Bulimia

Bulimia is a serious eating disorder and mental health condition which occurs as a result of a person with psychological issues using food, weight and exercise to deal with their emotions and thought patterns.

Sometimes, a person with bulimia has a deep desire to be thin or may have a very negative view of themselves, and disordered eating is how they control, or deal with, this. Bulimia causes a person to consume large amounts of food, usually more than they need to eat, and then ‘purge’, i.e. make themselves sick after eating, so as not to gain weight. Purging sometimes involves using laxatives or fasting. Some people may also over-exercise to avoid weight gain after a binge. Bulimia can have serious consequences and may lead to other health conditions.

Bulimia can affect anyone, both males and females. It’s often thought of, and portrayed in the media, as a condition affecting teenagers but, whilst it is prevalent amongst young people, it can affect people of all ages. It’s estimated that over 1.25 million people in the UK have an eating disorder, which may include bulimia, anorexia and other conditions. Some people have more than one type of eating disorder.

To understand more about bulimia, visit the NHS website.

Nobody really understands what causes bulimia. There are certain factors that make it more likely for a person to develop bulimia, which may be linked to experiences they have had, their upbringing and family, their personality, other mental health problems, or social pressures. For example, some people who have bulimia may have experienced abuse or domestic violence, have low self-esteem, have been bullied about their weight, or work in an industry where there is pressure to be thin (e.g. dance, modelling, athletics).

Understand more about the causes of bulimia and other eating problems.

Not everyone with bulimia will show all of these bulimia symptoms. Bulimia is usually characterised by the desire to binge then purge, but the way that each person with bulimia does this may differ. If a person only binge eats, without the purge, they may have a different eating disorder called Binge-Eating Disorder. If a person only suppresses the amount that they eat, i.e. skipping meals and fasting to avoid weight gain, but does not binge-eat, they may have anorexia. Some people are given a diagnosis of ‘eating disorder not otherwise specified’ (EDNOS) which may incorporate a combination of symptoms of the various other specific eating disorders, but may not fall into a definite category. It’s important to remember that eating disorders are mental illnesses, and so the thoughts, feelings and attitudes people have towards themselves and eating, and what eating means to them, is a key factor in their bulimia symptoms and bulimia diagnosis.

Many of the bulimia symptoms listed here are difficult to spot in other people, and a person with bulimia is likely to try very hard to hide their behaviours, perhaps choosing to never discuss their thoughts with anybody else. The most common signs of bulimia that you may spot in someone else, is fast eating of large amounts of food (or evidence of this, i.e. wrappers in the bin, a stash of ‘secret’ binge foods, etc), going to the bathroom/toilet after eating, and obsessive exercising.

It is a common misconception that bulimia causes a person to be thin or underweight. Due to the nature of this condition, most people eat and consume large amounts of calories, which are still used in the body despite the purging that may occur afterwards. Some people may experience weight fluctuation as a bulimia symptom but these may not be noticeable to other people.

Another common myth is that people with bulimia always want to be thin. Whilst lots of people with bulimia may have a desire to be thin or may purge because they fear gaining weight, it is now understood that for many people, bulimia is a result of deep-routed psychological problems.

Prolonged bulimia affects the body and may cause long term damage and serious health consequences. Some people experience an imbalance of electrolytes (especially potassium depletion), heart problems or heart failure, kidney failure, chronic fatigue, and bone damage leading to osteoporosis.

To find out more about bulimia symptoms, visit the Beat website.

If you are concerned that you may have bulimia or another type of eating disorder, you should visit your GP in the first instance and explain the symptoms you are experiencing. Advice from eating disorder charity Beat, suggests it is important to prepare for a GP appointment by writing down your symptoms of bulimia, your thoughts and feelings about eating, and the behaviours that you are concerned about. GPs are not experts in mental health disorders, and their knowledge of bulimia may be limited, so some people find that they do not receive the right treatment. Beat offers lots of advice about how to handle this, and what to expect when you visit your doctor about your possible bulimia symptoms.

Your GP may talk to you and ask questions, then carry out some basic health checks such as your blood pressure and heart rate. They are likely to refer you to a specialist team who deal with eating disorders.

If you are concerned about someone you know or love and think they may be displaying bulimia symptoms, Beat provides lots of advice about how to raise the issue with someone you know.

If you are worried that your child may be displaying signs of bulimia or an eating disorder, you may wish to read advice for parents from the NHS.

NHS patients will usually be offered a programme of guided self-help as the first step for bulimia treatment. This is likely to involve a book-based programme that you follow at home and with the support of a professional. It is likely to help you plan meals, understand your bulimia triggers, record foods and so on.

You may also wish to explore other options for online self-help.

Some people with a diagnosis of bulimia will be advised to take part in psychological therapy. The most common type is cognitive behavioural therapy (CBT). This explores the reasons for a person’s bulimia symptoms, and aims to help the person challenge the thought processes and feelings that are the root cause of their disordered eating. It is often challenging and requires openness and willingness to work through long-standing issues, past experiences and current problems.

Usually, CBT requires a person to carry out activities and tasks outside of therapy sessions, such as keeping a workbook or feelings diary. CBT is carried out by a trained mental health practitioner or psychologist. It is often very effective at helping someone with a bulimia diagnosis change their thoughts, but it does not work for everyone.

Sometimes, a different type of psychological treatment for bulimia may work better, and you can read more about recovery self-care here.

Psychological treatments for bulimia aim to help a person understand and reduce their emotional connection to food.

