Episode 245: Renae Norton, PhD - Bulimorexia
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. Suggested chapter markers 00:00 Welcome & guest intro 02:20 What is “bulimorexia”? How it differs from AN/BN 10:55 Why relapse stays high; critique of standard programs 18:30 Medical complications: heart, GI, dental, endocrine 28:15 Psychological patterns: anxiety, OCD traits, depression 34:40 Treatment pillars: re-feeding, DBT/EMDR, family work 45:05 Food quality and UPFs: guest’s perspective & debate 53:10 Intermittent fasting cautions; safe movement 58:20 Relapse prevention & outcomes 1:04:10 Advice to clinicians, families, and society 1:08:00 What’s next for Dr. Norton & closing Key takeaways (listener-friendly) Mixed patterns (restricting and binge/purge) may be under-recognized and can carry high medical risk. Slow, individualized re-feeding plus emotion-regulation skills (DBT) and family involvement improve safety and engagement. If you’re prone to restriction, consistent meals beat fasting. Recovery gains include less self-hatred, more connection, and functional life goals—progress over perfection. Sensitive content note This episode discusses eating-disorder behaviors (restriction, purging, laxatives, insulin manipulation) and medical complications. Please use discretion and support. Links & mentions Dr. Renae Norton — Norton Wellness Institute / Mind, Weight & Wellness Pro Book (forthcoming): Below the Radar: What They’re Not Telling You About Your Food Maudsley/Family-Based Treatment (FBT) overview DBT skills resources (distress tolerance, emotion regulation, interpersonal effectiveness) If you need help now: NEDA (US), BEAT (UK), local crisis lines, or your clinician. For clinicians Screen for mixed presentations (restrict + purge), including non-vomit purging (laxatives, insulin manipulation). Prioritize medical monitoring (vitals, electrolytes) during re-feeding; avoid one-size-fits-all calorie jumps. Integrate DBT skills, caregiver coaching, and regular eating structure; track arousal and urge patterns. The content of our show is educational only. It does not supplement or supersede your healthcareprovider's professional relationship and direction. Always seek the advice of your physician or other qualified mental health providers with any questions you may have regarding a medical condition, substance use disorder, or mental health concern.
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