Years ago, I’d stopped by a local cafeteria-style salad bar to grab some lunch.
Sitting at a booth catty-corner from ours, I saw a young woman, about 1/2 my age. It looked like she’d just gotten off the ski slopes, still wearing a ski suit. She was fit. Athletic-build. I wondered if she was a ski instructor or maybe a snowboarding coach. This is something I do—something I’d argue many of us do: we make up stories about people in our heads. Some stories we know we’re writing; others slip in unnoticed.
Damn, she was so hungry. She was alone, and she appeared to be staring off, somewhat vacantly. This was before we had distractions in our pockets. I felt a swell of emotion push right up into my throat. I recognized vacant eating. I guessed she easily put away thousands of calories without seeming to notice. I also knew what she likely had to do to hide the devouring and unseen woman within her. It broke my heart.
I power-binged and purged for most of my life, beginning with my Girl Scout cookie inventory when I was 11. It wasn’t until years later that I understood what I was seeing wasn’t personal failure, but historical repetition. People don’t talk about bulimia much. I think it freaks them out. The thing is, it’s on the rise.
Historical Persistence of Bulimia Nervosa
Bulimia nervosa, marked by repetitive binge–purge episodes characterized by recurrent episodes of binge eating followed by compensatory behaviors, has a long and complex history that predates modern psychological understanding. Cycles of bingeing and purging have appeared across cultures and eras, not as random pathology, but often as deliberate responses to cultural pressures around power, purity, control, or consumption. In ancient Rome, for example, historians suggest vomiting was ritualized among elites as a performance of excess. In ascetic religious traditions, abstaining from food was tied to moral or spiritual superiority1.
In the modern era, bulimia nervosa was first formally described in the late 20th century, with the publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980, which officially recognized it as a distinct psychiatric disorder. Since then, research has consistently shown that bulimia nervosa is a chronic and often treatment-resistant condition, with high rates of relapse and significant comorbidity with other mental health disorders, such as depression and anxiety.2
The persistence of bulimia nervosa can be attributed to a combination of biological, psychological, and sociocultural factors. Biological factors, including genetic predisposition and neurochemical imbalances, play a significant role, while psychological factors such as low self-esteem and perfectionism also contribute. Sociocultural factors, such as the idealization of thinness and the stigmatization of obesity, further exacerbate the behavior (See FN2).
Despite advances in treatment options, including cognitive-behavioral therapy (CBT) and pharmacological interventions, many individuals with bulimia nervosa continue to experience persistent symptoms, highlighting the need for innovative and more effective treatment approaches.3 4
This was certainly my story. I’ve found a way to heal from the behavior, but I came up in a different time. The battle I had over my body as an adult was solitary, isolated, and probably would have killed me if I didn’t find a way to work with it. The performance could end. Today, performance operates 24/7.
Social Media's Impact on Bulimia Nervosa
The rise of social media has had a profound impact on the prevalence and expression of bulimia nervosa, particularly among adolescents and young adults. Social media platforms, such as Instagram and TikTok, have become breeding grounds for the dissemination of harmful content that can trigger and perpetuate disordered eating behaviors.
One of the most significant ways in which social media contributes to bulimia nervosa is through the promotion of unrealistic beauty standards and the glorification of thinness. The proliferation of "thinspiration" and "fitspiration" content, which often features images of extremely thin or muscular individuals, can lead to body dissatisfaction and disordered eating behaviors among vulnerable individuals.5
Moreover, social media platforms have become a space for the sharing of pro-eating disorder (pro-ED) content, which includes tips and tricks for maintaining disordered eating behaviors, such as extreme calorie restriction and purging. This content not only normalizes disordered eating but also provides a sense of community and validation for individuals who are struggling with these behaviors, further perpetuating the cycle of bulimia nervosa (See FN1 & 5).
The impact of social media on bulimia nervosa is further compounded by the lack of awareness among users about the potential harms of such content. Many adolescents and young adults who engage with social media are unaware of how it can influence their body image and eating behaviors. This disconnect makes it difficult for them to critically evaluate the content they’re consuming.6
While social media is often criticized for its harmful effects, it also functions as a paradox, amplifying both toxic and potentially supportive content. Movements like body positivity and body neutrality have gained visibility online, promoting self-acceptance while pushing back against unrealistic beauty standards. Yet, their actual impact on reducing body dissatisfaction and bulimic behaviors remains unclear and contested in recent research (FN1 & 5).
Overall, the impact of social media on bulimia nervosa is complex and multifaceted, highlighting the need for further research into how social media can be both a harmful and a helpful tool in the context of eating disorders.