There are no medications that can help stop bulimia. Some people with bulimia may be given anti-depressant medication to help deal with depression and anxiety. If a person has related health problems due to their condition, they may be given medication to help with these.

Some people with a bulimia diagnosis may need to be cared for in a hospital or clinic, if they have complications or are very underweight.

Some people with bulimia may require the support of a dietician, who may be able to help them understand the importance of nutrition, and help them maintain a healthy weight and lifestyle, whilst letting go of the control they crave over food.

If you are concerned that your child may have bulimia or another eating disorder, the NHS offers advice and information to help you.

Bulimia symptoms in a child are often the same as those experienced by adults, and equally hard to spot. If your child is given a diagnosis of bulimia, they are likely to be referred to the Child and Adolescent Mental Health Service (CAMHS).

There are lots of family and youth support charities that may also provide bulimia help, such as Family Lives.

People with bulimia all have their condition for different reasons and they will all experience it differently. Living with bulimia is hard, due to the psychological issues it presents as well as the physical effects it has on the body.

Many people with bulimia have other mental health problems such as depression or anxiety. Some may have low self-esteem or have had experiences in their life that they found difficult. Some people with bulimia may feel worthless, not good enough, or use purging to gain some control when they feel they have none. Some people believe themselves to be overweight or may be scared of getting fat. They may feel guilty after binge-eating. These feelings and emotions can be all-consuming, and make daily life difficult. However, many people may appear to be fine in public or around other people, and that makes bulimia even harder to spot in others.

The physical symptoms of bulimia may involve a person making themselves sick after meals. This is a tough thing for anyone to do, but the compulsion and need to purge is so overwhelming that a person with bulimia will do it frequently.

Some people live with bulimia but do not seek help or a diagnosis for a long time. Bulimia treatment can also take some time and this will differ from person to person. Some people respond well and can recover within 6 months to a year, whereas other people report they struggle with their disorder for many years. Recovery can affect relationships, ability to work, social life, and family life.

Read this advice if you are providing bulimia support to a loved one.

Bulimia causes a person to develop an unhealthy relationship with food, and this is generally due to psychological reasons. Bulimia may cause anxiety around food. Binge eating in bulimia causes feelings of shame and disgust, which leads to purging. During recovery or self-help, a person with bulimia will learn to change their thoughts about food.

A diet for bulimia during recovery should help the person better understand the importance of nutrition and encourage them to eat a balanced diet with the right nutrients. A bulimia diet is likely to consist of meals and snacks that are balanced in terms of nutrients and the right amount of fats, fruits/vegetables, dairy, protein and carbohydrates. The Eatwell Guide is the approved, official guide to a balanced diet, and a bulimia diet is likely to be based upon achieving this.

You may be advised to take certain vitamin and mineral supplements for bulimia to replenish your body’s resources and make your body healthier again.

One of the symptoms of bulimia may be an obsession with exercise as a way to burn calories consumed during a binge. Exercise may also provide the person with a sense of control or achievement.

During treatment for bulimia and recovery, it can be difficult for a person to change their thoughts about exercise. It is advisable for them to seek professional support in how to exercise for fun and health rather than as part of their mental health condition. Many people with bulimia find contentment in physical activities such as yoga, that combine an element of mindfulness and relaxation.

Similarly, many people find that walking in nature can be therapeutic and beneficial.

Many people with bulimia are able to work throughout their eating disorder and even during recovery, but everyone is different. Other people may find that to recover and concentrate on treatment, they need to change jobs, reduce their working hours, or quit work completely. It can be difficult for a person with a bulimia diagnosis to tell colleagues and employers about their condition, as they fear stigma.

If you are an employer concerned about an employee who may have an eating disorder such as bulimia, read this advice on how to approach the subject of bulimia with employees.

Bulimia is often thought of as a condition that only affects females, but men are as likely to develop bulimia as women. Men may experience stigma about their eating disorder, and be less likely to seek help than women. This documentary gives an insight into men’s experiences of bulimia or other eating disorders.

Beat Chat Rooms – connect with and talk to other people in similar situations to you, using the Beat charity chat rooms

Anorexia, Bulimia and EDNOS Recovery Support Group – a Facebook support group for people affected by eating disorders to share stories, advice and information

Anorexia and Bulimia Care – a charity supporting people with bulimia and other eating disorders, offering online information and advice, regional support groups, nutritional guidance, befriending services, helpline and training services

Beat Eating Disorders – a charity supporting people with bulimia and other eating disorders, offering a huge amount of information and advice as well as a helpline and email support

Childline – a charity supporting young people, offering advice and support for those with bulimia or other eating disorders, as well as any other health, wellbeing or family problems, providing the well-known telephone helpline

Family Lives – advice if you are concerned your child may have bulimia, real life stories about this situation and a helpline for both parents and young people

Mind – a charity supporting people with mental health problems and their families, including those experiencing an eating disorder, such as bulimia, as well as related conditions, with lots of advice about coping, treatments and a helpline

National Centre for Eating Disorders – a charity providing information about eating disorders, including bulimia, as well as a directory of counsellors and professionals trained in eating disorder recovery

NHS – source of official medical advice and information about bulimia, including bulimia symptoms, bulimia treatments and living with the condition

Rethink – a mental illness charity with information about eating disorders, local services and support groups and a helpline

Student Minds – a charity supporting students with mental health problems, providing information about eating disorders and peer support programmes

Young Minds – a charity supporting young people and their families with a range of mental health conditions, including eating disorders like bulimia, providing advice and information online as well as a 24/7 text support line