Introduction

Bulimia is an eating disorder and mental health condition.

People who have bulimia go through periods where they eat a lot of food in a very short amount of time (binge eating) and then make themselves sick, use laxatives (medication to help them poo) or do excessive execise, or a combination of these, to try to stop themselves gaining weight.

Men and women of any age can get bulimia, but it's most common in young women and typically starts in the mid to late teens.

Symptoms of bulimia

Symptoms of bulimia include:

  • eating very large amounts of food in a short time, often in an out-of-control way - this is called binge eating
  • making yourself vomit, using laxatives, or doing an extreme amount of exercise after a binge to avoid putting on weight - this is called purging
  • fear of putting on weight
  • being very critical about your weight and body shape
  • mood changes - for example, feeling very tense or anxious

These symptoms may not be easy to spot in someone else because bulimia can make people behave secretively.

Getting help for bulimia

Getting help and support as soon as possible gives you the best chance of recovering from bulimia.

If you think you may have bulimia, see your GP as soon as you can.

They'll ask you questions about your eating habits and how you're feeling, and will check your overall health and weight. 

If they think you may have bulimia or another eating disorder, they should refer you to an eating disorder specialist or team of specialists.

It can be very hard to admit you have a problem and ask for help. It may make things easier if you bring a friend or loved one with you to your appointment.

You can also talk in confidence to an adviser from the eating disorders charity Beat by calling their adult helpline on 0808 801 0677 or youth helpline on 0808 801 0711.

Getting help for someone else

If you're concerned that a family member or friend may have bulimia, let them know you're worried about them and encourage them to see their GP. You could offer to go along with them.

Read more about talking to your child about eating disorders and supporting someone with an eating disorder.

Treatment for bulimia

You can recover from bulimia, but it may take time and recovery will be different for everyone.

Your treatment plan will be tailored to you and should take into account any other support you might need, such as for depression or anxiety.

If you're over 18, you'll probably be offered a guided self-help programme. This involves working through a self-help book, and often includes keeping a diary and making a plan for your meals.

You'll be supported by a therapist during this process. You may also be offered cognitive behavioural therapy (CBT).

If you're under 18, you may be offered family therapy as well as CBT.

Health risks of bulimia

Bulimia can eventually lead to physical problems associated with not getting the right nutrients, vomiting a lot, or overusing laxatives.

Possible complications include:

  • feeling tired and weak
  • dental problems – stomach acid from persistent vomiting can damage tooth enamel and also cause bad breath, a sore throat, or even tears in the lining of the throat
  • irregular or absent periods
  • dry skin and hair
  • brittle fingernails
  • swollen glands
  • fits and muscle spasms
  • heart, kidney or bowel problems, including permanent constipation
  • bone problems – you may be more likely to develop problems such as osteoporosis, particularly if you have had symptoms of both bulimia and anorexia

Causes of bulimia

We don't know exactly what causes bulimia and other eating disorders.

You may be more likely to get an eating disorder if:

  • you or a member of your family has a history of eating disorders, depression, or alcohol or drug addiction
  • you have been criticised for your eating habits, body shape or weight
  • you're overly concerned with being slim, particularly if you also feel pressure from society or your job (for example, ballet dancers, jockeys, models or athletes)
  • you have anxiety, low self-esteem, an obsessive personality, or are a perfectionist
  • you have been sexually abused

Binge-purge cycle

Bulimia is often a vicious cycle of binging and purging, triggered by things such as hunger, sadness or stress.

You may set very strict rules for yourself about dieting, eating or exercising.

Failing to keep to these then leads to periods of excessive eating and loss of control (binge eating), after which you feel guilty or ashamed.

You then purge to get rid of the calories, leaving you feeling hungry again, and the cycle continues.

 

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Symptoms

The main signs of bulimia are eating a large amount of food over a very short time (binge eating) and then ridding your body of the extra food (purging) by making yourself vomit, taking laxatives or excercising excessively, or a combination of these.

