How to Stop Purging After You Eat
Written by: Allyson Inez Ford, MA, LPCC | Eating Disorder Specialist & Founder of ED & OCD Therapy
Breaking the bulimia cycle
The cycle of bulimia is incredibly hard to break, which is confusing for many sufferers and loved ones, as purging is not enjoyable.
It’s a pretty unpleasant experience, as you can imagine. Sure, there may be a few minutes of relief and calm, but then the shame and self-disgust kicks in. Not to mention the physical side effects can are extremely unpleasant, especially the more you do it.
So how do people stop purging? We’re going to get into a few strategies that we often help our clients implement, but first let’s dive more into what purging is, why it happens, the cycle that fuels it and some of the risks.
What exactly Does it Mean to Purge ?
Purging, in the context of bulimia nervosa, refers to compensatory behaviors used in an attempt to prevent weight gain or change body size and shape after eating. For some people, this happens after a binge. For others, the urge to compensate can happen even after eating what would objectively be considered a ‘regular’ meal or snack because the person feels they have eaten too much.
Usually, a person with bulimia experiences intense anxiety, shame, guilt, or disgust after eating, along with a strong desire to ‘undo’ what they have eaten. There can be a fear that the food will be absorbed by the body and lead to weight gain, an extreme discomfort with fullness and/or a feeling that eating was somehow a mistake that needs to be corrected. Rigid beliefs around food (such as you can only eat when you are hungry or if you’re full you have eaten too much) come from diet culture and make us feel like we have done something wrong after we eat.
Purging can temporarily reduce some of that distress, which can make the behavior incredibly difficult to stop even when someone genuinely wants to stop doing it.
This is one of the reasons bulimia can become such a persistent cycle. The brain learns that purging provides a quick reduction in distress, even though the relief does not last. Over time, the urge to purge can become increasingly automatic, especially when someone is feeling full, anxious, ashamed, or disconnected from their body.
Purging can include many different behaviors, including:
Self-induced vomiting
Misuse of laxatives or other medications
Intentionally reducing or skipping insulin doses to influence weight or shape for people with Type 1 diabetes, sometimes referred to as diabulimia
It’s possible for someone to have bulimia without regularly vomiting. Purging can take many forms, and some behaviors (like compensatory exercise) are normalized within diet culture, which can make them harder to recognize as part of an eating disorder.
Why is it so difficult to stop purging?
If purging feels so awful, why do people keep doing it? The short answer is- because the behavior is serving a purpose.
For someone with bulimia, eating can bring up an enormous amount of anxiety or shame. Purging may temporarily make that anxiety or shame feel more manageable. It can create the sense that the person has undone the eating, regained control or prevented a feared consequence. It can also feel like a way to punish oneself after doing something ‘bad’ - sort of like religious repenting. After doing it, there is a sense that ‘goodness’ has been restored. That temporary relief reinforces the behavior and makes it more likely that the person will turn to purging the next time those feelings show up.
This is a form of negative reinforcement. The behavior gets reinforced because it removes or reduces something distressing in the moment.
The problem is that purging does not actually resolve the underlying fear of food, weight gain, fullness or body changes. Instead, it teaches the brain that those experiences are dangerous and that purging is necessary to cope with them. This can make the cycle stronger over time.
For many, There is another part of the cycle that Often gets overlooked: restriction
Many people with bulimia spend a significant amount of time trying to prevent themselves from eating what they consider as ‘too much’. They may skip breakfast, eat very little during the day, avoid foods they consider “bad,” compensate for previous eating or try to follow rigid food rules or diets.
Restriction inevitably increases physical hunger and preoccupation with food. This is an evolutionary response, as the body senses danger when one goes without eating regularly (it triggers our caveman brain that we may be in a famine). This drives us to ‘make up’ for the lack of food by eating a lot (sometimes not even a lot, sometimes it’s just an objectively regular or small amount). Afterward, the person with bulimia will feel intense guilt or fear at what they have done (eat) and turn to purging to cope.
