Bulimia nervosa

People with bulimia nervosa have an unhealthy eating cycle. They will eat a lot of food (bingeing) and then do something to try to avoid weight gain, such as vomiting or taking laxatives (purging).

*Last updated 25 May 2021

Bulimia nervosa (commonly known as bulimia) is an eating disorder and serious mental health problem. Someone with bulimia might feel parts of their life are out of control and use purging to give them a sense of control. Bulimia is a serious condition that can cause long-term damage, but there is help available.

Anyone can develop bulimia, but it’s most common in young people aged 13 to 17.

What are the symptoms of bulimia?

If you have bulimia, you may feel:

  • guilty or ashamed, especially after bingeing
  • preoccupied with your weight
  • as though your body is bigger or a different shape than it really is
  • stuck in a cycle of feeling out of control and trying to regain control
  • anxious or depressed
  • lacking in confidence and self-esteem
  • irritable and moody
  • numb.

The physical symptoms of bulimia include:

  • weight loss or frequent weight changes, although many people with bulimia stay the same weight
  • periods stopping or becoming irregular
  • tiredness or lethargy
  • constipation, bloating and stomach pains
  • sore throat and damaged teeth from stomach acid if you make yourself sick
  • a puffy face
  • swollen hands and feet.

Your behaviour may be affected. You may:

  • binge on food, particularly foods you think are bad for you
  • try to get rid of the food you’ve eaten (purge) by vomiting, taking laxatives or exercising a lot
  • eat in secret, or disappear after eating to purge.

Bulimia can cause serious physical damage to your body. Vomiting can damage your teeth. Laxative misuse can lead to heart disease and digestive problems such as irritable bowel syndrome (IBS) and constipation. It’s important to get help quickly if you think you have bulimia.

What causes bulimia?

There is no single cause of bulimia. There are many reasons why someone might develop bulimia and many factors that can contribute.

Common traits

An eating disorder can be a way of coping with distressing emotions and feelings. Many people report feeling sad or stressed, for example, before they binged.

Other common traits include:

  • low self-esteem or feeling worthless
  • perfectionism
  • a fear of being inadequate
  • a fear of rejection
  • a strong desire to gain the approval of others.

Biological and genetic factors

Research shows there may be genetic links to bulimia. Changes to the chemicals in our brains can also be a factor in developing bulimia.

What help is available?

Anyone can develop bulimia. If you’re worried you may have bulimia, contact your GP. They may not be an expert in treating eating disorders, but they will be able to assess any physical symptoms and then refer you to specialist eating disorder services.

Treatment may take time, but you can recover from bulimia.

Guided self-help

You may be offered guided self-help as a first step. This often involves working through a self-help book along with sessions with a therapist. The book may take you through a programme that helps you make realistic meal plans, understand your triggers and find other ways to cope with your feelings.

You may be offered an online self-help programme called Overcoming Bulimia Online. It’s free if you’re given an code by a healthcare professional or you can pay for access.

Talking therapies

Talking therapies can help you tackle your underlying thoughts and feelings triggering the bulimia and find healthier ways to cope. You may be offered:

  • Cognitive behavioural therapy (CBT). This can help you think about food in a healthier way and rebuild your self-esteem. In between sessions you may be asked to do tasks such as making small changes to your eating habits or keeping a daily diary of when and what you eat
  • Interpersonal therapy (IPT). This lets you discuss your relationships with other people. Rebuilding these relationships may stop you turning to food for emotional support. 

Medication

Antidepressants shouldn’t be the only treatment you’re offered. However, you may be offered them alongside self-help or therapy to manage other conditions such as depression, anxiety or obsessive compulsive disorder (OCD).

Inpatient treatment

Most people with bulimia will stay at home during their treatment. However, if you are very underweight, have heart problems, or are so ill that doctors feel you’re at risk, you may be admitted to hospital. Doctors will help you gradually reach a healthy weight and either start or continue your therapy.

Ways you can look after yourself

It’s difficult to recover from an eating disorder on your own, but there are things you can try alongside treatment and support. Beat has lots of tips for recovery, and Mind has ideas for self-care including managing relapses, changing unhealthy routines and being careful online.

You may find that support groups are useful. It can be comforting to talk to others who have had the same feelings and experiences. You could join Beat’s online support group for people with bulimia.

The NHS website has further tips on looking after your health while recovering from bulimia.