Important Milestones to Be Aware of in Bulimia Recovery

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    Recovery from conditions like bulimia nervosa (BN), anorexia nervosa (AN), binge eating disorder (BED), and other eating disorders is often a difficult process. The healing journey rarely happens in a straight line, and many people experience setbacks or even full-blown relapses on their way.

    Yet, these setbacks and growth spurts are all parts of the process. That’s why many measure recovery not in terms of length but in terms of milestones.

    Every journey is different, including how people show healthy growth. But there are some moments in bulimia nervosa recovery that can act as indicators that you or a loved one are making progress toward a healthier future and actively building toward long-lasting success.

    What is Bulimia Nervosa?

    Bulimia nervosa is a serious eating disorder that revolves around cycles of binging and purging. While struggling with BN, someone will experience periods of eating large amounts of food, then “compensate” for that behavior by purging through self-induced vomiting, fasting, misusing laxatives, or other unhelpful behaviors.

    And while these behaviors are often dangerous and lead to physical complications, they’re driven by a mixture of mental health concerns, including low self-esteem, distorted body image, and, in many cases, struggles with other conditions like anxiety, depression, or obsessive compulsive disorder.

    It’s addressing these deeply ingrained beliefs and mental health struggles that make the recovery journey for BN so tricky. Thankfully, a number of therapeutic techniques have been found to reduce these unhelpful thoughts and, subsequently, the unhelpful behaviors they encourage.

    Bulimia Recovery Milestones

    Once again, the eating disorder recovery process is hardly ever a straight line. Many in the eating disorder treatment community describe recovery as a series of stages, which can be cycled through in any order or repeated any number of times. [1]

    There are no “better” or “worse” ways to recover from bulimia nervosa. But these milestones frequently indicate that you or your loved one are on a positive trajectory. [2]

    Early Bulimia Recovery Milestones

    Using the “stages of change” model that describes recovery as a series of stages, these early recovery milestones may be considered part of the “pre-contemplation” or “contemplation” stages. These generally take place as someone is coming to grips with how serious the problem is or the fact that they’re struggling with disordered eating behaviors at all while they begin looking for help in earnest.

    Acknowledging there’s an issue is one of the earliest recovery milestones. Other early milestones include:

    As someone continues in the early stages of treatment and recovery, additional milestones may include changes in behavior and thought patterns and the earnest attempt to build or maintain a healthy support network.

    Physical Health Bulimia Recovery Milestones

    Physical recovery from BN is often the priority of a treatment team, especially in severe cases. Yet, while some physical results may be seen early on, others may take time or need to be worked on or periodically revisited throughout the recovery process.

    Progress with any significant health complications, including those involving heart rate and rhythm, blood pressure, and electrolyte levels, should be among the first signs of physical recovery from bulimia. Other milestones include:

    • Weight stabilization
    • Reduced use of eating disorder behaviors
    • Improved medical issues, such as reduced acid reflux or GERD symptoms
    • Establishment of regular eating patterns

    Nutritional recovery often goes hand-in-hand with physical recovery from an eating disorder. Some signs of progress in that realm include being more flexible about eating and meals, more comfort with eating socially, and a better concept of natural hunger/satiety cues.

    Mental Health Bulimia Recovery Milestones

    Mental health is generally the most challenging aspect of an eating disorder to treat. The recovery journey is often long and can be as frustrating and exhausting as it is rewarding.

    Some mental health milestones to be proud of achieving in BN recovery include:

    • Increased self-awareness and insight into triggers and emotions
    • Development of coping mechanisms and healthier ways to manage stress
    • Less anxiety around appearance or body image
    • Less urgency to diet, excessively exercise, or use other maladaptive coping mechanisms
    • Experiencing less frequent eating disorder symptoms
    • Feeling a greater sense of acceptance, higher self-esteem, or other improvements in outlook
    • Willingness to deal with other underlying issues, including trauma

    For many people with eating disorders, particularly those with bulimia nervosa, substance use disorder is a co-occurring condition. [3] Another milestone of mental health progress is less frequent use of harmful substances.

    Behavioral/Emotional Health Bulimia Recovery Milestones

    Behavioral health recovery is generally closely tied to mental health recovery. As someone learns and becomes more comfortable with healthier coping mechanisms and works through connected issues like previous traumas or mood disorders, it’s usually easier for them to control their behavior.

    Some milestones to look out for include:

    • Consistently following a treatment plan
    • Less frequent binge eating and purging episodes
    • Comfort with using alternate coping strategies
    • Comfort with returning to social activities and relationships
    • Returning to hobbies and interests

    Maintaining a solid support group is one of the best ways for someone to stay on track in their behavioral and emotional therapy. Sharing experiences with others in similar situations is a great way to maintain focus and positive momentum and receive ongoing support, even during setbacks.

    Long-Term Bulimia Recovery Milestones

    With conditions like bulimia nervosa, the healing process often depends on sustained recovery. The hope is that, eventually, new coping strategies and healthier perspectives become second nature, to the point where someone can easily maintain their healthier lifestyle.

    These are some milestones that may indicate you or a loved one are entering long-term recovery:

    • Long-term remission from binge/purge behaviors
    • Integration of recovery into daily life
    • Fulfillment of personal goals and aspirations
    • Advocacy and support for others in recovery
    • Celebration of milestones and ongoing self-reflection

    Milestones in Bulimia Nervosa Relapse Prevention

    Setbacks and full-blown relapses are also common in recovery. It’s important to remember that these are normal parts of the process, so do not beat yourself up, and focus on all the progress you’ve made rather than giving that progress up over a slip.

    Many treatment programs also address this aspect of recovery, offering additional strategies for dealing with setbacks. Some signs that those lessons have sunk in include:

    • Recognition of warning signs and triggers
    • Implementation of relapse prevention strategies
    • Maintenance of healthy lifestyle habits
    • Continued therapy and support
    • Flexibility and resilience in the face of setbacks

    If you or a loved one are experiencing a relapse, it’s important to speak with your therapist, eating disorder specialist, or another member of your treatment team. They can help offer support to get through this time and remind you of the ways you’ve learned to move past setbacks.

    The Importance of Recognizing and Celebrating Recovery Milestones

    Eating disorder recovery is a physically, mentally, and emotionally taxing process, and full recovery can often take years. That’s why it’s so important to recognize and celebrate these (and other) milestones when they occur.

    Taking the time to celebrate these moments helps establish the perspective of how much progress you’ve made. It allows you to feel good about yourself and how far you’ve come. And that hope and positivity are essential ingredients in maintaining a healing trajectory.

    Recognizing your struggle is hard enough, and putting in the work to improve is even more challenging. If you’re on the road to recovery from bulimia nervosa, no matter what stage of the process you’re experiencing, it’s reason enough to celebrate.

    Resources

    1. Prochaska JO, DiClemente CC, Norcross JC. (1992). In search of how people change. Applications to addictive behaviors. The American Psychologist; 47(9):1102–1114.
    2. Recovery. (n.d.) National Eating Disorders Collaboration. Accessed June 2024.
    3. Eskander N, Chakrapani S, Ghani MR. (2020). The Risk of Substance Use Among Adolescents and Adults With Eating Disorders. Cureus; 12(9):e10309.