My Buddhist Lens
As we see, Bulimia is typically described as a disorder involving loss of control, poor impulse regulation, and distorted self-image, a narrative frame that leaves out what I experienced: a ritual cycle that gave temporary relief. It didn’t feel chaotic. It felt ordered.
In Buddhist terms, it followed the logic of paṭicca samuppāda or dependent origination.
Vedanā (feeling tone): Unbearable sensation (anxiety, fear, anger, sense of being “out-of-control”
Taṇhā (craving): “I don’t want to feel this. Get this out, now.”
Upādāna (clinging): Control through ritual
Bhava (becoming): “I am someone who must do this.”
Jāti (birth): Identity reformulated
Jarā-maraṇa (suffering): Shame, fatigue, repetition
This is a ritual loop of self-making, and it highlights how the binge–purge cycle becomes a self-reinforcing identity ritual, rooted in clinging and craving.
“Our addiction is not to food or sex or success. It is to the sense of self.”
— David Loy, The Great Awakening (2003)7
Lask and Bryant-Waugh’s research mirrors dependent origination: the body’s confused conversation with itself.
Neurodevelopmental Models
What begins as a tightly structured ritual offering momentary control soon becomes deeply patterned, etched into perception, identity, and habit. The Buddha saw this, too. The Buddha mapped the cycle of craving long before we had brain scans. But modern neuroscience is starting to catch up, revealing how deeply these loops embed in the body itself.
Lask and Bryant-Waugh (2000) were among the first to emphasize the role of neurodevelopmental factors in the etiology of eating disorders, particularly in children and adolescents. Their work challenged traditional narratives focused primarily on sociocultural or psychodynamic explanations by introducing the possibility that certain individuals may experience fundamental disruptions in interoceptive awareness—the capacity to accurately detect and interpret internal bodily states such as hunger, satiety, emotional arousal, and pain. In individuals with bulimia, for example, these interoceptive signals may be misread, overly intense, or insufficiently registered, resulting in confusion between emotional and physiological needs. This internal ambiguity can make it difficult to distinguish whether one is hungry, anxious, or in need of comfort, potentially contributing to maladaptive eating behaviors as a form of self-regulation.
Rather than viewing bulimia as irrational or solely driven by external pressures, this model reframes disordered eating as a biologically plausible adaptation to an impaired internal signaling system. The ritualistic patterns associated with bulimia may emerge as attempts to restore a sense of coherence and control when internal cues are unreliable or disorienting. Lask and Bryant-Waugh’s (2000) perspective thus complicates reductionist views that attribute eating disorders solely to vanity, family dysfunction, or media influence, and instead underscores the importance of developmental and neurological factors that may predispose certain individuals to these behaviors even before sociocultural factors come into play.8
The Promise—and Limits—of Virtual Reality in Bulimia Nervosa Treatment
If bulimia is, in part, a response to distorted internal signals and a ritualized attempt to regulate what cannot be felt clearly, then any meaningful treatment must address perception—not just behavior. This is where virtual reality (VR) enters the picture.
VR is emerging as a promising tool for eating disorder treatment, including bulimia nervosa. By offering immersive, controlled environments, VR allows individuals to confront everyday triggers—eating in public, grocery shopping, mirror exposure—in real time, without real-world consequences. These simulations support exposure-based therapy, a central pillar of cognitive-behavioral interventions.91011
Pilot studies have shown that VR-enhanced CBT can help reduce binge–purge behaviors and body image distress by offering space to practice coping strategies in a safer, more manageable way. Some findings suggest that shared virtual spaces even enhance therapeutic rapport, giving clinicians and participants a way to explore emotional and physiological responses together.12
But while VR is a powerful behavioral tool, it cannot resolve the underlying craving, nor the deeper confusion of self that sustains the ritual.
The binge–purge cycle is not just a behavioral loop—it’s an identity loop. As Buddhist psychology teaches, craving arises in the presence of aversion to feeling, and clinging follows fast. The technological ability to simulate control doesn’t replace the embodied practice of learning to feel. No headset can rewire the clinging mind.
Yes, VR can help manage symptoms. It can even interrupt patterns. But without addressing the cultural, psychological, and ideological frameworks that normalize disembodiment, performance, and self-surveillance, we’re only improving the ritual—not releasing it.
A Different Ending
VR can offer structured environments to rehearse responses and reduce relapse risk, and it can support behavioral change. But if we stop there—if we mistake technical intervention for transformation—we miss the point.
Bulimia isn’t just about behavior. It’s about perception. It’s about attention. It’s about disconnection, reinforced by systems that appear to offer solutions but often deepen the problem.
