Bulimia Relapse: Signs and Prevention

Relapse is part of the recovery process. Each time you step back into a bulimia activity, you learn something you can apply when temptation strikes again. 

Less than 1% of the American population has bulimia. Those who do might cycle through several periods of wellness and relapse before they regain control over their eating habits. (1)

Patient speaking with a doctor

Bulimia recovery is difficult. Unlike other forms of disordered behaviors, like substance abuse or gambling addiction, abstinence isn’t an option. Food is part of everyday life. 

Those suffering from bulimia are surrounded by temptations to binge every day, and these triggers can be heightened at mealtimes. They may face added pressures during the holiday season when it seems like everyone around them is eating a huge amount of food very quickly. 

Relapse doesn’t mean failure. It simply means you need to reassess your treatment. 

Here’s what you need to know about bulimia relapse. 

What Does Bulimia Relapse Look Like?

In one study of people with bulimia, at the four-month treatment mark, about 44% had relapsed at least once. It’s a very common and understandable behavior. 

A typical bulimia relapse involves one of three behaviors. (2,3)

1. Disordered Eating

A binge-eating episode is a surefire symptom of a bulimia relapse. But you can also experience subtle diet signs, including these:

  • 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
  • Attempting to eat alone

2. Preoccupation With Weight

People with bulimia desperately want to lose weight or prevent weight gain. A return to those well-known thoughts could be a relapse. You might do the following:

  • Weigh yourself every day or multiple times per day
  • Spend a long time looking in the mirror (or covering up all the mirrors, so you won’t see yourself)
  • Talking about your weight and how you look
  • Assessing the weight of other people

3. Negative Self-Talk 

Your inner voice is powerful, and if you relapse, you might tell yourself that you’re fat, unlovable, alone, or disgusting. You might berate yourself for the things you did (or did not) eat, and you might compare yourself negatively to others. The bulk of your self-perception is negative.

7 Bulimia Relapse Warning Signs

Few people relapse to bulimic behavior quickly. Most people have a slow and steady slide into disordered thoughts and behaviors. The sooner you recognize the warning signs, the quicker you can take action and stop yourself from making a mistake. 

Known bulimia relapse warning signs include the following:

  1. Skipping meals 
  2. Exercising excessively
  3. Avoiding food-related situations (like meals or parties)
  4. Weighing yourself more frequently
  5. Telling yourself you are fat 
  6. Trying to gain control of your weight or diet 
  7. Trying to be “perfect” in how you eat or look 

Some relapse warning signs are individual. Think about what triggered you to binge or purge in the past, and get specific about those triggers. The better you can identify what causes disordered thoughts, the more likely you can stop them. (4)

How to Prevent a Bulimia Relapse 

Know that your relapse risks are highest within the first six or seven months of your recovery. You may struggle with triggers throughout your life, but this brief window is the most dangerous for you. (5)

Use three tactics to help limit your relapse risks. 

Don’t skip appointments, cut back on medication, or otherwise 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 major disruption in your life, such as a job loss or relationship issue, it’s wise to ramp up your therapy sessions. You are more susceptible to relapse during this time, so the extra support can help.

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

Bulimia recovery takes time, and recovery is a lifelong process. You won’t magically be fully recovered one day. You might deal with triggers for the rest of your life, but you’ll get better at managing them over time. 

Use your support system often. Speak openly and honestly about any problems you’re facing. Accountability is important.

You know what causes you to think poorly of yourself or crave a binge. Write down all of your triggers, and list what you can do when you face them. 

Your list might look like this:

  • Trigger: Holiday parties
    Coping mechanism: Go to a support group meeting first, and bring a trusted friend with me. 
  • Trigger: Thin models

Coping mechanism: Watch Netflix instead of television (to avoid model-filled advertisements).

  • 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, talk with your treatment team for tailored advice. 

Your therapist can help you identify your personal triggers and devise methods to best deal with them. This can involve minimizing your exposure to them as much as possible and coping mechanisms for when you can’t avoid them.

What to Do if You Have a Relapse 

At the 22-year mark, about two-thirds of people treated for bulimia recovered. You can be one of them, but you’ll likely go through a relapse first. (6)

Each relapse gives you an opportunity to understand a new trigger or a failed coping skill. In the immediate aftermath of 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?
Person thinking

Steps to Cope with Relapse

Follow these steps to cope with your relapse:

  • Remind yourself that relapse is expected. A relapse is a normal part of recovery. You can learn from it, and 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 during this time rather than self-isolating.
  • Research 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’re going to learn from it, and you’ll move forward. Spend time doing things you love with people you trust. You are more than your relapse. (7)

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

As with any chronic disorder, relapse is simply part of the journey to long-term recovery. It doesn’t mean you won’t succeed, and it doesn’t mean you don’t have hope. It simply means you need to adjust your approach and recommit to your recovery.

With some time and planning, you’ll be back on your feet. As you grow stronger in recovery, you’ll become better at resisting relapse triggers.

Resources


  1. Eating Disorders. National Institute of Mental Health.
  2. Relapse Predictors of Patients with Bulimia Nervosa Who Achieved Abstinence Through Cognitive Behavioral Therapy. (December 2002). JAMA.
  3. 10 Ways to Cope With a Relapse in Eating Disorder Recovery. National Eating Disorders Association.
  4. Eating Disorder Relapse and How to Prevent It. (December 2021). FEAST.
  5. Relapse in Anorexia and Bulimia Nervosa: A 2.5-Year Followup Study. (May 2005). European Eating Disorders Review.
  6. Recovery From Anorexia Nervosa and Bulimia Nervosa at 22-Year Followup. The Journal of Clinical Psychiatry.
  7. Relapse and Recurrence. National Eating Disorders Collaboration.

Last Update | 11 - 7 - 2022

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