Bulimia Nervosa is an eating disorder which affects approximately 1-2% of women and 0.5% of men worldwide. However, there is unfortunately a lot of stigma and shame experienced by those who struggle with bulimia and its related behaviours. In turn, this leads to many individuals struggling in silence, so the prevalence of bulimia is probably much higher.  

In this blog, we aim to discuss the signs and symptoms of bulimia, as well as common comorbidities and the treatment options that are available to those struggling with bulimia. Our goal is to offer understanding and support to those grappling with this complex disorder, as well as educate those who know less about bulimia to reduce the misunderstanding commonly associated with the disorder.  

What is Bulimia Nervosa? 

Bulimia Nervosa is characterised by recurrent episodes of binge eating followed by compensatory behaviours such as self-induced vomiting, excessive exercise, or misuse of laxatives. This cycle of binging and purging is often driven by a sense of loss of control and an intense fear of gaining weight. Bulimia affects individuals from all demographics and backgrounds, however, research has shown that individuals tend to experience a later diagnosis than eating disorders such as anorexia nervosa. It is thought that this may occur due to the secrecy of the eating disorder, meaning it takes individuals longer to speak out about their struggles.  

What are the signs of Bulimia Nervosa? 

As mentioned, bulimia can be a very secretive disorder. It is important to note that no eating disorder has a specific look, therefore it can be difficult to determine if someone is struggling with an eating disorder if they don’t mention it themselves.  

However, if you are concerned about yourself or a loved one, it is important to recognise the symptoms of bulimia to get help and know that recovery is possible. 

Common signs to look out for can include: 

• Frequent episodes of binge eating: Consuming large amounts of food in a short period, often feeling a loss of control during these episodes. As a loved one you may notice that food is going missing, lots of wrappers may be in the rubbish, or someone may disappear for a while and skip other meals.  

• Engaging in purging behaviours: This includes self-induced vomiting, misuse of laxatives or diuretics, fasting, or excessive exercise. As a loved one you may notice trips to the bathroom straight after eating, a change in eating or exercise pattern, or unpleasureable smells from the bathroom.  

• Preoccupation with body weight and shape: Intense fear of gaining weight and dissatisfaction with body appearance. As a loved one, you may notice someone commenting more on their own body or other people’s bodies.  

• Eating in secret: Individuals with bulimia may feel ashamed of their eating habits and may eat in secret to avoid judgment or scrutiny from others. As a loved one, you may notice that someone eats in their room, avoids social situations which involve food, or refuses to eat around others stating they have already eaten, or will aren’t currently hungry. 

• Physical signs: Swelling of the cheeks or jaw, calluses on the back of hands and knuckles from inducing vomiting, and dental issues from stomach acid exposure. 

How Bulimia Nervosa impacts day-to-day life 

Bulimia nervosa is not just about occasional overeating and compensatory behaviours. Individuals with Bulimia may experience constant preoccupation with food, their body, negative thoughts about themselves, and a desire to lose weight. Resulting from the guilt and shame individuals may experience, their lives can become very isolating and lonely, which is why talking about these issues and reducing the stigmas are so important to support individuals in their recovery. 

Bulimia Nervosa can negatively impact: 

• Cognitive function: Frequent bingeing and purging episodes can lead to significant cognitive impairments. Individuals may experience difficulties with concentration, memory, and decision-making, affecting their academic or professional performance. 

• Gastrointestinal issues: Chronic purging can cause severe gastrointestinal problems, including oesophagal tears, chronic sore throat, acid reflux, and constipation, making everyday activities uncomfortable and painful. 

• Metabolic instability: The erratic eating patterns and purging behaviours can lead to severe metabolic disturbances, causing fluctuations in energy levels, blood sugar instability, and electrolyte imbalances. This can result in periods of extreme fatigue and weakness, hindering daily functioning. 

