Bulimia nervosa is an eating disorder involving episodes of over-eating (bingeing) followed by compensatory behaviours in the form of purging. People with bulimia try to control their weight by severely restricting the amount of food they eat, then bingeing and purging the food from their body by vomiting, excessively exercising or using laxatives. As with many eating disorders, women are much more likely to develop bulimia than men. However, bulimia nervosa is becoming increasingly common in boys and men.
- Secrecy surrounding eating
- Lack of control over eating – Inability to stop eating. Eating until the point of feeling physical discomfort and pain
- Eating unusually large amounts of food with no obvious weight change
- Disappearance of food, numerous empty wrappers or containers around or hidden stashes of food
- Alternating between overeating and fasting
Purging signs and symptoms
- Going to the bathroom after meals – Frequently disappears after meals or taking trips to the bathroom to vomit. May run the water to disguise sounds of vomiting
- Using laxatives, diuretics, or enemas after eating. May also take diet pills to suppress appetite
- Smell of vomit – The bathroom or the person may smell like vomit.
- Excessive exercising – Works out intensely, especially after eating. Typical activities include high-intensity exercise such as running.
Physical signs and symptoms
- Calluses or scars on the knuckles or hands from sticking fingers down the throat to induce vomiting
- Puffy cheeks caused by repeated vomiting.
- Discoloured teeth from exposure to stomach acid when vomiting.
- Not underweight – Men and women with bulimia are usually normal weight or slightly overweight. Being underweight while purging might indicate a purging type of anorexia
- Frequently fluctuating weight – Weight may fluctuate due to alternating episodes of bingeing and purging
Cognitive Behavioural Therapy (CBT) is the current leading treatment for bulimia nervosa. CBT helps individuals to recognise their unhelpful or negative thinking, recognise the patterns in their behaviours and develop healthy strategies and skills to challenge or cope with their unhelpful thoughts. CBT is a structured skills based therapy that is most suitable for people who want to be guided by their therapist to find new ways of coping. CBT involves:
- Breaking the binge-and-purge cycle – The first stage of bulimia treatment focuses on stopping the vicious cycle of bingeing and purging and restoring normal eating patterns. This involves monitoring symptoms, avoiding situations that trigger binges, learning to cope with stress in alternative ways, eating regularly to reduce biologically driven food cravings, and tackling the urge to purge.
- Altering unhealthy thoughts and patterns – The next stage of treatment focuses on identifying and changing dysfunctional beliefs about weight, dieting, and body shape. This involves exploring attitudes about eating, and re-evaluating the idea that self-worth is based on weight
- Solving emotional issues – The final stage of treatment involves focusing on emotional issues that led to the development of the eating disorder. Therapy may also focus on relationship issues, underlying anxiety and depression, low self-esteem, and feelings of isolation and loneliness.
There is no single cause of bulimia. While low self-esteem and concerns about weight and body image play key roles, there are many other contributing causes. Binge eating is triggered by both physiological factors (hunger) and emotional factors such as stress, depression or anxiety. Effective treatment for bulimia nervosa needs to target both the physiological and the emotional triggers as well as the underlying causes