There are several possibilities: 1. Lack of motivation. The basis for successful treatment of eating disorders is the patient’s motivation to engage in treatment. Patients with bulimia often begin to make a real commitment to change because of some life crisis related to the bulimia problem, such as the loss of work and school opportunities, loss of intimate relationships, or serious physical problems. Insufficient motivation is difficult to start, and even if you start, it is difficult to sustain. 2. Expectations are too high. If you make “no more bulimia or vomiting from tomorrow” your requirement, failure is inevitable. Overcoming bulimia and vomiting is a gradual process. 3. Not enough courage. Overcoming the urge to binge eat and vomit at the beginning generates strong anxiety, which can easily knock back the patient’s courage.