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Learn more about the results we get at Within

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What is non-purging bulimia?

Bulimia nervosa (BN) is a serious eating disorder defined by cycles. People who struggle with this condition engage in episodes of binge eating—or eating large amounts of food in a short period of time—followed by episodes of compensatory behavior meant to make up for the binge.

Self-induced vomiting has become almost synonymous with bulimia nervosa in popular culture, but there are many types of compensatory behavior people with BN may turn to after binging episodes. 

Non-purging behaviors don’t involve physically expelling food from the body, such as fasting or excessively exercising after a binging episode. When someone favors these types of compensatory methods, they may have non-purging type bulimia nervosa.

Last updated on 
December 20, 2023
December 20, 2023
Non-purging bulimia
In this article

What compensatory behaviors present in bulimia nervosa? 

Compensatory behaviors are a range of behaviors utilized by people struggling with eating disorders to avoid weight gain or to alleviate the guilt associated with eating.12

These behaviors can take many forms, including purging behaviors and non-purging behaviors. Someone with BN may use purging and non-purging methods simultaneously or purging or non-purging behaviors exclusively.12

Purging behaviors involve the physical expulsion of food from the body. This includes many of the behaviors more commonly associated with BN, such as self-induced vomiting and the misuse of laxatives and enemas.

But there are also several non-purging compensatory behaviors people with BN may turn to after a binging episode. 

Non-purging compensatory behaviors

Non-purging compensatory behavior spans a wide range of actions and practices that may counteract the effects of eating or alleviate the negative emotions one may associate with eating. 

These types of behaviors have not only been found to be prevalent in adolescents with eating disorders but also associated with greater eating disorder symptomology and presentations of depression.12

Fasting

Some people living with BN may follow a binging episode with a period of fasting to compensate for the extra calories.

Such rigid food restrictions can lead to feelings of deprivation and cravings for “forbidden” foods.13 This, in turn, can lead to another binge episode, continuing the cycle of binging and fasting.

Excessive exercise

The idea of excessive exercise is to burn off calories that may have come from eating or binging.

Over time, the urge to exercise can become compulsive, whereby a person will still exercise while injured, feel anxious when unable to exercise, and neglect commitments in favor of exercising.14

Stimulant medications

Caffeine-based diet pills, certain prescription medications, and some recreational drugs work to increase energy and suppress appetite.

Someone with bulimia nervosa may use these stimulants or similar drugs to help them curb hunger and control their weight.

Dieting behavior

For many people with non-purging bulimia nervosa, skipping meals, reducing portion sizes, and practicing other dieting behaviors are common. Studies show these behaviors may, in many cases, precede actual compensatory behaviors associated with BN.11

These dieting behaviors can leave a person feeling hungry and deprived, which leads to a binging episode, and the cycle continues.

Signs and symptoms of non-purging bulimia

In many ways, non-purging type bulimia nervosa resembles purging-type BN. While favored compensatory behaviors differ between the two groups, there are many similar signs and symptoms, including:1,2

  • A preoccupation with body weight, shape, or size
  • A preoccupation with overall appearance
  • Regularly comparing one’s body to others
  • Low self-esteem or self-worth
  • Rigid rituals surrounding food and eating habits
  • Eliminating or only eating certain foods or food groups
  • Eating in secret
  • Hiding or hoarding food
  • Disappearance of large amounts of food
  • Hiding empty food containers and packaging
  • Fluctuating weight
  • Mood swings
  • Gastrointestinal complaints
  • Dizziness, fatigue, weakness
  • Feeling cold
  • Problems sleeping
  • Dry skin, brittle nails, thinning hair
  • Swelling

Additionally, someone with non-purging bulimia nervosa may:

  • Exercise excessively (longer than intended, despite illness, injury, etc.)
  • Be preoccupied with dieting, focus on nutritional information, or regularly diet
  • Skip meals, avoid eating with others, or avoid situations that involve food
  • Showcase bursts of energy that stimulants could cause

Treatment for bulimia nervosa non-purging type

Like other eating disorders and mental health conditions, non-purging BN is very complex, often developing alongside a number of co-occurring conditions, such as childhood trauma, dysfunctional personal relationships, anxiety, and depression.

As such, a comprehensive treatment plan with a multidisciplinary approach is often thought of as the best way to help someone with non-purging bulimia nervosa. This can include a combination of psychotherapy, medical care, nutrition therapy, movement therapy, and experiential therapies.

