What bulimia is
Bulimia nervosa, usually just called bulimia, is a serious eating disorder. It involves repeated episodes of eating a large amount of food in a short time while feeling out of control, known as bingeing. These episodes are accompanied by behaviours intended to compensate for eating or prevent weight gain, such as making yourself sick, fasting, exercising excessively or misusing laxatives or diuretics.
These behaviours can be dangerous. Laxatives and diuretics do not prevent your body from absorbing calories, and vomiting does not reliably undo a binge.
Many people with bulimia are not underweight, so weight or appearance alone cannot tell you whether someone has the condition. This is one reason it can go unnoticed for a long time, sometimes by family and friends, and sometimes even by the person themselves.
Bulimia can cause serious physical complications. Repeated vomiting can damage the teeth, gums, throat and digestive system, and may cause swollen salivary glands around the jaw. It can also upset the balance of salts and minerals in the body, such as potassium, which in some cases affects the heart. These effects can be long lasting, so getting help early matters.
Signs to look out for
Bulimia is often linked to low self-esteem and strong worries about body shape and weight. Those feelings are not always visible, but certain behaviours can be. Repeated binge eating and behaviours intended to compensate for it are key signs, but they may be hidden from others.
Other warning signs may include:
- hiding food, or large amounts of food going missing
- going to the bathroom soon after meals
- being very secretive about eating, or avoiding eating with others
- frequent dieting or strict rules about food
- exercising a lot, even when unwell or injured
- sore throat, tooth problems or marks on the knuckles from making yourself sick
- tiredness, bloating, constipation or irregular periods
- mood changes, anxiety or withdrawing from friends
These signs can have other causes, and someone with bulimia may show few outward signs. If you are concerned about eating behaviours or compensating for eating, seek advice rather than waiting for more signs to appear.
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How bulimia is diagnosed
In the UK, the first step is usually to see a GP. You can go on your own or take someone with you for support. If you are worried about a friend or family member, you can also speak to a GP or a charity about how to raise the subject.
The GP will normally ask about your eating habits, how you feel about your weight and body, and whether you make yourself sick, fast, exercise excessively or use laxatives or diuretics. They may also ask about your mood, your general health and any thoughts of self-harm or suicide. Answering honestly helps them understand what support you need, even if it feels uncomfortable.
They may check your weight, heart rate and blood pressure, and arrange blood tests to look at your salt and mineral levels. Depending on your symptoms and how you have been purging, you may also need an ECG to check your heart. These tests look for physical effects. No blood test can confirm or rule out bulimia, and a normal weight or normal results do not mean you are well.
If an eating disorder is suspected, NICE guidance recommends prompt referral to an age-appropriate community eating disorder service. This means the referral should be made straight away, although it does not guarantee an immediate appointment. Children and young people should be referred to an eating disorder service suited to their age, often a specialist team within children and young people's mental health services. In some areas you may be able to refer yourself.
Diagnosis is based on a clinical assessment. This looks at the nature, frequency and duration of binge eating and compensatory behaviours, how weight and shape affect your view of yourself, and your physical and mental health. Some people are diagnosed with a different eating disorder, such as OSFED (other specified feeding or eating disorder). They still need and deserve treatment.
Getting help and support
Bulimia can be treated, and many people recover fully. Treatment depends on your age, needs and local service, and arrangements differ between England, Wales, Scotland and Northern Ireland. For adults, options include bulimia-focused guided self-help and eating disorder focused cognitive behavioural therapy. Children and young people are usually offered family therapy focused on bulimia, with individual therapy available where appropriate. Ask your care team to explain the options and involve you in decisions about treatment.
Beat, the UK's eating disorder charity, offers helplines, online support and information for people affected and their families. The NHS website also has information on symptoms, diagnosis and treatment.
Waiting times for specialist services vary by area. If you are waiting, ask your GP for an agreed plan that covers any physical monitoring you need and clear instructions on what to do if things get worse.
Call 999 for severe chest pain, severe difficulty breathing, or collapse where the person does not recover promptly. For other urgent symptoms, including fainting or palpitations, seek urgent medical advice through the appropriate service where you live in the UK.
As well as this in your outline of the criteria it mentions bulimia is present in the ‘absence of anorexia’- please could you describe what this exactly means? As in, what is the difference between Binge and Purge Anorexia and Purge Bulimia?
Thank you! :)
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