Bulimia nervosa

More than 725,000 people in the UK are affected by an eating disorder.1

Bulimia nervosa is a type of eating disorder that affects 1-3% of people.2 Bulimia is a serious eating disorder where someone might feel that they have lost control over their eating and evaluate themselves according to their body shape and weight. Someone with bulimia may feel caught in a cycle of eating large quantities of food (known as ‘bingeing’), and then engaging with behaviours to compensate for this as an attempt to prevent gaining weight (known as purging).3

Signs and symptoms

Signs and symptoms of bulimia include:4,5  

  • Bingeing and purging behaviours.
  • Secretive eating behaviours.
  • Distorted perception of body shape or weight.
  • Feelings of guilt and shame around food and eating.
  • Anxiety or depression.
  • Disappearing after eating.
  • Feeling tired or lethargic.
  • Stomach pains.
  • Constant sore throat.
  • Signs of alcohol misuse.
  • Low self-esteem.

What causes bulimia?

Bulimia is a serious mental health problem that is caused by a wide range of biological, psychological and social factors. Reasons why someone may develop bulimia can be very different between individuals with bulimia. 

Some common factors that someone might develop bulimia might be:

Psychological factors

For many people with bulimia, food is a way of coping with distressing emotions and feelings. Many people report triggers or negative emotions occurring before a binge. For some people, their eating disorder becomes a way to deal with difficult emotions and triggers.6

Self-esteem has been found to be a risk factor for bulimia. Many people report that they feel worthless and have very low self-esteem. Some people might have perfectionist tendencies, fear that they are inadequate in some way, fear rejection or have strong desires to gain the approval of others.7

Biological factors

New research suggests that genetics, neurological changes or neurochemicals in the brain may be factors in developing bulimia.8

How can I know if I have bulimia?

If you are worried that you might have bulimia, you should speak to your GP who can help you and support you. You can also contact support in your area, and to find out what is available please refer to www.b-eat.co.uk.

You can take the Eating Attitudes Test to determine whether you may have an eating disorder that needs professional attention. The Eating Attitudes Test is a self-report measure that was developed by Garner and colleagues (1982).9

What treatments are available?

Talking therapies

Cognitive-behavioural therapy (CBT) is the most common type of therapy used for treating bulimia nervosa. CBT can help you to learn healthier ways of thinking about food and rebuild your self-esteem.

CBT may be between 16 and 20 sessions, each lasting about an hour, over six month duration. In between sessions, you will be asked by the therapist to perform different tasks, such as slowly making small changes to your eating habits, or keeping a daily diary of when and what you eat. 

Interpersonal therapy (IPT)

IPT is another talking therapy which has been adapted to be used with people who have bulimia nervosa. It allows you to discuss your relationships with other people. Rebuilding these relationships may stop you turning to food for emotional support. 

Medication

For some people medication can be offered alongside a programme of self-help or talking therapies, or as a first line of treatment. It is important that you talk to you GP or therapist about medications to decide what is the best option for you. Examples of these include anti-depressants such as selective serotonin reuptake inhibitors (SSRIs).   

Self-help

Keeping a diary of your eating habits may be helpful in understanding what triggers binges. 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 can find more information of what support is available in your area through Beat’s website at www.b-eat.co.uk/support-services

Overcoming Bulimia Online

An online self-help intervention based on Cognitive Behavioural Therapy (CBT) for individuals with bulimia nervosa and related eating disorders.

References

1PWC (2015). The Costs of Eating Disorders: Social, Health and Economic Impacts. Available at http://www.b-eat.co.uk/assets/000/000/302/The_costs_of_eating_disorders_Final_original.pdf?1424694814 [accessed September 2015]

2National Institute of Clinical Excellence (2004). Eating Disorders in over 8’s: management. Clinical Guide 9. Available at:  https://www.nice.org.uk/guidance/cg9 [Accessed on 22/01/16].

3B-eat (2014). Bulimia. Available at http://www.b-eat.co.uk/about-eating-disorders/types-of-eating-disorder/bulimia?gclid=CjwKEAjw1f6vBRC7tLqO_aih5WISJAAE0CYwemiFS_L35UmwgliOdrv5ZAqdztyhFLbjnobdx0zeLBoCioPw_wcB [accessed September 2015]

4B-eat (2014). Bulimia. Available at http://www.b-eat.co.uk/about-eating-disorders/types-of-eating-disorder/bulimia?gclid=CjwKEAjw1f6vBRC7tLqO_aih5WISJAAE0CYwemiFS_L35UmwgliOdrv5ZAqdztyhFLbjnobdx0zeLBoCioPw_wcB [accessed September 2015]

5NHS Choices. Bulimia. Available at: http://www.nhs.uk/Conditions/Bulimia/Pages/Introduction.aspx [Accessed February 2016].

6Sherwood, N.E. (2000). The perceived function of eating for bulimic, subclinical bulimic, and non-eating disorders women. Behavior Therapy, 31 (4), 777-793.

7Vohs, K.D., Voelz, Z.R., Pettit, J.W., Bardone, A.M., Katz, J., Abramson, L.Y., Heatherton, T.F. & Joiner, T.E. (2001). Perfectionism, Body Dissatisfaction, And Self-esteem: An Interactive Model of Bulimic Symptom Development. Journal of Social and Clinical Psychology: Vol. 20, No. 4, pp. 476-497.

8Berrettini, W. (2004). The Genetics of Eating Disorders. Psychiatry, 1 (3), pp. 18-25.

9Garner DM, Olmsted MP, Bohr Y, Garfinkel PE. (1982). The eating attitudes test: psychometric features and clinical correlates. Psychological medicine12 (04), 871-878.

10National Institute of Clinical Excellence (2004). Eating Disorders in over 8’s: management. Clinical Guide 9. Available at:  https://www.nice.org.uk/guidance/cg9 [Accessed on 22/01/16].

11National Institute of Clinical Excellence (2004). Eating Disorders in over 8’s: management. Clinical Guide 9. Available at:  https://www.nice.org.uk/guidance/cg9 [Accessed on 22/01/16].

12Beat Eating Disorders (2014). Help and Treatment. Available at http://www.b-eat.co.uk/about-eating-disorders/help-and-treatment [accessed September 2015]

13McClay, C.A.. Waters, L., McHale, C., Schmidt, U. & Williams, C. (2013). Online Cognitive Behavioural Therapy for Bulimic Type Disorders, Delivered in the Community by a Nonclinician: Qualitative Study. Journal of Medical Internet Research, 15 (3).