Bulimia nervosa is an eating disorder and mental health condition. People with bulimia are very anxious about their weight and focused on having the ‘right’ body shape. They also spend a lot of time thinking about food.
Symptoms of bulimia
The main symptoms of bulimia are:
- bingeing – overeating in a particular pattern
- purging – trying to reduce the effect of binging by attempting to get calories out of your body
- focus on food – thinking about food all the time, even when you don’t want to
- problems with self-esteem
- focussing on body image when it comes to food and weight
Diagnosing bulimia
When making a diagnosis, your GP will probably ask questions about your eating habits. For example, they could ask:
- how you feel about your weight
- if you’re concerned about it
- if you make yourself vomit regularly
- if you binge-eat
It’s important to answer these questions honestly. Your GP isn’t trying to judge you or ‘catch you out’. They just need to accurately assess how serious your symptoms are.
Weight and BMI
Your GP may check your weight and calculate your body mass index (BMI).
Blood tests and other tests
Your GP might check your pulse and blood pressure.
Sometimes an (electrocardiogram (ECG) may be needed to check how well your heart is working.
Your GP may do blood tests to check the level of:
- fluids in your body
- chemicals or minerals, like potassium in your blood
Blood tests look for the complications of bulimia. Even if they come back as ‘normal’, your GP may still refer you to a specialist if you’re experiencing bulimia symptoms.
Treating bulimia
Before your treatment begins, you’ll probably have an overall assessment of your health. Your GP or another healthcare professional will do this.
The assessment will help your healthcare professional plan for your treatment and care. For example, they may assess:
- your overall health and any medical needs
- your social situation, like how much support you have from family and friends
- your mood
- any risks that affect you, like whether you’re at risk of harming yourself
- whether there are any physical risks as a result of bulimia that need urgent treatment
Guided self-help
For many people, guided self-help can be an effective treatment for bulimia. Guided self-help is where you work through information and activities on your own. You’ll have regular support sessions with a professional (usually a psychologist).
Activities can include:
- worksheets
- a food diary
- meal plan
- writing about difficult thoughts and feelings
Eating disorder service
If guided self help is unsuccessful, your GP can refer you for treatment to an eating disorder service. An eating disorder service will usually offer a structured programme of psychological treatment.
Psychological treatment
The main type of psychological treatment for bulimia is cognitive behavioural therapy (CBT). CBT starts with the idea that thoughts, feelings, and behaviour are linked and affect one another. CBT helps to change the harmful behaviour while working on changing how you think about food, eating, and weight.
One alternative to CBT is interpersonal therapy (IPT). IPT explores the way you interact with other people. It also looks at the relationships you have, with the goal of improving them.
Medication
Antidepressants like selective serotonin reuptake inhibitors (SSRIs) may be used to treat bulimia. They can reduce the urges to binge and vomit.
The medication will usually take several weeks before it starts to work. You’ll usually start on a low dose. The dose will gradually increase as your body adjusts to the medicine.
Very few drugs are recommended for children and young people below the age of 18. It’s best not to take SSRIs if you have epilepsy or a family history of heart, liver or kidney disease.
Relapse
Recovery from bulimia can take a long time. It’s common for bulimia symptoms to return after treatment. This is often called a relapse, and is more likely during times of stress. If relapse happens, the approach to getting treatment is the same. The first step is going to your GP.
Complications of bulimia
There are physical complications associated with bulimia.
These can include:
- dental problems – regular vomiting can cause your stomach acid to damage the enamel on your teeth, which can lead to tooth decay
- repeated vomiting can cause bad breath and a sore throat
- due to a lack of nutrients, your skin and hair can become dry and your fingernails can become brittle
- your saliva glands can become swollen from frequent vomiting, which makes your face appear rounder
- frequent use of laxatives can damage your bowel muscles, causing permanent constipation (finding it difficult to poo)
- an increased risk of heart problems
Frequent vomiting or laxative use can cause:
- tiredness
- weakness
- abnormal heart rhythms
- kidney damage
- convulsions (fits)
- muscle spasms
If you have periods, bulimia can cause them to become unpredictable, or stop altogether. This does not mean bulimia makes you infertile. While it may be harder to get pregnant, you should continue to use birth control if you aren’t planning a pregnancy.
If you have diabetes, you’ll need regular health checks to help avoid problems with your eyes or other serious complications. This is particularly important if you have type 1 diabetes.
Getting help for bulimia
People with bulimia can be anxious about seeking treatment that might mean making changes to their eating habits.
Helping yourself
If you have eating problems or think you may have bulimia, it’s important to seek help as soon as possible. You could start by:
- talking to someone you trust, like a friend or member of your family
- going to see your GP – you may find it helpful to bring someone with you for support
Helping someone else
If someone close to you is showing signs of bulimia, you can offer help and support.
You could try talking to them about how they feel, and encourage them to think about getting help. Try not to put pressure on them or be critical of them, as this could make things worse. You could also offer to help by going with the person to see their GP.
You could speak to your own GP or a healthcare professional if you’d like some advice on how to help someone.