Bulimia nervosa is characterised by cycles of binge eating followed by purging behaviours — vomiting, laxative use, excessive exercise, or fasting. Like anorexia, it is frequently discussed in terms of its behavioural features. But for a significant proportion of people with bulimia, the binge-purge cycle is a response to anxiety — a way of managing emotional distress that brings temporary relief before producing shame, which produces more anxiety, which produces the next binge. Understanding this cycle is the starting point for breaking it.
The typical bulimic episode follows a recognisable emotional sequence. Anxiety or emotional distress builds — triggered by interpersonal conflict, social pressure, perceived failure, or sometimes by no identifiable cause. The person reaches a point of emotional overwhelm that feels intolerable. Binge eating begins — often described as a dissociative state in which the person feels numb, temporarily disconnected from the distress. The binge provides brief relief from the emotional intensity.
Purging follows — motivated by anxiety about weight gain, guilt about the binge, or a desire to 'undo' what happened. Purging temporarily reduces anxiety about the consequences of the binge. Shame and self-criticism follow, producing more anxiety — and the cycle is primed to begin again.
For many people with bulimia, the behaviour is not fundamentally about food or weight — it is a learned strategy for regulating intense emotional states. The binge provides temporary escape from anxiety; the purge provides temporary restoration of control. Both behaviours are reinforced because both reduce anxiety, however briefly.
This is the same mechanism that drives all compulsive anxiety behaviours: OCD rituals, agoraphobic avoidance, health anxiety checking. The behaviour reduces anxiety in the short term, which reinforces the behaviour, which maintains the anxiety disorder. Understanding this does not diminish the seriousness of the eating disorder — it illuminates the path to recovery.
Alongside the anxiety-management function of the binge-purge cycle, people with bulimia typically experience intense anxiety about weight, shape, and body image. This anxiety is real, even when — as is often the case — it is disproportionate to actual body weight or shape. It is generated by an amygdala that has learned to treat weight gain or body changes as existential threats.
Social anxiety often underlies the body image anxiety — a fear of being judged, rejected, or seen as inadequate. For expats, the additional social pressures of navigating a new cultural environment, the visibility that comes with being a foreigner, and the pool culture of coastal Spain can amplify pre-existing body anxiety significantly.
Bulimia requires medical monitoring, particularly given the physical risks of purging behaviours. Recovery is best supported by a multidisciplinary team that includes medical supervision, nutritional guidance, and psychological support. LAR Coaching can provide support for the underlying anxiety dimension of bulimia — addressing the emotional dysregulation, anxiety intolerance, and shame that drive the binge-purge cycle.
If you are living with bulimia in Spain and finding it difficult to access appropriate English-speaking support, please reach out. We can discuss what support looks like in your situation and work alongside your medical team.