Bulimia Nervosa: A Cycle That Is About More Than Food

To those around her, June is someone who always seems to manage her life well. She did well at school, does well at work, is cheerful. Everything around June appears to run smoothly.

What nobody sees is that June is caught in a cycle that is exhausting and full of shame. When emotion becomes overwhelming, or accumulated pressure reaches a certain point, she goes through episodes of eating in which she feels unable to control herself, followed by intense guilt and shame — and then by attempts to “undo” what has happened, which bring relief for only a moment before the shame and the whole cycle come round again.

June keeps all of this secret, for fear of being judged. And the secrecy itself leaves her more isolated and in greater distress. She feels stuck, exhausted, and wonders: “why can’t I stop?”

This article is an invitation to understand bulimia nervosa with care and with understanding. It begins with the most important sentence first: this is a psychiatric illness that can be treated. If you suspect that you or someone close to you is facing this, contact a doctor or a mental-health professional promptly, particularly where there are physical symptoms as well.

What bulimia nervosa is

Bulimia nervosa is one of the eating disorders — a serious psychiatric illness. It is characterized by a cycle between episodes of eating accompanied by a sense of having lost control, and dangerous compensatory behaviors intended to undo what has been eaten afterward. The cycle is driven by psychological distress, by shame, and by secrecy.

What is important to understand is that this illness goes far deeper than food or weight. For many people, the episodes of eating and of compensating may be a way of coping with overwhelming emotion, with pain, or with stress they do not know how to manage. Food and this cycle therefore function rather like a temporary instrument for relieving psychological distress, rather than being purely a matter of appetite. And because this is an illness that can seriously affect both body and mind, care from specialists is a necessity, not an option.

An illness that is usually hidden

What makes bulimia nervosa dangerous and overlooked is that it is usually hidden completely.

Many people with this illness have a body shape those around them do not notice, and usually appear to live perfectly ordinary lives. It occurs in people of every gender, every age, and every body shape. Shame and secrecy are at its heart, and a great many people therefore struggle with it quietly for a long time without anyone knowing. Someone “looking fine” from the outside does not mean they are not suffering inside. This is why finding the courage to speak, and reaching out for help, matters so profoundly.

A revolving door that is hard to step out of

An image that helps explain this cycle is a revolving door.

Think of a revolving door you step into hoping for relief from distress. Instead of carrying you out the other side, it turns you back to where you started, more exhausted than before. The relief that comes from compensating lasts only a moment, because the pain and the shame behind it are never addressed. So it comes round again, and again.

This is why telling someone to “just stop, and it will be over” never works. The way out does not lie in turning the door faster by force of will. It lies in receiving help to step out of that door altogether. And there is another important point: attempting to fast or restrict food strictly is usually the fuel that keeps this cycle turning, because accumulated deprivation pushes the cycle back around. Care is therefore not a matter of controlling more strictly. It is a matter of gradually defusing what keeps the door revolving.

The shame that locks the door, and the illness’s complex roots

What allows this cycle to keep turning longest is shame and secrecy. The more it is kept hidden, the more isolated a person becomes and the harder help is to reach. Shame therefore functions as the key that locks the door — and what most helps unlock it usually begins with that secret being heard with understanding rather than judgment.

As with others in this group, bulimia nervosa does not arise from a single cause. Research indicates roots in several contributing factors: biological and genetic factors, difficulty regulating emotion, perfectionism, past wounds, low self-esteem, along with dieting culture and pressure about body shape. Understanding it this way helps us stop blaming people for a lack of discipline, and turn instead toward seeing the genuine distress underneath.

Treatment and recovery: it begins with asking for help

The most important news is that bulimia nervosa is treatable, and recovery is genuinely possible. Many people who were caught in this cycle for a long time have been able to step out of it and return to lives free of it, with appropriate care. And the sooner help is received, the better the prospect of recovery.

Treatment requires a team of specialists across several disciplines: medical care, psychological therapy, and nutritional care under specialist supervision. These are the pillars for which nothing can substitute. Stepping forward to ask for help — from a doctor, a mental-health professional, or someone you trust — is not a sign of weakness. It is one of the bravest steps there is, and the beginning of unlocking a door that shame had locked.

As for approaches to caring for the mind such as hypnotherapy, we want to be clear here: it is not a treatment for bulimia nervosa, and it must never be used in place of, or in a way that delays, the primary treatment from a specialist team. At most it belongs as a complementary approach working alongside, and under, the treating team’s plan of care.

Within that limit, it can help support some of the underlying factors that often lie behind this condition: gradually restoring self-esteem, making it possible to regulate emotion better, easing perfectionism, releasing past wounds, gradually building a safer and gentler relationship with oneself, easing anxiety, and adjusting one’s view of self-care toward something gentler and more appropriate. All of this is complementary only. It is not treatment of the illness itself and cannot replace care from a specialist team. For an illness as serious as this, specialist treatment is the heart of the matter and must always come first.

At NBRH we hold that nobody should be defined by the illness they are facing, and we believe in the possibility of recovery when appropriate care is received. For a condition as serious as bulimia nervosa, we would say plainly, and with real care, that treatment from a specialist team is the most important and most necessary thing of all — and that reaching out for help today may be the beginning of finally stepping out of the revolving door.

To understand how shame kept in secret operates, and how it can be eased, we have written “Shame: When the Voice Inside Says We Are Not Enough”. And to learn how to treat yourself with more gentleness on the hardest days, “What Self-Compassion Is” may help steady you.