• Dental health: Regular self-induced vomiting exposes teeth to stomach acid, leading to enamel erosion, tooth sensitivity, and severe dental issues. This can cause chronic pain and require extensive dental work, impacting one’s daily comfort and self-confidence. 

• Mental preoccupation: Individuals with Bulimia often spend a significant amount of time thinking about food, planning binge and purge sessions, and dealing with emotional fallout. Sadly, mental preoccupation can be exhausting and detracts from their ability to focus on other aspects of life, such as work, hobbies, and relationships. 

• Social withdrawal: The secretive nature of Bulimia can lead individuals to avoid social situations, particularly those involving food. Consequently, this withdrawal can result in loneliness, isolation, and strained relationships, further exacerbating mental health issues. 

Comorbidities associated with Bulimia Nervosa 

• Alcohol and drug abuse: Individuals with Bulimia Nervosa may use substances like alcohol, stimulants, or sedatives to cope with emotional pain, reduce anxiety, or control appetite. This can lead to addiction and a cycle of dependence, complicating the recovery process. 

• Risk of overdose: The combination of purging behaviours and substance use increases the risk of overdose and severe medical complications, including heart problems and respiratory issues. 

• Depression: Many individuals with bulimia experience major depressive disorder, characterised by persistent sadness, feelings of hopelessness, and loss of interest in previously enjoyed activities. This comorbidity can intensify feelings of guilt and shame associated with Bulimia. 

• Bipolar disorder: Some individuals may suffer from bipolar disorder, experiencing extreme mood swings that range from manic episodes of high energy and impulsivity (which can exacerbate bingeing) to depressive episodes of low energy and despair. 

• Borderline Personality Disorder (BPD): BPD is characterised by intense emotional instability, fear of abandonment, and impulsive behaviours. The emotional turmoil associated with BPD can lead to disordered eating patterns as a means of coping with distressing emotions. 

• Obsessive-Compulsive Personality Disorder (OCPD): Individuals with OCPD may exhibit perfectionistic tendencies and a preoccupation with control, leading to rigid eating behaviours and extreme measures to control weight, heightening the risk of Bulimia. 

• Avoidant Personality Disorder: People with this disorder may engage in bingeing and purging to manage social anxiety and inadequacy. However, this can result in further social withdrawal and isolation. 

Treatment options for Bulimia Nervosa 

Effective treatment options are available for Bulimia Nervosa, including cognitive-behavioral therapy (CBT), medication, and support groups. Treatment for Bulimia involves stabilising a regular pattern of eating, understanding the emotions and experiences which lead to bingeing and purging, and establishing alternative coping mechanisms which allow you to navigate challenging situations without resorting to disordered eating behaviours. 

• Cognitive-Behavioural Therapy (CBT): CBT is considered the gold standard treatment for Bulimia and focuses on identifying and challenging maladaptive thoughts and behaviours related to food and body image. This therapy aims to develop healthier coping strategies and improve self-esteem. 

• Dietetic support: Dietetic support can aid in recovery from Bulimia Nervosa by providing personalised meal plans, nutritional guidance, and strategies to develop a healthy relationship with food. Additionally, dietitians can address underlying issues related to bingeing and purging, such as emotional eating triggers, and support individuals in adopting balanced eating habits to manage their symptoms effectively. 

However, at TBITC we recognise that not everyone will respond beneficially to the same treatments. Our clinicians are HCPC registered and have extensive experience in drawing in on a range of therapies that have shown beneficial interventions to improve clients’ eating disorder symptoms.  

If you or someone you know is struggling with bulimia nervosa, know that you are not alone. At The Body Image Treatment Clinic, we understand the challenges you face, and we’re here to help. Our compassionate team of psychotherapists and dietitians specialises in treating conditions which impact the body and mind. This includes bulimia nervosa and other eating disorders. 

To find out more, head over to our Eating Disorder Support page. You can also contact us to find out more about how we can help you on your recovery journey.