As you think about bulimia nervosa, it’s important that you understand that each of the symptoms interacts with every other symptom. Typically, when you’re struggling with bulimia, your weight and body image have a very strong effect on how you feel about yourself. Therefore, if you believe your body isn’t perfect, you then decide that you’re not a valuable person, and you feel bad about yourself—embarrassed, guilty, angry, sad, and so on. This self-invalidation and negative self-evaluation leads you to feel compelled to change how you look so that you can feel better about yourself. Through the messages of Western culture (for instance, “You’re not in the healthy weight range” or “You look different from the women in magazines or on television”), you have learned to invalidate yourself and now believe that losing weight is one powerful way you can feel better.

These thoughts, feelings, and behaviors form a vicious cycle. The cycle begins with you restricting to feel more in control of your weight, which sets you up to binge. Once you’ve binged, you feel a desperate need to get rid of the calories, so you find a way to do that. You then feel shame for using your eating disorder, and you feel out of control. In order to feel in control again, you decide to restrict—and the cycle continues. For example, you might have begun your attempts at losing weight by trying a diet program (a diet, by definition, encourages caloric restriction). You then noticed that you didn’t have the “willpower” to stick to such a restrictive diet. This is a common and culturally supported way to think about dieting. However, rather than being due to a lack of willpower, bingeing often results as a physiological response to an overly restrictive diet.

When going without eating for over four hours, your metabolism begins to shut down. This is the point when your body gives up trying to communicate to you that it needs food and the hunger pains stop. Like people, you probably feel better and more in control when the hunger pains temporarily go away. However, you may be thrown for a loop when you realize that the hunger isn’t gone for good. Once you allow yourself to eat again, you are much more apt to binge. This reaction is because your hunger becomes so intense that your body wrests control from your mind. Your body will be fed, no matter how much control you try to exert. As the definition of a binge indicates, you feel out of control during a binge and ashamed and guilty afterward. This all then leads you back into the cycle of bulimia. This happens because after a binge, you likely try to compensate for the calories consumed. By getting rid of the food through a compensatory behavior like self-induced vomiting, laxative abuse, or compulsive overexercise, you contribute unintentionally to the cycle of bulimia, unintentionally making things worse for yourself.

Once you “empty” your body, you set yourself up for yet another binge. In other words, your body is triggered to binge because it’s not getting the calories it needs. Not only does this feed the bulimia, but your embarrassment about the binge might prompt you to start covering up and being dishonest with friends and loved ones to hide what has been going on. These behaviors then lead to even more feelings of shame and guilt, adding fuel to your negative feelings about yourself and pushing you further into the cycle of bulimia. It’s important to note that the very behaviors that you have engaged in to make yourself feel better do make you feel better in the short run. The problem is that before long, these same behaviors lead to increased emotional pain, loss of control, and even more problem behaviors.

There are effective treatments to help you step out of this cycle! Although we must recognize that there are benefits to your bulimia, we remind you that those benefits are greatly outweighed by the damaging effects of the behaviors. As you read on, you’ll learn more effective and sustainable ways to cope with uncomfortable feelings, to again take pleasure in the human joy of nourishing yourself, and to gain some true control over your life.

Excerpt from The Dialectical Behavior Therapy Skills Workbook for Bulimia