As I've recently been in contact with many people, dealing with many various aspects of an eating disorder, I've come to realize just how common it is for someone with anorexia to eventually evolve into bulimic behaviors. I've known this on a cognitive level, but never so much on a personal basis, such as hearing from many people, especially women, who are experiencing this. What I am hearing is a great amount of shame, especially for those who have been in treatment for anorexia and thought they had defeated their eating disorder. This is irrational, yet very understandable, given the attitude that society has towards eating disorders in general.
Statistically, approximately 50% of anorexics will develop some sort of bulimic behavior during their illness. For someone who has been weight restored, and on the path to recovery, a "relapse" into bulimic behavior can be devastating. They feel an even greater loss of control with their eating, and a desperate fear of weight gain. This can cause depression, hopelessness, and other impulsive behaviors in an attempt to numb out their fears once again. All of these things are what I hear being expressed.
The reasons for this transition from anorexia (restricting) to bulimia can be due to a couple of very logical explanations.
1) If a person is not weight restored to a point where they are no longer biologically challenged, the likelihood is greater that they will not be able to continue to suppress their intake or weight, which will eventually result in impulsive binging (and possibly purging) behaviors. This begins only one more vicious cycle that commonly causes shame and isolation.
2) Sometimes a person who has had chronic anorexia for many years, and has tried several different treatments that have "failed" (in their eyes), their body may simply not be able to continue the extreme starvation. Biology takes over, and because this person hasn't established a healthy, consistent eating routine, binging may be out of control.
A person who is in this situation often expresses hopelessness, apathy, and just simply giving up on ever being free from their disorder. If the disorder is not treated, the medical and psychological consequences of these behaviors will only increase in severity, or in some cases, a person will just give up, believing that there is no hope for them.
There is ALWAYS hope, as long as there is life!! Anyone who has suffered with an eating disorder is very strong in character, whether they realize it or not. The key is to use that strength in a positive way to fight with all they have for the freedom they deserve!!