Bulimia nervosa

Bulimia nervosa (BSL), Bulimia nervosa (audio), Bulimia nervosa (Easy Read)

Bulimia nervosa is a serious eating disorder, and it is a mental health condition too. People with bulimia can find themselves trapped in a cycle. They eat a large amount of food (this is also called bingeing), and then try to get rid of it by vomiting, over exercising or using laxatives.

There are some common symptoms of bulimia nervosa, and you may notice some or all of them. They include:

• bingeing, which means eating an unusually large amount of food in a short time. This could be as much as a person might eat in a day, or more
• purging, which means trying to reduce the effect of bingeing by attempting to get food out of your body
• fasting, which means trying to restrict how much you eat
• focus on food, such as thinking about food all the time, being secretive about what you eat or hoarding food
• organising your life around a shopping, eating and purging cycle
• having a fear of eating in front of others
• focusing on your body shape and weight
• focusing on exercising to burn calories beyond a healthy level
• wearing baggy clothes to hide your body
• withdrawing from friends and family
• difficulty sleeping, or sleeping more than usual
• feeling irritable, low mood or anxiety
• feeling guilt, shame or despair
• always checking the ingredients or nutritional labels of food
• difficulty concentrating

For some people, bingeing and purging might be a way of coping with overwhelming feelings.

Speak to a doctor and ask for an urgent appointment if you think you have an eating disorder like bulimia nervosa, or if you are having symptoms like:

• collapsing or fainting
• dizziness
• significant tiredness or fatigue
• weakness
• dehydration
• muscle spasms
• pins and needles
• irregular heartbeat (arrhythmia)
• chest pains
• high levels of distress, like feeling really upset, agitated and uncomfortable

When your doctor is trying to diagnose bulimia nervosa, they will probably ask 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

Try to answer honestly. Your doctor isn't trying to judge you or catch you out. They just need to assess your symptoms accurately.

Your doctor may also check your weight and other physical measurements. If this feels frightening, you can ask not to be told your weight.

BEAT has more information on planning an appointment, how to talk to your doctor 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 hard to know which questions to ask at an appointment. It's ok to ask has some ideas that may help.

Your doctor might check your pulse and blood pressure. Sometimes an electrocardiogram (ECG) may be needed to see how well your heart is working.

Your doctor may also do blood tests to check the level of:

• fluids in your body
• chemicals or minerals, like potassium, in your blood

These blood tests look for the complications of bulimia nervosa. Even if the results come back as 'normal', your doctor may still refer you to an eating disorder specialist if you have symptoms of bulimia nervosa.

They may also suggest you make a dental appointment, because frequent vomiting can harm your dental health.

Before your treatment for bulimia nervosa begins, you will most likely have an assessment of your overall health. Your doctor or another healthcare professional will do this, and it helps them plan your treatment and care.

They may look at:

• 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

For many people with bulimia nervosa, guided self-help based on a cognitive behavioural approach can work well as a treatment. With guided self-help, you go through information and activities on your own, but you have regular support sessions along the way. The activities can include worksheets and writing about difficult thoughts and feelings.

Your doctor may refer you to an eating disorder service for treatment. These services usually offer a structured programme that can include physical monitoring, advice from a dietitian and psychological treatment.

The main psychological treatment for bulimia nervosa is cognitive behavioural therapy (CBT). It starts from the idea that your thoughts, feelings and behaviour are linked, and that each one affects the others. CBT tries to improve your eating behaviours. It helps you see how the way you think shapes how you feel and what you do.

One alternative to CBT is interpersonal psychotherapy (IPT). IPT looks at how your relationships with people close to you affect the way you feel, and how to improve those relationships.

Other psychological therapies include:

• integrative cognitive affective therapy
• schema therapy

Family Based Treatment (FBT) brings the whole family into solving their child or young person's eating disorder. In 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 who have bulimia nervosa.

If these treatments are not suitable, psychodynamic psychotherapy might be offered. This helps you understand how your current feelings and behaviour are shaped by your past experiences.

Doctors may use antidepressants called selective serotonin reuptake inhibitors (SSRIs) to treat bulimia. They can lessen the urge to binge and purge, and they can improve how you feel.

The medicine usually takes several weeks before it starts to work. You'll normally begin on a low dose, and the dose goes up gradually as your body adjusts to the medicine.

Very few types of medicine are recommended for children and young people below the age of 16.

Getting better from bulimia nervosa can take a long time, but treatment works for many people.

Symptoms can come back after treatment. This is often called a relapse, and it's more likely when you're under stress.

If a relapse happens, you go about getting treatment in the same way as before. The first step is to see your doctor. The strategies that helped you earlier are likely to help again.

Bulimia nervosa can cause a number of physical problems. These can include:

• dental problems, because regular vomiting lets your stomach acid damage the enamel on your teeth, which can lead to tooth decay
• bad breath and a sore throat from repeated vomiting
• dry skin and hair, and brittle fingernails, because of a lack of nutrients
• swollen saliva glands from frequent vomiting, which makes your face look rounder than before
• damage to your bowel muscles from frequent use of laxatives, causing permanent constipation (finding it difficult to poo)
• an increased risk of heart problems

Frequent vomiting or laxative use can also cause:

• tiredness
• weakness
• abnormal heart rhythms
• kidney damage
• convulsions (fits)
• muscle spasms

Some of these symptoms come from an imbalance in your electrolytes, in particular low potassium levels.

If you have periods, bulimia nervosa can make them unpredictable, or stop them altogether. This doesn't mean bulimia nervosa makes you infertile. It may be harder to get pregnant while you're living with the condition, but you should still 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 matters particularly if you have type 1 diabetes.

It's common for people with bulimia nervosa to have other mental health problems too, such as depression.

If you have bulimia nervosa, you may feel anxious about asking for treatment. But please get help as soon as you can, because the sooner you start, the better.

If you have eating problems, or you think you may have bulimia nervosa, get help as soon as you can.

You could start by:

• talking to someone you trust, like a friend, a member of your family or a teacher
• going to see your doctor (you may find it helpful to bring someone with you for support)

If someone close to you is showing signs of bulimia nervosa, you can offer them help and support.

You could talk to them about how they feel and encourage them to think about getting help. Try not to put pressure on them or criticise them, because this could make things worse. You could also offer to go with them when they see their doctor.

If you'd like advice on how to help, you can speak to your own doctor or another health professional.

You could also get help from an online or in person support group for people who have loved ones with eating disorders. Your doctor or health professional can help you find services that suit you. If you're at school, your pastoral care team might be able to help too.