Bulimia Nervosa

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)

Compensatory behaviours are used as a way of trying to control weight after binge eating episodes. They include:

• Vomiting
• Misusing laxatives or diuretics
• Fasting
• Excessive exercise
• Use of any drugs, illicit, prescription and/or ‘over the counter’ inappropriately for weight control (inappropriate use refers to use that is not indicated and for which the drug has not been prescribed).

Having awareness about Bulimia 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 Bulimia can be physical, psychological and behavioural. It is possible for someone with Bulimia 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

The risks associated with Bulimia are severe. People with Bulimia may experience:

• Chronic sore throat, indigestion, heartburn and reflux
• Inflammation and rupture of the oesophagus and stomach from frequent vomiting
• Stomach and intestinal ulcers
• Chronic irregular bowel movements, constipation and/or diarrhoea due to deliberate misuse of laxatives
• Osteoporosis– a condition that leads to bones becoming fragile and easily fractured
• Loss of or disturbance of menstrual periods
• Increased risk of infertility for all genders
• Irregular or slow heart beat which can lead to an increased risk of heart failure

Therapies to be considered for the treatment of Bulimia Nervosa 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 Bulimia Nervosa.