Bulimia Nervosa is characterised by repeated episodes of binge eating followed by compensatory behaviours. In addition, people with bulimia place an excessive emphasis on body shape or weight in their self-evaluation. This can lead to the person’s sense of self-esteem and self worth being defined by the way they look.

The reasons for developing BN will differ from person to person. Known causes include genetic predisposition and a combination of environmental, social and cultural factors.

What is binge eating?

Binge eating involves two key features:

• Eating a very large amount of food within a relatively short period of time (e.g. within two hours)
• Feeling a sense of loss of control while eating (e.g. feeling unable to stop yourself from eating)

A person with BN can become lost in a dangerous cycle of eating out of control and attempts to compensate which can lead to feelings of shame, guilt and disgust. These behaviours can become more compulsive and uncontrollable over time, and lead to an obsession with food, thoughts about eating (or not eating), weight loss, dieting and body image.

These behaviours are often concealed and people with Bulimia can go to great lengths to keep their eating and exercise habits secret. As a result, Bulimia can often go undetected for a long period of time.

Many people with BN experience weight fluctuations and do not lose weight; they can remain in the normal weight range, be slightly underweight, or may even gain weight.

What are the warning signs of Bulimia Nervosa?

Having awareness about BN and its warning signs and symptoms can make a marked difference to the severity and duration of the illness. Seeking help at the first warning sign is much more effective than waiting until the illness is in full swing. If you or someone you know is exhibiting some or a combination of these signs it is vital to seek help and support as soon as possible.

The warning signs of BN can be physical, psychological and behavioural. It is possible for someone with BN to display a combination of these symptoms.

Physical signs:

• Frequent changes in weight (loss or gains)
• Signs of damage due to vomiting including swelling around the cheeks or jaw, calluses on knuckles, damage to teeth and bad breath
• Feeling bloated, constipated or developing intolerances to food
• Loss of or disturbance of menstrual periods in girls and women
• Fainting or dizziness
• Feeling tired and not sleeping well

Psychological Signs:

• Preoccupation with eating, food, body shape and weight
• Sensitivity to comments relating to food, weight, body shape or exercise
• Low self esteem and feelings of shame, self loathing or guilt, particularly after eating
• Having a distorted body image (e.g. seeing themselves as overweight even if they are in a healthy weight range for their age and height)
• Obsession with food and need for control
• Depression, anxiety or irritability
• Extreme body dissatisfaction

Behavioural Signs:

• Evidence of binge eating (e.g. disappearance or hoarding of food)
• Vomiting or using laxatives, enemas, appetite suppressants or diuretics
• Eating in private and avoiding meals with other people
• Anti social behaviour, spending more and more time alone
• Repetitive or obsessive behaviours relating to body shape and weight (e.g. weighing themselves repeatedly, looking in the mirror obsessively and pinching waist or wrists)
• Secretive behaviour around food (e.g. saying they have eaten when they haven’t, hiding uneaten food in their rooms)
• Compulsive or excessive exercising (e.g. exercising in bad weather, continuing to exercise when sick or injured, and experiencing distress if exercise is not possible)
• Dieting behaviour (e.g. fasting, counting calories/kilojoules, avoiding food groups such as fats and carbohydrates)
• Frequent trips to the bathroom during or shortly after meals which could be evidence of vomiting or laxative use
• Erratic behaviour (e.g. spending large amounts of money on food)
• Self harm, substance abuse or suicide attempts

Find out more about the warning signs.

Treatment

Therapies to be considered for the treatment of BN include:

• Psychological Treatments
• Evidence-based self-help programs
• Cognitive behavioural therapy for Bulimia Nervosa
• Interpersonal psychotherapy
• Maudsley family-based treatment (for children and adolescents)
• Dialectical behaviour therapy
• Guided imagery
• Crisis intervention
• Stress management

Other treatments

Antidepressants (specifically selective serotonin reuptake inhibitors; e.g. SSRI) may also be prescribed for someone who is suffering from BN.

Find out more about specific treatment approaches.

Getting help

If you suspect that you or someone you know has BN, it is important to seek help immediately. The earlier you seek help the closer you are to recovery. While your GP may not be a specialist in eating disorders, they are a good ‘first base.’ A GP can provide a referral to a practitioner with specialised knowledge in health, nutrition and eating disorders.

Find help in your local area

Download Bulimia Nervosa Fact Sheet