Bulimia nervosa

Bulimia nervosa is defined by repeated episodes of binge eating followed by compensatory behaviours.

People with bulimia nervosa often 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 defined by the way they look.

Binge eating involves two key features:

  • Eating a very large amount of food within a relatively short period of time (e.g. within two hours)

  • Feeling a sense of loss of control while eating (e.g. feeling unable to stop yourself from eating)

Compensatory Behaviours

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

  • Vomiting

  • Misusing laxatives or diuretics

  • Fasting

  • Excessive exercise

  • Use of any drugs, illicit, prescription and/or ‘over the counter’ inappropriately for weight control (inappropriate use refers to use that is not indicated and for which the drug has not been prescribed)

A person with bulimia nervosa can become lost in a dangerous cycle of out of control eating and attempts to compensate which can lead to feelings of shame, guilt and disgust. These behaviours can become more compulsive and uncontrollable over time, and lead to an obsession with food, thoughts about eating (or not eating), weight loss, dieting and body image. 

These behaviours are often concealed 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 long periods of time.

Many people with bulimia nervosa 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 nervosa?

Someone with bulimia nervosa may display a combination of the following symptoms:

Physical signs

  • Frequent changes in weight (loss or gain)

  • 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

Find out more about the warning signs.

What are the risks associated with bulimia nervosa?

The risks associated with bulimia nervosa are severe and may include:

  • 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

Treatment

Evidence-based therapies to be considered for the treatment of bulimia nervosa include:

  • Maudsley family-based treatment (for young people)

  • Exposure therapy (for adults)

Find out more about specific treatment approaches.

Getting help

If you suspect that you or someone you know has bulimia nervosa, it is important to seek help immediately. The earlier you seek help the closer you are to recovery. Contact your GP for a referral to a practitioner with specialised knowledge in health, nutrition and eating disorders.

Find help in your local area.

 

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