What is bulimia nervosa?

Bulimia nervosa is an eating disorder. As with other eating disorders, bulimia nervosa can lead to serious health problems, but effective treatment is available.

People with bulimia nervosa can consume an enormous amount of food in one session. A person with bulimia nervosa finds it very difficult to control their eating during a binge.

They may then use 'purging' methods to try to get rid of the food. This can involve deliberate vomiting, taking laxatives, extreme exercise or other methods.

People with bulimia nervosa may also use strict dieting or fasting or take diet pills to compensate for the binges.

Although bulimia includes binge eating, there is a separate disorder called binge-eating disorder. Unlike people with bulimia nervosa, a person with binge eating disorder will not use compensatory methods such as self-induced vomiting or over-exercising to try to control weight after binge eating episodes.

Eating disorders are often a secret problem. Many people feel ashamed and afraid to seek help. Bulimia nervosa can cause serious damage to physical health and wellbeing. If you are struggling with binge eating, see your doctor.

What are the symptoms of bulimia nervosa?

Some common symptoms of bulimia nervosa include:

• not being able to control what you eat
• being secretive about eating
• visiting the bathroom after eating
• over-exercising
• being very self-critical or obsessed with body image
• having dramatic fluctuations in weight (unlike people with anorexia nervosa, people with bulimia nervosa are not usually underweight)
• feeling moody, guilty or ashamed
• feeling tired all the time

Some people with bulimia nervosa also have other mental health concerns, such as anxiety and depression. Some even have suicidal thoughts or make suicide attempts.

When should I see my doctor?

A lot of people with bulimia nervosa think they’re not sick enough or thin enough to need treatment. But making yourself vomit is dangerous, regardless of how much you weigh. If you don’t treat bulimia, it can have a serious impact on your health.

If you are binging and/or purging, or if you are worried about your eating, it’s important to speak to your doctor. If you don’t feel you can talk to a doctor, talk to someone you trust, such as a friend, family member or teacher. They will help you take the first steps towards treatment and recovery.

What causes bulimia nervosa?

There is no single cause of bulimia nervosa. It is thought to develop from a combination of genetic and environmental influences.

These are some of the factors that can increase someone's risk of developing bulimia nervosa:

• genetic factors: having a parent or sibling with an eating disorder
• childhood trauma: such as physical or sexual abuse
• personality: low self-esteem, perfectionism or impulsiveness
• stress: life events or chronic stress can trigger the onset of bulimia nervosa
• mental disorders: such as depression, personality disorder or addictions

Bulimia nervosa usually starts with a feeling of unhappiness about body image and weight. This is very common in today's world and many people feel pressure from society and the media to be thin.

Before bulimia nervosa begins, there is often a period of excessive dieting. However, the wrong kind of dieting can cause uncontrollable hunger and lead to binge eating. Feelings of guilt and shame after binge eating then cause the person to try to compensate by purging.

How is bulimia nervosa diagnosed?

A doctor can do a mental health assessment including asking you about your history of bingeing and purging episodes, mood and psychological issues. The doctor will also need to do a physical examination, blood tests and other investigations in case of any medical complications.

Many people with bulimia nervosa find it difficult to seek help. They may feel guilty or ashamed of their behaviour. But there is often a sense of relief after getting a diagnosis of bulimia nervosa because it can lead to successful treatment and recovery.

How is bulimia nervosa treated?

The first step is to see a doctor, who can then provide a referral to a psychologist, psychiatrist or dietitian as needed.

Treatment usually begins with psychotherapy, such as cognitive behaviour therapy (CBT), family-based treatment (for children and adolescents) and other kinds of therapy. This can help to overcome unhelpful thinking patterns about weight and body image, as well as improve mood and anxiety.

It is important to restore healthy eating habits, and seeing a dietitian for nutrition advice can be very helpful.

Some people with bulimia nervosa may be treated with an antidepressant to reduce their anxiety and improve their mood and self-control.

Self-help tools can also help. Read more about self-help tools.

Living with bulimia nervosa

Recovery can be a slow process and some people have relapses along the way. You can help your recovery by making sure you stick to your treatment plan, even if eating that way makes you feel uncomfortable.

Try not to weigh yourself or look in the mirror all the time. Talk to your treatment team about what sort of exercise you can do.

Learn all you can about the condition and what it’s doing to your body. You can talk to your doctor or a dietitian about what food you need to stay healthy.

Stress can trigger symptoms for bulimia nervosa to reappear, so it’s important to get back to treatment of the condition if that happens.

It’s also important to stay in touch with family and friends who care about you. Be kind to yourself.

Can bulimia nervosa be prevented?

You can encourage a healthy relationship with body weight and food in your children by building their confidence and pride in things other than how they look. Sitting down to eat together as a family, making eating enjoyable and discouraging dieting are all important ways of preventing an eating disorder.

Are there complications of bulimia nervosa?

Bulimia nervosa can cause serious damage to physical health, especially if purging is involved. Some of the physical symptoms of bulimia nervosa may include:

• gastrointestinal problems
• severely inflamed sore throat
• chronic dehydration
• dry skin
• swollen face or neck
• worn tooth enamel or tooth decay
• intestinal problems due to laxative abuse
• heartburn or stomach ulcers

Other physical symptoms include:

• malnutrition
• hair loss or hair changes
• intolerance to cold
• fainting
• calluses on knuckles (from trying to cause vomiting)
• bad breath
• heart failure

Resources and support

If you think you or someone you know might have bulimia nervosa, contact the following organisations for support, information and counselling:

• Butterfly Foundation — call 1800 33 4673
• National Eating Disorders Collaboration
• Eating Disorders Victoria (for people in Victoria with eating disorders) — call 1300 550 236