In this episode, Vera and Renae explore bulimorexia—a term used for people who oscillate between restriction and binge/purge behaviors—and how this mixed pattern might help explain stubborn relapse rates across eating disorders and food addiction. Dr. Norton shares her clinical lens on risks (medical and psychological), why some traditional programs may miss the mark, and what a holistic, skills-based, harm-reduction treatment can look like (family involvement, gentle re-feeding, DBT/EMDR, food quality, and relapse prevention).
Note: Some views expressed are the guest’s opinions and experience. This episode is educational and not medical advice. Please consult your care team.
What we cover:
Defining “bulimorexia”: alternating restriction with binge/purge; how it differs from anorexia nervosa and bulimia nervosa; why it’s easier to hide than classic anorexia.
Continuum vs. categories: where binge eating disorder fits; overlap with food addiction.
Why relapse is common: risks of aggressive refeeding; short-stay residential models; lack of individualized care; missing family systems support.
Medical risks (high-level): cardiac arrhythmias and hypotension, esophageal tears/GERD, laxative misuse and constipation, electrolyte disturbance, kidney strain, dental/enamel erosion, parotid swelling, menstrual disruption and fertility concerns.
Psychological load: anxiety/OCD traits, depression, social avoidance; the “addiction to restricting” and the short-term ‘high’ of hunger.
Treatment principles Dr. Norton uses:
Gentle, stepwise re-feeding (small, frequent meals; stabilize blood sugar; avoid triggering extremes).
Skills over meal plans (shop, prep, and eat whole foods; mindful interoception).
DBT for arousal regulation, plus EMDR and trauma work as indicated.
Family-based involvement (Maudsley-style boundaries and support).
Movement re-entry: slow, safe progression; curbing compulsive exercise.
Relapse prevention: strong parent/caregiver alignment, food routines, anxiety skills, and ongoing monitoring.
Contested terrain: ultra-processed food, additives, and differing regulations by region; the guest’s emphasis on “clean/organic” sourcing.
Intermittent fasting cautions: for restrict-prone folks, it can mask restriction; prefer regular, structured eating.
What recovery can look like: decreased self-hatred, restored relationships, school/work re-engagement, and more flexible functioning.
Resources from the guest: forthcoming book Below the Radar: What They’re Not Telling You About Your Food; wellness tools she finds helpful.
