Assessing Readiness to Recovery in Bulimia Nervosa

Woman with flower by a fence

Bulimia is an eating disorder that has ongoing episodes of binge eating.

The person struggles with periods of binge eating where large amounts of food are consumed in a two hour or less time period.

The binging is typically followed by feelings of shame, helplessness and a lack of self-control. After a binge episode occurs, there are compensating actions to prevent weight gain including fasting, excessive exercise, laxative and diuretic abuse, and vomiting [1].

To be considered to have bulimia, the behaviors happen at least once a week for three months to meet the criteria as listed in the DSM-V.

Individuals with bulimia tend to have a negative view of their body, shape, and weight. For the person struggling, the goal of the behaviors is to achieve physical perfection even at the cost of their physical, mental, and emotional health.

Symptoms and Signs That Help is Needed

Symptoms are varied and systemic. Complications can be both physical and psychological. Physical symptoms can include erosion of the esophagus, heart issues, facial swelling, the presence of blood in a person’s vomit, complaints of a sore throat, dry skin, or dizziness.

A person may also have scarring on their hands and knuckles from self-induced vomiting, irregular heartbeat, hemorrhoids, tooth decay, and red eyes.

Psychological symptoms can affect an individual’s thoughts and mood [1]. Symptoms include obsession with weight and body shape, fear of weight gain, and feeling out of control during a binge. Individuals tend to perceive their body as distorted and may obsessively compare themselves to others.

A person may also experience mood shifts due to an imbalance in their minerals and vitamins from purging. Sufferers tend to have an inability to eat in front of others due to feelings of shame and guilt or feelings of being judged when eating.

Assessing Readiness for Change

Change can be scary, especially if the eating disorder is chronic. The eating disorder produces complicated eating rules and behaviors of what the person ‘should’ do.

The sufferer may begin seeing the body and food become the enemy. The person begins to experience and believe that they are only worthy of self-loathing and self-hate.

With the eating disorder in charge, a person begins to fear food [2]. Food is internalized as black-and-white or ‘good’ or ‘bad.’ Bulimia traps the individual within the cycle of binging and purging behaviors and thoughts that will not allow them to break free and change.

Many individuals are unable to attend college or travel due to fear of the unknown. If a person can engage in these situations, the disorder may worsen, or they may be unable to enjoy new experiences due to the disorder.

Girl with flowers who overcame BulimiaAn eating disorder begins to shut out happiness, acceptance, and joy. At first, the disorder may make someone feel happy because of weight loss, or control over themselves, but as time passes these feelings disappear.

It acts as an ‘off switch’ for the person, and they forget, in a way, what it feels like to experience emotions.

As the disorder strengthens, feelings become numb which allows the person to only focus on the needs of the disorder.

Much energy is put into the behaviors and thoughts of the disorder, and it can be significantly exhausting. Underlying physical complications can cause a lack of energy, but often the stress of the disorder is both emotionally and physically draining.

Isolation from loved ones also occurs when the eating disorder is active. Loved ones may try to intervene, but the eating disorder will dismiss or deny the problem.

Motivation for Bulimia Treatment

Some individuals are ambivalent to change, and lack of motivation is associated with treatment refusal and relapse [3].

Motivational Interviewing (MI) is a type of therapeutic intervention that is used with eating disorder therapy to help with motivation for individuals who are struggling or feel stuck. It is shown to be associated with higher rates of treatment success [3].

Working with a treatment team to identify and understand the barriers to treatment is also vital. It can help with staying motivated and understanding the underlying issues of bulimia nervosa.

Methods of Change

The Readiness and Motivation Interview (RMI) is used to determine readiness and motivation in those with an eating disorder [3].

This assessment works by evaluating what their current level of motivation for change is, and the variance to which the sufferer is making changes for themselves or for someone else like a family member.

Girl in fieldResearch has shown that those with an eating disorder are more interested in making a change in binge symptoms and least interested in making changes to restriction, overeating, and use of compensatory behaviors [3].

It is helpful for the sufferer to understand what role the eating disorder plays in their life, and how it aids in the benefit or destruction of their life and health.

It is common for those with an eating disorder to feel guilt, shame, and embarrassment over their eating disorder.

This motivational interviewing approach tends to assist the sufferer in articulating what they wish to get out of treatment and their goals. These assessments and therapeutic tools can help determine a person’s readiness for change and recovery.

Image of Libby Lyons and familyAbout the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.

Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.


[1] Bulimia Signs and Symptoms – Am I Bulimic? (n.d.). Retrieved January 12, 2018, from
[2] 11 Reasons Why Recovery is Worth It. (n.d.). Retrieved January 12, 2018, from
[3] Addressing Motivational Issues in Eating Disorders. (n.d.). Retrieved January 12, 2018, from

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on March 7, 2018.

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