Bulimia Nervosa

A person with bulimia has not made a “lifestyle choice”, they are actually very unwell and need help.

Bulimia can be a dangerous eating disorder, as it is often not easily recognised by other people.

People with bulimia often appear to be a normal weight, but they have powerful urges to overeat which they alternate with periods of either starving themselves or employing a compensatory behaviour to balance out the episodes of binge eating.

The reasons for developing bulimia are different from person to person. However, some known causes include genetic predisposition, environmental, social and cultural factors.

People with bulimia place an excessive emphasis on body shape or weight in their self-evaluation. This can lead to the person’s sense of self-esteem and self worth being wholly defined by the way they look.

What is binge eating?

Binge eating involves two key features:

Eating a very large amount of food within a two hour period
Feeling a sense of loss of control while eating

What are compensatory behaviours?

Compensatory behaviours are used as a way of trying to control weight after binge eating episodes. They include:

Inducing vomiting
Taking laxatives, diuretics or other medications
Fasting/starving/rigid dieting
Excessive exercise

A person with Bulimia can become lost in a dangerous cycle of bingeing and compensating which can lead to feelings of shame, guilt and disgust. These behaviours can become more and more uncontrollable, and lead to an obsession with food, thoughts about eating behaviour, weight loss, dieting and body image.

These behaviours are often unseen, and people with bulimia can go to great lengths to keep their eating and exercise habits secret. As a result, Bulimia can often go undetected for a long period of time.

Many people with Bulimia experience weight fluctuations and do not lose weight; they can remain in the normal weight range, be slightly underweight, or may even gain weight.

What are the warning signs of Bulimia?

Having awareness about Bulimia and its warning signs and symptoms can make a big difference to the severity and duration of the illness. Seeking help at the first warning sign is much more effective than waiting until the illness has taken a hold. If you or someone you know is exhibiting some or a combination of these signs it is vital to seek help and support as soon as possible.

The warning signs of Bulimia can be physical, psychological and behavioural. It is possible for someone with Bulimia to display a combination of these symptoms.

Physical signs:

Frequent changes in weight (loss or gains)
Signs of damage due to vomiting including swelling around the cheeks or jaw, calluses on knuckles, damage to teeth and bad breath
Feeling bloated, constipated or developing intolerances to food
Loss of or disturbance of menstrual periods in girls and women
Fainting or dizziness
Feeling tired and not sleeping well

Psychological Signs:

Preoccupation with eating, food, body shape and weight
Sensitivity to comments relating to food, weight, body shape or exercise
Low self esteem and feelings of shame, self loathing or guilt, particularly after eating
Having a distorted body image (e.g. seeing themselves as overweight even if they are in a healthy weight range for their age and height)
Obsession with food and need for control
Depression, anxiety or irritability
Extreme body dissatisfaction

Behavioural Signs:

Evidence of binge eating (e.g. disappearance or hoarding of food)
Vomiting or using laxatives, enemas, appetite suppressants or diuretics
Eating in private and avoiding meals with other people
Anti social behaviour, spending more and more time alone
Repetitive or obsessive behaviours relating to body shape and weight (e.g. weighing themselves repeatedly, looking in the mirror obsessively and pinching waist or wrists)
Secretive behaviour around food (e.g. saying they have eaten when they haven’t, hiding uneaten food in their rooms)
Compulsive or excessive exercising (e.g. exercising in bad weather, continuing to exercise when sick or injured, and experiencing distress if exercise is not possible)
Dieting behaviour (e.g. fasting, counting calories/kilojoules, avoiding food groups such as fats and carbohydrates)
Frequent trips to the bathroom during or shortly after meals which could be evidence of vomiting or laxative use
Erratic behaviour (e.g. spending large amounts of money on food)
Self harm, substance abuse or suicide attempts

Who develops bulimia?

Sufferers of this eating disorder are most commonly women between the ages of 18 and 34. People with bulimia often present themselves for treatment between one and five years after the eating disorder has started. Because of the hidden nature of bulimia and the often normal weight appearance of sufferers, this condition may be much more prevalent than we realise.

What are the risks associated with Bulimia?

People with Bulimia may experience:

Chronic sore throat, indigestion, heartburn and reflux
Inflammation and rupture of the oesophagus and stomach from frequent vomiting
Stomach and intestinal ulcers
Chronic irregular bowel movements, constipation and/or diarrhoea due to deliberate misuse of laxatives
Osteoporosis– a condition that leads to bones becoming fragile and easily fractured
Loss of or disturbance of menstrual periods in girls and women
Increased risk of infertility in men and women
Irregular or slow heart beat which can lead to an increased risk of heart failure

Getting help

It is possible to recover from Bulimia, even if you have been living with the eating disorder for many years. The path to recovery can be very challenging. People with Bulimia can become entangled in a vicious cycle of eating and exercise behaviours that can impact their ability to think clearly and make decisions.

However, with the help of an ACFEB Approved Eating Disorder Practitioner and a high level of personal commitment, recovery is an achievable goal.

Recovery aims

Bulimia treatment means a new relationship with food and self-control around food and weight. Help for bulimia also means emotional strengthening, raising self worth and finding better ways of feeling in control without needing to purge. We start with a full assessment, to help build a personalised treatment plan that is right for you.

Bulimia treatment takes time and will focus on:

Gaining insight about bulimia and discovering what led to you developing it in the first place.
Managing the mixed feelings about letting it go and building motivation to change.
Nutritional guidance, to end compulsive eating and manage overeating without the need to purge and without gaining weight.
Emotional strengthening, to manage feelings like stress and unhappiness without turning to food or purging.
Managing bulimic thoughts and obsessions with food.
Self worth and body image healing.

Take the next step

Would you like to know how you developed your eating disorder and what can be done to help you recover?

ACFEB Approved Eating Disorder Practitioners understand eating disorders, why it is so hard to change, and how it affects your life.

Are you ready to change?