Bulimia nervosa

What is bulimia nervosa?

Bulimia nervosa is an eating disorder and a mental illness.

Eating disorders can have significant impacts on all aspects of a person’s life – physical, emotional and social. People can live with bulimia nervosa for a long time without seeking support. Recognising the signs and accessing treatment early is the best way to begin the journey to recovery.

People with bulimia nervosa engage in eating large amounts of food in a relatively short period of time (binge eating). During these episodes of binge eating, people feel that they have no control over the amount of food they consume, or the ability to stop. They then try to ‘make up for’ this food intake using a variety of compensatory behaviours.

Compensatory behaviours

Compensatory behaviours can include:

• self-induced vomiting
• using laxatives and diuretics
• fasting
• excessive exercise
• using medications inappropriately to control body weight.

People with bulimia nervosa often experience body dissatisfaction, distorted body image, and overvalue their body shape or size. This may influence their engagement in compensatory behaviours after binge eating.

Compensatory behaviours are not a lifestyle choice – they are a sign of a complex mental health problem. Dieting is the primary risk factor and trigger across all types of eating disorders. A person with bulimia nervosa can be of any body shape, size or weight.

The cycle of binge eating and engaging in compensatory behaviours leads to intense feelings of shame, guilt and disgust. The behaviours can become compulsive and obsessive. This can lead to a preoccupation with food, eating (or not eating), diet and body size, shape or weight.

Added to this cycle, a person with bulimia nervosa may also engage in behaviours to hide their eating and compensatory behaviours. This means the condition can go undetected and untreated for a long time, which has physical health implications for the person experiencing the eating disorder.

Symptoms of bulimia nervosa

Understanding the warning signs and symptoms can help you to recognise bulimia nervosa.

Physical symptoms of bulimia nervosa

Physical signs and symptoms of bulimia nervosa can include:

• weight change or fluctuations in weight
• dental erosion, bad breath
• swelling around the cheeks and jaw
• indigestion, frequent constipation, diarrhoea or new food intolerances
• heart-related conditions, irregular heart beat, low blood pressure
• fainting or dizziness that is not due to another illness or health condition
• fatigue and sleep difficulties
• loss of periods or altered menstrual cycles
• muscle fatigue, cramps.

Psychological symptoms of bulimia nervosa

Psychological signs and symptoms of bulimia nervosa can include:

• preoccupation or obsession with eating, dieting, exercise or body image
• fear of gaining weight
• sensitivity to comments about eating, dieting, exercise or body image
• feelings of shame, guilt and disgust, especially after eating and/or purging
• a distorted body image or extreme dissatisfaction with body shape
• anxiety or irritability around meal times
• low self-esteem, depression, anxiety or suicidality.

Behavioural symptoms of bulimia nervosa

Behavioural signs and symptoms of bulimia nervosa can include:

• repetitive dieting behaviour (such as counting calories, fasting, skipping meals, avoiding certain food groups)
• compulsive or excessive exercise, even when sick or injured
• avoiding social situations and/or becoming more socially withdrawn
• eating alone or in secret, avoiding other people at meal times
• hiding food
• frequent trips to the bathroom during or after eating
• use of laxatives, enemas, diuretics or appetite suppressants
• spending large amounts of money on food
• self-harming behaviour, substance misuse and suicidality.

Long-term effects of bulimia nervosa

Physical problems that may be caused by ongoing bulimia nervosa can include:

• gastrointestinal conditions associated with compensatory behaviours
• heart-related issues
• ongoing dental problems
• weakened bones (osteoporosis)
• infertility in men and women
• electrolyte imbalance from self-induced vomiting – this can cause severe dehydration, and damage nerves, muscles and organs.

Diagnosis of bulimia nervosa

Diagnosing bulimia nervosa can be difficult, because people with this condition:

• are across the weight spectrum (bodies of all shapes and sizes)
• may not display other noticeable physical indicators of illness
• may actively try to conceal their behaviours.

For these reasons, bulimia nervosa can go undiagnosed for a long time.

If you think you (or someone you know) might have bulimia nervosa, it is important that you see your doctor as soon as possible. The sooner you seek help, the sooner you can start to recover, and the more effective treatment can be.

Other healthcare professionals (such as dieticians, psychologists or psychiatrists) can recognise this mental illness, but may not be able to give you a full physical check-up. This is why visiting your doctor is important.

To diagnose bulimia nervosa, a doctor:

• will need to do a full physical check-up
• may complete blood tests
• may ask questions about your health – including questions about your emotional health and wellbeing, medical history and lifestyle.

Treatment of bulimia nervosa

Like other eating disorders, treatment for bulimia nervosa needs to address both your physical and mental health. Early treatment is the best way to help you on your journey of recovery. The journey can be difficult, but you can get there with the right support.

A GP experienced in supporting people with an eating disorder is a good first point of contact. Once bulimia nervosa is diagnosed, your doctor can assemble a team of healthcare professionals who will be best suited to help you.

The types of healthcare professionals who might be involved include:

• psychiatrist
• psychologist
• dietitian
• family therapist
• social worker.

There are a range of psychological treatments available to treat eating disorders. Research indicates that the most effective therapies for bulimia nervosa include:

• Cognitive Behavioural Therapy Enhanced (CBT-E)
• Cognitive Behaviour Therapy – Guided Self Help (CBT-GSH)
• Interpersonal Therapy (IPT).

Your healthcare professionals will work with you to help you work out the links between your thinking, your emotional response and your eating behaviour. Support groups can be helpful as an additional source of support, alongside treatment from healthcare professionals.

Most people with bulimia nervosa are treated outside a hospital setting. However, if the condition is severe, treatment in a hospital might be needed. Outpatient treatment and day programs can also be very helpful in supporting people as they make changes to their patterns of behaviour, thinking and eating.

Other treatment options include medications and supplements for any physical symptoms and, in some cases, medication to help your mental health (for example, antidepressants).

Learn more about treatment for eating disorders for children/young people and for adults.

Where to get help

• In an emergency, always call triple zero (000)
• A GP (doctor) experienced in supporting people with an eating disorder
• Eating Disorders Victoria Hub Tel. 1300 550 236 – support from Monday to Friday, 9:30 am to 4:30 pm
• Community health centre
• Lifeline Tel. 13 11 14
• Suicide Line Tel. 1300 651 251
• Kids Helpline Tel. 1800 55 1800
• Butterfly Foundation’s National Support Line Tel. 1800 ED HOPE (1800 33 4673) – support from 8 am to midnight, 7 days