Bulimia Nervosa

Bulimia nervosa is a form of eating disorder which is characterised by binge eating and purging (vomiting). Some people with bulimia can go for long periods of time without eating to try and lose weight. Bulimia nervosa is a condition that affects both the body and mind and people who have bulimia nervosa try to control their weight by eating large amounts at a time and then making themselves vomit. Many people also use laxatives to help them lose weight.

Bulimia is more common among women than men, with women are ten times more likely to suffer from the condition than men. However, the number of cases among men has increased in recent years. Symptoms tend to develop during the late teenage years and the condition is most common among young women. Bulimia can also affect children but it is very rare. It is estimated that around 1 in 50 women will suffer from bulimia at some point in their lives.

Binge eating usually involves high-calorie ‘naughty’ foods, such as chocolate, cakes and crisps, and in the case of bulimia is followed by vomiting (known as purging). Most people with bulimia nervosa tend to eat in private and have secret stores of food.

What causes bulimia nervosa?

There is no exact cause of bulimia nervosa. The acts of binge eating and purging are often a mechanism for controlling body weight and losing weight, but the condition is more complex than this and often there are other factors involved, including environmental factors and personality traits.

Possible causes and triggers of bulimia nervosa include:

• Low self-esteem.
• Mental health conditions, including anxiety disorders, obsessive-compulsive disorder and depression.
• Stress.
• Hormonal changes associated with puberty.

Environmental factors have become increasingly influential in many cases and in recent years there has been a great deal of attention on weight and body image in the media, magazines and television shows, who have been criticised for promoting an unrealistic body image. Many people who read magazines and watch TV can feel under pressure to lose weight and be thin, because the models, actresses and pop stars they see in the media are usually very slim. The fashion industry has also been criticised as most designers only use very thin models, with most fitting into a certain mould of over 5’9 tall and being a UK size 4, 6 or 8.

Some experts also believe that certain personality traits increase the chance of developing bulimia, which includes being competitive, being a perfectionist and always wanting to be in control.

Symptoms of bulimia nervosa

The main symptoms of bulimia are:

• Binge eating (usually on high-calorie foods).
• Purging (making yourself sick).

Other symptoms of bulimia include:

• Hiding and stashing food and lying to others about your eating habits.
• Feeling guilty after binge eating.
• Changes in body weight.
• Bouts of starvation.
• Depression.
• Anxiety
• Obsessing about food.
• Having unrealistic ideas and aims about what your body should look like.
• Feeling fat when you are a healthy weight for your height.

Often, people who have bulimia nervosa find themselves in a vicious cycle, where they eat to gain control and cope with difficult emotions and then vomit because they feel guilty about eating.

How is bulimia nervosa diagnosed?

It is important that you see your GP as soon as possible if you think you have bulimia nervosa. You should not feel embarrassed or ashamed to talk to your GP and it is important that you answer any questions they ask as honestly as possible. When you see your GP they will ask you questions about your eating habits, your symptoms and how you feel about yourself. If your GP thinks you have bulimia they will refer you for specialist help, depending on the severity of your condition.

It can be very difficult to admit that you have a problem and to ask for help, but there is support available to you. Your GP will not judge you and are there to help and provide you with the treatment you need to feel better.

Complications of bulimia nervosa

Bulimia nervosa can contribute to several complications, including:

• Oral health problems, such as stained teeth, bad breath and weakened enamel, which increases the risk of decay. These problems are caused by vomiting on a regular basis.
• Weak hair and dull skin.
• Swollen glands.
• Bowel problems, including constipation brought about by prolonged use of laxatives.
• Irregular periods.
• Heart problems.
• Increased risk of digestive conditions.
• Swollen hands and feet.
• Dehydration.
• Increased risk of kidney damage.
• Inflammation of the oesophagus and stomach (caused by vomiting).
• Patches of rough, sore skin on the knuckles (this is caused by putting the hands down the throat to make yourself vomit).

Treating bulimia nervosa

Treatment for bulimia nervosa depends on the individual and the severity of the condition. Possible treatments include:

• Psychological therapies: therapies such as cognitive behavioural therapy and counselling can be very effective, as they help people to identify problems and find new ways of dealing with them, instead of getting caught up in the cycle of bingeing and purging.
• Medication: medication is not a direct treatment for bulimia but it may be prescribed to help associated symptoms and conditions, such as depression.
• Hospital treatment: in extreme cases, hospital treatment may be required to monitor an individual constantly.
• Advice about healthy eating and diet.

Recovering from bulimia

It can take several years to recover from bulimia and some people always have difficulty when it comes to their relationship with food. In order to recover it is essential for people to develop a healthy attitude to food and change their eating habits, in order to prevent damage to their body and increase confidence and self-esteem.

Help and support

Bulimia can be a very difficult condition to combat, for those affected as well as their friends and relatives. There is help available from your GP or you can contact charities, such as the Mental Health Foundation, BEAT and ABC (Anorexia and Bulimia Care).