What is bulimia nervosa?

Bulimia nervosa is an eating disorder and a serious mental illness. People who have bulimia often binge eat, meaning that they eat far more food than is normal in a short amount of time. They may feel like they have no control over how much food they eat and try to make up for their binge eating by making themselves vomit, using laxatives, fasting or excessively exercising.

People with bulimia are often in the normal weight range. It is common for people with the condition to try to hide their condition from others, so diagnosing it can be very difficult. Overcoming bulimia can be very challenging, but doctors, therapists and other healthcare professionals can help people with the condition to think more positively about themselves and their weight and develop a healthy attitude towards food.

Bulimia nervosa can cause negative thinking about personal weight.  

Laxatives

Any substance that causes or encourages bowel movements.

Signs and symptoms

A person with bulimia has a regular behaviour of binge eating followed by deliberate vomiting (purging), using laxatives or diuretics, fasting or excessively exercising to counteract their initial overeating. Typically, the cycle of overeating and purging or fasting occurs once or twice a week.

Warning signs

It is common for a person with bulimia to try and hide their condition from others. Sometimes there may be several warning signs that a person is suffering from bulimia. These may be physical signs, changes in behaviour, or changes in the way a person thinks.

Physical signs

Physical signs of bulimia include:

  • Weight loss or weight gain;
  • Signs of frequent vomiting, including damage to teeth or bad breath;
  • Fainting or dizziness, and;
  • Tiredness.

Behavioural signs

Some of the behaviours that may be associated with bulimia include:

  • Not eating food around others;
  • Hoarding food;
  • Frequent vomiting or use of laxatives;
  • Lying about eating habits;
  • Extreme dieting;
  • Excessive exercising, and;
  • Frequent use of the toilet during meals or after eating.

Psychological signs

Psychological signs associated with bulimia include:

  • Obsession with food and body shape;
  • Low self-esteem;
  • Having a distorted body image, and;
  • Depression or anxiety.

A teenage girl standing in front of a mirror unhappy with her reflection.Having a distorted body image is a common symptom of bulimia nervosa. 

Anxiety

A feeling of tension, nervousness and dread about future events. It can trigger physical symptoms such as a rapid pulse or breathing difficulties.

Diuretics

A substance that promotes the production and excretion of urine.

Laxatives

Any substance that causes or encourages bowel movements.

Causes and risk factors

It is not known exactly what causes bulimia. Both men and women can develop the condition. It is thought to develop from a combination of genetic and environmental factors. A person may be more likely to develop the condition if they:

Genetic

Related to genes, the body's units of inheritance or origin.

Types

There are two main subtypes of bulimia, which are classified on the basis of how people compensate after binge eating.

Purging bulimia

Purging bulimia is when a person tries to get rid of the food they have eaten after a binge by making themselves vomit or by misusing laxatives, which are medicines usually used to relieve constipation. Purging may also include a person giving themselves an enema or taking diuretics, which are medications that help your body get rid of excess water and salt through the urine.

Non-purging bulimia

Non-purging bulimia occurs when a person compensates for their binge eating by going for long periods without eating (fasting), or by exercising excessively.

Diuretics

A substance that promotes the production and excretion of urine.

Enema

A procedure in which fluid or gas is injected into the rectum for cleansing, diagnostic or therapeutic purposes.

Laxatives

Any substance that causes or encourages bowel movements.

Methods for diagnosis

Bulimia can sometimes be difficult to diagnose. Many people with the condition are in the normal weight range and tend to hide their behaviour from others. To work out if a person has bulimia or another type of eating disorder, a doctor will ask them questions about their medical history, mental health and lifestyle.

Types of treatment

There are a number of different treatment options available for people with bulimia. Treatment can involve a combination of psychotherapy, which is sometimes called 'talking therapy' and medication to help improve the person's mental health.

Psychotherapy

If you have bulimia, meeting regularly with a therapist to discuss your thoughts and feelings may help you manage your condition. This is known as psychotherapy. A common type of therapy used to help treat bulimia is called cognitive behaviour therapy, which can help to teach people affected by an eating disorder healthy ways of thinking about food and how to think more positively about themselves and their weight.

A young woman in a session with a therapist.Psychotherapy can assist with treatment of bulimia nervosa. 

Medication

In some cases, a doctor may prescribe antidepressants, in addition to psychotherapy, to help treat bulimia. This may include selective serotonin reuptake inhibitors, such as fluoxetine.

Antidepressants generally need to be taken for at least two weeks before there is any improvement in symptoms. When stopping antidepressant medication, the dose usually needs to be reduced gradually over time to prevent any withdrawal responses.

Side effects

As with many medications, some people may experience some side effects when taking antidepressants. Some common side effects include nausea, dizziness, tiredness and sexual dysfunction. Some antidepressants can have more serious side effects if they are taken with certain other medications or herbal remedies, or when combined with alcohol.

Very rarely, some antidepressants may increase suicidal thoughts and the risk of suicide. The risk is highest in the first weeks after starting antidepressant treatment, or when the dose of antidepressants is changed. If someone experiences suicidal thoughts, it is important to contact a doctor immediately.

Antidepressants

Medication used to treat depression and other mood disorders.

Cognitive behaviour therapy

A psychological or 'talking' therapy that focuses on changing unhelpful thoughts and behaviours that are causing a person distress.

Serotonin

A chemical messenger within the brain that is thought to play a role in mood and behaviour. Many antidepressant medications act by increasing the amount of serotonin in the brain.

Sexual dysfunction

Any abnormal difficulty that interferes with the sexual response or sexual activity of an individual or a couple.

Potential complications

Over time, bulimia can lead to several other medical complications. The frequent cycles of binge eating and purging can cause dehydration and result in low levels of essential salts and minerals, known as electrolytes, in your body. Bulimia can also lead to problems with the digestive system including irregular bowel movements and constipation.

Exposure to stomach acid from frequent vomiting can cause damage to the gullet (oesophagus) and teeth, leading to dental cavities and damaged tooth enamel.

Dehydration

The state of insufficient hydration; excessive loss of water; requiring more water in order to function normally.

Digestive system

The series of organs within the body that contribute to the digestion of food. It begins at the mouth and ends at the anus, and includes the stomach, small and large intestines as well as the pancreas, gallbladder and liver.

Electrolytes

Substances that form ions when dissolved in water. These include potassium and sodium minerals that are necessary for normal functioning of the body and all its cells.

Oesophagus

Also called the gullet or food pipe, it is the muscular tube connecting the throat and stomach. It is lined with a mucous membrane. After ingestion, food and drink travel down the oesophagus to be digested in the stomach.

Tooth enamel

The outer layer of the tooth. Typically 1-2mm thick, this is the whitest part of the tooth, forming a protective shell over the underlying dentine.

Prognosis

Bulimia is a long-term condition that requires long-term management. It is possible to recover from an eating disorder, but recovery can be very challenging. If the warning signs are detected and treated early, there is a better chance of recovery. A team of doctors, therapists and other healthcare professionals can help people with the condition return to a healthy lifestyle.

There are several steps that can be taken to reduce the chance of developing an eating disorder such as bulimia. Promoting a positive body image, improving self-esteem and learning about nutrition and good general health may reduce your risk of developing an eating disorder. 

Nutrition

The uptake of nutrients that are necessary for bodily functions.