A bulimic person's shame may lead her to try to hide not only her eating-disorder behaviors but also her basic needs and yearnings. She may wish that her needs and desires did not exist and may try to act as if she does not need or want anything or anyone. When that attempt inevitably fails, she may wish that others could magically read her mind and respond to her needs and wants without her having to ask for anything. To avoid the shame of expressing her needs and desires, she turns to food, rather than relationships, for comfort".

A bulimic person may be so disconnected from her experience that she does not even know what she needs or wants. If she does not know, needing something or someone only confirms her sense that she is weak and inadequate. She believes her needs are not legitimate, and therefore finds it difficult to seek care or engage with any care she does manage to seek. In fact, she is likely to greet others' expressions of concern with contempt, the very contempt with which she views herself".

Yet because her needs and yearnings are real and pressing, she must find some way to express them: she puts into body what she cannot yet put into words. Her eating disorder serves as her voice, her attempt to express and meet her needs and desires without directly asking for anything".

In yet another paradox, bulimia nervosa serves as both an expression of feelings and a defense against experiencing feelings, particularly shame, anger, loneliness, sadness, envy, and guilt. A person with bulimia nervosa fear, whether consciously or unconsciously, that painful feelings would be unbearable, even annihilating".

Recovering is a process of coming to experience a sense of self. More precisely, it is a process of learning to sense one's self, to attune to one's subjective physical, psychic, and social self- experience. These woman's core sense of shame and their difficulty tolerating painful emotions had led them to avoid turning their attention inward to their internal sense of things. In recovering, they "came to their senses" and learned to trust their sensed experience, in particular their sense of "enoughness"".