Bulimia nervosa

Published by Bupa's Health Information Team, September 2010.

This factsheet is for people who have bulimia nervosa, or who would like information about it.

Bulimia nervosa, often shortened to bulimia, is an eating disorder. A person with bulimia has difficulties regulating their food intake. Periods of excessive overeating (bingeing) followed by periods of starvation often occur. It's also common that someone with bulimia tries to get rid of the food or calories they have consumed, for example by making themselves 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 (eg chocolate and cakes). This is followed by a feeling of shame and sometimes severe anxiety.

If you have bulimia, you rid yourself of the food or calories you have consumed. This is called purging. You may do this by vomiting, by taking laxatives, diuretics (water tablets) or possibly illegal drugs called amphetamines, by exercising excessively, by fasting or through a combination of these.

About one in 50 women have bulimia at some point in their lives. Bulimia most often develops in women in their late teens to early twenties but can occur at any age in men or women. Bulimia is less common in men - for every 10 women with bulimia, about one man has the condition.

If you have bulimia, you will usually be within the normal 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

If you have bulimia, you may do the following:

• not eat with others or go to the toilet after meals to vomit the food you have eaten
• have a binge-purge cycle at least twice a week for three months or more
• secretly hoard food
• be obsessed with exercise
• become secretive and unwilling to socialise
• self-harm

If you have bulimia, you are 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 are larger in shape than you are. You might be feeling 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 will probably not be very underweight, and may be overweight.

Other symptoms can include:

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

Complications of bulimia nervosa

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

• tooth decay, discoloured teeth, gum disease and bad breath caused by stomach acid in your mouth from regular vomiting - also patches of rough skin on your knuckles or fingers if you use them to make yourself vomit
• a puffy face around your jaw from swollen salivary glands (glands in the mouth which produce saliva)
• dehydration
• kidney damage
• inflammation of your stomach and oesophagus (the tube leading from your mouth to your stomach), caused by the acid in vomit
• damage to your heart and palpitations (irregular heart beat)
• swollen hands and feet
• dry skin and hair loss
• damage to your bowel muscles caused by use of 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. Emotional, physical and social reasons may be involved.

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
• mood conditions, particularly depression
• obsessive-compulsive disorder - this is a condition causing anxiety due to obsessively thinking about things or doing certain actions

If you have a perfectionist personality or one of these conditions, 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:

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

Diagnosis of bulimia nervosa

Getting help is very important. Admitting you have a problem is the first step, though it can be the hardest. Taking that step means you should be able to find the support and treatment you need to stop 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.

He or she 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.

You can recover from bulimia but it can be a long process and, in times of stress, you may relapse. For treatment to work, you must want to get better.

Self-help

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

Medicines

Your GP may prescribe medicines (eg fluoxetine) to treat depression in the short term. Antidepressants can reduce bingeing and purging. However, there is no clear evidence that they can treat eating disorders long-term, so you'll need other help too.

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 around 16 to 20 sessions over four to five months.

Interpersonal therapy (IPT) is another talking therapy which allows you to discuss your relationships with other people. Rebuilding these relationships may stop you turning to food for emotional support. These kinds of therapy usually take longer, around eight to 12 months.

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 to want to help even though you may find unwanted pressure or criticism may make matters feel worse.

You may wish to make your own choices but may need much love and support. If you recognise you have a problem, others may be able to offer help with practical matters such as finding medical help and support groups. Support groups can provide advice and information for you, friends and family.

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

For sources and links to further information, see Resources.