The Bulimia cycle Usually ends up looking like:
Restriction → increased hunger and food preoccupation → binge eating → shame, anxiety, disgust → purging → temporary relief → restriction again
Breaking this cycle often means starting with working on getting regular nourishment, challenging food rules, working on body acceptance, coping with body image distress, shame and any other beliefs that make eating feel unsafe.
What are the Medical risks of purging?
Purging can have serious medical consequences, especially when it happens frequently or over a long period of time. The risks vary depending on the type of purging, how often it occurs, and the person’s overall health- but it is worth noting that there is a life threatening risk each time you purge.
Self Induced Vomiting Risks
Self-induced vomiting can cause dehydration and electrolyte abnormalities, which can affect the heart and even cause heart failure. Repeated vomiting can also irritate or tear the esophagus, damage tooth enamel, cause swollen salivary glands and lead to chronic throat and gastrointestinal problems. In some cases, vomiting can cause a tear in the esophagus that requires emergency medical attention. If you see blood in your vomit, you need to go to the emergency room and seek medical care as soon as possible.
Laxative Misuse
Laxative misuse can also lead to significant dehydration and electrolyte abnormalities, along with gastrointestinal complications. Compensatory exercise can contribute to injuries, exhaustion, inadequate energy availability and other physical consequences when the body is not receiving enough nutrition to support the amount of activity.
Other Risks To Note
There are also risks that people may not think about when they picture purging. Using fingers or other objects to induce vomiting can cause injury to the mouth, throat or esophagus. There is also a risk of choking or aspiration. From a harm reduction standpoint, it is safer to purge with your fingers rather than a foreign object, as an object can get stuck in your throat. Though I don’t recommend either, it’s important to meet people where they are at and offer strategies to support safety and limit risks.
In severe cases, complications from bulimia can result in death. This is one of the reasons medical monitoring is an important part of treatment for bulimia. You do not need to be visibly underweight or appear medically unwell for an eating disorder to have serious effects on your body.
The Psychological Risks of Purging
The physical risks are only part of the picture. Purging can also strengthen the eating disorder psychologically.
Purging often provides a temporary reduction in anxiety after eating. That relief can teach your brain that purging is an effective way to cope with distress, which can make the urge feel stronger the next time you experience similar emotions.
Over time, this can create a cycle where eating leads to anxiety, anxiety leads to an urge to purge, and purging becomes the primary way of getting relief. You may begin to feel increasingly afraid of eating without having access to a way to compensate.
Purging can also increase shame, self-criticism and it’s incredibly isolating. Many people find themselves spending more and more time thinking about food, their body, what they ate, whether they will purge and how they can prevent themselves from gaining weight. The eating disorder can begin to take up a significant amount of mental space and interfere with relationships, work, school, travel and other parts of daily life.
How to Cope with the Urge to Purge
Learning how to ride out an urge to purge is an important part of recovery (forgive the unintentional, cheesy rhyme). The goal is not necessarily to make the urge disappear immediately. It is to practice experiencing the urge without automatically acting on it.
Here are some strategies that can help:
Urge surfing
Urges always follow a pattern. The intensity starts out mild or moderate, then it peaks, and eventually it come back down. It’s much like a wave in the ocean. When an urge to purge comes up, try observing it with the analogy of an ocean wave in mind, rather than immediately responding to it.
You can remind yourself that an urge is an experience that will change if you can ride out the wave of intensity. Having a list of things to distract yourself with and setting a timer for 20 minutes can help so much. Even if you do end up acting on it in the end, delaying the urge is a huge step and creates a wedge between you and bulimia. If 20 minutes feels inaccessible, start smaller. Five minutes is still a step in the right direction!
Your brain also gets to learn something powerful when you delay or refuse to act on an urge: you do not have to act on the purge simply because the urge is present. You have agency to try something new.
