood sugar to fall rapidly. When your blood sugar is too low your body sends signals to eat, making a binge more likely. 
  • Laxatives are even less effective. Studies have found that laxatives only remove about 10-15% of the energy consumed. They can, however, cause significant damage to your body (internal link). 
  • Diuretics don’t impact body composition. Diuretics only lead to water loss, not fat loss. They do put you at risk of dehydration and electrolyte imbalances. 
  • Diets don’t work. Almost everyone who diets will regain the weight (estimates are around 90%). Regular eating helps to keep blood sugar stable and prevent binges. 
  • Set-point theory: Our bodies have a natural weight range that they prefer to be in. Trying to keep your weight artificially lower than its natural set point triggers internal mechanisms to return to the set point (e.g., increasing hunger). This means that it’s almost impossible to maintain your weight below your set point without actively restricting what you eat. And we already know that dieting puts you at risk of bingeing. 
  • Vomiting causes irritation and swelling of the throat, ulcers, bleeding and in rare cases oesophageal rupture. Repeated vomiting also causes disturbance of electrolytes. 
  • Laxative use can cause a loss of bowel function, constipation, increase in tolerance levels, water retention, electrolyte imbalance, and in rare cases permanent damage resulting in lifelong reliance on laxatives. 
  • Electrolyte imbalance: Hypokalaemia (low potassium) is the most common risk. It causes cardiac problems, swelling, and in rare cases death. Most people will experience little to no symptoms meaning you can be entirely unaware of the danger. 

3. Pros and cons

By now you’ve clearly listed your fears about recovering from bulimia and read some important information about eating disorders. Now we are going to explore the pros and cons of recovery, an exercise is borrowed from Chris Fairburn’s CBT-E therapy for eating disorders. 

Start by writing down a list of reasons you aren’t ready to recover from bulimia. By recovery I mean giving up dieting, accepting your body, and stopping bingeing and vomiting (or any other compensatory behaviours). Your reasons probably overlap with the fears you have already written down. 

Now think about all the reasons you’d like to get better. Think about this across the different areas of your life. For example:

  • Physical health
  • Psychological health
  • Family
  • Friends
  • Romantic relationships 
  • Career / study
  • Hobbies / interests 

Try to be as detailed as possible. For example, if one reason to get better is “better relationship with friends”, think about how that would look, For instance: “I will be able to go out for meals with Penny and Lara and enjoy it rather than being stressed about what I’m eating”. 

Example pros and cons list for bulimia recovery.

Now, take a moment to review your list. Try this again, but this time imagine you are 5 years older. Use these prompts to help you: 

  • What would life look like in these areas if you are recovered? 
  • What would life look like if you are still struggling with an eating disorder? 
  • Would you be bingeing more or less? 
  • What would your emotional well-being look like?  
  • What do you want your family life to look like? 
  • Would you hope to have children? 
  • If you have children, how old are they and what do family meal times look like?
    What do you want your career to look like? 
  • Are you in a relationship? How is the relationship going? 
  • What has happened to your physical health? 
  • Do you have health problems? How do these impact your life? 
  • If you are well, what are you able to do now?   

4. Values

When you have an eating disorder, it can rob you of the rest of your life. You might stop doing things that are important to you. Or lose your sense of who you are, what you are passionate about, and what brings you joy. 

Let’s take a moment to reconnect with your values. Values are like guiding principles in your life, showing you the direction you want to go. They’re not specific goals but more like arrows pointing to how you want to act, treat others, yourself, and the world. 

If you have been unwell for a long time, you might not know what is important to you anymore. Take a moment to experiment with this values exercise borrowed from Russ Harris

First, download this checklist of values. 

Read through the example values and rate them in terms of how important they are to you. If you struggle to identify your values, think about someone you admire (a friend, family, celebrity). What values are important to them? 

Once you have rated them all, pick five that are the most important to you. Use these prompts to reflect on the impact the eating disorder has had on your values:

  • Which values am I living my life in line with? 
  • Have any values become side-lined? Or pushed out by my eating disorder? 
  • If I stay unwell, what values would get ignored? 
  • If I get better, which values would I be able to follow? 
  • How do I want to live my life? 
Sunset with a signpost in shadow to represent personal values.

5. Write a letter from your future self 

This exercise helps you picture and make your future feel more real. First, imagine again that it is 5 years time and you are still not ready to recover from bulimia. Grab a pen and paper again and write a letter from your future self to your current self. 

You can use your letter to describe: 

  • What does daily life look like? 
  • Where do you live?
  • What job do you do? 
  • What physical health complications are you experiencing? 
  • What will your weight be?
  • Who do you spend time with? 
  • Describe your relationships with your family, friends and loved ones
  • Are you happy? 

Now write a second letter. This time write from the perspective of a healthy, recovered and thriving version of yourself. You can use the same prompts. 

Pen and paper letter writing.

Conclusions

Take a minute to look at your pros and cons list, your values, and your letters from your future selves. Look back at the key psychoeducation described earlier. What conclusions do you draw?  Have you chosen recovery? 

Write these conclusions down! Keep them somewhere easily accessible. This could be on your phone, in your bedroom, or in your purse. 

You could also record some voice notes to yourself to listen to whenever you notice yourself return to an early stage of change (precontemplation, contemplation, preparation).

Happy woman smiling with trees in background

If you’re ready to take back control, you can use this guide on how to find a good therapist in the UK. 

I’ve also written a summary of how much eating disorder therapy costs here. 

If private therapy is too costly, or you are on an NHS waiting list, you can get started with this list of the 15 best eating disorder recovery self-help books


References

Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. Guilford Press.

Harris, R. (2019). ACT made simple: An easy-to-read primer on acceptance and commitment therapy. New Harbinger Publications.

Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: toward an integrative model of change. Journal of consulting and clinical psychology51(3), 390.

Schmidt, U., Startup, H., & Treasure, J. (2018). A cognitive-interpersonal therapy workbook for treating anorexia nervosa: the Maudsley model. Routledge.

Waller, G., Cordery, H., Corstorphine, E., Hinrichsen, H., Lawson, R., Mountford, V., & Russell, K. (2007). Cognitive behavioral therapy for eating disorders: A comprehensive treatment guide. Cambridge University Press.

About

Welcome. I'm Dr Jenny Davis, a Clinical Psychologist with a special interest in eating disorders. I'm passionate about helping people recover and build a healthy relationship with food. 

Subscribe

Chalk Hill Psychology Blog

Sign-up to receive regular updates and resources from Dr Jenny Davis

You May Also Like… 

0 Comments

0 Comments

Submit a Comment

Your email address will not be published. Required fields are marked *