What is Bulimia?

Bulimia (or bulimia nervosa) is a serious mental illness. It can affect anyone of any age, gender, ethnicity or background. People with bulimia are caught in a cycle of eating large quantities of food (called bingeing), and then trying to compensate for that overeating by vomiting, taking laxatives or diuretics, fasting, or exercising excessively (called purging). Treatment at the earliest possible opportunity gives the best chance for a fast and sustained recovery from bulimia.

It’s normal for people who aren’t suffering from an eating disorder to choose to eat a bit more or “overindulge” sometimes. This shouldn’t be confused with a binge eating episode. Binge eating is often a way to cope with difficult emotions; someone may feel driven to binge eat if they’re feeling stressed, upset or angry, for example. During a binge, people with bulimia don’t feel in control of how much or how quickly they’re eating. Some people also say that they feel as though they’re disconnected from what they’re doing. The food eaten during a binge may include things the person would usually avoid.

Episodes of binge eating are often very distressing, and people may feel trapped in the cycle of bingeing and purging. People with bulimia place strong emphasis on their weight and shape, and may see themselves as much larger than they are.

Symptoms of bulimia

The binge/purge cycles associated with bulimia can dominate daily life and lead to difficulties in relationships and social situations. Bulimia can cause serious physical complications as well – frequent vomiting can cause problems with the teeth, and people may go to lengths to make themselves sick that could cause them harm. Laxative misuse can seriously affect the heart and digestive system. People with bulimia may also experience symptoms such as tiredness, feeling bloated, constipation, abdominal pain, irregular periods, or swelling of the hands and feet.

However, as sufferers are often a “normal” weight and often hide their illness from others, it can be very difficult to spot from the outside. Moreover, people with bulimia are often reluctant to seek help. As with other eating disorders, people around a person with bulimia will probably notice changes to their mood and feelings before seeing any physical change. They may also be preoccupied with and secretive around food, and feel self-conscious about eating around others. Low self-esteem, irritability and mood swings, and feelings of guilt, shame, and anxiety, especially after a binge, are also common.

If someone’s symptoms don’t exactly match all the criteria used to diagnose bulimia – for example, if the binge/purge cycles don’t happen as often as may be expected – they might be diagnosed with OSFED (other specified feeding or eating disorder). OSFED is as serious as any other eating disorder and it’s just as important that people suffering with it get treatment as quickly as possible.

What to look out for:

Behavioural Signs

If someone is developing bulimia, often changes in behaviour are noticeable before changes to physical appearance. Signs include: 

• Either frequently checking body shape or weight or avoiding looking at their body or checking their weight.
• Comparing their body with those of others
• Eating large amounts of food (bingeing)
• Purging after bingeing by vomiting, over-exercising, using laxatives or diuretics, fasting
• Organising life around shopping, eating and purging behaviour
• Secrecy, especially about eating
• Hoarding food
• Mood swings
• Irritability
• Social withdrawal
• Misuse of laxatives and diuretics 
• Misuse of alcohol
• Self-harm
• Compromise of education and employment plans
• Disappearing during or soon after eating (in order to purge)
• Excessive exercising 
• Lack of sexual interest

Psychological Signs

• Spending a lot or most of their time thinking about food
• Feeling anxious and tense, especially around meal times or when eating in front of others
• Difficulty concentrating
• Low confidence and self-esteem
• Worries about weight and shape
• Fear of gaining weight
• Distorted perception of body shape or weight
• Feeling of loss of control over eating
• Feelings of guilt and shame after bingeing and purging 
• Other mental illnesses, such as depression or anxiety

Physical Signs

• Vomiting
• Difficulty sleeping
• Tiredness
• Bloating
• Constipation
• Stomach pain
• Swelling of the hands and feet
• Poor skin condition
• Damage to teeth
• Irregular or stopped periods
• Swollen salivary glands
• Calluses on the backs of the hands if fingers are used to cause vomiting 
• Imbalance in electrolytes (essential substances found in the blood)
• Stomach problems 
• Blood sugar swings, potentially leading to mood swings and fainting
• Regular changes in weight, which may go up or down, though often remains “normal”, making bulimia harder to spot

Long-term Effects

Bulimia can cause serious damage to the body. Long-term effects of bulimia include: 

• Permanent damage to teeth
• Damage to the vocal chords and throat
• Damage to the intestines and stomach
• Increased risk of heart problems
• Kidney damage

If left untreated, bulimia nervosa can cause long-term harm to the body and may even be fatal. However, many physical effects of bulimia are reversible or can be prevented from worsening with the right treatment, and eating disorders are treatable, with full recovery possible.

What causes bulimia?

There are many different reasons that someone might develop bulimia, and many factors that can contribute. It’s important to remember that eating disorders are often not about food itself, and treatment should address the underlying thoughts and feelings that cause the behaviours.

Who can get bulimia?

Bulimia can affect anyone of any age, though it often develops during adolescence or early adulthood. It is also possible for someone to move between diagnoses if their symptoms change – there is often a lot of overlap between different eating disorders. Bulimia may develop from another eating disorder, or a person’s symptoms may change to better resemble those of another eating disorder. If you’re worried about yourself or someone you know, even if only some of the signs are present, you should still seek help immediately, as this gives the best chance of recovery. The first step is usually to make an appointment with the GP.