Like anorexia nervosa, bulimia nervosa (or just bulimia) is a type of disordered eating by which sufferers attempt to control their weight. The sufferer will consume vast quantities of food, often secretly, in a short period of time (bingeing) before attempting to purge the food by inducing vomiting, using laxatives or, in non-purging bulimia, by exercising excessively.

Bulimia causes are complex. Low self-esteem and poor body image are risk factors, as is a history of abuse. While social body ideals create unrealistic expectations, it’s not fully understood why some people develop eating disorders and others don’t, although evidence indicates there may be a genetic predisposition.

What are its symptoms?

Bulimia is largely characterised by the cycle of bingeing and purging. Other signs and symptoms of bulimia can include:

  • Secretive eating
  • Preoccupation with weight
  • Eating to the point of physical discomfort
  • Irregular meals
  • Frequent trips to the bathroom, particularly after eating. Vomiting sounds may be disguised by running water
  • Excessive exercise, particularly after eating
  • Laxative use
  • Kilojoule restriction
  • Depression

Bulimia can also lead to complications such as:

  • Discoloured teeth and dental erosion due to exposure to stomach acid
  • Peptic ulcers
  • Gastric reflux
  • Constipation
  • Trauma to the mouth and throat, as well as swollen salivary glands

How is it diagnosed?

As people with bulimia tend to hide their behaviour and are often of a normal weight, it may be difficult to detect. Commonly a physical examination and a psychological evaluation will be necessary to make a diagnosis of bulimia.

The patient will need to have had recurrent episodes of binge eating, feelings of no control during these episodes, some way in which they purge or work off the additional kilojoules, and feelings of self-worth strongly linked to their body shape or weight. If they meet these criteria and they occur over a certain prolonged period of time, a healthcare provider may advise treatment for bulimia.

What are your treatment options?

The two mainstays of bulimia treatment are psychotherapy and medication.

Cognitive behavioural therapy (CBT) is used to help patients identify their unrealistic or negative thought patterns and help foster empowering or positive behaviours instead. Research suggests that it is the most effective psychotherapeutic intervention for this condition.

Antidepressants can be used in conjunction with psychotherapy to help address any underlying depression and some have been shown to decrease the compulsive aspect of the binge-purge cycle. Breaking this cycle and resolving emotional issues are both key to treating the disease.

Recovery can also involve a dietician experienced in assisting those with eating disorders.

Can it be prevented?

There is no guaranteed way to prevent bulimia, but fostering and reinforcing a healthy body image in children and adolescents can play an important part in discouraging disordered eating.

If you begin to notice negative behaviours towards food or poor body image in your child, address the problem immediately – your paediatrician, GP or a therapist will be able to advise the best course of action.

The accuracy of this information was checked and approved by physician Dr Thomas Blake in June 2015