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Bulimia nervosa

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Bulimia nervosa, often shortened to bulimia, is an eating disorder. A person with bulimia has difficulties regulating their food intake. Periods of excessive overeating (bingeing) followed by periods of starvation often occur. It’s also common that someone with bulimia tries to get rid of the food or calories they have consumed, for example by making themselves sick.

About bulimia nervosa
Symptoms of bulimia nervosa
Complications of bulimia nervosa
Causes of bulimia nervosa
Diagnosis of bulimia nervosa
Treatment of bulimia nervosa
Help and support

 

About bulimia nervosa

If you have bulimia, you have cycles of eating too much in a short period of time – often in secret. This is called binge-eating or bingeing. Bingeing usually involves eating lots of high-calorie foods, commonly thought of as treats (eg chocolate and cakes). This is followed by a feeling of shame and sometimes severe anxiety.

If you have bulimia, you rid yourself of the food or calories you have consumed. This is called purging. You may do this by vomiting, by taking laxatives, diuretics (water tablets) or possibly illegal drugs called amphetamines, by exercising excessively, by fasting or through a combination of these.

About one in 50 women have bulimia at some point in their lives. Bulimia most often develops in women in their late teens to early twenties but can occur at any age in men or women. Bulimia is less common in men - for every 10 women with bulimia, about one man has the condition.

If you have bulimia, you will usually be within the normal weight range for your height. The other main eating disorder is anorexia nervosa, which is characterised by excessive weight loss. Some people with bulimia have had, or develop, anorexia.

Symptoms of bulimia nervosa

If you have bulimia, you may do the following:

  • not eat with others or go to the toilet after meals to vomit the food you have eaten
  • have a binge–purge cycle at least twice a week for three months or more
  • secretly hoard food
  • be obsessed with exercise
  • become secretive and unwilling to socialise
  • self-harm

If you have bulimia, you are preoccupied with thoughts of food or cravings and have an intense fear of gaining weight. You may have a distorted view of your body and think you are larger in shape than you are. You might be feeling depressed and anxious, find concentrating difficult, and have feelings of guilt and shame about your eating habits.

Physically there may be no signs. Your weight may fluctuate – you will probably not be very underweight, and may be overweight.

Other symptoms can include:

  • bloating and a feeling of fullness
  • tiredness and weakness
  • indigestion
  • tummy pains
  • sore throat (from vomiting)
  • constipation or diarrhoea
  • irregular periods

Complications of bulimia nervosa

Over time, bulimia can lead to various physical problems. These can include:
tooth decay, discoloured teeth, gum disease and bad breath caused by stomach acid in your mouth from regular vomiting – also patches of rough skin on your knuckles or fingers if you use them to make yourself vomit,a puffy face around your jaw from swollen salivary glands

  • dehydration
  • kidney damage
  • inflammation of your stomach and oesophagus (the tube leading from your mouth to your stomach), caused by the acid in vomit
  • damage to your heart and palpitations (irregular heart beat)
  • swollen hands and feet
  • dry skin and hair loss
  • damage to your bowel muscles caused by use of laxatives

It's important to get treatment for bulimia to reduce the risk of these complications.

 

Causes of bulimia nervosa

It isn’t clear why some people develop bulimia. The reasons are probably different for everyone. Emotional, physical and social reasons may be involved.

The following emotional or mental health conditions are also associated with bulimia.

  • low self-esteem – this is not thinking highly about your self-worth and associating it with your body weight
  • mood conditions, particularly depression
  • obsessive–compulsive disorder – this is a condition causing anxiety due to obsessively thinking about things or doing certain actions
  • If you have a perfectionist personality or one of these conditions, an eating disorder may give you a sense of control and achievement.

There are certain other factors that may make it more likely that you will develop bulimia, for example:

  • living in a Western society
  • being influenced by media images of thinness
  • having type 1 diabetes
  • for women, starting your periods at a young age
  • having had anorexia
  • being on lots of weight-loss diets in the past
  • a family history of eating disorders – this could be due to genetic factors or copying the behaviour of other family members
  • a specific emotionally stressful event, such as divorce, leaving home or abusive family relationship
     

Diagnosis of bulimia nervosa

Getting help is very important. Admitting you have a problem is the first step, though it can be the hardest. Taking that step means you should be able to find the support and treatment you need to stop bulimia and improve your life.

Talk to your GP first. He or she will ask about your life and eating habits and will examine you to check for any physical problems resulting from bulimia.

He or she may refer you to a psychiatrist or psychologist who is trained in the treatment of eating disorders.

 

Treatment of bulimia nervosa

You should start treatment for bulimia as soon as you can.
You can recover from bulimia but it can be a long process and, in times of stress, you may relapse. For treatment to work, you must want to get better.

Self-help

Bulimia can sometimes be treated by a self-help programme with help from a therapist. This treatment allows you to develop skills that will help you manage your bulimia.

Keeping a diary of eating habits and learning about healthy eating and sensible weight control may be helpful.
Support groups may help. It can be comforting to talk to other people who may have had similar feelings and experiences..

Medicines

Your GP may prescribe medicines (eg fluoxetine) to treat depression in the short term. Antidepressants can reduce bingeing and purging. However, there is no clear evidence that they can treat eating disorders long-term, so you’ll need other help too.

Talking therapies

A type of talking treatment, or psychotherapy, called cognitive behavioural therapy (CBT) is often used. CBT can help you to learn healthier ways of thinking about food and rebuild your self-esteem. You’re likely to have around 16 to 20 sessions over four to five months.

