Bulimia: The signs, symptoms and treatment

Bulimia Nervosa, often referred to as bulimia, is a serious mental health condition that causes changes in a person’s relationship with food, eating habits and their body. 

People with bulimia experience episodes of binge eating where they eat a lot of food in one short period where they feel they can’t control what they’re eating. These binge episodes are followed by periods of feeling guilty and trying to compensate for the binge by getting it out of the body as quickly as possible or finding other ways to ‘make up for it.’

This might involve feeling a need to get rid of the food immediately by vomiting it up or by using laxatives, diuretics or other medication to purge the food. It may also involve severely restricting food intake after a binge or using heavy exercise to burn off the calories. This pattern repeats over time and becomes a cycle. Bulimia can affect people of any gender, age, sexual orientation, body size or ethnicity.

A person with bulimia’s body weight may stay consistent over time, or their weight may go up and down. This means bulimia is often less noticeable than anorexia and it can go untreated for longer. Many people with bulimia try to hide the illness because they feel guilty or ashamed, but if you think you might have bulimia, know that it is not your fault, it is nothing to be ashamed of, and you deserve help and support. 

Why do people develop bulimia?

It is not always clear why someone develops bulimia. The condition doesn’t necessarily have one specific cause and the causes are different for different people. In some cases, bulimia symptoms can begin to emerge when that person is engaging in a diet. Worries about body image often play a role in bulimia, but while the condition can seem like it’s all about food and body size on the surface, the root causes are usually linked to how the person feels about themselves and what they’re going through in their lives.

The behaviours around eating that other people can see are just the external expression of inner emotional turmoil. Mental health difficulties like anxiety and low self-esteem, a family history of eating disorders, addiction, or traumatic experiences are all associated with developing bulimia.

To better understand how bulimia affects a person, it can be helpful to think of it as a coping mechanism. Like any eating disorder, bulimia causes a person to control food and their body to manage distress and feel in control when something else in their life is making them feel out of control or unsafe. Understanding this makes it easier to understand how scary it can be to stop engaging in eating disorder behaviours.

Signs and symptoms of bulimia

Bulimia is a mental health condition that causes people to engage in a repeating cycle of binge eating and then doing things to ‘cancel out’ or compensate for the eating binge. Not everyone who experiences bulimia will have the exact same profile of symptoms and different symptoms can emerge and change as the condition develops over time.

Some of these symptoms affect your behaviour, while others affect how you think and how you feel. The behaviours associated with bulimia can also lead to physical health complications over time.

Because some symptoms of bulimia don’t develop straight away, it’s important to keep in mind that you should still reach out for help and support, even if you aren’t experiencing physical symptoms or complications.

Like all eating disorders, bulimia begins in the mind, affecting how you think and feel first and foremost. Mental distress and inner turmoil have a very real impact on wellbeing and they do not have to be accompanied by physical complications to justify care and support. Below is a list of signs and symptoms of bulimia. This list doesn’t capture all experiences associated with bulimia and each individual’s experience with bulimia is different and unique. 

Behavioural symptoms when dealing with bulimia

• Engaging in episodes of binge eating
• Using control of food as a way to cope with emotional difficulties and stress
• Engaging in purging behaviours (vomiting or taking laxatives), restricting your food intake or doing intense exercise to ‘compensate’ for eating binges
• Hiding food

Psychological symptoms of bulimia

• Being preoccupied with your body shape and weight
• Feeling afraid of gaining weight
• Feeling guilty after eating
• Experiencing mood swings
• Anxiety and low mood
• Feeling out of control
• Feeling afraid or uncomfortable when eating in public or around other people
• Spending a large amount of time thinking about what you’re eating on a daily basis

What is an eating binge?

Bingeing on food is a term that can often come up casually in conversation, but in the context of eating disorders, an eating binge has a specific definition. An eating binge means eating an amount of food within any 2 hour period that is much larger than most people would eat during a similar period of time and under similar circumstances.

During an eating binge, the person feels like they can’t stop eating or control what or how much they are eating. A person might eat much faster than usual or feel overly full, during a binge. Following the binge, the person often feels ashamed of what they have eaten.

Shame is a common element of an eating binge, but it is important to remember that experiencing an eating binge is nothing to feel ashamed of. Episodes of binge eating can be triggered by emotional factors like anxiety, low moods, negative thoughts, or stressful experiences. How often you binge eat is different for everyone, maybe it only happens once every few months, or maybe you binge and get rid of the food several times a day. 

Is binge eating different from emotional eating or comfort eating?

Emotional eating, sometimes called comfort eating, is where you eat food because you’re experiencing negative feelings and you want to replace them or numb them with comfort and positive feelings that food can bring. Food can bring people pleasure and eating to feel comforted is a really common thing that a lot of people do to a certain extent. It isn’t something you should feel guilty about. It is a way of coping that many people use and definitely not anything to feel ashamed of.

Similar to emotional eating, an eating binge can also be triggered by emotional factors like stress and negative feelings. Unlike emotional eating, binge eating is a compulsive behaviour where the person overeats and feels like they can’t control what they’re eating and can’t stop when they want to.

