What To Expect In Bulimia Recovery

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Last updated on October 17th, 2023 at 02:15 am

Bulimia nervosa recovery can come with many physical and psychological impacts.  If you are suffering from bulimia, your healthcare team will work to progress through the treatment that is right for you. 

Treatment for bulimia nervosa typically includes: 

• Weight restoration
• A healthcare team including a physician, therapist, and eating disorder dietitian)
• Meal support 
• Sitting with urges to purge
• Managing edema

This article will walk you through what to expect in bulimia treatment and how to navigate the treatment option that is most suitable for you. 

Severity Of Bulimia Nervosa

The severity of bulimia and what type of treatment you should seek will depend on how frequently compensatory behavior occurs. 

Compensatory behavior in bulimia nervosa can include: 

• Vomiting
• Misusing laxatives
• Misusing diuretics
• Misusing prescription medications in attempt to shrink the body
• Excessive exercise
• Abusing insulin dosing (for type 1 diabetics)

Mild Severity Bulimia: 

Compensatory  episodes 1-3 times per week 

Moderate Severity Bulimia: 

Compensatory episodes 4-7 times per week

Severe Severity Bulimia: 

Compensatory episodes 8-13 times per week

Extreme Severity Bulimia: 

Compensatory episodes 14+ times per week

Low-frequency bulimia occurs when compensatory episodes are infrequent but still present.  People with low frequency bulimia would technically fall into the OSFED (Other specified feeding or eating disorders) rather than bulimia nervosa.  

More severe compensatory behaviors and restrictions will require higher levels of care for recovery.

It is critical to remember that ALL severity levels (even 1 time using compensatory behavior) require appropriate treatment for bulimia.  The difference is simply in what level of treatment is most appropriate. 

Many people at advanced stages of bulimia are experiencing starvation syndrome and will require a treatment team trained in eating disorders to manage the complex physical and behavioral symptoms that arise.

Bulimia Recovery Stages

Bulimia treatment should not be viewed as a step by step or linear process. Instead, think of the recovery journey like completing a puzzle.  Each step in recovery yields another puzzle piece. 

Stages of bulimia recovery include: 

1. Telling someone you trust you have an eating disorder 
2. Deciding if outpatient or residential treatment is the most appropriate option
3. Following an  eating disorder meal plan unique to your needs
4. Meal support to help with adequate food intake and urges to purge
5. Weight restoration 
6. Managing negative body thoughts
   

Stages of bulimia recovery do not always occur in this order. It is very common to need to repeat stages in bulimia recovery.  This should not be considered failing at recovery, but rather relearning.  

Bulimia Recovery Symptoms 

Some common symptoms of bulimia recovery include: 

• Bloating 
• Edema
• Swollen glands
• Slowed digestion 
• Constipation or diarrhea 
• Binge eating
• Rumination syndrome 
• Substance abuse
• Gastroparesis (delayed digestion)

Depending on the severity of bulimia symptoms, recovery may also include managing the following symptoms: 

• Pseudo Bartter syndrome
• Low sodium
• Low or high volume status
• Depleted calcium
• Low serum calcium
• Low potassium 
• Low or high bicarbonate levels 
• Managing dental damage or sores in the mouth

You should work with a qualified clinical team to manage symptoms of bulimia recovery.  Without proper treatment, some of the conditions listed above can be life threatening. 

Bulimia Recovery Bloating 

Bloating in bulimia recovery can occur as a result of: 

• Pelvic floor dysfunction 
• Sitting with the urge to purge
• High levels of body dissatisfaction 
• Binge restrict cycles
• Discontinuing laxative use (leading to fluid retention)
• Delayed gastric emptying from malnutrition
• Anxiety induced IBS
• Imbalance in microbiome 

Bulimia bloating can sometimes be reduced by: 

• Diligently following meal plan (bloating will still happen but will be for a shorter time frame)
• Having liquid calories for some meals and snacks
• Normalizing bathroom habits 
• Meditation 
• Heating pads 
• Practicing various breathing techniques

Weight Gain Expectations In Bulimia Recovery

There are often a lot of fears around gaining weight in bulimia recovery. This can lead to mental restrictions around food even if you are physically eating the food. Working with a qualified healthcare team can help ease some of these discomforts and let you know what to expect.

The expectation for weight gain in bulimia recovery will be different for everyone.  If growth records are available, the weight target will likely be the weight that matches your trends on a BMI chart growth curve. 

Other things to consider in weight gain during bulimia recovery are: 

• Target weights will likely be a range (typically of about 20 lbs)
• Clinical markers like getting your period back, normal GI function, and hair regrowth or loss of lanugo, will impact weight goal
• Weight gain expectations may include overshoot weight gain for tissue and organ repair

The eating disorder voice will likely tell you things like: 

• It’s okay to gain weight but not too much 
• You can start dieting “normally” once you stop purging
• You don’t need to gain weight because you’re at a “healthy” BMI

These are all myths that too often show up in ed recovery. It is very important that you work with your healthcare team to work through some of these negative thoughts about weight gain.  

Weight restoration as quickly as possible is critical for a full recovery from bulimia. 

Staying Motivated In Bulimia Recovery 

Eating disorder recovery can feel like a long, impossible road.  You might feel like you are failing at both your eating disorder and recovery on a daily basis.  It might feel as though you will never eat normally again.

Here are some tools that can help you stay motivated in your bulimia recovery: 

• Keeping a list of positive body affirmations 
• Navigating weight comments 
• Reading recovery books to share in other people’s recovery journeys
• Using body positive journal prompts and journaling regularly 
• Having a plan when nothing sounds good to eat
• Challenging fear foods and food rules  
• Practice food neutrality
• Honor all types of hunger
• Practice challenging your internal fatphobia

It’s important to know that eating disorder recovery is nonlinear. However,  it’s critical you resist the urge to engage in eating disorder behavior even one time as this can quickly spiral into an eating disorder relapse. 

There is a world of food and body freedom, and EVERYONE deserves access to it.  You are worthy of recovery.

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