Interpersonal therapy (IPT) is another talking therapy which allows you to discuss your relationships with other people. Rebuilding these relationships may stop you turning to food for emotional support. These kinds of therapy usually take longer, around eight to 12 months.

Hospital treatment

Most people who have bulimia don’t need to go into hospital. But if you have serious health problems that put your life at risk, or if you’re at risk of suicide or self-harm, you may need to be admitted to hospital.
 

Help and support

It’s upsetting for loved ones to see you putting your health at risk and it's natural that they to want to help even though you may find unwanted pressure or criticism may make matters feel worse.

You may wish to make your own choices but may need much love and support. If you recognise you have a problem, others may be able to offer help with practical matters such as finding medical help and support groups. Support groups can provide advice and information for you, friends and family.

 

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Help and support
See our answers to common questions about bulimia nervosa, including:

How can I recognise if someone I know has bulimia?
My friend has bulimia, what can I do to help?
I'm pregnant and I have bulimia, what can I do?

 

How can I recognise if someone I know has bulimia?

It can be difficult to notice if someone close to you has bulimia because he or she will often go to great lengths to hide it.

People with bulimia often have a normal body weight but some have weight swings. If you're worried that your friend or relative has bulimia, there are a number of signs you can look out for.

Explanation

If your friend or relative has bulimia, then you're probably already aware that something is wrong. There are a number of common behaviours that people with bulimia show, but it's important to remember that many of the signs of bulimia are present with other problems.

If someone you know has bulimia, he or she may do the following.

  • If someone you know has bulimia, he or she may do the following.
  • Talk about his or her body weight or shape, and think he or she is overweight.
  • Be pre-occupied with what he or she is eating and worried about putting on weight.
  • Regularly make excuses to avoid eating with you or other people (eg by telling you that he or she has already eaten or doesn't feel hungry).
  • Go to the toilet or bathroom immediately after eating.
  • Worry about money as he or she may be spending it on food for binges or laxatives and diuretics.
  • Exercise excessively.
  • Appear tired and anxious, particularly around meal time.
  • Withdraw from social events or isolate themselves.
  • Have a puffy face from swelling of the salivary glands due to vomiting. He or she could also have worn-out teeth from vomiting.
  • Talk about what you should and shouldn't eat.

It's important that you keep an eye out for the signs of bulimia and, if you're worried about your friend or relative, you may want to get professional advice before you express your worries to him or her.
 

My friend has bulimia, what can I do to help?

It can be difficult to know how to help a friend who has bulimia, especially if the friend is secretive about his or her feelings. But there are a number of things you can do if someone you know has bulimia.

Explanation

It's important that you talk to your friend to get a better idea about his or her feelings towards bulimia. This will help you to understand what your friend is going through and how he or she is coping with the symptoms.

You may find it difficult to talk with your friend at first and he or she may become aggressive or secretive. This could be because your friend is worried about rejection or doesn't want to recognise that he or she has an eating disorder. If your friend acknowledges that he or she has bulimia, encourage him or her to seek professional help. You could find medical help and support groups on your friend’s behalf. Your friend may value the support if you offer to book the appointment or accompany him or her on the first visit.

Try to make your friend feel safe and relaxed so he or she can be open with you. It's important you express your worries in a caring and thoughtful way. If your friend doesn't feel ready to talk, let him or her know that you will be supportive and continue to be a friend.

You may want to find out more information about bulimia. It can be helpful if you talk to other people who are in the same situation as you. You can talk about how it's making you feel and share your ideas of different approaches.

Don't blame your friend for his or her eating disorder, or try to persuade him or her to change. This may push your friend further away. It's important that he or she is in control of recovery. Don't rush your friend, because you may lose his or her trust. What is most important is letting him or her know that your support is always there.

 

I'm pregnant and I have bulimia, what can I do?

If you have bulimia while you're pregnant, you risk the health of both you and your baby. It's important that you seek medical help to reduce the risks associated with bulimia.

Having the correct support from professionals and people who care for you when you are pregnant is important. Don't be afraid to be honest and share your anxieties about your body, food or your emotions so that you can get the best advice and support.

Explanation

Having bulimia during pregnancy can put your baby at risk of low birth weight and you may be more likely to have complications during your pregnancy. You're also at risk of suffering from postnatal depression.

If you have bulimia and you're pregnant, you may worry about weight gain and the change in your body shape. However, you may find that your symptoms of bulimia improve during pregnancy, as you become aware of the harmful effects on your unborn baby. You should try to stop vomiting, using laxatives or water tablets (diuretics) as these may affect your pregnancy.

It's important to talk to your GP and allow healthcare professionals to support you throughout your pregnancy and after you have given birth. Your GP can advise you about your pregnancy. He or she will refer you to an obstetrician (a doctor who specialises in pregnancy and childbirth) who has experience with similar pregnancies.

You should speak to your midwife and health visitor about your eating disorder. He or she can give you and your baby better support and help during and after your pregnancy.
You may be referred to an eating disorder specialist who will work with the other medical professionals supporting you to give specific advice and medical information about bulimia.

It's important to eat a well-balanced diet during your pregnancy so that you don't put your baby at risk of poor growth and development. You should speak to a nutritionist or dietitian about your diet during and after pregnancy. He or she will give you guidance on nutrition and can create a plan for healthy eating.

He or she will also help you to get back to a healthy weight after you give birth.

Further information

Beating Eating Disorders (beat)
0845 634 1414 (adult helpline)
0845 634 7650 (youthline)
www.b-eat.co.uk

Mental Health Foundation
www.mentalhealth.org.uk
 

Sources

This information was published by Bupa’s Health Information Team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: August 2010.

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