Bulimia nervosa (known as bulimia) is an eating disorder that affects up to one in 50 women and one in 500 men. Bulimia is a very serious condition where a person eats large quantities of food whilst feeling they have lost control over the amount they eat (binge-eating) and then to try to get rid of food itself (for example by vomiting) or try to get rid of the effects of the food (for example by exercising or trying to cut down on eating after bingeing).

Laxatives or diuretics (which speed the passage of food and liquid through your body and can be very dangerous when misused) are often also taken in the mistaken belief that this will help prevent weight gain.

What causes bulimia nervosa and who can get it?

Bulimia is similar in some ways to anorexia nervosa because unhappiness and distress tend to be expressed through changes to eating behaviour and deep unhappiness and dislike of weight and shape. It’s not really known exactly what causes bulimia. But, as with anorexia, it is most likely to be a combination of factors, including your genes, biological factors, what is happening in your life and your social environment.

Some young people feel that modern society puts pressure on them to be thin, and may lead them to feel dissatisfied and unhappy about their own appearance. However, bulimia is more complex than this and is often linked to feelings of low self-esteem and difficulty managing a range of negative feelings and situations.

If you have bulimia you may see your eating habits as one of the things you can control in your life. You may try to cut down, but find that when you get too hungry or too upset about things you can’t stop yourself from eating. This might then make you feel even worse.

Bulimia develops in different people for a whole range of different reasons, but it can usually be understood as a person’s way of coping with difficult feelings or unhappiness. This unhappiness could be a result of lots of different things, including bullying, rejection, exam pressures, difficult relationships or physical or sexual abuse.

Over 85 per cent of reported cases of bulimia happen in girls in their late teens and early twenties. But around ten per cent of people with bulimia are men.

What are the signs and symptoms of bulimia?

If you have bulimia you are likely to think about food a lot of the time. You may crave it constantly and eat a lot of high-calorie foods (ice cream, chocolate and cakes) in secret.  Some people with bulimia binge and vomit now and then, while other people do it several times a day.
If you have bulimia you will probably feel ‘fat’ and are not happy with the way you look – you may see yourself as being overweight when you are not. You may feel guilty after eating, which makes you want to be sick. You might also feel negative about yourself as a whole, not just how you look. This is caused by low self-esteem. 
Bulimia may give you a short-term feeling of being in control and less anxious, but this soon wears off and can leave you feeling disgusted, unwell and out of control again.
Other signs/symptoms of bulimia include:

• Irregular periods
• Tiredness
• Damage to teeth (from vomiting which rots tooth enamel)
• Sore throat and heartburn from repeated vomiting
• Skin problems – such as spots
• Puffy face from swollen salivary glands
• Heart problems
• Fluctuating weight

• Constipation or problems caused by laxatives
• Feelings of depression and anxiety
• Exercising excessively

How is bulimia normally diagnosed and treated?

If you have bulimia you may well be a normal weight, so it can be difficult for a doctor to tell from your weight alone. Unlike anorexia, bulimia does not usually make people have obvious weight loss. Therefore there aren’t usually visible signs, although you may be doing a lot of physical damage to your body. This means that the bulimia sometimes goes on for a long time before people seek help. It is important not to do this, as being sick and using laxatives can cause irreversible damage and the longer it goes on, the worse it can be.

You may find yourself going to the doctors because of problems related to the bulimia – like constipation, stomach pains, or problems with your periods.

The first step in recovery from bulimia is to recognise that you have a problem. Then it is important to seek advice from your doctor – and to be open about your symptoms. Your doctor will put you in touch with various health professionals who will help and support your recovery.

The most effective treatment for bulimia has been shown to be cognitive behavioural therapy (CBT), which explores how your thoughts, feelings and behaviours are all linked up. Every person’s situation is different and your therapist will help you think through your difficulties and find better ways of coping. You will also be given information about how to eat healthily and stop the cycle of binge-eating and purging. Cognitive behavioural therapy (CBT) or other forms of ‘talking’ or psychological therapies can really help.

Sometimes doctors prescribe antidepressant medication, which is usually used together with one of the psychological therapies. As with anorexia, actively wanting to get better is a very good sign in terms of your recovery and how successful your treatment is.

When should I seek medical help?

Even if you are a normal weight, bulimia can severely damage your body. The bingeing and vomiting can damage your teeth and the lining of your stomach. Being sick and using laxatives can also cause an imbalance of electrolytes (salts needed in your blood and tissue) which can lead to dehydration. If you think you may have bulimia, it really is very important to try to get help as soon as possible. This is because the earlier you treat the condition, the better the outcome is likely to be.

Looking forward

Treatment has a good success rate for people with bulimia; 60-70 per cent of people make a full recovery.

The seriousness of bulimia varies from person to person. Some people have milder symptoms which may come and go depending on how much stress someone is under. If this is the case for you, it is still best to try to get some help, as everyone faces stressful periods in their life and bulimia can be a difficult and damaging way to try to deal with things. Again, wanting to get better from the condition is a really good sign, and often makes all the difference in making a full recovery.

For more help and information

• Visit Anorexia & Bulimia Care or call their helpline on 01934 710336
• The charity beat (formerly the Eating Disorders Association) have loads of resources. You can call the adult Helpline on 0845 634 1414 or the Youth Helpline on 0845 634 7650.
• Young Minds provides information and advice on child mental health issues. You can ring on 0800 018 2138.

Last reviewed by Great Ormond Street Hospital: 30 June 2008

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