What Is Bulimia Nervosa?

Bulimia nervosa is characterised by repeated episodes of binge-eating followed by behaviour aimed at compensating for the out of control eating. These compensatory behaviours can include fasting, self-induced vomiting, the use of laxatives and diuretics or appetite suppressants and excessive exercising.

In many cases, bulimia begins with a diet but the preoccupation with food and weight becomes obsessive and can take over the person's life. Eventually, they will become locked into a compulsive cycle of bingeing and purging (getting rid of the food) or resorting to other ways of preventing weight gain. Attempts to break the cycle often fail. The person begins to feel more and more out of control. Self-esteem is very low as it is measured against the ability to control one's eating, weight, shape and size. On the outside, a person with bulimia may seem very capable, positive, successful and on top of things. However, on the inside, they may be struggling desperately with feelings of guilt, shame, self-loathing and ineffectiveness.

For some people, bulimia develops after a period of anorexia. In such cases, diagnosis is not always clear-cut and treatment can be more complex.

Many people with bulimia maintain a normal body weight. As a result, the disorder can sometimes go unnoticed and untreated for a long time. The longer the binge-purge cycle remains in place, the harder it becomes to overcome it.


Main Features

  • Repeated episodes of binge eating, i.e. eating larger than normal quantities of food in a short space of time.
  • Compensating for binges - this can take the form of purging or getting rid of the food by vomiting or using laxatives. Other means of trying to ensure there is no weight gain include periods of fasting or dieting, exercising and using diuretics.
  • Preoccupation with body weight, shape and size.
  • Self-evaluation is influenced significantly by body weight, size and shape.
  • Hormonal disturbance including irregular menstruation.

Other Signs & Symptoms

Physical signs and symptoms:

  • Frequent changes in weight.
  • Lethargy, tiredness and insomnia.
  • Dehydration.
  • General digestive problems (cramps, wind, constipation, diarrhoea)
  • Poor skin condition.
  • Headaches, tension.
  • Sore throat and mouth ulcers, husky voice.
  • Calluses on fingers.
  • Irregular periods.
  • Enlarged salivary glands.
  • Erosion of tooth enamel, tooth decay.

Psychological signs and symptoms:

  • Feeling emotional, irritability, mood swings.
  • Dissatisfaction with body image.
  • Feeling out of control.
  • Feelings of inadequacy and worthlessness.
  • Feelings of guilt and shame.
  • Depression and related symptoms.
  • Anxiety.

Other behavioural signs:

  • Preoccupation with dieting.
  • Regular binges (uncontrollable overeating).
  • Being sick after meals.
  • Disappearing to the lavatory after meals in order to get rid of food.
  • Secret hoarding of food.
  • Secret disposal of vomit (e.g. bags of vomit hidden in bedroom).
  • Abuse of laxatives.
  • Excessive exercising.
  • Lying.
  • Risk-taking behaviours such as alcohol or drug misuse, shoplifting, promiscuity, self-harm.
  • Problems dealing with social situations and interaction with others


Health Consequences Of Bulimia

Frequent vomiting and the use of laxatives in particular can lead to dehydration and to the depletion of electrolytes (body salts). When this occurs, it can seriously affect the body's ability to function properly. All organs can be affected. The heart is particularly at risk.

Getting a medical check up is an essential part of treatment as the effects of bingeing and purging are not obvious and need to be properly assessed. A simple blood test will indicate the level of dehydration and electrolyte depletion. Dietary advice can then be sought to help correct these problems

If a person is severely dehydrated or depleted of essential nutrients, hospitalisation may be required.

Depression and high levels of anxiety and periods of emotional overwhelm often accompany bulimia. Addressing these and other psychological aspects of the disorder is crucial to recovery.

Frequent vomiting can cause erosion to tooth enamel and dental decay. Your dentist will advise you on how best to care for your teeth and reduce the risk of further damage as dental damage is not reversible.

The misuse of laxatives also has dangerous health implications. Coming off laxatives can be difficult. Laxatives are used under the misguided belief that they are an effective means of controlling weight. In fact, the use of laxatives offers no benefits and contributes only to exacerbating physical symptoms and feelings of dependency.


Getting Help

The effects of bulimia are less apparent than the effects of anorexia. A person with bulimia can maintain a normal weight for their height and they may outwardly give the impression of coping well with life's challenges. They may put off seeking help and support because they are frightened of the reaction they might get if they disclose what they are doing. Shame and the fear of rejection become powerful barriers to change. Being able to come out of isolation may take time.

Recovery can only begin when a person is ready to change. Change can be made easier for a person if those around them inform themselves about bulimia and about how they can offer support and show understanding.

Many people with bulimia manage to recover on their own with the right level of support. Nowadays there are many self-help programmes available. These can be used on their own or under the guidance of professionals if needed. The Bodywhys booklet "Binge eating - Breaking the Cycle - a self help guide towards recovery" offers information and suggestions for breaking out of compulsive behaviours and taking back control.

A combination of nutritional advice and psychotherapy can provide powerful support to facilitate the changes needed for full recovery.

Cognitive behavioural therapy is known to be effective. This form of therapy helps a person to look at the false beliefs that underlie their sense of self and their behaviour. It encourages the person to evaluate themselves more realistically and to move towards accepting themselves as they are. Individual psychotherapy and group therapy also aim at increasing self esteem by achieving greater self acceptance and developing coping/problem solving skills so that the eating disorder itself is no longer used as a coping tool. Family therapy can help identify and resolve problems within the family that may be contributing to the eating disorder. Anti-depressants are sometimes prescribed to help with the depression that often accompanies bulimia and, in some cases, to help reduce the frequency of bingeing and purging.

Support groups can be very useful in reducing feelings of isolation and in providing encouragement through some of the more difficult parts of recovery.

Most people will experience some periods of relapse and these need to be recognised as part of recovery and not as a failure. Learning to cope with relapse can actually increase the chances of long term recovery.

Further information can be found in the books listed on our Booklist and from other websites for eating disorders and related issues. See our list of Websites or contact the Bodywhys Helpline: lo call 1890 200 444.