Other signs of bulimia include:

  • fear of putting on weight
  • being very critical about your weight and body shape
  • mood changes - feeling very tense or anxious, for example
  • thinking about food a lot
  • feeling guilty and ashamed, and behaving secretively
  • avoiding social activities that involve food
  • feeling like you have no control over your eating

You may also notice physical signs like:

  • feeling tired
  • a sore throat from being sick
  • bloating or tummy pain
  • a puffy face
  • self-harming

Warning signs of bilimia in someone else

The following warning signs could indicate that someone you care about has an eating disorder:

  • eating a lot of food, very fast
  • going to the bathroom a lot after earting, often returning looking flushed
  • excessively or obsessively exercising

Getting help

Getting help and support as soon as possible gives you the best chance of recovering from bulimia.

If you think you may have bulimia, see your GP as soon as possible.

If you are concerned that a family member or friend may have bulimia, let them know you are worried about them and encourage them to see their GP.  You could offer to go along with them.

You can also talk in confidence to an adviser from eating disorders charity Beat, by calling their adult helpline on 0808 801 0677 or their youth helpine on 0808 801 0711.

 

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Treatment

Treatment may take time, but you can recover from bulimia.

Treatment for bulimia is slightly different for adults and those under 18 years old.

Treatment for adults

Guided help

You will probably be offered a guided self-help programme as a first step in treating your bulimia. This often involves working through a self-help book combined with sessions with a health care professional, such as a therapist.

These self-help books may take you through a programme that helps you to:

  • Monitor what you are eating – this can help you notice and try to change patterns in your behaviour
  • Make realistic meal plans – planning what and when you intend to eat throughout the day can help you regulate your eating, prevent hunger and reduce binge eating.
  • Learn about your triggers – this can help you to recognise the signs, intervene and prevent a binge-purge cycle.
  • Identify the underlying causes of your disorder – this means you can work on those issues in a healthier way.
  • Find other ways of coping with your feelings.

Joining a self-help support group, like one of the Beat online support groups for people with bulimia, may be helpful to you.

If self-help treatment alone isn't enough or hasn't helped you after four weeks, you may also be offered cognitive behavioural therapy (CBT) or medication.

Cognitive behavioural therapy

If you are offered CBT, it will usually involve up to 20 sessions across 20 weeks.

CBT involves talking to a therapist, who will help you explore emotions and thoughts that could be contributing to your eating disorder, and how you feel about your weight and body shape. 

They will help you to adopt regular eating habits and show you how to stick to them. They should also show you ways to manage difficult feelings and situations to stop you from relapsing once your therapy ends.

Treatment for children and young people

Family therapy

Children and young people will usually be offered family therapy. This involves you and your family talking to a therapist, exploring how bulimia has affected you and how your family can support you to get better.

You may also be offered CBT, which will be the same as the CBT offered to adults.

Looking after yourself

It's important to look after your health while recovering from bulimia.

If you are vomiting regularly, the acid in your vomit can damage your teeth over time. In order to minimise this damage you should:

  • avoid brushing teeth immediately after vomiting so you don't wear away the enamel
  • rinse your mouth out with a non-acidic mouthwash
  • make sure you see your dentist regularly
  • don't drink or eat acidic foods. such as fruit juice, during a binge and after purging
  • don't smoke

Vomiting can also lead to dehydration. To avoid this, make sure you drink plenty of fluids to replace what you have vomited.

Medication

Antidepressants should not be offered as the only treatment for bulimia. But you may be offered an antidepressant, such as fluoxetine (Prozac), in combination with therapy or self-help treatment, to help you manage other conditions, such as: 

  • anxiety or depression
  • social phobia
  • obsessive compulsive disorder (OCD)

Antidepressants are very rarely prescribed for children or young people under 18.

Where treatment will happen

Most people with bulimia will be able to stay at home during their treatment. You will usually have appointments at your clinic and then be able to go home.

However, you may be admitted to hospital if you have serious health complications, including:

  • being very underweight
  • problems with your heart
  • being very ill and your life being at risk
  • being under 18 and your doctors believing you don't have enough support at home
  • doctors being worried that you might harm yourself or are at risk of suicide

Your doctors will keep a very careful eye on your weight and health if you're being cared for in hospital. They will help you to reach a healthy weight gradually, and either start or continue any therapy you are having.

Once they are happy with your weight, as well as your physical and mental health, you should be able to return home.

Further support for bulimia

There are many organisations that support people with bulimia and their families, including:

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 12/06/2019 07:49:48