Bulimia nervosa explained

What bulimia nervosa is

Bulimia nervosa is an eating disorder. It usually shows up as a cycle that repeats. There are times of binge eating, when eating feels out of control and you feel you cannot stop, often eating much more or differently from usual. After a binge, people try to make up for it, for example by making themselves sick, using laxatives, not eating for long stretches or exercising very hard.

Underneath the cycle, how you feel about yourself often depends a great deal on your body shape and weight. Many people with bulimia also try to follow strict rules about what, when or how much to eat.

This sheet describes bulimia in general. It is not a test. Only a qualified professional can assess whether it fits you, and they will do that with you.

What bulimia is not

Bulimia is not a choice, a lack of willpower or a sign of weakness. It is a recognised health problem, and it can be treated.

It can affect anyone: people of any age, gender, background or body size, including men and boys. Many people with bulimia are an average or higher weight, so others may not notice anything is wrong. Binges often happen in secret, and many people feel deep shame about them. That shame can make it hard to tell anyone, but therapists and GPs who work with eating problems have heard it many times before and will not judge you.

Does any of this feel familiar?

Tick anything that sounds like you, or none. This is to help you and your therapist talk about it, not a score.

How it can affect your body and mood

Bulimia can affect how you feel. Many people feel low, anxious, guilty or ashamed, and thoughts about food, shape and weight can take up much of the day. Some people start to avoid eating with others or going out.

It can also affect your body. Stomach and bowel problems and feeling tired are common. Making yourself sick or using laxatives can upset the balance of salts in your blood, which can affect your heart. This can happen at any weight, and you can feel well while your body is under strain. Your GP can check your physical health, which may include blood tests.

If you have also been eating very little, your therapist can share a sheet on how under-eating changes eating, mood and thinking.

If you are making yourself sick, using laxatives or eating very little, tell your therapist and your GP. If you faint, have chest pain or a racing or uneven heartbeat, get urgent medical help.

Why it is hard to stop on your own

Bulimia has a cycle built into it. Strict rules about eating leave you hungry and on edge, so a rule is easily broken. When that happens, it can feel as if you have failed completely, and a binge can follow. Afterwards, shame and worry about your shape lead to trying to make up for it and to even stricter rules, which sets up the next binge. Upsetting events and feelings can also set off a binge, because eating can bring short-term relief.

This is why trying harder to control your eating usually keeps the cycle going rather than ending it. It is not a sign that you are doing something wrong. Your therapist can share a sheet that explains this cycle in more detail.

What help can involve

In the UK, NICE guidance says that adults with bulimia can be offered a guided self-help programme focused on bulimia, with support sessions from a professional. If that is not enough or does not suit you, the next step is usually cognitive behavioural therapy (CBT) for eating disorders, with a therapist. Young people are usually offered family therapy focused on bulimia, with their family involved.

CBT for bulimia often starts by building a pattern of regular meals and snacks, which helps to break the cycle. Later it works on what keeps the problem going, such as strict food rules, the way you judge yourself by shape and weight, and how events and feelings affect your eating. Your therapist can share a sheet on the stages of this treatment.

Your GP has a part to play too, by checking your physical health while you have treatment.

Recovery

Many people recover from bulimia, including people who have had it for a long time. Recovery often means eating regularly without binges or making up for eating, and feeling that your worth rests on many parts of your life, not just your shape or weight.

Setbacks are common and are not a sign of failure. They are something to bring to your therapist, so you can learn from them together.

Your questions

You can bring this to your next session.