by Frank D. Young Ph.D., C. Psych.[1]


Bulimia Nervosa is an emotional and behavioral disorder that involves fasting and other distorted eating patterns, purging through excessive exercise and/or self-induced vomiting, rigid and rulebound thinking patterns, and other emotional disturbances.


This self-help program is designed for those who have sincerely decided that they want to end their bulimic practices and habits and make a commitment toward sustained recovery. It will not work unless you are committed to its principles. You can prepare for it by carefully examining all the positives that bulimia has allowed you in your life (escape from boredom, numbing the pain of disappointment, eating your anger, etc.). Resolve that you will face these emotions and find other ways of dealing with them.

Come to the point in your life where you are sick and tired of being sick and tired. Decide that you will do whatever it takes to get better, that other than the life of your child or the loss of your livelihood you will put this recovery as your main focus in the next 3 months. If you have made this step, you are motivationally ready to begin the program.


  1. Set a start date and begin to assemble the necessary materials and arrangements to support success.


  1. Gather a support team or network. Generate a list of 12-20 people and their phone numbers and contact information. Ask each person for their support in your recovery from bulimia. Find out at what times of day or under what circumstances they will be unavailable to help (e.g. after 10 p.m., at work, etc.). Tell them you will be calling them to calm yourself down when you are in danger of being overwhelmed with the impulse to binge and purge (BP) in the next few months. You maybe will only need 5-15 minutes of their time, but ask them to return your call as soon as possible after you have left them a voicemail message. Check out your system by doing a “dry run” or “fire drill” as if you did need help, to test the availability and response times of your friends and family on your support team. This step is very important, so don’t skip it. You need to be able to have confidence that you can ask for help when you need it, and that help will mostly be available.



  1. Gather nutritious foods that are easy to prepare. You will be following Canada’s Food Guide approximately. You will be eating 3 meals and 1-2 snacks per day. On almost every eating occasion you will be eating some kind of animal protein (chicken, beef, pork, fish, eggs) preferably starting from your first bite. This practice will stabilize your blood sugar level and minimize the production of insulin, thereby stabilizing body weight and improving the feeling of satiety. The best practice is to go to the deli department at the grocery store and have them finely slice ham or turkey or some other luncheon meat. Every morning, the first thing you will do is pop 2 slices of this meat in your mouth while you are deciding what else to eat for breakfast. This will begin to set the protein platform that is so crucial to recovery. Another necessary fast food is frozen vegetables, because the can easily be microwaved and ready to eat within 2 minutes. This can be used as a substitute for binge foods if eaten about 20 minutes before a key binge time. Anything that takes time and work to prepare could undermine your resolve when you are tired or short of time. Keep it simple and fast. Soups, especially vegetable soups and stews, are also fast and helpful. Breads for sandwiches and cereals for breakfast or snacks are handy. The dairy group is handled with cheese, milk, and yogurt. Finally, fruit and salad veggies are important. To summarize, virtually all eating occasions should have a representative of the 4 food groups: Animal protein, bread or cereal, fruit or veggies, and cheese or milk. If you are dedicatedly vegetarian, or you object to any part of this regime, stop now! This program is not for you. Without full and balanced eating, especially during the first 10 hours awake each day, you will not succeed. Skipping meals and snacks is a guaranteed way to generate the rebound eating that will sabotage your recovery.


  1. Eat slowly and mindfully to allow the satiety mechanism to operate properly. As you may recall, your body and brain need 20 minutes to trigger the signal that you have eaten enough. Ignore distractions. Do not multitask. Focus on the act of eating. In the first month of the program, you need to eat regularly as if you were taking medication, whether you are hungry or not. Later, after your digestive system has been retrained, you may opt for eating on demand, but have no period of fasting go longer than 4 hours. Paradoxically, regular eating is your best insurance against BP relapse.



  1. If the impulse to purge with vomiting or laxative abuse is overwhelming, arrange to have supervised eating in your first week of recovery. You recovery buddies remain with you until the impulse to purge the food has passed (usually within an hour of eating). Trips to the washroom are accompanied by your support person to prevent you from vomiting. In opposite-sex pairings, the bathroom door is kept open, or some other arrangement is made. Remember, this response suppression is for your own good. It is easy to sabotage this part of the program. If you cannot tolerate this temporary and somewhat embarrassing invasion of privacy, perhaps this program is not for you.


