What is bulimia nervosa?

Bulimia nervosa (bulimia) is an eating disorder. An eating disorder is not a choice but a complex mental health condition.

Bulimia nervosa involves binge eating (eating a large amount of food in a short period of time). If you have bulimia nervosa you may have a hard time controlling your eating during a binge.

After a binge, people with bulimia nervosa use other behaviours to compensate (make up for the binge) and manage their weight. These can be:

• vomiting
• misusing medicines such as laxatives or diuretics
• extreme exercise
• fasting
• misuse of medicines for weight control

This pattern of binge eating and compensatory behaviours can become harder to control as time goes on.

These behaviours are often done in secret. Like other eating disorders, bulimia nervosa can cause serious health problems. However, help is available.

Binge eating disorder

Although people with bulimia binge eat, there’s a separate disorder called binge eating disorder.

People with binge eating disorder eat a lot of food very quickly. However, they don’t use compensatory behaviours to manage their weight after binge eating.

What are the signs of bulimia nervosa?

Signs of bulimia can be:

• physical
• psychological
• behavioural

Physical signs of bulimia are:

• your body weight going up and down — however most people with bulimia are average weight
• swelling around your cheeks or jaw, calluses on your knuckles, damaged teeth and bad breath — due to vomiting
• feeling bloated or constipated
• new food intolerances
• loss of, or changes to your menstrual periods in females
• fainting or dizziness
• feeling tired all the time

Psychological signs of bulimia are:

• obsession with eating, food, body shape and weight
• being sensitive to comments about food, weight, body shape or exercise
• low self-esteem
• feelings of shame, self-loathing or guilt, particularly after eating
• having a distorted body image
• depression, anxiety or irritability

Behavioural signs of bulimia are:

• food disappearing, hoarding of food or hiding uneaten food
• avoiding meals with other people and saying they have eaten when they haven’t
• dieting behaviour or exercising too much — exercising when sick or in bad weather
• obsessive behaviours relating to body shape and weight — repeatedly weighing themselves or looking in the mirror
• frequent trips to the bathroom during or after meals — could be linked to vomiting or laxative use
• erratic behaviour — spending large amounts of money on food, sometimes stealing food from shops
• self-harm, substance abuse, suicidal thoughts, or making suicide attempts

What causes bulimia nervosa?

There’s no single cause of bulimia nervosa. It’s thought to be linked to a combination of:

• genetic factors
• environmental influences
• social causes
• cultural reasons

Anyone can get an eating disorder.

When should I see my doctor?

If you or someone you know has bulimia nervosa, it’s important to get help. The earlier you get help the closer you are to recovery.

Your doctor can give you support and help you get treatment.

If you, or someone you know, are experiencing bulimia, get support as early as possible.

When to seek urgent help

If you, or someone you know, is having suicidal thoughts and is in immediate danger, call triple zero (000). To talk to someone now, call Suicide Call Back Service 1300 659 467 or Lifeline on 13 11 14.

If you think someone is having a medical emergency, you should seek urgent help.

Emergency symptoms to look out for are:

• being confused or disoriented
• fainting or seizures
• chest pains or having trouble breathing
• being too weak to walk or collapsing
• cold or clammy skin
• hurting themselves accidentally or on purpose
• being suicidal

It’s important to tell medical staff that the person may have an eating disorder.

How is bulimia nervosa diagnosed?

Your doctor will ask you about your symptoms and may examine you.

They may arrange for you to have blood tests.

Your doctor may refer you to:

• an eating disorder specialist
• a psychologist or psychiatrist
• a dietitian

How is bulimia nervosa treated?

Bulimia can be treated with psychotherapy.

There are many types of psychotherapy. Treatment for bulimia can include:

• eating disorder focussed cognitive behaviour therapy (CBT)
• interpersonal psychotherapy
• Maudsley family-based treatment (for children and adolescents)
• dialectical behaviour therapy (DBT)
• guided imagery

Other treatments are:

• evidence-based self-help programs
• crisis intervention
• stress management

Your treatment will depend on how old you are. Treatment for adults is different to treatment for people aged less than 18 years.

It’s important to restore healthy eating habits. Seeing a dietitian for nutrition advice can be very helpful.

Some people with bulimia nervosa may be given antidepressants. These medicines can help to reduce your anxiety and improve your mood and self-control.

If you need more intensive support, you may be treated in hospital.

Recovering from bulimia nervosa

Recovery from bulimia looks and feels different for everyone.

It’s important to get help from a professional. Sometimes talking with another person can help you better understand what causes your triggers.

It’s important to keep in contact with family and friends who care about you. This can help you feel close to others. Be kind to yourself and spend time doing things you enjoy.

You may have relapses (setbacks) during your recovery. These are common.

Can bulimia nervosa be prevented?

Programs to prevent bulimia focus on:

• self-esteem
• media awareness
• strengthening family relationships
• decreasing pressure for you to conform to body ideals

If you’re a parent, you can help your child build:

• a healthy relationship with food
• their confidence in things other than their looks

Eating together as a family and not promoting dieting can help prevent an eating disorder.

What are the complications of bulimia nervosa?

Some physical complications of bulimia are:

• chronic sore throat, indigestion, heartburn and reflux
• inflammation of your oesophagus or stomach due to frequent vomiting
• stomach ulcers and intestinal ulcers
• chronic (ongoing) constipation or diarrhoea due to laxative misuse
• osteoporosis (a condition where your bones break more easily)
• loss of, or changes in, menstrual periods and an increased chance of infertility
• irregular or slow heartbeat leading to an increased risk of heart failure

Resources and support

If you think you or someone you know might have bulimia, contact these organisations for support:

• Butterfly Foundation — call 1800 33 4673.
• National Eating Disorders Collaboration

For support and information about eating disorders and mental health, there are organisations that can help.

• Eating Disorders Families Australia (EDFA) supports the families and carers of people with an eating disorder. You can call them on 1300 195 626.
• The InsideOut eClinic includes Binge Eating eTherapy (BEeT) — a free, online clinic that you can access at any time.
• You can call Medicare Mental Health on 1800 595 212 for advice and to connect to local mental health services. Check the operating times here.
• If you are thinking about suicide, you can call Lifeline on 13 11 14or chat online.

Languages other than English

• Embrace Multicultural Mental Health has information about eating disorders in multpile community languages.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.