Therapy for non-purging bulimia nervosa

Cognitive behavioral therapy (CBT) is the leading psychotherapy approach for treating bulimia nervosa of all types.3 However, other therapies have had positive outcomes in treating eating disorders, including:4,5,6,7,8,9,10

Experiential treatments for bulimia nervosa can help a person heal by getting them out of their mind and into their body. They include:

  • Art therapy
  • Dance therapy
  • Music therapy
  • Psychodrama
  • Wilderness therapy
  • Recreational therapy
  • Yoga therapy
  • Adventure therapy

Finding help for bulimia nervosa

An individualized treatment plan can help you learn how to love your body, feel good about yourself, and have a healthy relationship with food, eating, movement, yourself, and others.

Remote treatment that works

At Within Health, we strive to help clients in just this way. Our multidisciplinary team of experts can help create a treatment plan catered to your specific needs and history to help ensure you have just the right kind of help and support needed to overcome these hurtful thoughts and behaviors.

Get help today

Always remember it’s not your fault. An eating disorder can be a way to cope with difficult feelings or situations and society’s sometimes unrealistic expectations about appearance. But there are healthier ways to deal with hard things. And finding the right kind of treatment can be the first step toward a healthier and happier future.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.

Resources

  1. Harrington, B. C., Jimerson, M., Haxton, C., & Jimerson, D. C. (2015). Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. American Family Physician, 91(1), 46–52.
  2. Bulimia Nervosa. (n.d.). National Eating Disorders Association. Accessed September 2023.
  3. Murphy, R., Straebler, S., Cooper, Z., & Fairburn, C. G. (2010). Cognitive behavioral therapy for eating disorders. The Psychiatric Clinics of North America, 33(3), 611–627.
  4. Manlick, C.F., Cochran, S.V. & Koon, J. (2013). Acceptance and Commitment Therapy for Eating Disorders: Rationale and Literature Review. Journal of Contemporary Psychotherapy, 43, 115–122.
  5. Ter Huurne, E. D., de Haan, H. A., Postel, M. G., DeJong, C. A. J., VanDerNagel, J. E. L., & van der Palen, J. (2021). Long-term effectiveness of web-based cognitive behavioral therapy for patients with eating disorders. Eating and Weight Disorders, 26(3), 911–919.
  6. Kass, A. E., Kolko, R. P., & Wilfley, D. E. (2013). Psychological treatments for eating disorders. Current Opinion in Psychiatry, 26(6), 549–555.
  7. Ivanova, I., Watson, J. (2014). Emotion-focused therapy for eating disorders: enhancing emotional processing. Person-Centered & Experiential Psychotherapies, 13(4), 278-293.
  8. Butler, R.M., Heimberg, R.G. (2020). Exposure therapy for eating disorders: A systematic review. Clinical Psychology Review, 78.
  9. Lester, R. J. (2017). Self-governance, psychotherapy, and the subject of managed care: Internal Family Systems therapy and the multiple Self in a US eating-disorders treatment center. American Ethnologist, 44(1), 23-35.
  10. Miniati, M., Callari, A., Maglio, A., & Calugi, S. (2018). Interpersonal psychotherapy for eating disorders: current perspectives. Psychology Research and Behavior Management, 11, 353–369.
  11. Brewerton, T., Dansky, B., Kilpatrick, D., O’Neil, P. (2000). Which comes first in the pathogenesis of bulimia nervosa: Dieting or bingeing? International Journal of Eating Disorders, 28(3), 259-264. 
  12. Colleen Stiles-Shields, E., Labuschagne, Z., Goldschmidt, A. B., Doyle, A. C., & Le Grange, D. (2012). The use of multiple methods of compensatory behaviors as an indicator of eating disorder severity in treatment-seeking youth. The International Journal of Eating Disorders, 45(5), 704–710.
  13. Hill, A. (2007). The psychology of food craving: Symposium on ‘Molecular mechanisms and psychology of food intake’. Proceedings of the Nutrition Society, 66(2), 277-285.
  14. Lichtenstein, M. B., Hinze, C. J., Emborg, B., Thomsen, F., & Hemmingsen, S. D. (2017). Compulsive exercise: links, risks and challenges faced. Psychology Research and Behavior Management, 10, 85–95.

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