Bulimia nervosa

A–Z / B / Bulimia nervosa

Also known as bulimia

Living through bulimia can be overwhelming, frightening, and isolating. People with bulimia want to lose weight, so they try not to eat, but after a while they give in to the urge to eat. They will eat a large amount of food all at once.

Almost immediately they feel so worried that they might gain weight that they do things like making themselves vomit, or taking large amounts of laxatives, or by exercising to excess.

Bulimia is an eating disorder. There are four types of eating disorders that are talked about:

AnorexiaWhere a person believes they are fat, even when they are not and may have lost a lot of weight.

Bulimia: Where a person eats very large amounts of food because they are starving. Then they worry about gaining weight so they make themselves vomit, takes laxatives or exercise to extremes.

Binge eating disorder: Where a person eats an excessive amount of food within a short period of time (two hours) and feels a loss of control while eating.

Other eating disorders: Where a person has signs of either bulimia or anorexia but not enough signs to definitely state they have these conditions. This category is often called Eating Disorder not Otherwise Specified (EDNOS) by doctors, and usually occurs at an early age. It is very common and doctors treat is as seriously as the other categories of eating disorder. Any form of eating disorder is a complex mental illness that can have serious physical, emotional and social impacts.

We will focus on bulimia here

 About half of all cases of bulimia start before the age of 19, and almost all before the age of 45. Most people who develop bulimia are women.

Many people feel ashamed of their bulimia and, because they can sense other people's prejudice, often keep their condition hidden. Workmates and friends don't understand and may turn their backs on a person they know who has a mental health problem. Even families and whānau and mental health workers can be over-anxious, controlling and pessimistic. None of this helps. Sometimes the discrimination feels worse than the illness itself.

It’s good to know that with help, even if you continue to have some episodes of bulimia you can still experience recovery and live a happy and worthwhile life.

What causes bulimia?

There’s no clear cause of an eating disorder. This makes it more upsetting for the person, family and friends, as they all try to think about what could have started it and what to do about it, but that is not possible. Nevertheless, the following types of people do tend to have an increased risk of developing an eating disorder:

  • those whose career or sport requires them to be thin – dancers, gymnasts, models, jockeys or body builders
  • those who are overweight
  • those with a number of different problems including childhood sexual abuse, trauma or neglect, drug or alcohol problems and unstable relationships
  • people with diabetes
  • those with problems of self-esteem and identity
  • young people living within families that make them feel that they are only worthwhile when they are very good at study or sport, very well behaved, or thin and attractive and who feel worthless if they do not match up to family expectations
  • people who are depressed; feeling sad or irritable much of the time and avoid doing things with friends
  • people with high personal expectations – always striving to be perfect in everything.

Cultural factors should not be ignored when we think about what can cause bulimia in vulnerable people. We are constantly bombarded with the message that women need to be thin to be considered beautiful, and men need to muscular and lean. Since a thin shape is normal and healthy for only a very few women, others must either struggle with feelings of not being good, perfect or self-controlled enough or begin to diet. Men tend to over-exercise.

For people at risk of an eating disorder a number of things could set them off, such as:

  • a life crisis or the death of a loved one
  • family changes
  • a relationship break-up
  • moving home or school
  • a change of job
  • school problems
  • a personal failure.

Signs to look for (symptoms)

There are many symptoms of an eating disorder. These may not relate to everybody, and sometimes it can be difficult to notice any signs at all. Early signs of bulimia could include:

  • extreme concern about being too fat and thinking about food and dieting all the time
  • increasing isolation from others
  • secret eating and purging (vomiting or taking laxatives)
  • food disappearing from the house, especially high calorie foods
  • spending long periods in the bathroom especially immediately after meals, sometimes with the tap running (or music playing) for long periods
  • shoplifting food
  • swollen cheeks (a little like mumps) caused by repeated vomiting
  • excessive tooth decay - vomiting causes damage to tooth enamel
  • strenuous exercise routine, even exercising when injured or unwell
  • severe weight changes
  • sudden mood changes, irritability, depression, anxiety, sadness, anger, difficulty in expressing feelings
  • poor concentration and being unusually tired
  • constant pursuit of thinness.

Some of these signs can relate to different problems and not to eating disorders, but if there are several of these signs together, it could mean an eating problem.

Eating Disorders Association of New Zealand has a great online checklist to help you recognise how much your eating disorder is affecting your life. 

How the doctor determines if you have an eating disorder (diagnosis)

There is no straightforward test for bulimia and no universally agreed treatment path or medication that provides a cure. The first step is taking with your doctor and asking for help.

Eating disorders are complex. A person with an eating disorder will very often also experience depression, anxiety and a lack of self worth.

While your doctor may not be an expert in treating eating disorders, they will be able to assess any physical problems resulting from your eating disorder and can also help you to contact specialist eating disorder services.

Treatment options

Uncovering the underlying psychological reasons that are causing an eating disorder is essential in helping people on their path to recovery. The most successful treatment for eating disorders in the longer term is by talking to a specialist who can help with your emotional needs and can help you take control of your eating.

However, for successful treatment, you must be at a stage where you accept that you want to have bulimia out of your life.

Psychosocial treatments (therapy)

These are non-medical treatments that address your emotional needs such as your thinking, behaviour, relationships and environment. This involves talking with a trained professional who uses clinically researched techniques, usually talking therapies, to assess and help you understand what has happened, and to help you make positive changes in your life.

Psychoeducation (providing education)

Education can be extremely important to help the person with bulimia, their family/whānau and supporters to understand this disorder and help in the recovery. Your health professional will give you information about the disorder, suggest different ways to handle it, and discusses any complications which may occur.

 There are also numerous self-help books available in the shops which some find to be a useful first stage in getting help. They can teach you about some of the ways of dealing with your eating disorder and they can also get you used to reading about or discussing problems which you have previously kept completely to yourself. They are generally written by medical experts but draw on the experience of people who have eating disorders.

Medication

There are no drug treatments of established benefit in the treatment of bulimia. There are a few that may help deal with some of the associated problems, and these are prescribed from time to time. These include antipsychotic and antidepressant medications.

You should be told what effects you should notice from any medication, receive clear instructions about how you should take them and what precautions are necessary.

If you are pregnant or breast feeding no medication is entirely safe. Before making any decisions about taking medication at this time you should talk with your doctor.

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

When considering taking any supplement, herbal or medicinal preparation you should consult your GP to make sure it is safe and will not harm your health, for example, by interacting with any other medications you are taking.

Physical health

It's really important to look after your physical wellbeing. Make sure you get an annual check up with your doctor. Being in good physical health will also help your mental health.

What you can do if you think you or a loved on has bulimia

  • Talk to your doctor if you suspect you, or a loved one, has bulimia, or any type of eating disorder. 
  • If you suspect a loved one has an eating disorder, let them know that you are worried and that you care about them. 
  • Encourage them to see their doctor or school counsellor, but don’t force them to (unless they are significantly underweight and their health it at risk. 
  • Just be there for them and be aware that one day they may want your help.
  • It is known that people with bulimia stand a higher risk of developing depression, anxiety problems or alcohol and drug problems, so it is important that help is sought as soon as possible.
Thanks to Janet Peters, registered psychologist for reviewing this content. Date last reviewed: September, 2014.