Bulimia nervosa

This content mentions body image and eating disorders, which some people may find triggering.

Summary

What are the symptoms of bulimia?
What causes bulimia?
What help is available?

Bulimia nervosa (commonly known as bulimia) is an eating disorder and serious mental health problem. Someone with bulimia might feel parts of their lives are out of control and use purging to give them a sense of control. Bulimia is a serious condition that can cause long-term damage, but help is available.

Anyone can develop bulimia, but it’s most common in young people aged 13 to 17.

What are the symptoms of bulimia?

If you have bulimia, you may feel:

guilty or ashamed, especially after bingeing
preoccupied with your weight
as though your body is bigger or in a different shape than it really is
stuck in a cycle of feeling out of control and trying to regain control
anxious or depressed
lacking in confidence and self-esteem
irritable and moody
numb

The physical symptoms of bulimia include:

weight loss or frequent weight changes, although many people with bulimia stay the same weight
periods stopping or becoming irregular
tiredness or lethargy
constipation, bloating and stomach pains
sore throat and damaged teeth from stomach acid if you make yourself sick
a puffy face
swollen hands and feet

Your behaviour may be affected. You may:

binge on food, particularly foods you think are bad for you
try to get rid of the food you’ve eaten (purge) by vomiting, taking laxatives or exercising a lot
eat in secret, or disappear after eating to purge

Bulimia can cause serious physical damage to your body. Vomiting can damage your teeth. Laxative misuse can lead to heart disease and digestive problems such as irritable bowel syndrome (IBS) and constipation. It’s important to get help quickly if you think you have bulimia.

What causes bulimia?

There is no single cause of bulimia. There are many reasons why someone might develop bulimia and many factors that can contribute.

Common traits

An eating disorder can be a way of coping with distressing emotions and feelings. Many people report feeling sad or stressed, for example, before they binged.

Other common traits include:

low self-esteem or feeling worthless
perfectionism
fear of being inadequate
fear of rejection
a strong desire to gain the approval of others

Biological and genetic factors

Research shows there may be genetic links to bulimia. Changes to the chemicals in our brains can also be a factor in developing bulimia.

What help is available?

Anyone can develop bulimia. If you’re worried you may have bulimia, contact your GP. They may not be an expert in treating eating disorders, but they will be able to assess any physical symptoms and then refer you to specialist eating disorder services.

Treatment may take time, but you can recover from bulimia.

Guided self-help

You may be offered guided self-help as a first step. This often involves working through a self-help book and sessions with a therapist. The book may take you through a programme that helps you make realistic meal plans, understand your triggers and find other ways to cope with your feelings.

You may be offered an online self-help programme called Overcoming Bulimia Online. It’s free if a healthcare professional gives you a code, or you can pay for access.

Talking therapies

Talking therapies can help you tackle your underlying thoughts and feelings triggering bulimia and find healthier ways to cope. You may be offered:

Cognitive behavioural therapy (CBT). This can help you think about food in a healthier way and rebuild your self-esteem. In between sessions, you may be asked to do tasks such as making small changes to your eating habits or keeping a daily diary of when and what you eat
Interpersonal therapy (IPT). This lets you discuss your relationships with other people. Rebuilding these relationships may stop you from turning to food for emotional support.

Medication

Antidepressants shouldn’t be the only treatment you’re offered. However, you may be offered them alongside self-help or therapy to manage other conditions such as depression, anxiety or obsessive-compulsive disorder (OCD).

Inpatient treatment

Most people with bulimia will stay at home during their treatment. However, if you are very underweight, have heart problems, or are so ill that doctors feel you’re at risk, you may be admitted to a hospital. Doctors will help you gradually reach a healthy weight and either start or continue your therapy.

Ways you can look after yourself

It’s difficult to recover from an eating disorder on your own, but there are things you can try alongside treatment and support. Beat has many tips for recovery, and Mind has ideas for self-care, including managing relapses, changing unhealthy routines and being careful online.

You may find that support groups are useful. It can be comforting to talk to others with the same feelings and experiences. You could join Beat’s online support group for people with bulimia.

The NHS website has further tips on looking after your health while recovering from bulimia.