Bulimia Relapse: Signs and Prevention

Less than 1% of the American population has bulimia.¹ It is a very complex mental illness that can have very serious medical complications. Yet, it is treatable, and although challenging, recovery is possible.  

Those who struggle with bulimia might cycle through several periods of wellness and relapse before they establish a healthier relationship with food, eating, and their bodies.

Eating disorder relapses are part of the recovery process. And stressful life events can trigger a relapse. These can include moving, going to a new school, starting a new job, losing a job, losing a loved one, getting married, having a baby, and even the holidays. In one study of people with bulimia nervosa, at the four-month treatment mark, about 44% had relapsed at least once.² Knowing what to look for and what to do can help you weather a relapse if you find yourself resorting to disordered behaviors.

What Does Bulimia Relapse Look Like?

A typical bulimia relapse involves engaging in at least one of three behaviors with increasing frequency.³

Disordered Eating

A restrict-and-binge episode is a symptom of a bulimia relapse. Signs you might be heading toward a relapse include:

• Worrying over the calories in each bite of food you take
• Making lists of foods that are good and bad
• Thinking about food almost all of the time
• Fantasizing about eating forbidden foods 
• Limiting when or how much you eat
• Skipping meals
• Eating alone

Preoccupation With Weight

People with bulimia desperately want to lose weight or prevent weight gain, regardless of physical health. Becoming preoccupied with weight again could indicate a relapse, such as:

• Weighing yourself every day or multiple times per day
• Spending a long time looking in the mirror (or covering up all the mirrors so that you won’t see yourself)
• Talking about your weight and how you look
• Assessing the weight of other people
• Exercising excessively to burn calories and control weight

3. Negative Self-Talk 

Engaging in negative self-talk can lead to a relapse. This can include:

• Using unkind words to describe yourself
• Berate yourself for the things you did (or did not) eat
• Comparing yourself negatively to others

Few people relapse to disordered eating behaviors quickly. So, it’s helpful to remind yourself of the warning signs, be aware of your triggers, and be ready to reach out to your support network when you find yourself struggling. 

How to Prevent a Bulimia Relapse 

Relapse risks are highest within the first six or seven months of your recovery.⁴ Knowing this can help you be more aware of when you may be headed toward a relapse. 

You can also use these three tactics to help reduce your relapse risks. 

Follow Your Treatment Plan

Don’t skip appointments, cut back on medication, or opt out of treatment unless your team tells you it’s time. Pulling back on therapy, even when you feel well, could leave you vulnerable to relapse.

Cutting back on therapy or other supportive measures is not an option during the 6 to 12 months or so of recovery. This is your most vulnerable time, so you need to set yourself up for success.

If you experience any significant disruption in your life, such as a job loss or relationship issue, it’s wise to talk to a mental health professional and perhaps even ramp up your therapy sessions. You are more susceptible to relapse during this time, so the extra support can help.

Be Open and Honest

If your negative thoughts and cravings return, talk with your team. Don’t assume your issues will fade away independently or people will think less of you for struggling. 

Bulimia recovery takes time, and recovery is often a lifelong process. You will likely deal with triggers for the rest of your life, but you’ll get better at managing them over time. 

Rely on your support system. Speak openly and honestly about any problems you’re facing. Know that your team is there to help you whenever you need it.

Deal With Your Triggers 

It can be helpful to write down your triggers and list what you can do when you face them. 

Your list might look like this:

• Trigger: Holiday parties
  Coping mechanism: Bring a trusted friend to a support group meeting first. 
• Trigger: Thin models
  Coping mechanism: Take a break from social media and all other media. Get outside in nature and admire the diversity of all living things.
• Trigger: Stress
  Coping mechanism: Meditate every morning and keep a stress ball with me to squeeze throughout the day. 

If you’re not sure what your triggers are or what to do about them, your treatment team or therapist can help you identify your triggers and devise methods to best deal with them. This can involve minimizing your exposure to them as much as possible and using appropriate coping mechanisms when you can’t avoid them.

Talk to your eating disorder therapist about a relapse prevention plan.

What to Do if You Have a Relapse 

At the 22-year mark, about two-thirds of people treated for bulimia have recovered.⁵ This may sound like a long time and be discouraging. But recovery is a lifelong journey. 

You may experience a relapse but think of each as a learning experience that strengthens you, an opportunity to understand a new trigger, and a practice of a new coping skill. 

Immediately after a bulimia relapse, ask yourself these questions:

• Where were you?
• Who were you with?
• What were you thinking?
• Were you tired, hungry, or angry? 
• What did you try?

Steps to Cope with Relapse

Follow these steps to cope with your relapse:⁶

• Remind yourself that relapse is expected. A relapse is a normal part of recovery. You can learn from it; it doesn’t mean you’re weak or hopeless. It’s simply part of the recovery journey.
• Reach out for help. Talk with your treatment team about the relapse, and connect with your friends and family for added support. It’s important to talk to others rather than self-isolate during this time.
• Research new coping mechanisms. Think about what led to the relapse, and determine what coping skills might work better. When you encounter these triggers in the future, you’ll be better equipped to deal with them.
• Redirect your energy. You don’t have to obsess or dwell on your relapse. It happened, you’ll learn from it, and you’ll move forward. Spend time doing things you love with people you trust. You are more than your relapse. 

A bulimia relapse is discouraging, and it’s okay to feel anger or grief. Feel your emotions, but don’t let them overpower you. 

Eating disorders are very complex, and relapse is simply part of the journey to long-term recovery. It doesn’t mean you won’t succeed. It simply means you need to adjust your approach and recommit to your bulimia nervosa recovery.

As you grow stronger in eating disorder recovery, you’ll become better at resisting relapse triggers.