  1. While eating requires a moderation strategy, vomiting can be stopped entirely. Purging by vomiting or laxatives send the body into a state of nutritional emergency, adding more emotional upset that increases the likelihood of further episodes of bingeing-purging (BP). Furthermore, research has shown that, in the long run BP is an ineffective strategy for weight loss. As soon as you begin to swallow food, empty calories are begun to be absorbed by the walls of the esophagus even before the food reaches the stomach! That’s why people can still gain weight, even if they vomit every single thing they eat.



  1. Pattern Disruption part 1: the Replacement Rule. You can quit bulimia for the rest of your life if you follow this rule exactly: after any instance where you vomit either deliberately or accidentally you replace the vomited food with the same kind and amount of that food. For example, if you ate 4 doughnuts, then purged them, you would immediately have to eat another 4 doughnuts and keep these doughnuts down. This procedure could repeat any number of times, as long as the ritual ended with keeping that same amount of food down for digestion to occur. This pattern disruption is called a spoiling intervention because it typically defeats the thinking process “I’ll just get rid of this food and I will be okay.” It also works because it allows for a way of getting back on track so that an accidental slip will not become a slide. If you can’t stomach the Replacement Rule and commit to it fully, you may not be ready for this program.


  1. Pattern Disruption part 2: the Purging Uniform. Another intervention that has had outstanding success over the years is to have the client select her favorite dress, then require that she can vomit as much as she wants, but only if she is wearing her favorite dress. This idea requires the client to carry around her favorite dress in a gym bag wherever she goes as a constant reminder that she is in a recovery program. The time and effort required to change into the dress usually outlast the 20 peak minutes of an impulse before it subsides. It also makes it more difficult to be sneaky and hide the disorder from discovery from others. Even when done alone at home, it introduces a symbol of recovery that spoils the indulgent privacy of a very personal and intimate ritual. It disempowers the bulimia’s control over your life.



  1. Imagery of a new future during and beyond recovery. Using the audio tape “Building Self-Esteem: The Mirror of your Mind” by listening to side B every day, 5 days a week will keep you focused on a life beyond the grip of your disorder and its body image disturbances, a life of increasing freedom and emotional and psychological empowerment. As imagery guides our behavior, you will break through scripts such as “I’ll never be good enough” “I don’t deserve success or happiness.” ”I am unworthy” and other negative self-statements will fade as you go beyond them to envision your future life. In addition, the A-side of the tape focuses on digesting compliments to integrate them with your developing self-esteem, parallel to digesting food properly to nourish your body.


  1. Fluid retention. Unless a person is more than 20% below their Biological Set Point, they typically will gain no weight in this program of nutritionally balanced eating. I am assuming that you know how to avoid large amounts of junk food high in saturated fats (French fries, potato chips, you know what I mean). I am also assuming that you are following a lifelong commitment to have at least 2 aerobic exercise sessions and at least 1 or 2 other non-aerobic activities (walking, dancing, etc.) per week. If you haven’t made this commitment to yourself, now is a good time in your life to build these positive habits into your lifestyle. Thankfully, ending bulimia will allow for more time and energy to pursue these changes. Now, there is one caution: many but not all people who follow this program to end purging will notice more fluid retention of up to 5 pounds. Although this may be somewhat uncomfortable in the short run, it will redistribute and rebalance within 3 menstrual cycles as your body learns to adapt to your recovery.



  1. Remember to call your team quickly for emotional support even for the slightest things that could upset you, like a disappointment, or a fight with you boyfriend, or some other frustrating event. Get support early. Don’t let bad feelings fester and grow into an impulse to BP. Never mind that you are leaning on your friends and family or bothering them. They have volunteered to help, so you need them right now; make sure you use their help rather than jeopardize your recovery.


So there you have it! This program does not cover cognitive distortions such as all-or-nothing, black-white thinking, overpersonalizing, negative self-talk, perfectionism, and other personality traits that are often seen underlying eating disorders. If these persist beyond your initial recovery, you may want to seek the further assistance of a therapist or counselor. However, this present program will help alleviate most of the distress that is generated by bulimia itself. This disorder sometimes invades and entirely disrupts some people; it’s like the disorder has a life of its own. With this program you have a great chance to get your life back for yourself.


This program is offered to you free of charge as part of the grace of the universe. However, please do not abuse this privilege by taking it for granted. It will only work if you work. My pleasure in offering it will be fully compensated by the news of your recovery over this disorder. Your caring community wishes you all the best. Fy.

[1] Frank D. Young Ph.D., C. Psych. #200, 2003 – 14TH Street N.W. Calgary, Alberta T2M 3N4

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