Emotional eating and binge eating exist on a spectrum, with emotional eating at the lower end and binge eating at the more severe end. Engaging in emotional eating doesn’t mean that you will go on to engage in binge eating or develop an eating disorder.

While binge eating is a symptom of bulimia, experiencing binge eating on its own doesn’t mean you have bulimia, Binge eating may also be a symptom of other eating disorders, like binge eating disorder. If your eating habits are beginning to worry you, talking to your GP or calling the Bodywhys helpline can help.

Complications of bulimia

There are physical side effects that can develop as a result of bulimia. Experiencing physical complications can be frightening, but many of these issues can be reversed and improved with appropriate treatment. Some of the complications that can arise with bulimia include:

• Vomiting regularly can cause tooth decay and other dental problems 
• Vomiting regularly can cause choking 
• Vomiting regularly can cause throat problems
• Having problems sleeping
• There is an increased risk of stomach or digestive problems like acid reflux and stomach pain, diarrhea, bloating, and constipation
• Glands in your throat might swell
• You may experience skin problems
• You may experience hair loss
• If you get periods, these can change or become irregular
• You might feel tired, emotional and have mood swings
• You might suffer from anxiety, depression, low self-esteem, shame or guilty feelings
• You might feel very alone and unable to stop the eating disorder
• You can become run-down and have dangerously low levels of essential minerals in the body. 
• There is an increased risk of heart problems 
• In extreme cases, bulimia can cause death due to heart failure

What is Diabulimia?

Diabulimia is a term used to describe people with type 1 diabetes who are experiencing bulimia or another eating disorder and purposefully restrict their insulin in order to lose weight or compensate for an eating binge. The term diabulimia is not used by medical professionals as a separate diagnosable mental health condition, but restricting insulin to change your body weight is considered a type of purging behaviour related to eating disorders.

If you have diabetes, making changes to your prescribed insulin treatment is dangerous and comes with many serious physical health consequences. If you are restricting your insulin, it’s important that you reach out for support from your GP or a mental health professional. 

Getting treatment for bulimia

Thinking that you might be experiencing bulimia can be a scary thought. If you have recognised that you’re experiencing some of the symptoms listed above you might be tempted to ignore them or try to avoid the subject, but you deserve to reach out for help and support. No matter how hard it may seem, it is possible to make a recovery.

Recovery is not always linear. It can be one step forward and one step back sometimes, and what recovery means to you might be different to what it means for someone else. Everyone’s recovery journey is different and it may take time, but recovery from bulimia is always possible at any stage.

If you think you may have bulimia, going to your GP as soon as you can and letting them know what’s going on is an important first step. They will be able to point you in the right direction to get treatment. Sometimes the idea of speaking to your GP about concerns around eating habits can be daunting. If you feel like you’re not ready to take that step just yet, you could call the Bodywhys helpline. Their helpline is open to anyone, and is delivered by a team of trained volunteers. It offers non-judgemental and confidential support and information about eating disorders.

If you are worried about a friend or family member, talk to them about it and encourage them to go see their GP. You can also offer to go with them if they don’t want to go alone. 

The types of treatment you receive can depend on your situation, but in general, the aim of treatment is to help you gain control over the bulimia symptoms so that you can return to eating regular meals without engaging in purging or bingeing. The treatment will also help you work on the thoughts, feelings and experiences that are underlying the behavioural symptoms. Getting treatment that is evidence-based and specialised for eating disorders makes a substantial difference to a person’s recovery and quality of life. Trying to recover from bulimia, or any eating disorder, by yourself can be really isolating and hard.  Reaching out for support from professionals, family, and friends can make all the difference and help to get you through. 

Talking therapy and family therapy

Talking therapy is usually a part of treatment for bulimia. Some people will take part in individual talking therapy or group therapy, while others (especially young people) might do family-based treatment with members of their family. The aim of talking therapy is to help you understand the root causes of your eating disorder, and to work towards feeling more comfortable with food. 

A form of Cognitive Behavioural Therapy (CBT) called CBT-E is often used to support recovery from bulimia. CBT-E has been enhanced in certain areas, and particular strategies have been added to specifically address eating disorders and their core symptoms. CBT-E looks at the ways that our thoughts affect our behaviours and feelings. Through CBT-E, you can develop strategies to help you build self-awareness and identify triggers, create helpful routines, and manage compulsive thoughts and unhelpful behaviours.  All of these are important steps towards a future free from bulimia. 

If you’re younger, you take part in family-based treatment (FBT), involving you and your family talking to a therapist. FBT will look at how you have been affected by your bulimia, and what your family can do to support you in getting better. 

Other sources of support for bulimia

You can reach out to Bodywhys for advice or information on bulimia. Bodywhys is the Eating Disorders Association of Ireland and provides confidential support, information, understanding and a listening ear to those affected by eating disorders. You do not need a diagnosis to talk to Bodywhys.

How friends and family can help

Setting out on a recovery journey can be daunting, but you don’t have to do it alone. Recovering from bulimia can be made easier if the people around you take the time to learn about the condition, how it impacts you, and how they can show understanding and support you. If you found the information in this article helpful, it could be a good idea to share it with some of the people in your life. 

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