Like anorexia nervosa (AN), binge eating disorder (BED), and other eating disorders, BN is a complex condition impacting both mental and physical health, which can make eating disorder recovery equally complex.
Patients may see improvement in some areas before others or see certain eating disorder behaviors ebb and flow as they continue with treatment. But researchers have developed a way to better understand bulimia recovery as a whole, allowing patients and doctors alike to accurately track the recovery journey.
What Are the Stages of Bulimia Nervosa Recovery?
To help them determine the path of someone’s recovery from bulimia nervosa, medical professionals often use a diagnostic tool called the stages of change model.
Rather than presenting BN recovery—or recovery from any number of serious mental health conditions—as a linear path on which someone continually gets better until they’re eventually cured, the stages of change model interprets recovery as a cyclical experience.
The model maps out six major areas of bulimia recovery. Its non-linear format allows patients to cycle through these stages in any order or possibly travel back and forth between stages as they approach a more solid recovery. [1]
While there is no set order to the stages-of-change model, pre-contemplation is often thought of as the first major stage of BN recovery.
This aspect of the journey is fairly distinct from the other stages. It describes the point before a patient desires recovery in earnest. They may fully deny they have a problem or acknowledge some disordered eating habits but feel no need or want to change.
In general, bulimia patients in the pre-contemplation stage believe the benefits of their disordered behaviors outweigh the costs to their physical and mental health. They will likely be more focused on controlling their eating behaviors than on seeking out bulimia treatment.
There can be no earnest seeking of treatment—and, generally, no recovery from bulimia—without the contemplation stage.
At this point in their recovery journey, a patient begins to see their eating behaviors as unhealthy or possibly begins to understand them as a coping mechanism for anxiety disorders or other closely related issues.
They may still be unsure about what they want to do and may not yet be ready to accept that they need help. But, at this point, someone has at least developed a sense of inner conflict, where they are no longer sure their behavior is worth the consequences.
At the preparation stage of change, a person has started to accept that they want to make changes regarding their eating disorder behaviors. They may start making small changes on their own, and they may start reaching out to others about their feelings and the fact that they may need help.
Yet, despite tipping more prominently toward the desire to seek treatment, patients may still experience inner conflict at this point. They may feel they need to make a change but not feel ready for certain aspects of treatment, such as altering their food intake in a way that promotes weight gain.
This stage represents the point where more proactive recovery begins, with a person beginning to take significant, legitimate steps toward receiving treatment and making healthy changes.
At this point, a patient may feel ready to talk to medical professionals and willing to implement the suggestions of those professionals. They may start trying out healthier coping mechanisms to handle the way they feel about food and their own body.
It’s important to note that behaviors such as self-induced vomiting, binging episodes, and diet restriction may still occur during this stage. They may come and go many times while a patient continues working on their recovery.
The process is generally not fast and nearly never linear. But what continues to mark the action stage throughout is the active effort to reduce unhealthy behavior.
For many people in recovery, this stage is the goal of treatment. At the maintenance stage of change, a person has gained control over their disordered behaviors and is able to sustain a comparatively healthy lifestyle.
It’s normal to occasionally have thoughts and feelings about disordered eating during this or any stage of bulimia nervosa recovery. But when someone has reached the point of maintenance, these thoughts are rarely acted upon.
Likewise, someone in the maintenance stage may still think more about food and body image than the average person, but the techniques and coping mechanisms they’ve learned in recovery can generally help them control these feelings and live a full, functional life.
Generally considered the “final” stage of the change model, termination represents the point at which a person has refrained from disordered eating, or having significant thoughts about, or impulses to engage in, disordered eating, for a sustained period of time.
The stage is as close to “full recovery” as is generally acknowledged for eating disorders. Someone at the termination phase has become adept at managing their thoughts and behaviors and is typically thought to be less susceptible to potential triggers.
Yet, while termination is achievable for many people, it can be difficult to reach this point or to comfortably maintain it. Focusing on this outcome, and this outcome alone, could create unhealthy expectations for those in treatment, many experts warn.
Instead, emphasis is generally put on achieving sustained maintenance. This can inspire people to develop the skills needed to resist disordered eating but relieve them from the pressure of “never” having a disordered thought or falling back into disordered behavior.
Bulimia Recovery and Relapse
Relapse isn’t a “stage” of the change model in the same way the other stages are, but it’s still important to understand how it interplays with the other phases of recovery.
Technically, relapse describes when someone engages in disordered behavior after a period of abstaining from that behavior. When it comes to BN, this could mean engaging in binging episodes or a range of contemplative behaviors, including those someone may not have originally struggled with.
When it comes to the stages-of-change model, it’s possible for someone to experience a relapse at any stage. Likewise, it’s possible to re-enter the recovery effort at any stage after a relapse incident. This can be a very disheartening experience, and it can sometimes lead people to regress on their path to recovery.
But equating these episodes to “failing” is unfair and inaccurate. One slip, or even multiple setbacks, does not negate the months of work someone has put in. Rather than look at the progress “lost” during a relapse, patients going through this difficult scenario are encouraged to look at the amount of progress they’ve made overall.
What to Do After a Relapse
Many treatments for bulimia nervosa teach techniques for recognizing a trigger or oncoming relapse and ideas for recommitting to recovery after one of these disheartening incidents.
If you or a loved one have experienced relapse, you may want to speak with a mental health professional or a member of your treatment team. These experts can offer support and advice about how to get back on track, how to forgive yourself for this scenario, and how to avoid similar situations moving forward.
Some patients also find help in bulimia nervosa support groups after an incident of relapse. These groups are filled with people who have gone through similar experiences, and they can share what their recovery was like and help someone realize that relapse is neither uncommon nor a “failure.”
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Movement Through The Stages of Bulimia Recovery
Movement through these stages can vary significantly, depending on the individual, the type of support they have, and the severity of their eating disorder, among other factors.
Some people may move more slowly through these stages, while others may go back and forth between different stages, and still, others may skip some stages entirely. These differences are normal and illustrate why it’s important not to compare oneself to others in terms of recovery progress and speed.
This isn’t to say you shouldn’t seek changes to your recovery routine if you think something isn’t working. If you’re concerned about your progress, talk with a treatment professional about what you think may be wrong and your expectations for treatment.
Ultimately, all that really matters is giving yourself the best odds possible of achieving a sustained and healthy recovery.
Finding Treatment & Support
Though it may seem out of reach for those going through it, recovery from bulimia nervosa is entirely possible. In fact, a majority of people with BN are able to reach recovery if given the right support and sustained treatment. [2] But in order for the process to happen, it’s vital to seek help.
Speaking with a doctor, therapist, or other trusted medical professional is a great place to start. These experts are often educated on many types of eating disorders and can help point you in the direction of a good treatment program or provide you with the best next steps.
If you’d rather not broach this topic with someone face-to-face, there are a number of eating disorder hotlines that can also help. These anonymous services can help connect you with trained volunteers who can listen to your concerns, provide evidence-based information on eating disorders, and link you to further support and treatment resources.
But no matter where you look for help, the important thing to remember is that recovery is always possible.
Resources
- Stages of Change. National Eating Disorders Collaboration. Accessed January 2023.
- Eddy KT, Tabri N, Thomas JJ, Murray HB, Keshaviah A, Hastings E, Edkins K, Krishna M, Herzog DB, Keel PK, & Franko DL. (2017). Recovery From Anorexia Nervosa and Bulimia Nervosa at 22-Year Follow-Up. The Journal of Clinical Psychiatry; 78(2):184–189.