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Bulimia nervosa

Bulimia nervosa, often shortened to bulimia, is an eating disorder. If you have bulimia, it means you have difficulties regulating your food intake. Bulimia tends to involve periods of excessive overeating (bingeing) followed by periods of starvation. It's also likely that if you have bulimia, you try to get rid of the food or calories you have consumed, for example, by making yourself sick.

About bulimia nervosa

If you have bulimia, you have cycles of eating too much in a short period of time, often in secret. This is called binge eating or bingeing. Bingeing usually involves eating lots of high-calorie foods, commonly thought of as treats (for example, chocolate and cakes). This leads to a feeling of shame and sometimes severe anxiety.

Bingeing is followed by purging – this is when you rid yourself of the food or calories you have eaten. You may do this by vomiting or taking medicines including laxatives, diuretics (water tablets) or possibly illegal drugs called amphetamines. Alternatively, you may exercise excessively, starve yourself or use a combination of these.

About one to two women in 100 will have bulimia at some point in their lives. Bulimia most often develops in women in their late teens to early twenties, but it can occur at any age in men or women. Bulimia is less common in men – fewer than one man in 100 gets the condition.

If you have bulimia, you will usually be within the healthy weight range for your height. The other main eating disorder is anorexia nervosa, which is characterised by excessive weight loss. Some people with bulimia have had, or develop, anorexia.

Symptoms of bulimia nervosa

Bulimia has many symptoms, some of which are related to how you think and behave and others that are physical. Behavioural symptoms of bulimia include:

  • not eating with others or going to the toilet after meals to vomit the food you have eaten
  • having a binge-purge cycle at least twice a week for three months or more
  • secretly hoarding food
  • being obsessed with dieting and exercise
  • becoming secretive and unwilling to socialise
  • self-harming, such as scratching or cutting yourself

If you have bulimia, you’re preoccupied with thoughts of food or cravings and have an intense fear of gaining weight. You may have a distorted view of your body and think you’re larger in shape than you really are. You may feel depressed and anxious, find concentrating difficult and have feelings of guilt and shame about your eating habits.

Physically, there may be no signs. Your weight may fluctuate – you most likely won’t be very underweight, and may be slightly overweight.

Other physical symptoms can include:

  • bloating and a feeling of fullness
  • tiredness and weakness
  • indigestion
  • stomach pains
  • sore throat (from vomiting)
  • constipation or diarrhoea
  • irregular periods
  • dehydration
  • fainting

Complications of bulimia nervosa

Over time, bulimia can lead to various physical problems. These can include the following.

  • You may develop tooth decay, discoloured teeth, gum disease and bad breath caused by stomach acid in your mouth from regular vomiting – it’s important to see a dentist to reduce long-term effects.
  • You may also have patches of rough skin on your knuckles or fingers if you use them to make yourself sick.
  • Vomiting can also cause you to have a puffy face around your jaw because your salivary glands in your mouth, which produce saliva, become swollen.
  • Loss of water caused by frequent vomiting can lead to kidney damage and kidney stones.
  • Acid in vomit can cause inflammation of your stomach and oesophagus (the tube leading from your mouth to your stomach).
  • Vomiting can upset the levels of salts in your blood and lead to damage to your heart and palpitations (irregular heart beat).
  • Regularly using laxatives can cause swollen fingers.
  • Your skin may be in a poor condition and be very dry, and you may have hair loss.
  • Your bowel muscles can be damaged because of using laxatives.

It's important to get treatment for bulimia to reduce the risk of these complications.

Causes of bulimia nervosa

It isn't clear why some people develop bulimia. The reasons are probably different for everyone and may be emotional, physical or social.

The following emotional or mental health conditions are also associated with bulimia.

  • Low self-esteem – this is not thinking highly about your self-worth and associating it with your body weight.
  • Mental illness, particularly depression – bulimia may begin as a way of managing your unhappiness.
  • Obsessive-compulsive disorder – this is a condition that causes anxiety because of obsessively thinking about things or doing certain actions.
  • If you’re a perfectionist by nature, an eating disorder may give you a sense of control and achievement.

There are certain other factors that may make it more likely that you will develop bulimia, for example:

  • a family history of eating disorders – this could be a result of genetic factors or copying the behaviour of other family members
  • a specific emotionally stressful event, such as divorce, leaving home or an abusive family relationship
  • living in a Western society
  • being influenced by media images of thinness
  • having type 1 diabetes
  • having had anorexia
  • being on lots of weight-loss diets in the past

Diagnosis of bulimia nervosa

Getting help is very important. Admitting you have a problem is the first step, though it can be the hardest. Making that move means you’re more likely to be able to find the support and treatment you need to overcome bulimia and improve your life.

Talk to your GP first. He or she will ask about your life and eating habits, and will examine you to check for any physical problems resulting from bulimia.

Your GP may refer you to a psychiatrist or psychologist who is trained in the treatment of eating disorders.

Treatment of bulimia nervosa

You should start treatment for bulimia as soon as you can.

Bulimia is a serious condition, but you can recover from it. About half to three-quarters of all people treated for bulimia completely recover, but it can be a long process and happen slowly over months or years. In times of stress, you may relapse. Even if bulimia doesn’t go away completely, treatment can help you binge and purge less, which can help make you feel better and healthier. For treatment to work, you must want to get better.


Bulimia can sometimes be treated by a self-help programme with guidance from a therapist. This treatment allows you to develop skills that will help you to manage your bulimia.

Keeping a diary of eating habits and learning about healthy eating and sensible weight control may be helpful.

Support groups may help. It can be comforting to talk to other people who may have had similar feelings and experiences. Family members may also find it useful to attend self-help meetings for relatives and carers.

Talking therapies

A type of talking treatment, or psychotherapy, called cognitive behavioural therapy (CBT) is often used. CBT can help you to learn healthier ways of thinking about food and rebuild your self-esteem. You're likely to have between 16 and 20 sessions, each lasting about an hour, over four to five months. In between sessions, you will be set tasks to do, such as making small changes to your eating habits or keeping a diary of what you eat and when.

Interpersonal therapy (IPT) is another talking treatment that allows you to discuss your relationships with other people. Rebuilding these relationships may stop you turning to food for emotional support. This kind of therapy usually takes longer.

Dietary advice

You may see a dietitian for help and advice with healthy eating. This will help you get into a steady pattern of eating without bingeing, vomiting or purging so you can maintain a healthy weight. A dietitian will also help you understand what a healthy weight is for your height and why.


Your GP may prescribe you a type of antidepressant medicine called a selective serotonin reuptake inhibitor (SSRI), such as fluoxetine, to treat depression in the short term. Antidepressants can reduce the urge to binge and purge, improving your symptoms in two to three weeks. However, there is no clear evidence that they can treat eating disorders long-term, so you will need other help too.

Hospital treatment

Most people who have bulimia don't need to go into hospital. But if you have serious health problems that put your life at risk, or if you're at risk of suicide or self-harm, you may need to be admitted to hospital.

Help and support

It's upsetting for loved ones to see you putting your health at risk and it's natural that they will want to help, even though you may see this as them putting you under unwanted pressure or criticising you, which makes matters worse.

You may wish to make your own choices but may need a great deal of support. If you recognise that you have a problem, others may be able to offer help with practical matters such as finding medical help and support groups.

Produced by Polly Kerr, Bupa Health Information Team, November 2012.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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  • Publication date: September 2010

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