2. Make a DBT pros and cons list
When you are highly distressed, it can be difficult to remember why you want recovery. A pros and cons list can help you step outside of the immediate urge and reconnect with the bigger picture. DBT (dialectical behavioral therapy) has a helpful twist to the standard pro/con list as it helps you look at what pros vs. cons are short vs. long term.
Try writing down in a journal:
What do I get from purging in the short term? What do I get from it in the long term?
What does purging cost me in the short term? What does it cost me in the short term?
What do I gain by resisting the urge? In the short term vs. long term?
What might I be able to do with my life if I spent less time caught in the binge-purge cycle?
Reflecting on the short-term vs. long term can be really eye opening and help with the motivation to resist an urge. It also highlights the underlying functions of your relationship to bulimia, which will be different for everyone.
3. Identify your emotional triggers for Bulimia and create a coping plan Ahead of Time
Purging is often connected to emotional experiences that happen around eating. You may notice stronger urges when you feel ashamed, anxious, angry, lonely, sad, overwhelmed, exhausted or uncomfortable in your body. It can help to identify your most common triggers ahead of time and create a plan for what you will do instead when they show up.
For example:
Trigger: I feel extremely full after dinner and start thinking that I ate too much. This makes me feel ashamed of myself and uncomfortable in my clothes.
What I usually do: Go to the bathroom and purge to make the feelings go away.
What I can try instead: Stay in the living room with my partner, remind myself that fullness is temporary, change into loose fitting clothes, turn on my comfort TV show or movie and give myself 30 minutes before making any decisions about compensating.
Having a plan in place before you are overwhelmed can make it easier to access those coping skills when you actually need them.
4. Address the underlying restriction In Bulimia
For many people this one of the most important pieces of bulimia recovery (although not everyone with bulimia restricts, many do). Restriction can take a lot of different forms. Sometimes it is obvious, such as skipping meals or fasting, counting calories or avoiding only certain foods (aka dieting). It can also be much more subtle. You might constantly negotiate with yourself about whether you have earned a meal, feel intense food guilt for eating something ‘bad’ or delay eating as long as possible. Physical and psychological restriction can increase hunger, food preoccupation, and vulnerability to binge eating. Afterward, the distress surrounding the binge can increase the urge to purge.
This is why simply trying to stop purging while continuing to heavily restrict food can leave you feeling stuck. Recovery usually involves addressing the entire cycle, including the restriction that may be helping maintain it.
How Therapy for Bulimia Can Help You Recover
Bulimia treatment is about much more than learning how to stop vomiting or laxative use. A good treatment plan looks at the whole cycle and helps you understand what keeps your specific eating disorder going.
In therapy, we may work on:
Establishing more consistent and adequate nourishment
Reducing binge eating and purging behaviors
Identifying and challenging the emotions and thoughts that lead up to the bulimia cycle
Increasing tolerance for fullness and other uncomfortable physical sensations
Working through fear of weight gain and body changes
Developing coping skills for difficult emotions and distress tolerance
Addressing shame and self-criticism
Exploring what underlying needs and psychological conflicts exist underneath the purging behavior
Exploring the relational and interpersonal factors that contribute to your eating disorder
Working through any underlying trauma (if applicable)
Developing a stronger sense of identity and life worth living outside of the eating disorder
Treatment can also involve working with a medical provider and dietitian when appropriate. Eating disorders affect both physical and psychological health, so having a team that can support both is often an important part of recovery.
You also do not need to wait until your symptoms become “bad enough” to seek treatment. If you are spending any amount of time thinking about food, your body, bingeing, purging, or compensating for what you eat, that is enough reason to reach out as eating disorders tend to only spiral and get worse.
Looking for a Bulimia Therapist in CAlifornia?
If you are struggling with bulimia, you do not have to keep managing the binge-purge cycle on your own.
If you are looking for a bulimia therapist in San Diego or virtual throughout California, Maryland, Tennessee, Utah or Washington, reach out to schedule a free 15-minute phone consultation. Together we can explore what you have been experiencing, answer any questions you have about treatment, and discuss what a path towards recovery might look like for you.
