Bulimia nervosa
Bulimia nervosa
Bulimia nervosa is a serious eating disorder and mental health condition. If you are living with bulimia, you may feel caught in a cycle you can't easily break: eating a large amount of food in one go, often called bingeing, and then trying to "undo" it through vomiting, over exercising or using laxatives.
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Common Symptoms
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
When to See a Doctor
Speak to your GP practice and ask for an urgent appointment if you think you may have an eating disorder such as bulimia nervosa, or if you notice symptoms such as collapsing or fainting, dizziness, marked tiredness or fatigue, weakness, dehydration, muscle spasms, pins and needles, an irregular heartbeat, chest pain, or a level of distress where you feel very upset, agitated and uncomfortable.
Diagnosis
When making a diagnosis, your GP will probably ask questions about your eating habits.
They could ask:
- how you feel about your body shape or weight
- if you make yourself sick after eating
- if you use other methods of purging or use laxatives
- if you binge eat
It is important to answer these questions honestly. Your GP is not trying to judge you or catch you out. They just need to accurately assess your symptoms.
Your GP may also check your weight and other physical measurements. If this feels frightening, you can ask that you not be told your weight.
BEAT have more information on planning an appointment, how to talk to your GP and what will happen at an appointment.
If it would help you, you can take a friend or family member to your appointment.
It can be difficult to know what the right questions to ask at an appointment are. It is ok to ask; there are some ideas that may be helpful.
Blood tests and other tests
Your GP might check your pulse and blood pressure.
Sometimes an electrocardiogram, or 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 nervosa. Even if they come back as normal, your GP may still refer you to an eating disorder specialist if you are experiencing bulimia nervosa symptoms.
They may also suggest you make a dental appointment, as frequent vomiting can harm your dental health.
Treatment
Treatment for bulimia nervosa
Before your treatment begins, it’s likely you’ll 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.
They may assess:
- your overall health and any medical needs
- your social situation, like how much support you have from family and friends
- your mental wellbeing or other mental health concerns
- any other risks that might affect you
- whether there are any physical health risks that need urgent treatment
Guided self-help
For many people, guided self-help, based on a cognitive behavioural approach, can be an effective treatment for bulimia nervosa.
Guided self-help is where you work through information and activities on your own. You’ll have regular support sessions.
Activities can include things like worksheets and writing about difficult thoughts and feelings.
Eating disorder service
Your GP may refer you for treatment to an eating disorder service. An eating disorder service will usually offer a structured programme of treatment which may include physical monitoring, dietetic advice and psychological treatment.
Freed has more information about seeking help for an eating disorder.
Psychological treatment for adults
The main type of psychological treatment for bulimia nervosa is cognitive behavioural therapy (CBT).
CBT starts with the idea that thoughts, feelings, and behaviour are linked and affect one another. CBT aims to improve your eating behaviours. It tries to help you see how the ways you think, affect how you feel, and what you do.
One alternative to CBT is interpersonal psychotherapy (IPT). IPT explores the way your relationships with people close to you impact the way you feel and how to improve these relationships.
Other psychological therapies include:
- integrative cognitive affective therapy
- schema therapy
The psychological therapies matrix for Bulimia Nervosa explains what therapies are most likely to help you based on your needs and the current evidence.
Learn more about talking therapies
Family Based Treatment (FBT) involves the whole family in solving their child or young person’s eating disorder. During FBT parents and carers are an essential part of the solution and members of the treatment team.
CBT may also be used. It can be tailored for young people experiencing bulimia nervosa.
If these treatments are not suitable then psychodynamic psychotherapy might be offered. This helps you understand how your current feelings and behaviour are shaped by your past experiences.
Medication
Antidepressants like selective serotonin reuptake inhibitors (SSRIs) may be used to treat bulimia. They can reduce the urges to binge and purge and improve how you feel.
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 types of medication are recommended for children and young people below the age of 16.
Relapse
Recovery from bulimia nervosa can take a long time but treatments are effective for many people.
Symptoms may 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 to go to your GP. Using the strategies you found useful before are likely to be helpful.
Complications
Bulimia nervosa can lead to a number of physical problems, and it helps to know what to watch for.
Some of the more common ones include:
- Dental problems: repeated vomiting brings stomach acid up into your mouth, and over time this wears away tooth enamel and can lead to decay.
- Bad breath and a sore throat, both linked to frequent vomiting.
- Dry skin and hair, along with brittle fingernails, caused by a lack of proper nutrients.
- Swollen saliva glands from frequent vomiting, which can make your face look rounder than usual.
- Permanent constipation, or difficulty passing stool, from bowel muscles damaged by frequent laxative use.
- A higher risk of heart problems.
Frequent vomiting or laxative use can also cause tiredness, weakness, abnormal heart rhythms, kidney damage, convulsions (fits), and muscle spasms. Many of these symptoms happen because your electrolytes become unbalanced, especially when your potassium level drops too low.
If you have periods, bulimia nervosa can make them irregular or cause them to stop altogether. This does not mean you cannot become pregnant. It may be harder to conceive while living with bulimia nervosa, but you should still use birth control if you are not planning a pregnancy.
If you live with diabetes, regular health checks are important to help protect your eyes and prevent other serious complications, and this matters especially if you have type 1 diabetes.
It is also common for people with bulimia nervosa to face other mental health difficulties, such as depression.
Getting help for bulimia nervosa
Many people with bulimia nervosa feel anxious about seeking treatment, but reaching out for help as early as possible makes a real difference.
Helping yourself
If you have trouble with eating, or think you may have bulimia nervosa, try to seek help as soon as you can.
A good starting point could be:
- talking to someone you trust, such as a friend, a family member, or a teacher
- visiting your doctor, and bringing someone along with you for support if that would help
You can find more guidance on preparing for a doctor's visit, including what to expect during the appointment, from a trusted eating disorder organisation.
Helping someone else
If someone close to you is showing signs of bulimia nervosa, you can offer them help and support.
Try talking with them about how they are feeling, and gently encourage them to consider getting help. Avoid putting pressure on them or being critical, since this can often make things harder. You could also offer to accompany them to see a doctor.
If you would like advice on how to support someone, you can speak with your own doctor or another healthcare professional.
It can also help to connect with an online or in-person support group for people who have loved ones with eating disorders. A doctor or healthcare professional can guide you toward services that suit your situation, and if you are in school, your pastoral care team may be able to help as well.
You can also read more about how to support someone with an eating disorder.
Further support
You can find information and services offering advice and support for eating disorders. When reaching out, avoid sharing personal information such as your name, location, or details of any personal health conditions.