Bulimia nervosa is an eating disorder and mental health condition.

People who have bulimia try to control their weight by severely restricting the amount of food they eat, then engage in episodes of binge eating and purging.

As with other eating disorders, bulimia nervosa can be associated with:

  • low self-esteem
  • alcohol abuse
  • depression
  • self-harm

Binge eating and purging

Eating disorders are often associated with an abnormal attitude towards food and body image.

People tend to have different eating habits depending whether due to religious practices, concerns for health, or even food preference. For example, people with a food intolerance need to avoid eating certain foods to stay healthy. However, people suffering from eating disorders tend to use their eating habits and behaviours to cope with emotional distress, and often have an abnormal or unrealistic fear of food, calories and being fat.

Because of this fear, people with bulimia nervosa tend to restrict their food intake. This results in periods of excessive eating and loss of control (binge eating), after which they induce themselves to vomit or use laxatives (purging). They purge themselves because they fear that the binging will cause them to gain weight, and usually feel guilty and ashamed of their behaviour. This is why these behaviours are usually done in secret.

Such binge-purge cycles can be triggered by hunger or stress, or are a way to cope with emotional anxiety.

Symptoms of bulimia 

The main signs of bulimia are binge eating and purging (ridding your body of food by making yourself vomit or taking laxatives).

There may also be psychological symptoms, such as:

  • an obsessive attitude towards food and eating
  • unrealistic perceptions about body image
  • depression and anxiety
  • isolation – losing interest in other people

Without treatment, bulimia can lead to a number of physical complications.

Binge eating

Binge eating is repeatedly eating vast quantities of high-calorie food, without necessarily feeling hungry or needing to eat. The urge to eat can begin as an attempt to deal with emotional problems, but can quickly become obsessive and out of control.

Binge eating usually occurs over a short span of time. Afterwhich the individual may feel physically uncomfortable. When binge eating is a symptom of bulimia, it happens regularly, not just once or twice.

Binge eating episodes are sometimes spontaneous. They can also be planned, where a shopping trip is made to buy foods specifically to binge on.


Purging is a response to binging. After eating lots of food in a short period of time, some may feel physically bloated and unattractive. And the feeling of guilt, regret, and self-hatred sinks in.

However, the main impulse to purge is a powerful, overriding fear of putting on weight.

The most common methods of purging involve inducing the self to vomit or using laxatives to promote the rapid transit of food.

Other methods of compensation after a binge include taking diet pills, over-exercising, extreme dieting, starvation or even using illegal drugs, such as amphetamines.

Cycle of guilt

Bulimia is often a vicious circle. If the condition is present, it is likely that one has a very low self-esteem. There is a false perception of body image wherein one thinks he/she is overweight,even though one has a normal or near normal weight.

This may make one to impose strict rules on dieting, eating, or exercising, which are very hard to maintain. Failure to comply with these strict rules will induce episodes of binging of the things one has denied for themselves. After feeling guilty about binging, attempts to rid off calories are done through purging.

Diagnosing bulimia 

If an eating disorder such as bulimia is suspected, the first step is to recognize the problem and visit your doctor. Some may not take the problem seriously, but bulimia may affect health in the long run.

Accepting the need for help and support is the first step to recovery, but this may be a very difficult step. Most people who have bulimia hide their situation for months or years before seeking help. It can often take a change of situation, such as the start of a new relationship or living with new people, to make a person with bulimia want to seek help.

Preparing a list of questions before consulting your doctor may help. Once you have explained your situation, your doctor will decide whether to refer you to a mental health team.

The team will include:

  • specialist counsellors
  • psychiatrists
  • psychologists
  • nurses
  • dietitians
  • other healthcare professionals

Treatment depends on the degree of the condition. A self-help programme may be recommended by the physician to start recovery before referring to specialist treatment.

Full recovery from bulimia is possible. The earlier treatment is started, the quicker the recovery process.

Do I have an eating disorder?

Doctors sometimes use questionnaires such as the SCOFF questionnaire to help recognise people who maybe suffering from an eating disorder. The questionnaire is composed of five questions:

  • Scoff: Do you ever make yourself vomit because you feel uncomfortably full?
  • Control: Do you worry you have lost control over how much you eat?
  • One stone: Have you recently lost more than one stone (six kilograms) in a three-month period?
  • Fat: Do you believe yourself to be fat when others say you are too thin?
  • Food: Would you say that food dominates your life?

If two or more of these questions are answered with a yes, then an eating disorder may be present.


Treating bulimia 

Recovery from bulimia is possible, but may be a long and difficult process. The first step towards getting better is to recognize the problem and the strong will to get well. This may involve a big change in lifestyle and circumstances.

If you are concerned about a friend or family member, it can be difficult to know what to do. It is common for someone with an eating disorder to be secretive and defensive about their eating and their weight, and they will probably deny being unwell.

Treatment usually begins with psychological therapy, which aims to help re-establish healthy attitudes towards eating. People with bulimia need to explore and understand the underlying issues and feelings that are contributing to their eating disorder, and change their attitudes to food and weight.

Medications may be suggested by the physician, usually in addition to psychological treatment.

Psychological treatment

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is the most common type of psychological treatment for bulimia. It involves talking to a therapist and looking at your emotions in detail to work out new ways of coping with situations, feelings and food. It may also involve keeping a food diary, which will help determine what triggers binging episodes.

Interpersonal therapy

As with CBT, interpersonal therapy (IPT) involves meeting with a therapist to discuss the condition. However, the focus is more on personal relationships than problems with food. The aim of IPT is to help you establish supportive relationships, which can draw your focus away from eating.


Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) may be used to treat bulimia. The SSRI usually recommended to treat bulimia is called fluoxetine (brand name Prozac).

SSRIs are mainly used to treat depression, but are also used to treat:

  • eating disorders
  • obsessive compulsive disorder (OCD)
  • anxiety
  • social phobia

As with any antidepressant, an SSRI will usually take several weeks before it starts to work. It is started on a low dose, which is gradually increased until the body adjusts to the medicine.

When taking an SSRI’s, frequent visits with your GP is done after two, four, six and twelve weeks to monitor the progress and to evaluate for the response to treatment. Not everyone responds well to antidepressant medicines, so it’s important to carefully monitor response to treatment.

Very few drugs are recommended for children and young people below the age of 18. It is also best not to take SSRIs if you have epilepsy or a family history of heart, liver or kidney disease.

Hospital treatment

Bulimia is not usually treated in hospital. But if serious health complications occur placing life at risk, hospital admission becomes necessary. Hospital treatment is also considered if there is a high risk of suicide or self-harm.

The recovery process

Once diagnosed, people with bulimia may recover, but it may take a long time. It can be very difficult, both for the patient and their loved ones.

To recover, someone with bulimia needs to:

  • change their eating habits
  • change the way they think about food and their body image
  • gain weight safely, if necessary

The longer someone has bulimia, the harder it is to re-learn healthy eating habits and gain weight. It is important to start treatment as early as possible, so the person has the best chance of recovery.

For most people, recovery goes through several stages, with progress seeming to go backwards and forwards.

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