What is bulimia nervosa?

Bulimia nervosa is an eating disorder. An eating disorder is not a choice but a complex mental health condition.

Bulimia nervosa involves binge eating (eating a large amount of food in a short period of time). A person with bulimia nervosa can find it very difficult to control their eating during a binge.

This is followed by compensatory behaviours to manage their weight. This may be a combination of:

• vomiting
• misusing medicines such as laxatives or diuretics
• extreme exercise
• fasting
• inappropriate use of drugs for weight control

This pattern of binge eating and compensatory behaviours can become more compulsive and uncontrollable over time.

These behaviours are often hidden. As with other eating disorders, bulimia nervosa can lead to serious health problems, but treatment is available.

What are the signs of bulimia nervosa?

Signs of bulimia can be:

• physical
• psychological
• behavioural

Physical signs:

• fluctuations in weight, however most people are of average weight
• damage due to vomiting — swelling around the cheeks or jaw, calluses on knuckles, damage to teeth and bad breath
• feeling bloated or constipated
• having new food intolerances
• loss of, or changes to, menstrual periods in females
• fainting or dizziness
• being tired all the time

Psychological signs:

• being preoccupied with eating, food, body shape and weight
• being sensitive to comments about food, weight, body shape or exercise
• low self-esteem
• having feelings of shame, self-loathing or guilt, particularly after eating
• having a distorted body image
• depression, anxiety or irritability

Behavioural signs:

• disappearing food or hoarding of food
• avoiding meals with other people
• saying they have eaten when they haven’t
• hiding uneaten food
• dieting behaviour
• spending more time alone
• obsessive behaviours relating to body shape and weight — repeatedly weighing themselves or looking in the mirror
• excessive exercising — exercising when sick or in bad weather
• frequent trips to the bathroom during or after meals
• use of compensatory behaviours — vomiting or using laxatives, appetite suppressants or diuretics
• erratic behaviour — spending large amounts of money on food
• self-harm, substance abuse, suicidal thoughts, or making suicide attempts

Binge eating disorder

Although people with bulimia binge eat, there’s a separate disorder called binge-eating disorder.

People with binge-eating disorder eat large quantities of food in a short period of time. However, they don’t use compensatory behaviours to manage their weight after binge eating.

What causes bulimia nervosa?

There’s no single cause of bulimia nervosa. It’s thought to be associated with a combination of:

• genetic factors
• environmental influences
• social causes
• cultural reasons

Anyone can develop an eating disorder.

When should I see my doctor?

If you or someone you know has bulimia nervosa, it’s important to get help.

The earlier you get help the closer you are to recovery.

Your doctor can give you support and help you get treatment.

How is bulimia nervosa diagnosed?

Your doctor may:

• ask about your symptoms
• do a physical examination
• ask about your medical history
• order blood tests
• arrange other tests

Your doctor may refer you to:

• an eating disorder specialist
• a psychologist or psychiatrist
• a dietitian

How is bulimia nervosa treated?

The first step is to see a doctor. Treatment for adults is a bit different than that for people aged less than 18 years.

Psychotherapy can be used to treat bulimia. Types of psychotherapy for bulimia nervosa can include:

• eating disorder focussed cognitive behaviour therapy (CBT)
• interpersonal psychotherapy
• Maudsley family-based treatment (for children and adolescents)
• dialectical behaviour therapy (DBT)
• guided imagery

Other treatments that may be used are:

• evidence-based self-help programs
• crisis intervention
• stress management

It’s important to restore healthy eating habits. Seeing a dietitian for nutrition advice can be very helpful.

Some people with bulimia nervosa may be treated with antidepressant medicine. These medicines are used to reduce anxiety and improve your mood and self-control.

If you need more intensive treatment and support, you may be treated in hospital.

The earlier you get treatment, the greater your chance of recovery.

Recovering from bulimia nervosa

Recovery from bulimia looks and feels different for everyone.

You may have relapses during your recovery. These are common. You can learn more about yourself and what may trigger your symptoms if you do have a relapse.

Getting professional help is important. Sometimes someone else can help you better understand your triggers.

It’s also important to stay in touch with family and friends who care about you. This can help you feel connected. Be kind to yourself and start spending time on your interests.

Can bulimia nervosa be prevented?

As the cause of bulimia nervosa isn’t known, it can’t be prevented.

However, if you’re a parent you can encourage your child to have a healthy relationship with food. You can build their confidence in things other than how they look.

Sitting down to eat together as a family and discouraging dieting may also help prevent an eating disorder.

Are there complications of bulimia nervosa?

Bulimia nervosa can cause serious damage to your physical health. Some of the physical symptoms of bulimia nervosa are:

• chronic sore throat, indigestion, heartburn and reflux
• inflammation of your oesophagus or stomach due to frequent vomiting
• stomach ulcers and intestinal ulcers
• Chronic (ongoing) constipation or diarrhoea due to misuse of laxatives
• osteoporosis
• loss of, or changes in, menstrual periods
• an increased risk of infertility
• irregular or slow heartbeat leading to an increased risk of 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

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.