If we keep treating bulimia as a personal flaw or as the residue of trauma, we ignore the forces—media, therapy models, cultural ideologies—that help sustain it.
Free Mindful Eating Course in VR – Starts September
If you’ve struggled with food, control, or the noise in your head around eating, this is for you.
I’m offering a free mindful eating course in virtual reality starting this September. It’s not therapy, and it’s not a fix. It’s a space to slow down, pay attention, and get honest about what’s happening in the body, without judgment.
I’m a certified embodiment coach with 25 years of meditation practice and lived experience in recovering from the binge–purge cycle. This course is grounded in direct experience, Buddhist psychology, and body-based awareness.
If you’re curious, committed, or just tired of managing the cycle alone, you’re welcome here.
Details coming soon. Reach out if you want to be on the interest list.
References
Çınaroğlu, M. (2024). Body Image in The Digital Era: Thinspiration, Fitspiration, And Related Disorders. Turkish Research Journal of Academic Social Science. https://doi.org/10.59372/turajas.1441987
Sansoni, M., Varallo, G., Malighetti, C., Tuena, C., Di Lernia, D., Cesa, G., Manzoni, G. M., Castelnuovo, G., & Riva, G. (2024). Unlocking the potential of virtual reality to expand treatment frontiers for bulimia nervosa: a pilot study to explore the impact of virtual reality-enhanced cognitive-behavioral therapy. Virtual Reality. https://doi.org/10.1007/s10055-024-00971-8
Hartmann, S., Timm, C., Barnow, S., Rubel, J., Lalk, C., & Pruessner, L. (2024). Web-Based Cognitive Behavioral Treatment for Bulimia Nervosa. JAMA Network Open, 7(7), e2419019. https://doi.org/10.1001/jamanetworkopen.2024.19019
Liu, J., Giannone, A., Wang, H., Wetherall, L., & Juarascio, A. S. (2024). Understanding Patients’ Preferences for a Digital Intervention to Prevent Posttreatment Deterioration for Bulimia-Spectrum Eating Disorders: User-Centered Design Study (Preprint). https://doi.org/10.2196/preprints.60865
Nawaz, F. A., Riaz, M. M. A., Banday, N. ul ain, Singh, A., Arshad, Z., Derby, H., & Sultan, M. A. (2024). Social media use among adolescents with eating disorders: a double-edged sword. Frontiers in Psychiatry. https://doi.org/10.3389/fpsyt.2024.1300182
Ladwig, G. (2024). Risks and benefits of social media trends: The influence of “fitspiration”, “body positivity”, and text-based “body neutrality” on body dissatisfaction and affect in women with and without eating disorders. Body Image, 50, 101749. https://doi.org/10.1016/j.bodyim.2024.101749
Loy, D. R. (2003). The great awakening: A Buddhist social theory. Wisdom Publications. https://archive.org/details/greatawakeningb00loyd
Lask, B., & Bryant-Waugh, R. (2013). Eating disorders and the brain: Ian frampton and mark rose. In B. Lask, & R. Bryant-Waugh (Eds.), Eating disorders in childhood and adolescence (4th ed., pp. 125-147). Routledge. https://doi.org/10.4324/9780203076415-10
Sansoni, M., Varallo, G., Malighetti, C., Tuena, C., Di Lernia, D., Cesa, G., Manzoni, G. M., Castelnuovo, G., & Riva, G. (2024). Unlocking the potential of virtual reality to expand treatment frontiers for bulimia nervosa: a pilot study to explore the impact of virtual reality-enhanced cognitive-behavioral therapy. Virtual Reality. https://doi.org/10.1007/s10055-024-00971-8
Fakhrou, A., Avincola, G., Farruggio, G., Verduzzo, I., & Caponnetto, P. (2024). Virtual Reality as an Innovative Tool for Eating Disorders Psychological Treatment. Health Psychology Research, 12. https://doi.org/10.52965/001c.123286
Bould, H., Kennedy, M.-R., Penton‐Voak, I. S., Thomas, L. M., Bird, J., & Biddle, L. (2024). Exploring How Virtual Reality Could Be Used to Treat Eating Disorders: Qualitative Study of People With Eating Disorders and Clinicians Who Treat Them. 1, e47382. https://doi.org/10.2196/47382
Hartmann, S., Timm, C., Barnow, S., Rubel, J., Lalk, C., & Pruessner, L. (2024). Web-Based Cognitive Behavioral Treatment for Bulimia Nervosa. JAMA Network Open, 7(7), e2419019. https://doi.org/10.1001/jamanetworkopen.2024.19019