Bulimia Nervosa

People with bulimia often feel at war with themselves. They frequently invest considerable energy in managing distressing thoughts about experiences, past and present, and maintaining control of their emotions.

Dr Charlie Baily - PhD, CPsychol

What is bulimia?

Bulimia Nervosa, most commonly known as bulimia, is a serious mental health condition. It involves:

• Consuming large quantities of food in a discrete period of time (bingeing)
• An accompanying sense of lack of control in which the person feels he or she cannot control what or how much is eaten.
• This is followed by dysfunctional compensatory behaviours such as self-induced vomiting, laxative, diuretic or enema usage, excessive exercise or fasting.
• The binge-purge cycle is then repeated – this may be several times a month or as often as multiple times a day.
• People with bulimia base their view of themselves excessively on their body shape and weight.

Bulimia is a highly distressing mental health illness that causes very real and serious health risks to its sufferers, both physical and emotional. The fact that people with the condition are often a relatively normal weight or sometimes overweight can obscure these difficulties. However, left untreated, bulimia can be fatal.

Bulimia often co-occurs alongside other mental health conditions, such as anxiety, depression, PTSD and substance abuse.

What causes bulimia?

There isn’t one single reason why someone will develop bulimia, but there are certain factors that, in combination, make it more likely.

1. Biological causes of bulimia
   Genetic research suggests that bulimia has a strong hereditary component and research has shown that people with bulimia appear to be more likely to have mutation in a gene responsible for how appetite is controlled¹.
   
   As with anorexia, neurotransmitters that play an important role in communication within the brain have been shown to have abnormal levels in people with bulimia – for instance serotonin, which is believed to play an important role in the regulation of mood, impulsivity and satiation, has been found to be suppressed in people with bulimia in multiple studies.
   
   Low levels of cholecystokinin (CCK), a gastrointestinal hormone involved in regulating fullness cues, have also been found in people with bulimia².
   
   
2. Psychological causes of bulimia
   Many studies suggest that people with bulimia tend towards:
   • Emotional lability
   • Impulsivity
   • Extroversion
   • High novelty-seeking
   • Uncertain sense of identity
   • Prone to self-criticism
   • Often very sensitive to social approval.

   Their poor self-concept leaves them vulnerable to body image difficulties and dieting, and through binging and purging they may find a short-term means of coping with intense and rapidly fluctuating emotions.
   
   Depression, anxiety, and personality disorders are also very common in people with bulimia. Some studies suggest that over half of people with bulimia may also have experienced one of these conditions.

3. Environmental causes of bulimia
   Early trauma, abusive relationships, transitioning away from home and stress related to work or competitive hobbies can all increase susceptibility to bulimia. Controlling eating patterns, be it through binging or starvation, may be one way of gaining control over experiences and emotions that can seem overwhelming.
   
   For many people with bulimia, the disorder becomes a physical manifestation of their internal turmoil, particularly where they don’t have the words or ability to talk about their feelings.

¹ Kinzig, KP., et al (2002)
² Pirke, K., et al (1994)

Symptoms of bulimia

Common signs that you or a loved one may have bulimia include:

• Consuming large quantities of food in one sitting – often in secret
• Feeling out of control of what and how much one has eaten during binge episodes
• Not remembering what has been consumed during a binge
• Feelings of immense disgust, shame or guilt following a binge
• Panic if purging cannot take place
• Hoarding food
• Obsessive thoughts about food / the next binge
• Self-induced vomiting
• Excessive exercise regimes
• Fasting after a binge, sometimes for several days
• Becoming socially withdrawn
• Depression
• Anxiety
• Obsession with body image and weight
• Stomach complaints
• Heart palpitations
• Burst blood vessels on face (shown as small, red pinpricks).

Take our online Bulimia test

The physical risks of bulimia

Bulimia places immense pressure on someone’s physical health.

Medical problems associated with the illness include:

1. Electrolyte imbalance
2. Dental erosion
3. Damage to the stomach due to excessive stretching
4. Oesophageal irritation, tears or even rupture.
5. Excess strain on the heart – leading to heart palpations or even heart attacks.

Physical health implications can be long term so, as with any mental health condition, the earlier help is sought, the easier it is to get a positive outcome.

Treatment for bulimia

The average duration for bulimia is 5 years and like other eating disorders, the chance of making a full recovery increases the earlier that help and intervention is sought.

As the rate of co-morbidity is high for people with bulimia (4 in 5 people also have another psychiatric condition), understanding all aspects of an individual’s health is a key starting point.

Treatment for bulimia may include a Psychiatric assessment (the first step in addressing any of the co-morbidities such as a personality disorder, substance abuse, depression or anxiety) and then treatment with a Psychologist or Psychotherapist.

Read more about eating disorder treatment

Download our Adult Eating Disorder Assessment Guide

Bulimics experience moments of extreme loss of control and emotion dysregulation. These may provide temporary emotional relief but are often followed by extreme self-loathing and sometimes even suicidal impulses. The restrict-binge-purge pattern of bulimia can be seen as a behavioural manifestation of this highly self-reinforcing internal conflict.

Dr Charlie Baily

PhD, CPsychol

Clinical Psychologist

London

Dr Charlie Baily is a Clinical Psychologist currently working in the private sector. He has a PhD in Clinical Psychology and is a member of The British Psychological Society and Health and Care Professions Council.