Summary

  • Bulimia nervosa is an eating disorder and a severe mental illness.
  • Bulimia nervosa can go undetected for a long time because people often have body weight close to the healthy range.
  • People with bulimia nervosa will binge eat and then make up for the excess energy intake using techniques like vomiting or excessive exercise.
  • Understanding the signs of bulimia nervosa and seeking early treatment is the best way to begin your journey to a complete recovery.
Bulimia nervosa is an eating disorder and a severe mental illness that can go undetected for a long time. People with this condition need treatment so they are able to begin the journey to recovery.

People with bulimia nervosa will binge eat large amounts of food in a relatively short period of time, and feel that they have no control over the amount of food consumed, or the ability to stop.

People with bulimia nervosa try to compensate or make up for this excess energy intake using a variety of techniques including:
  • vomiting
  • laxatives and diuretics
  • fasting
  • excessive exercise
  • using medications inappropriately to control body weight.
These activities are not a lifestyle choice, but a sign of a complex mental health problem. Dieting is the primary risk factor and trigger across all eating disorders.

People with bulimia nervosa often have body weight closer to the healthy range for their age and height. It was estimated that in 2012, over 78,000 Australian women and over 29,000 men had bulimia nervosa.

Overview of bulimia nervosa

The cycle of binge eating and purging, and exercising leads to intense feelings of shame, guilt and disgust. The behaviours can become compulsive and obsessive, and lead to a fixation on food and obsessive thinking about food, eating (or not eating), diet and body image.

Added to this cycle, the person with bulimia nervosa often also engages in behaviours to hide the eating, dieting, purging or exercise, which means the condition can go undetected and untreated for a long time, with physical health implications.

Ongoing bulimia nervosa can cause physical problems including:
  • sore throat, indigestion, heartburn and acid reflux
  • stomach and intestinal ulcers
  • ongoing dental problems attributed to vomiting
  • chronic problems with the gut, such as constipation or diarrhoea from the use of laxatives, which can lead to complications such as prolapsed bowel
  • weakened bones (osteoporosis)
  • infertility in men and women
  • irregular heartbeats or a slow heart rate that can lead to heart failure
  • electrolyte imbalance from purging can cause severe dehydration damaging nerves, muscles and organs.

Symptoms of bulimia nervosa

Understanding the warning signs and symptoms can help you to recognise bulimia nervosa early. Early treatment is the best way to begin the journey to a complete recovery.

Physical symptoms of bulimia nervosa

Physical signs and symptoms can include:
  • frequent fluctuations in body weight – either up or down
  • signs of damage from frequent vomiting, such as swelling around the cheeks and jaw, damaged teeth and bad breath
  • frequent constipation, diarrhoea or new food intolerances
  • fainting or dizziness not due to another illness or condition
  • fatigue and inability to sleep well
  • in women, loss of periods or altered menstrual cycles, although you can still have periods and have bulimia nervosa.

Psychological symptoms of bulimia nervosa

Psychological signs and symptoms can include:
  • preoccupation or obsession with eating, dieting, exercise or body image
  • sensitivity to comments about eating, dieting, exercise or body image
  • feelings of shame, guilt and disgust, especially after eating and/or purging
  • a distorted body image or extreme dissatisfaction with body shape – people can think they are fat even when they have a healthy body weight
  • low self-esteem, depression, anxiety or irritability.

Behavioural symptoms of bulimia nervosa

Behavioural signs and symptoms can include:
  • unexplained disappearance of food – hiding of binge-eating episodes
  • secretive behaviour around food – hiding uneaten food or saying they have eaten when they haven’t
  • becoming more antisocial and withdrawn
  • eating alone and avoiding other people at meal times
  • frequent trips to the bathroom after eating
  • dieting behaviour – obsessive dieting, counting kilojoules, avoiding certain food groups
  • use of laxatives, enemas, diuretics or appetite suppressants
  • spending large amounts of money on food
  • self-harming behaviour, use of illegal substances and suicide attempts.

Diagnosis of bulimia nervosa

Diagnosing bulimia nervosa can be difficult, because people with this condition often have a body weight in the healthy weight range, may not display other physical indicators of illness and engage in activities that hide this mental illness. For these reasons, bulimia nervosa can go undiagnosed for a long time.

To diagnose bulimia nervosa or other eating disorders, a doctor will need to do a full physical check-up, carry out blood tests and ask questions about your health, including your emotional health and wellbeing, medical history and lifestyle, to see if you have the symptoms and behaviours of the condition such as those listed above.

Treatment of bulimia nervosa

Like other eating disorders, treatment for bulimia nervosa needs to help both your physical and mental health. Early treatment is the best way to help you towards a full recovery. The journey can be difficult, but you can get there with the right help and commitment.

A doctor experienced in supporting people with an eating disorder is a good first point of contact. Once bulimia nervosa is diagnosed, your doctor can help you assemble a team of healthcare professionals who will be best suited to help you.

The types of healthcare professional who might be involved include a:
  • psychiatrist
  • psychologist
  • dietitian
  • family therapist
  • social worker.
Specialist psychotherapy can be effective, but there are other psychotherapy, behavioural therapy and guided self-help options.

Your healthcare professionals will need to ask a lot of questions to help you work out the link between the way you think and your eating behaviour. Support groups can be helpful, but do not replace treatment from healthcare professionals.

Most people with bulimia nervosa are treated outside a hospital setting. While treatment does not necessarily have to involve a hospital stay, if the condition is severe, temporary treatment in a hospital might be needed. Outpatient treatment and day programs can also be very helpful in supporting people as they make changes to behavioural, thinking and eating patterns.

Other treatment options include medications and supplements for any physical symptoms and, in some cases, medication to help your mental health (for example, antidepressants).

Where to get help

  • A doctor experienced in supporting people with an eating disorder Eating Disorders Victoria Helpline Tel. 1300 550 236 – support from Monday to Friday 9.30 am to 5.00 pm
  • Community health centre
  • In an emergency, always call triple zero (000)
  • Lifeline Tel. 13 11 14
  • Suicide Line Tel. 1300 651 251
  • Kids Helpline Tel. 1800 55 1800
  • Butterfly Foundation’s National Support Line Tel. 1800 ED HOPE (1800 33 4673) – support from Monday to Friday 9 am to 5 pm (except public holidays)

Things to remember

  • Bulimia nervosa is an eating disorder and a severe mental illness.
  • Bulimia nervosa can go undetected for a long time because people often have body weight close to the healthy range.
  • People with bulimia nervosa will binge eat and then make up for the excess energy intake using techniques like vomiting or excessive exercise.
  • Understanding the signs of bulimia nervosa and seeking early treatment is the best way to begin your journey to a complete recovery.
References
  • Bulimia nervosa, 2011, National Eating Disorders Collaboration. More information here.
  • Paying the price – 70 billion reasons to get eating disorders right, Butterfly Foundation for Eating Disorders. More information here.
  • Aigner M, Treasure J, Kaye W, et al., 2011, ‘World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of eating disorders’, The World Journal of Biological Psychiatry, vol. 12, no. 6, pp. 400–433. More information here.

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This page has been produced in consultation with and approved by: Eating Disorders Victoria (EDV)

Last updated: August 2013

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