How the bulimia cycle keeps itself going
A maintenance-cycle explainer on how judging yourself by shape and weight, strict dieting, binge eating and making up for it feed each other, and how the cycle can be broken. Simplified from Fairburn, Cooper and Shafran (2003): the four additional maintaining processes are left out, and the cycle is told in words without a diagram.
Written by Tarun Vermani, Trainee Clinical Psychologist Updated
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How the bulimia cycle keeps itself going
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The trap
If bulimia has stuck around, it is not because you lack willpower. Bulimia has a trap built into it: the things you do to try to get back in control are the same things that keep the cycle turning. This sheet shows how the parts link up, and how the cycle can be broken.
The bulimia cycle
At the centre of the cycle is how you judge yourself. For many people with bulimia, feeling good about yourself depends a great deal on your shape, your weight and how well you control your eating.
That leads to strict dieting: rules about what you can eat, how much and when. The rules are often so strict that breaking them is almost certain. Going a long time without food leaves you very hungry, and certain foods start to feel forbidden.
Sooner or later a rule gets broken. Hunger, a stressful event, a row, feeling low or lonely, or simply eating a forbidden food can all set this off. The slip can feel like proof that you have failed, and an 'I've blown it now' feeling can turn it into a binge.
After a binge come shame, worry about your shape and an urge to make up for it. You promise yourself to be stricter, and the dieting starts again. That sets up the next slip, and round it goes.
Which parts fit you?
Tick any part of the cycle you recognise, or none. There is no score.
Why making up for eating backfires
Making up for a binge, for example by being sick, using laxatives, not eating or exercising very hard, can feel as if it undoes the damage. In fact, being sick and using laxatives get rid of much less of what you have eaten than most people believe, and they put a strain on your body. And because they seem to cancel a binge out, they take away one of the things that would normally hold you back from bingeing, so binges can become easier to start.
Not eating or exercising hard to make up for it keeps the strict dieting going, which sets up the next round of hunger and slips. Each round also adds to the shame and secrecy.
Eating can also become a way of coping with hard feelings, because a binge can numb or distract for a short while. The relief does not last, and the shame afterwards often makes the feelings worse.
If you are making yourself sick, using laxatives or eating very little, tell your therapist and your GP. If you faint, have chest pain or a racing or uneven heartbeat, get urgent medical help.
How the cycle breaks
The way out is to loosen the cycle at the points that hold it together, with your therapist's help, one step at a time.
Regular eating comes first. Eating planned meals and snacks through the day, and not making up for them, takes away the hunger and the long gaps that set up binges. Your therapist can share a sheet for planning regular eating.
Next comes handling events and moods in other ways, so that a bad day does not have to change how you eat. Your therapist can share a sheet on this too.
Then, step by step, you loosen the food rules, bring back foods you have been avoiding, and widen what you judge yourself on, so that your shape and weight become one part of your life rather than the whole of it. Each change is planned together, at a pace you agree.
Over to you
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When to use ‘How the bulimia cycle keeps itself going’
‘How the bulimia cycle keeps itself going’ is a psychoeducation handout based on cognitive behavioural therapy (CBT), most often used in CBT for eating disorders.
It is designed to be read within therapy rather than as a standalone self-help tool: a therapist introduces it and discusses it with the client. You can preview the full handout above, then assign it for clients to read between sessions on any device or download it as a print-ready PDF. Where a short reflection is included, it offers space to respond to the reading.
How it works
Most people work through it in around 8 minutes. It moves through six short sections to read:
- The trap: If bulimia has stuck around, it is not because you lack willpower. Bulimia has a trap built into it: the things you do to try to get back…
- The bulimia cycle: At the centre of the cycle is how you judge yourself. For many people with bulimia, feeling good about yourself depends a great deal on…
- Which parts fit you? Tick any part of the cycle you recognise, or none. There is no score.
- Why making up for eating backfires: Making up for a binge, for example by being sick, using laxatives, not eating or exercising very hard, can feel as if it undoes the damage.…
- How the cycle breaks: The way out is to loosen the cycle at the points that hold it together, with your therapist's help, one step at a time. Regular eating…
- Over to you
The handout can be read on a phone, tablet or computer, or downloaded as a print-ready PDF. If it includes a reflection, answers entered on the Formulate platform are saved automatically and shared back with the therapist for review before the next session.
The CBT approach behind it
‘How the bulimia cycle keeps itself going’ introduces a CBT approach that involves mapping how the parts of a problem connect and keep it going (formulation). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This handout is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: a transdiagnostic theory and treatment. Behaviour Research and Therapy, 41(5), 509-528. doi:10.1016/S0005-7967(02)00088-8
- Fairburn, C. G. (2008). Cognitive Behavior Therapy and Eating Disorders. Guilford Press.
- Murphy, R., Straebler, S., Cooper, Z., & Fairburn, C. G. (2010). Cognitive behavioral therapy for eating disorders. Psychiatric Clinics of North America, 33(3), 611-627. doi:10.1016/j.psc.2010.04.004
- National Institute for Health and Care Excellence (2017). Eating disorders: recognition and treatment (NG69, updated 2020). NICE.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
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